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PubMedDate not supplied

Regeneration of the coracoacromial ligament after acromioplasty and arthroscopic subacromial decompression.

The clinical observation of apparent and complete regeneration of the coracoacromial ligament after known partial excision of the ligament and acromioplasty has been investigated. Ten patients who had open revision surgery following failure of symptomatic relief after arthroscopic subacromial decompression were studied. All of them had acromioplasty with documented partial resection of the coracoacromial ligament at the first operation. There were 5 men and 5 women with an average age of 54.5 years (range, 44-65 years). In all patients surgery revealed a ligamentous structure resembling the coracoacromial ligament that was attached to the anterior acromion. Histology in all patients revealed appearances indistinguishable from normal ligament, which was in continuity with the reformed periosteum of the acromion.

Acromion↗
PubMedDate not supplied

Deformation and strain characteristics along the length of the anterior band of the inferior glenohumeral ligament.

Efficacious surgical treatment of anterior glenohumeral instability often requires repair of the anteroinferior capsulolabral structures, including the glenoid origin of the anterior band of the inferior glenohumeral ligament. Rupture in this location, the Bankart lesion, may be accompanied by nonrecoverable stretching of the anterior band. The purpose of this study was to evaluate the amount and location of nonrecoverable stretching with tensile testing. Twelve glenoid-soft tissue-humerus complexes from fresh-frozen glenohumeral joints were studied by means of a custom jig, an Instron machine, and a video digitizing system. The joints were positioned to simulate that known to cause apprehension for anterior instability. Nonrecoverable deformation differed along the length of the anterior band but was slight in all locations. For those that failed at the glenoid insertion region, the mean nonrecoverable deformation was 0.10 +/- 0.16 mm (mean +/- SEM) at the bone-labral junction of the glenoid insertion region and 0.38 +/- 0.23 mm at the labral-ligament junction of the glenoid insertion region. It was 0.53 +/- 0.23 mm at the ligament midsubstance and 0.04 +/- 0.10 mm at the humeral insertion region. For those that failed at the glenoid insertion region, the nonrecoverable stretching was 1.4% +/- 1.9% at the bone-labral junction of the glenoid insertion region and 3.5% +/- 2.0% at the labral-ligament junction of the glenoid insertion region. It was 2.3% +/- 1.1% at the ligament midsubstance and 0.0% +/- 1.4% at the humeral insertion region. Rupture of the anterior band resulted in little nonrecoverable stretching at both the site of failure and elsewhere along the length, remote from the failure site. Surgical repairs after initial dislocation may restore the length of the anterior band of the inferior glenohumeral ligament with little shortening.

Adult↗
PubMedDate not supplied

Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint.

This experiment was conducted to determine the primary ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. Twenty-four unpaired cadaver specimens were mounted in a custom fixture. Anterior and posterior translations were measured under a sub-failure load in the intact specimen and again after transecting one randomly chosen ligament (anterior capsule, posterior capsule, interclavicular ligament, and costoclavicular ligament; n = 6 for each group). Cutting the posterior capsule resulted in significant increases in anterior translation and posterior translation. Cutting the anterior capsule produced significant increases in anterior translation. Cutting the costoclavicular and interclavicular ligaments had little effect on sternoclavicular joint translation. The posterior capsule is the most important restraint for anterior and posterior translation of the sternoclavicular joint. The anterior capsule is another important restraint for anterior translation. The costoclavicular and interclavicular ligaments have little effect on anterior or posterior translation of the sternoclavicular joint.

Aged↗
PubMed1997

The capsular ligaments of the wrist.

Variable descriptions and nomenclatures of the ligaments of the wrist can be found in the literature. To verify the multiple concepts advanced about this subject and to provide a basis for a better understanding of the individual variations of carpal biomechanics, and of the numerous pathomechanical concepts found in the literature, this study attempted to report the gross anatomy of the capsular carpal ligaments and their variations. Precise dissection of 66 anatomical preparations enabled to observe the origin, insertion, and number of fascicles of the capsular ligaments of the wrist. The anatomy of the capsular ligaments of the wrist displayed, besides relatively constant structures, considerable individual variations that concerned particularly the ulnocarpal and dorsal ligaments. A classification of the specimens according to variations in the important wrist ligaments has been advanced and has to be refined by a more extensive analysis. The possible influence of these variable configurations upon carpal biomechanics, diagnosis, classification and treatment of carpal pathologies seems conceivable but still has to be determined.

Cadaver↗
PubMed2004

Ligamentous reconstruction around the elbow using triceps tendon.

Posttraumatic instability of the elbow joint can be osseous or ligamentous. Ligamentous instability can be in valgus or in posterolateral rotatory direction. Rupture of both the lateral and medial collateral ligament of the elbow can be seen as an isolated injury, or it can be part of a more complex injury such as a dislocation. Persistent insufficiency of the lateral collateral ligament of the elbow results in posterolateral rotatory instability. Insufficiency of the medial collateral ligament, the anterior part in particular, results in valgus instability. Persistent symptoms after nonoperative treatment are an indication for reconstruction. In the past, ligamentous reconstruction at both the lateral and medial side was performed using palmaris tendon graft through bony drill holes. In this article I describe a new technique using ipsilateral triceps tendon, fixed in drill holes using bioabsorbable interference screws. This technique allows simplified graft tensioning and improved graft fixation, and avoids the risk of fracturing of the bony tunnels. An accelerated rehabilitation protocol can be applied. The final result depends on proper isometric reconstruction, associated lesions or degeneration of the elbow joint and adequate after-treatment. Taking these factors into account, the technique described shows promising short-term results.

Adult↗
PubMed2003

MR analysis of the transverse ligament in the late stage of whiplash injury.

PURPOSE: To analyse and classify structural changes in the transverse ligament in the late stage of whiplash injury by use of high-resolution MRI, and to evaluate the reliability of our classification. MATERIAL AND METHODS: Ninety-two whiplash-injured (2-9 years previously, mean 6 years) and 30 non-injured individuals underwent proton-weighted MR imaging of the craniovertebral junction in three orthogonal planes. Structural changes in the transverse ligaments were graded twice (grades 1-3) based on increased signal, independently by 3 radiologists with a 4-month interval. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa (K). RESULTS: Image quality was excellent in 109 cases and slightly reduced in 13. Twenty-two out of 30 ligaments in the control group were classified as normal (73%) compared with only 32 out of 92 in the injured group (36%). Two or all 3 observers agreed in their grading in 101 out of 122 ligaments (83%). Intraobserver agreement (weighted K) was fair to good (0.33-0.73). Pair-wise interobserver agreement was fair (0.24-0.39). Reasons for divergent grading were insufficient knowledge of normal variations, low signal intensity in the peridental soft tissue obscuring the ligament and interpretation flaw. CONCLUSION: Whiplash trauma can damage the transverse ligament. By use of high-resolution proton-weighted MR images such lesions can be detected and classified. The reliability of this classification still needs improvement.

Adolescent↗
PubMed2006

Effects of ligament sectioning on the kinematics of the distal tibiofibular syndesmosis: a radiostereometric study of 10 cadaveric specimens based on presumed trauma mechanisms with suggestions for treatment.

BACKGROUND: Syndesmotic injuries of the ankle without fractures can result from external rotation, abduction and dorsiflexion injuries. Kinematic studies of these trauma mechanisms have not been performed. We attempted to describe the kinematics of the tibiofibular joint in cadaveric specimens using radiostereometry after sequential ligament sectioning, and resulting from different trauma mechanisms and axial loading, in order to put forward treatment guidelines for the different types of syndesmotic injuries. METHODS: We assessed the kinematics of the distal tibiofibular joint in fresh-frozen cadaveric specimens using radiostereometry in the intact situation, and after alternating and sequential sectioning of the distal tibiofibular and anterior deltoid ligaments. To assess which of the known trauma mechanisms would create the largest displacements at the syndesmosis, the ankle was brought into the following positions under an axial load that was comparable to body weight (750 N): neutral, dorsiflexion, external rotation, abduction, and a combination of external rotation and abduction. RESULTS: In the neutral position, the largest displacements of the fibula consisted of external rotation and posterior translation. Loading of the ankle with 750 N did not apparently increase or decrease the displacements of the fibula, but gave a larger variety of displacements. In every position, sectioning of a ligament resulted in some fibular displacement. Sectioning of the anterior tibiofibular ligament (ATiFL) invariably resulted in external rotation of the fibula. Additional sectioning of the anterior part of the deltoid ligament (AD) gave a larger variety of displacements. In general, sectioning of the posterior tibiofibular ligament (PTiFL) gave the smallest displacements. Combined sectioning of the ATiFL and the PTiFL resulted in a larger variety of displacements in the neutral position. Sectioning of the AD together with the ATiFL and PTiFL resulted in tibiofibular displacements in the neutral situation exceeding the maximum values found in the intact situation, the most important being fibular external rotation. INTERPRETATION: Sectioning of the ATiFL results in mechanical instability of the syndesmosis. Of all trauma mechanisms, external rotation of the ankle resulted in the largest and most consistent displacements of the fibula relative to the tibia found at the syndesmosis. Based on our findings and the current literature, we recommend that patients with isolated PTiFL or AD injuries should be treated functionally when no other injuries are present. Patients with acute complete ATiFL ruptures, or combined ATiFL and AD ruptures should be treated with immobilization in a plaster. Patients with combined ruptures of the ATiFL, AD and PTiFL need to be treated with a syndesmotic screw.

Aged↗
PubMed1998

Androgen action during male sex differentiation includes suppression of cranial suspensory ligament development.

The cranial suspensory ligament is located on the border of the cranial (mesonephric) mesentery in adult female mammals, which runs between the cranial pole of the internal genitalia and the dorsal abdominal wall. Absence of the cranial suspensory ligament in male mammals depends upon exposure of its primordium to fetal testicular androgens and is a prerequisite for testis descent. Female rats were exposed to 5alpha-dihydrotestosterone propionate at different stages of genital development, and cranial suspensory ligament development was studied in neonatal and in adult animals. Androgens suppressed cranial suspensory ligament development when exposure started during the early stages of genital development, until day 19 postconception (pc). Androgen receptor expression was immunohistochemically detected in the cranial mesentery of both sexes from day 16 pc onwards. A decrease of androgen receptor expression in female fetuses from day 18 pc onwards coincided with the appearance of a differentiated cranial suspensory ligament, as evidenced by the expression of two cell differentiation markers: alpha-smooth muscle (alpha-SM) actin and desmin. alpha-SM actin was located on the outer border of the cranial mesentery of both sexes at day 17 pc, and expression increased only in female fetuses. On day 19 pc, desmin expression was also detectable in the a-SM actin-positive cells. Proliferation and apoptosis indices of cells in the cranial mesentery, as analysed by 5'-bromodeoxyuridine incorporation and by detection of DNA strand breaks (TUNEL method) respectively, did not show any difference between the sexes, neither on day 17 nor on day 18 pc. Since primordial cells of the cranial suspensory ligament highly express the androgen receptor during the period of gestation when androgens can suppress cranial suspensory development, altered morphogenesis of these cells may be a direct consequence of androgen action.

Actins↗
PubMed2004

Changes in gonadal steroid receptors in the cardinal ligaments of prolapsed uteri: immunohistomorphometric data.

BACKGROUND: The precise mechanism of uterine prolapse is poorly understood. This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate the differential expression of gonadal steroid receptors in human cardinal ligaments of prolapsed uteri compared with non-prolapsed controls. METHODS: Specimens from women with pelvic organ prolapse (POP) stage III (n = 33), together with the appropriate controls (n = 25), were stained for estrogen receptor alpha (ERalpha), ERbeta, progesterone receptor (PR), androgen receptor (AR) and Ki-67. The control materials were samples of the cardinal ligaments obtained from pre- and post-menopausal women with no prolapse, who were not using hormonal therapy. RESULTS The prolapsed ligaments expressed 1.5-2.5 times more ERalpha-positive cells (statistically significant in post-menopausal women not taking HRT, P < 0.001), a 3-4 times greater percentage of AR-positive cells (P = 0.004 and P = 0.008 in pre-menopausal and post-menopausal women not taking HRT, respectively) and twice the percentage of PR-positive cells (statistically significant in the pre-menopausal group, P = 0.03) compared with the no prolapse group. Expression of ERbeta was twice as high in the ligaments of pre-menopausal women with no prolapse compared with those with prolapse (P = 0.02), and no significant difference was found in the post-menopausal groups. The use of HRT was significantly associated with low AR and high PR expression. Ki-67 expression was not detected in these specimens. CONCLUSIONS: The clearly discernible levels of expression of ERalpha, ERbeta, AR and PR in the prolapsed cardinal ligaments may suggest a relationship to the process of tissue stretch 'trauma', rather than an effect of the menopausal status, HRT use or cell proliferation. The use of HRT in post-menopausal women appears to offset some of the changes observed with the prolapse.

Adult↗
PubMed1996

Evaluation of endometriosis in uterosacral ligaments by transrectal ultrasonography.

Uterosacral ligaments are one of the common targets of pelvic endometriosis, which is usually clinically rather than surgically diagnosed. This study was performed to determine if uterosacral ligaments infiltrated by endometriosis could be detected by transrectal ultrasonography. Uterosacral ligaments in non-endometriosis subjects (n = 64) were observed as low echoic homogeneous arcs in both sides of the uterine cervix. Patients who had endometriosis (n = 29) on the ligaments showed thick and irregularly-shaped uterosacral ligaments by the transrectal ultrasound examination. The results also suggested that the thickness of uterosacral ligaments was associated with the clinical symptoms. Transrectal ultrasonography may provide quantitative information to manage patients with infiltrating endometriosis.

Adult↗
PubMed1980

Classification of knee ligament instabilities.

1) The intactness of the posterior cruciate ligament is a key to the basic classification system of the knee. 2) With an intact posterior cruciate ligament, single or combined rotatory instability may occur. 3) With a tear of the posterior cruciate ligament, straight instability may be found. 4) An intact posterior cruciate ligament limits the instability of the knee in full extension (adduction or abduction stress test). 5) The anterior drawer test is somewhat equivocal. A strongly positive result of the anterior drawer test does suggest that the anterior cruciate ligament is not intact, although a moderately positive result may not implicate this ligament.

Humans↗
PubMed2002

Ultrasound: a powerful tool in the diagnosis of ulnar collateral ligament injuries of the thumb.

Proper treatment for injuries to the ulnar collateral ligament (UCL) of the metacarpophalangeal joint of the thumb relies on an accurate diagnosis of the pathology of the ligament. The current study evaluates the accuracy of ultrasonography to diagnose the specific pathology related to UCL injuries. The charts of 16 patients who underwent 21 studies of the UCL were reviewed. Ten patients had studies that indicated a complete tear, and eight of those patients underwent surgical exploration. Intraoperatively, 7 of the 8 patients were found to have ruptured ligaments. Six patients had studies that indicated intact ligaments. Four patients were treated with immobilization and a fifth patient underwent surgical treatment for a separate pathology. All patients regained stability of the ligament. The final patient had a repeat examination that indicated a rupture and the patient was found to have a markedly attenuated ligament on exploration. In conclusion, ultrasound is a useful modality for making a correct diagnosis of UCL pathology.

Adolescent↗
PubMed1992

Role of the capsulo-ligamentous structures in rotation and combined flexion-rotation of the lumbar spine.

We carried out experiments on whole cadaveric lumbar spines in order to determine the role that each of the capsulo-ligamentous structures play in axial rotation in the neutral position and in the flexed position. Eight specimens were first tested intact, then after division of all the apophyseal joint capsules between L1 and the sacrum. Another five specimens were also first tested intact, then after division of the supra- and interspinous ligaments and yellow ligament, and finally after cutting the posterior longitudinal ligament and posterior annulus at each level as well. The results show that there is considerable variation in the axial rotation of the lumbar vertebrae within the same spine and across different spines. The apophyseal joint capsules limit rotation both in neutral and flexed positions. In flexion, the amplitude of rotation in the lumbar spine is reduced. Of the capsulo-ligamentous structures, it is the posterior annulus and the posterior longitudinal ligament that seem to play the more important role in limiting axial rotation while the spine is flexed.

Adult↗
PubMed1998

Role of medical capsule and transverse metatarsal ligament in hallux valgus deformity.

The role of the medial capsule and transverse metatarsal ligament in hallux valgus deformity including stability of the first metatarsophalangeal and adjacent joints was investigated in vitro. The three-dimensional positions of the proximal phalanx, first metatarsal, and second metatarsal before and after sectioning the medial capsule and metatarsal ligament were measured using a magnetic tracking system. Valgus deformity of the hallux increased with medial capsule sectioning an average of 22.3 degrees +/- 6 degrees. Valgus deformity of the hallux increased with medial capsule and metatarsal ligament sectioning an average of 27.4 degrees +/- 9.1 degrees. Valgus deformity of the hallux did not change significantly after sectioning the metatarsal ligament only. No significant changes were found in varus and eversion of the first metatarsal, in valgus of the second metatarsal, in the distance between first and second metatarsal heads after sectioning the medial capsule, or in the metatarsal ligament. This study shows the importance of the medial capsule in hallux valgus deformity. The transverse ligament did not contribute substantially to cause the deformity.

Aged↗
PubMed1999

Arthroscopic posterior cruciate ligament reconstruction using a one-incision technique.

Thirty-seven patients with a posterior cruciate ligament injury underwent arthroscopic posterior cruciate ligament reconstruction using a one-incision technique with bone-patellar tendon-bone autograft or allograft. The tibial tunnel was started at the distal end of the graft donor site on the proximal tibia and exited posteriorly at the flat spot 15 mm below the articular margin and just lateral to the midline. The femoral tunnel was made through the lateral anterolateral portal. The 25 mm long proximal bone plug was passed easily through the tibial tunnel using a specially designed suture pusher and guided into the femoral tunnel by pulling the leading suture with the knee flexed 30 degrees. Firm proximal and distal fixations were achieved with interference screws. At a minimum 2 year followup (range, 24-68 months), average knee ligament evaluation scores were 91.1 (range, 67-99) in the Lysholm knee scoring scale and 89.3 (range, 67-99) in the Hospital for Special Surgery knee ligament rating form. The average side to side difference of the posterior translation measured by the KT 2000 arthrometer was 6.08 (range, 5-7 mm) mm preoperatively and 2.2 (range, 0-6 mm) mm postoperatively. There were no significant differences between the acute and the chronic cases. The results of the isolated posterior cruciate ligament injury group were better than the combined ligamentous injury group. The one-incision technique minimizes injury to the extensor mechanism, especially the vastus medialis obliquus muscle, and medial scar. Rigid fixation of the long proximal bone plug allows early rehabilitation.

Adolescent↗
PubMed1999

The effect of hyperbaric oxygen on medial collateral ligament healing in a rat model.

Hyperbaric oxygen has been shown to promote healing in bone and some soft tissues. This study was undertaken to determine its effect on ligamentous healing. Forty-eight Sprague-Dawley rats underwent a standardized surgical laceration of the right (divided) medial collateral ligament, whereas the left (undivided) medial collateral ligament was not surgically lacerated. A control group of 24 rats recovered without intervention. An experimental group consisting of the other 24 rats was exposed to hyperbaric oxygen at 2.8 atmospheres for 1.5 hours a day for 5 days after the surgery. Six rats from each group were euthanized at 2, 4, 6, and 8 weeks. The stiffness and final force to failure were recorded for the divided and undivided medial collateral ligaments. At 4 weeks, a statistically greater force was required to cause failure of the previously divided ligaments that had been exposed to hyperbaric oxygen than those that had not. The stiffness and force to cause failure of previously divided ligaments were statistically greater at 4 weeks than at 2 weeks, whether or not hyperbaric oxygen was used. No additional statistical increases in stiffness or force were observed at 6 weeks.

Animals↗
PubMed2001

Neural anatomy of the transverse carpal ligament.

Carpal tunnel syndrome is one of the most commonly diagnosed disorders of the upper extremity. The etiology of the neuropathy is known to be associated with many disorders, with the etiology of carpal tunnel syndrome mainly attributable to ischemia of the median nerve. The purpose of this study was to determine the presence of neural elements within the transverse carpal ligament. Fourteen transverse carpal ligaments were harvested from seven male and seven female fresh frozen cadavers with an average age of 76 years. The tissues were stained with S-100 using a standard immunoperoxidase technique used to localize neural tissue. The transverse carpal ligament consisted of interwoven bundles of fibrous connective tissue. It was found to have an intraligamentous and extraligamentous neural network consisting mostly of free nerve endings and pacinian corpuscles. Ruffini's corpuscles were not identified. This study showed that there is neural innervation to the transverse carpal ligament. Pacinian corpuscles have been shown to be mechanoreceptors which respond to changes in joint position, whereas free nerve endings have been identified as nociceptors. Neural innervation were present in the transverse carpal ligament, and the nociceptive information relayed by these neural elements may contribute to the pain associated with carpal tunnel syndrome. In addition to being a mechanical wrist stabilizer, the transverse carpal ligament also may play a role in proprioception of the wrist.

Aged↗
PubMed2004

Venous thrombosis in the broad ligament: is it a predictor of postoperative pulmonary embolism in gynecological cancer patients? A case-control study.

Pulmonary embolism is a common postoperative complication in gynecological oncology patients and is often fatal. A substantial proportion of venous thrombi responsible for pulmonary emboli originate in the pelvic veins. The significance of thrombi in the veins of the broad ligament identified in surgical specimens is unknown. In a case-control study, women with postoperative pulmonary embolism (cases) were identified from the Gynecological Oncology service at the Washington Hospital Center and compared with consecutive surgical pathology accessions (controls). Only the broad ligament veins were evaluated for the presence of organizing thrombi. Eight patients, all of whom had a gynecological malignancy, were diagnosed postoperatively with pulmonary embolism. Six were diagnosed clinically by spiral CT from 4 to 115 days after surgery, and two were diagnosed by open lung biopsy of a new pulmonary lesion approximately 1 year postoperatively. None of the cases was shown to have thrombi in the broad ligament veins. Thrombi in the broad ligament veins were present in three of 30 control patients with malignancies. Among 56 controls without malignancies, 3 had broad ligament thrombi. These findings suggest that the presence of organizing thrombi in the broad ligament veins does not predict postoperative pulmonary embolism.

Broad Ligament↗