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At least 19 recordsLinked to original sources

Centrifugal and biochemical comparison of proteoglycan aggregates from articular cartilage in experimental joint disuse and joint instability.

Two models involving altered joint loading were compared with regard to their effects on the biochemical composition and proteoglycan aggregate structure of articular cartilage. Disuse atrophy was created in greyhound dogs by nonrigid immobilization of the right knee in 90 degrees of flexion, and joint instability was created by transection of the anterior cruciate ligament. Similarities and differences between the two experimental groups at two different time periods were examined to investigate why joint instability induces progressive and irreversible changes to the articular cartilage, whereas joint disuse induces changes that may be reversible when the joint is remobilized. The following studies were performed on the cartilage from all experimental and control groups: (a) compositional analyses to determine water, uronate, and hydroxyproline contents; (b) high performance liquid chromatography for detection of hyaluronan and chondroitin sulfates; and (c) centrifugation analyses of nondissociatively extracted and purified proteoglycans to isolate and quantify the populations of monomers and slow and fast-sedimenting families of aggregates. In general, all cartilage was found to have a decreased ratio of proteoglycan to collagen after 4 weeks of disuse, and this ratio returned to control values at 8 weeks. In contrast, cartilage had an elevated ratio of proteoglycan to collagen as well as increased hydration at 12 weeks after transection of the anterior cruciate ligament. The most striking contrast between the two models was the finding of an approximately 80% decrease in the content of hyaluronan at both time periods after transection of the anterior cruciate ligament, with no evidence of a change after disuse. The results of centrifugation analyses indicated a significant decrease in the quantity of proteoglycan aggregates in both models. However, this decrease was associated primarily with a loss of slow-sedimenting aggregates after disuse and a loss of both slow and fast-sedimenting aggregates after transection of the anterior cruciate ligament. Furthermore, the population of fast-sedimenting aggregates was depleted to a greater extent than that of the slow-sedimenting aggregates. The preservation of fast-sedimenting aggregates as well as hyaluronan after periods of joint disuse but not joint instability suggests a possible mechanism for the reversibility of cartilage changes. Although the proteoglycan aggregates were depleted after disuse atrophy, it is possible that an aggregate-depleted matrix could recover when normal proteoglycan synthesis is resumed. In contrast, although synthesis may be maintained or elevated after transection of the anterior cruciate ligament, the matrix may not be repopulated with aggregates because there is an insufficient amount of hyaluronan.

Analysis of Variance↗

Contribution of runt-related transcription factor 2 to the pathogenesis of osteoarthritis in mice after induction of knee joint instability.

OBJECTIVE: By producing instability in mouse knee joints, we attempted to determine the involvement of runt-related transcription factor 2 (RUNX-2), which is required for chondrocyte hypertrophy, in the development of osteoarthritis (OA). METHODS: An experimental mouse OA model was created by surgical transection of the medial collateral ligament and resection of the medial meniscus of the knee joints of heterozygous RUNX-2-deficient (Runx2+/-) mice and wild-type littermates. Cartilage destruction and osteophyte formation in the medial tibial cartilage were compared by histologic and radiographic analyses. Localization of type X collagen and matrix metalloproteinase 13 (MMP-13) was examined by immunohistochemistry. Localization of RUNX-2 was determined by X-Gal staining in heterozygous RUNX-2-deficient mice with the lacZ gene insertion at the Runx2-deletion site (Runx2+/lacZ). Messenger RNA levels of type X collagen, MMP-13, and RUNX-2 were examined by real-time reverse transcriptase-polymerase chain reaction analysis. RESULTS: RUNX-2 was induced in the articular cartilage of wild-type mice at the early stage of OA, almost simultaneously with type X collagen but earlier than MMP-13. Runx2+/- and Runx2+/lacZ mice showed normal skeletal development and articular cartilage; however, after induction of knee joint instability, they exhibited decreased cartilage destruction and osteophyte formation, along with reduced type X collagen and MMP-13 expression, as compared with wild-type mice. CONCLUSION: RUNX-2 contributes to the pathogenesis of OA through chondrocyte hypertrophy and matrix breakdown after the induction of joint instability.

Animals↗

An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability.

Fourteen patients with posttraumatic distal radioulnar joint instability were treated with a reconstruction of the distal radioulnar ligaments. The technique is anatomically accurate, is reproducible, and requires less dissection than previously described techniques. Candidates for the procedure had joint instability and an irreparable triangular fibrocartilage complex. Ten patients had bidirectional instability. Two patients had a concurrent corrective osteotomy of the distal radius for a malunion. The procedure restored stability and relieved symptoms in 12 of 14 patients at 1 to 4 years' follow-up evaluation. One patient with a deficient sigmoid notch and one with ulnocarpal ligament injury did not achieve full stability. All patients attained near full pronation and supination. The procedure is an effective treatment for an unstable distal radioulnar joint when its articular surfaces are intact and the other wrist ligaments are functional, and it can be used in combination with a distal radius corrective osteotomy.

Adolescent↗

Trapeziometacarpal joint instability after Bennett's fracture-dislocation.

BACKGROUND: Investigation of trapeziometacarpal joint instability was undertaken following Bennett's fracture-dislocation. METHODS: We treated six patients who were experiencing trapeziometacarpal joint instability following Bennett's fracture-dislocation. The average age of the patients at the initial visit was 22.2 years. There were four men and two women. All six patients complained of trapeziometacarpal joint pain and instability preoperatively. Fluoroscopy confirmed that the beak fragment moved with the shaft fragment. The length of time from injury to surgery ranged from 1 to 29 months (average 10.7 months). Ligament reconstruction based on Eaton's method was performed on five patients, and in one patient the fracture site was osteotomized and reduced and the dorsoradial ligament repaired. RESULTS: Over an average follow-up observation period of 20 months, none of the patients complained of severe joint pain or instability. CONCLUSIONS: When treating Bennett's fracture-dislocation, it is necessary to pay careful attention not only to accurate anatomic reduction of the joint surface but also to joint instability.

Adolescent↗

Biomechanical analysis of reconstructions for sternoclavicular joint instability.

BACKGROUND: A variety of reconstructive methods have been described for the treatment of sternoclavicular joint instability, yet none have been analyzed in the laboratory, to our knowledge. The purpose of the present study was to evaluate three different reconstruction techniques with use of a cadaveric model: (1) intramedullary ligament reconstruction, (2) subclavius tendon reconstruction, and (3) reconstruction with use of a semitendinosus graft placed in a figure-of-eight fashion through drill-holes in the clavicle and manubrium. METHODS: Thirty-six fresh cadaveric specimens were mounted supine on a materials testing machine in a custom testing fixture and were subjected to anterior and posterior subfailure translation to determine stiffness in the intact state after preloading. One of the three reconstruction methods was performed, and the specimens were subjected to anterior or posterior translation to failure. Changes in stiffness compared with the intact state were analyzed statistically. RESULTS: In the anterior direction, the stiffness of the semitendinosus figure-of-eight reconstruction was significantly greater than that of the intramedullary ligament reconstruction but was not significantly different from that of the subclavius tendon reconstruction. The peak load to failure (as defined by translation equal to the anteroposterior diameter of the medial head of the clavicle) was 230.3 +/- 146.1 N for the semitendinosus figure-of-eight reconstruction, 84.6 +/- 45.7 N for the intramedullary ligament reconstruction, and 75.6 +/- 19.0 N for the subclavius tendon reconstruction. In the posterior direction, the stiffness of the semitendinosus figure-of-eight reconstruction was significantly greater than those of both of the other reconstructions. The peak load to failure was 241.4 +/- 49.7 N for the semitendinosus figure-of-eight reconstruction, 85.0 +/- 22.8 N for the intramedullary ligament reconstruction, and 51.5 +/- 28.9 N for the subclavius tendon reconstruction. CONCLUSIONS: The figure-of-eight semitendinosus reconstruction for sternoclavicular joint instability has initial biomechanical properties that are superior to those of the intramedullary ligament reconstruction and subclavius tendon reconstruction techniques. CLINICAL RELEVANCE: While it is difficult to extrapolate in vitro data to the clinical situation, the figure-of-eight semitendinosus technique has superior initial biomechanical properties and may produce improved clinical outcomes in the surgical treatment of sternoclavicular joint instability.

Analysis of Variance↗

A technical solution for secondary arthritis due to chronic proximal tibiofibular joint instability.

Chronic instability of the proximal tibiofibular joint is an uncommon diagnosis and not frequently reported in the literature. The management options of this joint instability, complicated with secondary arthritis, have rarely been discussed and consist mainly of fibular head resection or arthrodesis of this joint. We describe a new technical procedure for addressing both the instability and the joint secondary arthritis. Stability of the joint is achieved by ligament reconstruction using a biceps femoris split passed through the tibial metaphysis and fixated back to the fibular head using bone anchors. The arthritic changes are addressed by interposition of a vascularized fascia lata strip. The described procedure offers a firm stabilization with no need for postoperative restrictions and an alternative to the inadvisable joint arthrodesis or resection.

Arthritis↗

Intra-articular volume and hip joint instability in dogs with hip dysplasia.

UNLABELLED: The nature of the instability of the hip joint in dogs with dysplasia of the hip was investigated. In the experimental canine model, instability of the joint, as shown by subluxation of the femoral head on a roentgenogram, was accompanied by an increase in the volume of the synovial fluid and of the ligamentum teres and, therefore, an increase in the intra-articular volume. Injection of a buffered solution of hyaluronic acid into non-subluxated hip joints in situ increased subluxation, whereas withdrawal of synovial fluid from one joint with severe subluxation reduced the degree of subluxation. The withdrawal of varying amounts of synovial fluid from excised but intact joints resulted in a decrease in the lateral displacement of the femoral heads. Injection of the hyaluronic acid solution into excised joints resulted in increased lateral displacement of the femoral heads. The results suggest that the joint instability associated with canine hip dysplasia is related to increased intra-articular volume. CLINICAL RELEVANCE: Instability of the hip joint (abnormal laxity) is a feature of hip dysplasia in dogs and congenital dislocation of the hip in children. The canine disease can provide a valuable model in which to examine the pathogenesis of hip instability. The model may be useful to test prophylactic procedures to prevent joint instability and thus ameliorate disease.

Animals↗

Second metatarsophalangeal joint instability in the athlete.

In a group of athletically active patients, second metatarsophalangeal joint instability was diagnosed in nine patients (11 toes). A positive drawer sign was pathognomonic of early second metatarsophalangeal joint instability. A soft tissue realignment procedure was used to stabilize the second metatarsophalangeal joint in seven toes. In five of seven cases (71%), good to excellent results were noted at an average follow-up of 20.4 months.

Adult↗

A new clinical outcome measure of glenohumeral joint instability: the MISS questionnaire.

Many standard shoulder outcome measures do not adequately cover the range of problems and issues specifically encountered in glenohumeral joint instability and have been shown not to be sensitive enough to detect clinical change with intervention adequately. The purpose of this report is to present a prospective evaluation of a new self-administered patient questionnaire specifically designed to assess glenohumeral joint instability. The evaluation involved test-retest reliability and comparison with the Shoulder Rating Questionnaire (SRQ). Sixty-four patients with confirmed glenohumeral joint instability were assessed with both the Melbourne Instability Shoulder Scale (MISS) and SRQ 12 preoperatively and at 6 months after shoulder reconstructive surgery. Twenty-two patients were recruited into a reliability study of the MISS questionnaire. The test-retest reliability of the MISS was found to be 0.98 (interclass correlation coefficient, mixed-model analysis of variance, absolute agreement). Assessment of agreement between the MISS and SRQ questionnaires indicated very poor pretest agreement (0.33) and moderate agreement at 6 months (0.66). The differences between the MISS and SRQ were statistically significant both before surgery (paired t = 13.2, degrees of freedom [ df ] = 63, P < .001) and at 6 months' follow-up (paired t = 7.9, df = 63, P = .001). Change in the questionnaire scores measured from surgery to 6 months' follow-up was significantly greater in the MISS (mean, 30; SD, 19.1; median, 30.8) than in the SRQ (mean, 16.6; SD, 12.8; median, 14.3) (Wilcoxon test: z = -5.8, P = .0001). The results of this study show that the MISS questionnaire is a reliable outcome questionnaire and has a greater range to detect changes in shoulder instability than more global outcome questionnaires such as the SRQ. The higher scores encountered on the SRQ may mean that it underestimates the severity of a patient's instability problem.

Adult↗

Hip joint instability in breech pregnancy.

222 consecutive fetuses found by ultrasound to be in breech presentation in the 33rd gestational week were followed with repeated examinations in weeks 35 and 38. Ninety-one of these fetuses persisted in breech presentation until delivery, while cephalic version occurred in 131. The frequency of hip joint instability was 21% in the breech delivered group and 1.5% in the vertex delivered group. The position of the fetal legs was established at each ultrasound examination. The intrauterine fetal attitude was classified as extended when the fetuses had extended knees and maximally flexed hips at all ultrasound examinations. This occurred in 30 breech delivered fetuses, 47% of which developed hip joint instability. Only 8% of the breech born infants with flexed legs in utero developed hip joint instability. It is concluded that instability of the hip joint is a consequence of the intrauterine attitude, rather than of the breech delivery per se.

Breech Presentation↗

Chronic finger joint instability reconstructed with bone-ligament-bone graft from the iliac crest.

Five patients with chronic instability of digital joints presented with instability and functional disability. Two patients had ulnar collateral ligament damage of the thumb metacarpophalangeal joint and another had chronic multidirectional instability due to radial collateral ligament, dorsal capsule and palmar plate laxity of the metacarpophalangeal joint of the thumb. The fourth patient had a lax radial collateral ligament and palmar plate of the proximal interphalangeal joint of the little finger and the fifth had chronic laxity of the ulnar collateral ligament of the interphalangeal joint of the thumb. All were reconstructed with bone-ligament-bone graft harvested from the iliac crest. The graft was fixed with screws and joint stability was achieved intra-operatively in all patients. All patients achieved a stable joint with improved functional performance at final follow-up.

Adult↗

The classification and early diagnosis of knee joint instability.

A working classification of knee joint instability includes anatomic and pathologic classifications. The anatomic classification defines the direction of the instability causing the abnormal function to the patient. A structural classification delineates the pathologic lesion. An ability to correlate one with the other ensures proper understanding of the subject. An accurate diagnosis following the acute injury is the basis of effective treatment. Residual chronic disability in many instances will be avoided. Injuries involving the cruciate ligaments constitute difficult diagnostic problems. Anterior cruciate ligament lesions lead to predictable patterns of chronic instability. Posterior cruciate ligament lesions may be associated with trauma sufficiently severe to impair the neurovascular status of the limb.

Humans↗

Ulnar styloid fractures associated with distal radius fractures: incidence and implications for distal radioulnar joint instability.

Ulnar-sided injuries of the wrist have received more attention recently for their potential negative impact on the outcome of distal radius fractures. Radiographs and medical records were retrospectively reviewed for 166 distal radius fractures treated during a 1-year interval. Distal radius fractures were classified according to the AO system, and accompanying ulnar styloid fractures were evaluated for both size and displacement. Each distal radius fracture was also evaluated for radiographic and clinical evidence of distal radioulnar joint instability. The distribution of ulnar styloid fractures was not random; greater than one third involved the base. All distal radius fractures complicated by distal radioulnar joint instability were accompanied by an ulnar styloid fracture. A fracture at the ulnar styloid's base and significant displacement of an ulnar styloid fracture were found to increase the risk of distal radioulnar joint instability.

Adolescent↗

[Combined lateral ankle and calcaneocuboid joint instability].

Up to now there was no publication describing a combined instability of the calcaneocuboid and lateral ankle joint. A 38 years old teacher (a former gymnast) complained about increasing giving way symptoms and pain at the lateral foot and ankle. Because of this, he was unable to take part in sports activities. Clinical investigation revealed lateral ankle and calcaneocuboid joint instability. Surgical treatment was done using periosteal flap augmented capsular reefing for both joints, resulting in full ability in sport and profession four months later.

Adult↗

Concurrent interdigital neuroma and MTP joint instability: long-term results of treatment.

INTRODUCTION: An interdigital neuroma is a common source of forefoot pain, and while second metatarsophalangeal joint instability is a less common entity, it can be a concomitant source of pain. The purpose of this study was to evaluate the long-term clinical course and surgical outcomes of the treatment of these concomitant problems. METHODS: 121 consecutive patients (131 feet and 136 neuromas) were evaluated and treated for a symptomatic interdigital neuroma from 1981 to 1997. Of these, 24 patients (20%) had a concurrent interdigital neuroma (IDN) and second metatarsophalangeal (MTP) capsular instability that underwent surgical treatment. At the final follow-up examination, 20 patients (21 feet) were evaluated by an independent orthopaedic surgeon with a standardized clinical and radiographic examination, patient self-assessment and outcome measures. RESULTS: Overall, there were 18 females and two males (21 feet) treated with an average age of 54 years at the time of surgery that returned for examination and follow-up at an average of 80 months (48 to 108 months) following surgery. Seventeen patients (85%) rated their result as good or excellent and three as fair. Six patients had mild continued symptoms referable to the second toe and none to the neuroma. Simultaneous neuroma excision and second MTP stabilization was performed in 15 cases and in six cases a staged repair was performed. The mean visual analog pain score was 1.4 (0=no pain, 10=severe pain) and mean MHAQ score was 1.13 (1-1.625) with activity modification stemming from hip, back and knee complaints. CONCLUSION: With careful patient selection and preoperative assessment, resection of an interdigital neuroma and stabilization of second metatarsophalangeal joint instability resulted in a high percentage of successful results at greater than four years following the procedure. Objective results were comparable to previous reports on the surgical treatment of isolated interdigital neuroma and crossover second toe reconstruction. Subjective patient satisfaction was high but both subjective and objective results were lower in patients with persistent symptoms of MTP instability.

Comorbidity↗

Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer.

We report on a comparative measurement of anterior knee joint laxity on 30 healthy test subjects and 30 patients with anterior knee joint instability using a new knee testing device (Rolimeter) and the KT- 1000 arthrometer compared to manual assessment of the anterior tibial translation in 30 degrees flexion (Lachman's test). We wanted to establish the reliability of the Rolimeter device compared to manual assessment and to the KT- 1000 arthrometer. The statistical evaluation by means of an analysis of variance (ANOVA) at a significance level of 5% showed no significant difference in the exactitude of measurement between the Rolimeter and the KT-1000 arthrometer, but altogether a significant difference between both instrumental methods compared with manual assessment. Thus the Rolimeter provides an economic, exact and simply operating device for quantifying anterior knee joint instability.

Adolescent↗

Functional bracing for distal radioulnar joint instability.

Symptomatic chronic distal radioulnar joint (DRUJ) instability can be a challenging disorder to treat surgically. This study used a cadaver model to assess the effect of functional forearm bracing on DRUJ instability. The specimen upper extremities were mounted on a platform and the DRUJ was destabilized sequentially. The effect of both prefabricated commercial braces and custom-made braces on joint stability was documented by computed tomography. Both braces markedly reduced DRUJ translation in both full pronation and full supination. The custom-made brace overreduced the DRUJ in full pronation. Our results suggest that functional forearm bracing may be effective in reducing instability of the DRUJ without greatly restricting motion of the wrist, forearm, or elbow.

Analysis of Variance↗