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At least 235 records · Page 13Linked to original sources
PubMed2004

Characterization of and osteoarthritis susceptibility in ADAMTS-4-knockout mice.

OBJECTIVE: To determine the importance of the enzymatic activity of ADAMTS-4 in normal growth and development and to evaluate the role of ADAMTS-4 in the progression of osteoarthritis (OA). METHODS: We generated catalytic domain-deleted ADAMTS-4-transgenic mice and performed extensive gross and histologic analyses of various organs. The mice were challenged by surgical induction of joint instability leading to OA, to determine the importance of the enzymatic activity of ADAMTS-4 in the progression of the disease. The response of wild-type (WT) and ADAMTS-4-knockout (ADAMTS-4-KO) articular cartilage to interleukin-1 and retinoic acid challenge in vitro was also evaluated. RESULTS: ADAMTS-4-KO mice up to 1 year of age exhibited no gross or histologic abnormalities in 36 tissue sites examined. Despite evidence of ADAMTS-4 expression and activity in growth plates of WT mice, catalytic silencing of this proteinase caused no abnormalities in skeletal development, growth, or remodeling. There was no effect of ADAMTS-4 knockout on the progression or severity of OA 4 weeks or 8 weeks after surgical induction of joint instability. Enzymatic cleavage of aggrecan at the TEGE(373-374)ARGS site was clearly evident after exposure of articular cartilage from ADAMTS-4-KO mice to inflammatory cytokines. CONCLUSION: Although expression of the ADAMTS-4 gene has been found in many tissues throughout the body, deletion of enzymatic activity did not appear to have any effect on normal growth and physiology. Our study provides evidence that ADAMTS-4 is the primary aggrecanase in murine growth plates; however, deletion of its enzymatic activity did not affect normal long bone remodeling. Our results also lead to the hypothesis that, in the mouse, ADAMTS-4 is not the primary enzyme responsible for aggrecan degradation at the TEGE(373-374)ARGS site. The elucidation of the relative importance of ADAMTS-4 in the pathologic process of human OA will require examination of human OA tissues and evidence of disease modification in patients following therapeutic intervention.

ADAM Proteins↗
PubMed2001

Physiological and mechanical adaptation of periarticular cancellous bone after joint ligament injury.

The relation between blood flow and bone mineral density (BMD) of periarticular bone was examined in an in vivo model of joint instability. Eighty mature New Zealand White rabbits were randomly assigned to experimental [anterior cruciate ligament transection (ACLX)], sham-operated control, or age-matched normal control groups. Experimental rabbits underwent unilateral transection of the right anterior cruciate ligament, and the nonoperated left [contralateral (Cntra)] limb was a within-animal control. BMD and blood flow to the periarticular bone in the femoral condyles were assessed in each group at 2, 4, 6, 14, and 48 wk postsurgery, using quantitative computed tomography scanning and entrapment of colored microspheres. BMD was significantly lower (5%) in the ACLX compared with Cntra limbs. Periarticular bone blood flow in the ACLX limbs was significantly greater than in the Cntra limb (29%) in the early stages (6 wk) after injury. Up to 48 wk post-ACLX, a significant correlation was found between increased blood flow and decreased BMD in the periarticular bone of the femoral condyles in the ACLX limbs. This correlation suggested that heightened blood flow may be linked to mechanisms of bone adaptation in joints after ligament injury.

Adaptation, Physiological↗
PubMedDate not supplied

Nonconstrained total elbow arthroplasty.

Thirty capitellocondylar unhinged implant arthroplasties were performed on 27 patients during the period from October 1976 through June 1981. The average patient age was 59.4 years, with a preoperative diagnosis of rheumatoid arthritis in 28 elbows and osteoarthritis in two elbows. Follow-up periods averaged 39.9 months (range, 10-62 months). The indication for elbow arthroplasty were intractable pain, joint instability, failed synovectomy, or bilateral limitation of motion. Ranged of motion evaluations showed moderate increases in flexion, pronation and supination after operation, although there was no significant improvement in extension. Ewald functional evaluation scores improved significantly from the mean of eight points prior to operation to the postoperative mean of 85 points. The significant complications occurring were deep wound infections, necessitating removal of the prosthesis (6.6%), and subluxation (13.2%), which responded to conservative treatment by long-arm casting. One patient required reconstruction of the medial collateral ligament for subluxation. Ulnar nerve paresthesia developed in 10% of the patients. One patient required neurolysis and transposition of the nerve for relief of symptoms. The posterolateral approach was adopted to reduce the incidence of ulnar nerve complications.

Adult↗
PubMed1996

Rehabilitation of injuries in competitive swimmers.

Competitive swimmers perform highly repetitive motions, therefore characteristic overuse injuries of the shoulder, back, and knee can occur. A thorough history and examination should be performed by both physician and physical therapist. The combination of hypovascularity, fatigue, poor stroke mechanics, and the progressive instability of a hypermobile joint results in shoulder impingement. Medical evaluation should determine the existence of any glenohumeral joint instability or signs of impingement. Back injuries are most commonly due to disc degeneration, hyperextension, or myofascial involvement. Medial knee pain is most common in breaststroke swimmers and may be due to excessive valgus and rotatory stress. Frequently seen diagnosis includes patellofemoral pain, medial collateral ligament stress syndrome, and medial synovitis. Treatment will focus on elimination of inflammation. Rehabilitation should focus on stabilisation exercises for hypermobile joints, postural correction, strengthening and flexibility.

Athletic Injuries↗
PubMed1996

[Stener lesions: ultrasonography assessment in 12 cases].

We investigated the ultrasonographic (US) features of Stener injury and thus the role of US in the diagnosis of this condition. Stener injuries are characterized by the tear of the cubital ligament system of the first metacarpophalangeal joint during hyperabduction. This condition may be associated with the displacement of the ligament proximal stump above the thumb adductor muscle. We examined 12 patients (9 men and 3 women) with a clinical diagnosis of joint instability due to hyperabduction of the first metacarpophalangeal joint. All the US exams were performed with a linear probe (7.5-10 MHz); a 13-MHz probe was also used in 7 patients. All the patients were submitted to radiography in the standard projections, to detect associated bone injuries. US allowed the identification of a round lesion surrounded by a hypoechoic halo, between the distal edge of the dorsal interosseous muscle of the first finger and the first metacarpal bone (the proper Stener injury) in 4/12 patients. In contrast, no typical sign was shown in the other 8 patients. US results were then compared with surgical findings. The diagnosis of proper Stener injury was surgically confirmed in 4 patients. Only 2 patients with clinical signs of thumb instability, who were negative for Stener injuries at US, were submitted to surgery which demonstrated the ligament tear responsible for joint instability, but ruled out the displacement. To conclude, US must be integrated with clinical signs because this imaging method accurately shows complete tears with displaced proximal stump of the cubital ligament.

Adult↗
PubMed2002

Diagnosis and surgical repair of stifle luxation in a spur-thighed tortoise (Testudo graeca).

This report describes stifle luxation resultant from multiple ligamentous injuries in a spur-thighed tortoise (Testudo graeca). Despite an absence of obvious trauma in the case history, the tortoise presented with acute, unilateral hind limb lameness. Diagnosis of stifle luxation was based on cranial drawer motion, increased rotational joint instability. and radiographic findings. Joint stabilization was accomplished by a combination of cranial cruciate reconstruction using an autograft of lateral vastus muscle in an over-the-top procedure and lateral imbrication of the joint capsule. Postoperative management included restriction of limb movement for 6 wk and parenteral chondroprotective regime. Treatment was effective in restoring clinically normal function to the limb.

Animals↗
PubMed1997

Non-operative treatment of subacromial impingement syndrome.

We performed a retrospective study of 616 patients (636 shoulders) who had subacromial impingement syndrome to assess the results of non-operative treatment. The diagnosis was made on the basis of a positive impingement sign and the absence of other abnormalities of the shoulder, such as full-thickness tears of the rotator cuff, osteoarthrosis of the acromioclavicular joint, instability of the glenohumeral joint, or adhesive capsulitis. All patients were managed with anti-inflammatory medication and a specific, supervised physical-therapy regimen consisting of isotonic exercises for strengthening of the rotator cuff. The average duration of follow-up was twenty-seven months (range, six to eighty-one months). Over-all, 413 patients (67 per cent) had a satisfactory result. One hundred and seventy-two patients (28 per cent) had no improvement and went on to have an arthroscopic subacromial decompression. Thirty-one patients (5 per cent) had an unsatisfactory result but declined additional treatment. Seventy-four (18 per cent) of the 413 patients who had a successful result had a recurrence of the symptoms during the follow-up period; the symptoms resolved with rest or after resumption of the exercise program. The patients were stratified according to age, the duration of symptoms, and acromial morphology. Patients who were twenty years old or less and those who were forty-one to sixty years old fared better than those who were twenty-one to forty years old. Patients who were more than sixty years old had the poorest results. Sixty-seven (78 per cent) of the eighty-six patients in whom the symptoms had been present for less than four weeks had a satisfactory result, compared with 144 (63 per cent) of the 228 who had had the symptoms for one to six months and with 202 (67 per cent) of the 302 who had had the symptoms for more than six months. Thirty-two (91 per cent) of the thirty-five patients who had a type-I acromion had a successful result, compared with 173 (68 per cent) of the 256 who had a type-II acromion and with 208 (64 per cent) of the 325 who had a type-III acromion. Shoulder dominance, gender, and concomitant tenderness of the acromioclavicular joint did not affect the result significantly (p = 0.084, 0.555, and 0.365, respectively).

Adolescent↗
PubMedDate not supplied

Histologic evaluation of the glenohumeral joint capsule after the laser-assisted capsular shift procedure for glenohumeral instability.

Glenohumeral joint capsule obtained from 42 patients who had undergone an arthroscopic laser-assisted capsular shift procedure was evaluated histologically. A total of 53 samples from the anterior inferior glenohumeral ligament of the joint capsule were collected before and at various times after the procedure (range, 0 to 38 months). Despite glenohumeral instability, joint capsule of the patients before the procedure showed no significant histologic lesions. Laser treatment significantly altered the histologic properties of the tissue as evidenced by hyalinization of collagen and necrotic cells (time 0). Tissues sampled during the short-term period (3 to 6 months) after the procedure demonstrated fibrous connective tissue with reactive cells and vasculature. Collagen and cell morphology returned to normal in the middle- to long-term period (7 to 38 months) after the procedure, while the number of fibroblasts remained elevated. Joint capsule collected from the shoulders of six patients who experienced stiffness after the procedure showed persistent synovial, cellular, and vascular reaction even after 1 year postoperatively, the cause of which is unclear. This study revealed histologic evidence of robust tissue healing and maturation after thermal treatment by the laser-assisted capsular shift procedure, although mechanical and biochemical characterization of the tissue was not evaluated. Correlation with clinical follow-up must be performed to further clarify the advantages and disadvantages of this procedure.

Adult↗
PubMed2003

Grade III radial collateral ligament injuries of the thumb metacarpophalangeal joint: treatment by soft tissue advancement and bony reattachment.

PURPOSE: The purpose of this study is to report the results of intact radial collateral ligament (RCL) soft tissue sleeve advancement with bony reattachment without additional soft tissue reinforcement as the sole surgical repair technique for the treatment of grade III RCL injuries to the thumb metacarpophalangeal (MCP) joint in acute, chronic, and late cases. METHODS: During a 20-year period, 38 of 45 patients (84%) with grade III RCL injuries were found to have tears at or adjacent to the metacarpal head (25 patients) or the proximal phalanx (13 patients) and underwent surgical repair at a mean of 10.8 months after injury. Patients were evaluated at a mean follow-up time of 3.8 years (minimum, 1 year), comparing pre- and postoperative standard thumb x-rays, varus (adduction) MCP joint stress x-rays, joint range of motion, pinch and grip strengths, clinical deformity, and subjective symptoms. RESULTS: Thirty-three patients (87%) were symptom free. Thirty-five patients (92%) regained normal pinch and grip strength. Thirty patients (79%) had full range of motion at the MCP joint, and no patient lost any interphalangeal joint motion. No recurrent symptomatic MCP joint instability was noted. Three patients (8%) had mild residual asymptomatic MCP joint volar subluxation. One patient had progression of pre-existing degenerative joint changes. CONCLUSION: Acute, chronic, and late grade III RCL instability of the thumb MCP joint can be successfully treated in the majority of cases by RCL soft tissue sleeve advancement and bony reattachment alone without the need for other soft tissue reinforcement.

Adolescent↗
PubMedDate not supplied

An assessment of the interexaminer reliability of tests for shoulder instability.

Accurate noninvasive clinical tests of shoulder instability are important in assessing and planning treatment for glenohumeral joint instability. An interexaminer agreement trial was undertaken to estimate the reliability of commonly used clinical tests for shoulder instability. Thirteen patients with a history suggestive of instability, who had been referred to a shoulder specialist for treatment of their symptomatic shoulders, were examined by four examiners of differing experience. Good to excellent interexaminer agreement was found for most variations of the load-and-shift test, with the best agreement in the 90 degrees abducted position for the anterior direction (intraclass correlation coefficient [ICC] = 0.72) and in the 0 degrees abducted position for the posterior (ICC = 0.68) and inferior (ICC = 0.79) directions. Fair to good interexaminer reliability was found for the sulcus sign (ICC = 0.60). With regard to the provocative tests, agreement was best when apprehension was used as the criterion for a positive test and was better for the relocation (ICC = 0.71) and release tests (ICC = 0.63) than for the apprehension (ICC = 0.47) and augmentations tests (ICC = 0.48). Reliability was poor (ICC < 0.31) when pain was used as the criterion for a positive test. These results indicate that the load-and-shift, sulcus, and provocative tests (apprehension, augmentation, relocation, and release) are reliable clinical tests for instability in symptomatic patients when care is taken with respect to arm positioning and if apprehension is used as the criterion for a positive provocative test.

Adolescent↗
PubMed1998

Scoring in forefoot surgery: a statistical evaluation of single variables and rating systems.

We assessed 13 scores for forefoot surgery and their single parameters in 200 cases of hallux surgery. Outcome expressed in descriptive terms from excellent to poor, as well as calculated as a numerical value differed to a great extent. The rank correlation between different scores showed poor conformity, in some combinations even slight negative correlations. The rank correlation between single parameters and the overall outcome gave good values for some variables included in most scores, e.g., walking distance, general activity, problems on uneven surfaces, shoe wear, cosmetics and pain. Little, if any, correlation was found for joint instability, range of motion of the MTP- and IP-joints, the use of walking aids and medication. We find a need for a generally accepted score, with parameters of high clinical relevance.

Activities of Daily Living↗
PubMedDate not supplied

Radiographic analysis of transverse plane digital alignment after surgical repair of the second metatarsophalangeal joint.

We undertook a retrospective cohort study of 51 feet in 49 patients with surgically managed second metatarsophalangeal joint instability, including repair of the crossover second toe deformity. The fundamental intervention consisted of proximal interphalangeal joint arthrodesis combined with second metatarsophalangeal joint relocation and Kirschner-wire transfixation, and this was performed alone or in combination with one of the following additional surgical maneuvers: flexor tendon transfer or flexor set release, flexor plate repair, placement of a plantar-lateral retention suture, extensor tendon transfer, metatarsophalangeal arthroplasty, metatarsal osteotomy, or second-to-third syndactyly. The outcome of interest was the presence of a transverse plane second metatarsophalangeal joint angle of 0 degrees to 15 degrees measured on the late postoperative follow-up radiograph. Overall, the median angular correction for all second metatarsophalangeal joint interventions was 8 degrees , and second-to-third syndactyly yielded the most long-term correction followed by, in descending order of the amount of angular correction, use of the fundamental intervention in combination with metatarsophalangeal joint arthroplasty, placement of a plantar-lateral anchor suture in the flexor plate, metatarsal osteotomy, flexor tendon transfer, flexor plate repair, extensor tendon transfer, and the fundamental intervention as a solitary procedure. A sensitivity analysis indicated that our results were resistant to the influence that an unmeasured variable would impart on the data. The results of this investigation should aid surgeons treating patients with unstable second metatarsophalangeal joints, and can be used in the development of future clinical trials and observational studies that focus on the management of this common deformity.

Adult↗
PubMed1998

Vascular volume determination of articular tissues in normal and anterior cruciate ligament-deficient rabbit knees.

The vasculature of diarthroidal joints has been well documented; however, the volume of vessels supplying different articular tissues is unknown. Angiogenesis, the formation of new vessels from preexisting ones, is difficult to quantify in joints due to the unavailability of a suitable technique. Although angiogenesis is known to occur in rheumatoid arthritis, the development of new vessels following joint injury has not been ascertained. A vascular casting technique was developed using carmine red dye to measure the vascular volume of the medial collateral ligament (MCL), lateral collateral ligament (LCL), menisci, medial capsule, and infrapatellar fat pad of the rabbit knee joint. Vascular volume determinations were repeated at 4 weeks in a group of anterior cruciate ligament (ACL)-transected animals and in a sham-operated control group. The volume of vessels supplying the MCL was estimated to be 0.22 +/- 0.07 microliter (mean +/- S.E.M.), the LCL volume was 0.25 +/- 0.05 microliter, the medial meniscus volume was 0.19 +/- 0.03 microliter, the lateral meniscus volume was 0.40 +/- 0.08 microliter, the medial capsule volume was 0.14 +/- 0.05 microliter, and the infrapatellar fat pad volume was 1.90 +/- 0.62 microliters. Following ACL transection, angiogenesis was found to occur in the MCL only. All other tissue vascularities were not significantly different from sham-operated controls. A quantifiable method for measuring vascular volume of knee joint tissues has been described. Joint instability stimulates angiogenesis in the ipsilateral MCL; however, the absence of angiogenic activity in other articular tissues might help explain the lack of posttraumatic healing associated with these joints.

Animals↗
PubMed2005

Effect of changes in cruciate ligaments pretensions on knee joint laxity and ligament forces.

The knee joint cruciate ligaments are reconstructed with the rationale to avoid joint instability, recurrent injury, damage to soft tissues and osteoarthritis. Wide range of procedures with different stiffness, pretension, orientation and insertion locations have been proposed with the primary goal to restore the joint laxity. Apart from the general lack of success in preservation of force in the reconstructed ligament itself, the concern, not yet addressed, arises as to the effect of such perturbation on the other intact cruciate ligament. The interaction between cruciate ligament forces is hypothesized in this work. Using a 3-D nonlinear finite element model of the tibiofemoral joint, we examined this hypothesis by quantifying the extent of coupling between cruciate ligaments while varying the prestrain in each ligament under flexion with and without anterior-posterior (A-P) loads. A remarkable coupling was predicted between cruciate ligament forces in flexion thus confirming the hypothesis; forces in both cruciate ligaments increased as initial strain or pretension in one of them increased whereas they both diminished as one of them became slack. Moreover, changes in laxity and in ligament forces as a cruciate ligament prestrained or pretensioned varied with flexion angle and external loads. These findings have important consequences in joint functional biomechanics following a ligament injury or replacement surgery and in selection of laxity matched or ligament force matched pretensioning protocols.

Anterior Cruciate Ligament↗