Diagnostic and surgical arthroscopy.
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Arthroscopes↗
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Results for “LIGAMENTS, ARTICULAR”
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[Metamorphosis of cells and intercellular substances in skeletogenesis].
We investigated the attachment of tendons to the skeleton (tubercula humeri, patella) in regard to the chondrogenesis and osteogenesis in these areas. Then we compared our findings with those in other sites of skeletogenesis. A metamorphosis, transformation, of structure and nature of cells and intercellular susbstances in correlation with another by feedback characterized the transition from perichondrium and periost or tendon to the skeleton. The initial form of cells are in the case of tendons without doubt the special form of fibrocytes, the tendocytes. We believe that this finding confirm the earlier expressed opinion fibrocytes of the periost with the same structure as tendocytes metamorphose to osteoblasts. The metamorphosis of cells and intercellular substances at tendon attachments occur like in other regions of skeletogenesis (periost, epiphysis) in relative clearly definable stages: tendon, Ansatzstruktur (attachment structure), Ansatzknorpel (attachment cartilage) as a part of apophysis or Einstrahlungsknochen (invading bone). In regard to histogenesis periost and attachment structure are homologous formations. The latter one may be a reticular structure of collagen fibers or a fibrocartilage of which the cells are surrounded from a polysaccharide capsule and a fiber capsule partly accompanied by needle like minerals. The osseous attachment is composed from parallel running fibrils. This structure forms a Grenzstreifen (border sector) with a varied number of needle like crystals along the fibrils. The amount of minerals are increased in the Grenzlinie (border line) to bone and subsequently the crystals disappear. The tendinous mineralisation is a temporary one. However, the fibrils get the Fibrillencharakter (nature of fibrills) of the fibrils of lamellar bone. Later on the bone minerals appear. It is doubtful that osteogenesis occur always in the same manner. However, the vague term ossification can only concern the bone specific metamorphosis of fibrils, never the widely distributed mineralisation. Therefore, skeletogenesis ist one of the metamorphosis stages from the embryonal (!) determinated skeletal mesenchyme to mature and finally to old and atrophying bone. This metamorphosis may be a process probably following a controlled program. A developmental stage releases the development of the next one. A feedback influences the organisation of the different parts, e.g. cells and intercellularsubstances. The increasing diversity of the system developed in the way of Selbstorganisation (self-reproduction). With the exhaustion of the program informations started the ageing.
Animals↗
Factors influencing elbow instability.
Stability or instability of the elbow is contingent upon three distinct but interrelated conditions: radiocapitellar articular continuity, coronoid process integrity and medial collateral ligament competency through an intact anterior oblique ligament. The latter, the anterior oblique ligament of the medial collateral ligament both in anatomic experimentation and clinical cases appears to be the most critical factor in elbow stability. The reconstruction of the unstable elbow must focus on this medial supporting ligament for a predictable result.
Athletic Injuries↗
[Distortion of the wrist joint].
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Carpal Bones↗
[New aspects of the diagnosis and treatment of injuries of the fibrous apparatus of the knee joint. II (author's transl)].
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Cartilage, Articular↗
Knee joint structure and function.
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Cartilage, Articular↗
Arthroscopy of the distal radioulnar joint. Indications, portals, and anatomy.
Carpal tunnel syndrome is defined as a clinical condition related to dysfunction of the median nerve specifically related to the carpal tunnel. This article reviews anatomy, current surgical treatment options, technique, indications and contraindications, efficacy, complications, and the author's own perspective on the subject.
Arthroscopy↗
Computed arthrotomography of glenohumeral instability.
In spite of recent advances in imaging technology, computed arthrotomography continues to be a useful imaging modality for shoulder evaluation. The spatial resolution of computed tomography (CT) and the longer clinical experience continue to provide advantages over magnetic resonance imaging (MRI). Computed arthrotomography remains a simple and reliable method for evaluation of the glenoid labrum in patients with shoulder instability.
Arthrography↗
Adductor magnus tenodesis for patellar dislocation. Technique and preliminary results.
Fourteen patients with acute or chronic patellar instability had treatment with a new reconstructive procedure. It consists of isokinetic augmentation of the medial patellofemoral ligament (PFL) by making a tenodesis of the distal adductor magnus tendon to the medial border of patella. The patients were reviewed at a mean of 6.9 +/- 0.5 years after operation. In 12 patients, the subjective result was good. One patient had redislocation.
Adolescent↗
Biomechanics of the subtalar joint complex.
The subtalar joint complex is formed by the posterior talocalcaneal joint and the acetabulum pedis lodging the talar head. The basic motion at the joint is that of male ovoid surfaces moving over female ovoid surfaces and vice versa. The motion generated at the joint is that of flexion-supination-adduction or extension-pronation-abduction. The subtalar motion is generated by the contour and orientation of the articular surfaces and is guided by the intrinsic ligaments: the interosseous talocalcaneal ligament of the canalis tarsi and the cervical ligament. Further support is provided by the extrinsic ligaments: the calcaneofibular ligament and the tibiocalcaneal fascicle of the deltoid ligament. Under tibiotalar vertical loading with internal rotation, the subtalar joint complex is in a close-pack position with maximum talar head surface contact in the acetabulum pedis. The component ligaments of the latter are under maximum tension. The posterior talocalcaneal surfaces are interlocked laterally.
Biomechanical Phenomena↗
Maintaining and restoring mobility in middle and old age: the importance of the soft tissues.
For many older individuals, impairment of musculoskeletal function, especially weakness, stiffness, and pain, cause progressive disability, thereby limiting mobility and decreasing the quality of life. With advancing age, musculoskeletal soft tissue function declines, susceptibility to degenerative diseases and injuries increases, and the ability to recover from disease or injury declines; these changes increase the probability of impairment (Fig. 1). However, the function of individual cells, tissues, or organ systems may remain stable or even improve temporarily with age, and a number of interventions have the potential to maintain or improve musculoskeletal function. Age-related changes in cells, tissues, and musculoskeletal function are not necessarily unidirectional or uniform among individuals, organ systems, tissues, or cells, nor are they necessarily irreversible. Surgical procedures can restore mobility for many patients with age-related musculoskeletal injuries or degenerative diseases. Regular resistance and range-of-motion exercises can decrease the age-related loss of strength and help maintain or restore flexibility. However, exercise programs can also cause injury. Older individuals should have a careful medical evaluation before starting an exercise program, and the program should be selected based on this evaluation. This is especially important for individuals with systemic illness and for individuals at greater risk of musculoskeletal injury, including people with previous joint injuries, obesity, osteoarthritis, joint deformity, weakness, or restricted joint motion. Trophic hormone replacement or supplementation may also modify age-related changes in the soft tissues, including loss of strength, but these hormones have adverse effects. Systemic or local use of growth factors and cell transplantation after expanding the population of mesenchymal stem cells in culture could improve healing in older people. Other potential methods of slowing or reversing age-related deterioration of the soft tissues include inhibition of posttranslational modification of matrix proteins and alteration of the activity of selected transcription factors. In particular, better understanding of the role of transcription factors in cell sequence may make it possible to devise methods of delaying or reversing age-related loss of cell proliferative and synthetic capacity.
Adult↗
Chondrocalcin as a marker of articular cartilage degeneration in anterior cruciate ligament-deficient knees.
This study assessed articular cartilage deterioration and the effect of meniscal tears to evaluate the usefulness of chondrocalcin as a joint fluid marker in 43 patients with anterior cruciate ligament (ACL) deficiency. A significant correlation was found between the cartilage damage and time after injury. The high incidence of long longitudinal tears of the medial meniscus with increased cartilage damage, especially in chronic cases, suggests that this type of meniscal tear contributed to the deterioration of ACL-deficient knees. Chondrocalcin concentrations were found to have a significant correlation with cartilage damage.
Adolescent↗
[Cutis laxa syndrome associated with articular calcification punctata].
One case of congenital cutis laxa with delayed development, ligamentous and articular laxity, multiple diverticulum and articular punctuated calcifications, with ultrastructural study, is presented. Literature is reviewed, reporting the known data about pathogenesis and inheritance.
Calcinosis↗
Motion loss after ligament injuries to the knee. Part II: prevention and treatment.
This is the second part of a two-part review on motion problems after ligament injuries to the knee. The first part, published in the September/October 2001 issue, discussed normal and abnormal knee motion, terminology, risk factors, and pathoanatomy. The purpose of this article is to review current concepts on prevention and treatment of motion problems, summarizing the recent and pertinent studies that discuss this complicated clinical problem. The first part of this article will discuss the different classification schemes that have been published on motion loss of the knee. Prevention strategies will be discussed next, followed by early recognition. Finally, a discussion of the various treatment options and published results will be presented in detail, together with the authors' nine-step systematic surgical approach to the stiff knee.
Anterior Cruciate Ligament↗
Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques.
One hundred and twenty-seven patients who had a rupture of the anterior cruciate ligament agreed to participate in a prospective, randomized study of three arthroscopically assisted reconstruction techniques. One hundred and twenty-five patients (125 reconstructions) were evaluated after a mean duration of follow-up of forty-two months (range, two to five years). Group I included forty patients who had a two-incision reconstruction with use of an autogenous semitendinosus-gracilis graft, group II consisted of forty patients who had a two-incision reconstruction with use of an autogenous patellar-ligament graft, and group III included forty-five patients who had a single-incision reconstruction (endoscopic technique) with use of an autogenous patellar-ligament graft. The male-female ratio, age range, level of athletic activity, interval between the injury and the reconstruction, previous operative procedures, and associated injuries were similar in all three groups. The same postoperative rehabilitation protocol was followed for all patients. Testing with a KT-2000 arthrometer at maximum manual force was done at the follow-up evaluation; the difference in laxity between the involved knee and the contralateral knee was three millimeters or less in thirty-three patients (83 per cent) in group I, thirty-seven patients (93 per cent) in group II, and thirty-nine patients (87 per cent) in group III. A difference of two millimeters or less was found in thirty patients (75 per cent) in group I, thirty-one patients (78 per cent) in group II, and thirty-five patients (78 per cent) in group III. Thirty-five patients (88 per cent) in group I, thirty-eight patients (95 per cent) in group II, and forty patients (89 per cent) in group III returned to at least the same level of athletic activity. Four grafts (two in group I and two in group II) failed as a result of trauma. There was one additional failure in groups I and III, as evidenced by a difference of nine and seven millimeters, respectively, on instrumented testing of laxity. The significant findings were that no knee was rated D according to the system of the International Knee Documentation Committee (p < 0.002, 94 per cent confidence level) and that fewer additional operative procedures were done on patients in group III (p < 0.08). Also, it was found that the patients in group II returned to a greater level of athletic activity (p < 0.02) and that a higher percentage of the patients in this group had a difference of three millimeters or less on testing with the KT-2000 arthrometer than in the other two groups (p < 0.08). However, with the numbers available, there were no significant differences in the over-all outcome among the three groups (p > 0.1). Importantly, the rate of failure was not greater and the outcomes were not less satisfactory for the late reconstructions than they were for the acute reconstructions (those performed less than three weeks after the injury), including those done with an autogenous semitendinosus-gracilis graft in a chronically unstable knee.
Adolescent↗
Midterm results of arthroscopic treatment of scapholunate ligament lesions associated with intra-articular distal radius fractures.
Since 1993, we have treated 30 patients with acute intra-articular distal radius fractures using arthroscopic assistance. Concomitant lesions of the intrinsic scapholunate (SL) ligaments were diagnosed in 12 patients (40%). Using the grading system of Geissler et al. [13], the identified lesions included a single grade I tear, three grade II, six grade III, and two grade IV. The grade III and IV lesions were accompanied by intraoperative findings of marked instability. Therefore operative stabilization was performed by temporary scapholunate and scaphocapitate arthrodesis. Seven patients in this group (87.5%) were followed up clinically and radiologically for an average of 3 years postoperatively. Clinical examination included range of motion and a subjective questionnaire concerning pain and ability to work. Objective grip strength was measured using a Jamar-tester and compared to the contralateral wrist. Radiological evaluation consisted of posteroanterior and lateral views and of stress views in radial and ulnar deviation. Data were evaluated by the scoring systems of Jakim et al. [21], Cooney et al. [5] and by the demerit point system of Gartland and Werley [12], as modified by Sarmiento et al. [36]. An excellent result was present in 100% of our patients by the Gartland and Werley system, in 86% by that of Jakim et al., and in 60% by that of Cooney et al. Based on a subjective questionnaire, all of the patients had an excellent or good result.
Adult↗
The three-dimensional active rotary stabilization of the knee.
The careful examination of insertions and directions of the tendons of the knee peri-articular muscles permits a global conception of the action of the 29 couples in rotatory stabilization. First, an analytic study of the tibial and femoral rotatory stabilization is considered. Second, the three-dimensional rotatory mechanical coupling between femur and tibia is developed. The anatomical complexity of the musculotendinous elements allows understanding of the risks of desynchronisation of the articular joint in case of lesion of the central ligament pivot.
Aged↗
The effects of sectioning of the posterior cruciate ligament and the posterolateral complex on the articular contact pressures within the knee.
Articular contact pressures in ten cadaveric knees with intact ligaments were measured with the use of film and a model that simulated non-weight-bearing resistive extension of the knee. The measurements were repeated after sequential sectioning of the posterior cruciate ligament and the posterolateral complex (the posterolateral capsule, the popliteus muscle and tendon, and the lateral collateral ligament). Patellofemoral pressures and quadriceps load were most significantly elevated after combined sectioning of the posterior cruciate ligament and the posterolateral complex. Medial compartment pressure was significantly elevated after sectioning of the posterior cruciate ligament. The results coincided with, and may partially explain, the clinical findings associated with these types of ligamentous injuries.
Aged↗