[Routine stability examination of articular ligament injuries in the knee joint during anesthesia].
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Adolescent↗
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Results for “LIGAMENTS, ARTICULAR”
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Developmental failure of the intra-articular ligaments in mice with absence of growth differentiation factor 5.
OBJECTIVE: To show the phenotypic characteristics of the knee joints in brachypodism mice (bp mice), which carry a functional null mutation of the growth differentiation factor 5 (GDF5) gene, we investigated the adult and embryonic bp mice. METHOD: Radiographic and macroscopic examinations of the knee joint of adult bp mice were performed. A histological examination of the knee joint of bp mice from E12.5 to E18.5 was also performed. RESULTS: Radiographic and macroscopic examinations of the adult bp mice showed anterior dislocation, hypoplastic condyles, and absence of the intra-articular ligaments. Safranin O staining of knee joints of the embryonic bp mice showed severe hypoplasty of the chondroepiphyses and intra-articular ligaments at E16.5. There was no difference in the number and location of 5-bromo-2'-deoxyuridine (BrdU)-positive cells between wild-type and bp mice through E12.5 to E14.5. A terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) study showed excessive cell death of mesenchymal cells of the future knee joint in bp mice at E12.5 and E13.5. CONCLUSION: bp mice exhibit developmental failure of the condyles and intra-articular ligament of the knee joints.
Animals↗
[Architecture of collagen fibers in the meniscus of the human knee joint, with special reference to the medial meniscus and its connection to the articular ligaments].
1. To understand the meniscus-tears the architecture of their collagenic fibers is of interest, particularly so the connection of the fibers of the medial meniscus with the collateral ligament. 2. The ligaments of 12 knee joints have been studied macroscopically and with the aid of thick serial sections under polarized light. 3. The main portion of the tibial collateral ligament passes the articular space without any connection with the capsule or the meniscus. The upper oblique portion of the ligament runs inside the external zone of the meniscus to the posterior attachment of the latter. Immediately inferior to the articular space the oblique fibers have another attachment. 4. The findings in respect of the arrangement of the fibers in the menisci differ from those in earlier studies. Only in the external zone the fibers run approximately parallel to the outer border. After leaving the external zone the fibers run in an arched way through the middle zone. In the internal zone these fibers have nearly a radial direction. 5. The architecture of the menisci is discussed under functional aspects. It does not correspond to a "spring" but to a tendon, which is extended over a hypomochlion. 6. Forms and localisations of meniscus-tears have been discussed under viewpoint of architecture and compared with clinical results: The typical tear of the posterior segment of the medial meniscus is the horizontal cleavage. The present opinion according to which longitudinal tears are the typical meniscus lesion, seems to be doubtful.
Cartilage, Articular↗
[Functional consequences of crossing of articular ligaments].
The movements occurring at joints with fully congruent articular surfaces, such as ball-and-socket joints and hinge joints, can be roughly infered from the geometrical forms of their articular surfaces. In these cases pure sliding occurs between the moving surfaces. But this is no longer true for incongruent joints, and in such joints the ligaments play an important role in determining the frequently complex nature of the movements these joints produce : with combinations of sliding and rolling between their moving surfaces. Finally, the instantaneous velocity of these moving surfaces is also strongly influenced by the arrangement of the ligaments.
Humans↗
Porcine anterior cruciate ligament fibroblasts are similar to cells derived from the ligamentum teres, another non-healing intra-articular ligament.
Porcine ligament fibroblasts were cultured from the anterior cruciate (ACL), medial collateral (MCL), and ligamentum teres (LT). There were no apparent differences in confluent cellular morphology among the ligament cell types as evaluated by phase contrast microscopy. The proliferation rate of MCL cells from 24-120 h was significantly higher (p < 0.05) than that of cells from either the LT or the ACL. MCL cells produced more collagen and less non-collagenous protein than the LT and ACL as determined by [3H]proline incorporation. This resulted in MCL cells producing a higher percentage (37%, p < 0.05) of collagen relative to total protein than either the ACL (28%) or the LT (32%). The MCL cells produced a significantly higher percentage (34.7%, p < 0.05) of type-III collagen relative to total type-I and III collagen than either the ACL (29.2%) or the LT (29.5%). The LT and MCL cells had similar and significantly greater coverage of in vitro wounds than the ACL. This study provides the first in vitro study of the LT and demonstrates that fibroblasts from the LT and ACL, two ligaments that heal poorly, have similar in vitro characteristics, with the exception of wound healing.
Animals↗
[Effect of external extra-articular ligament plasty on the results of anterior cruciate ligament reconstruction with patellar tendon, a 4 years follow-up].
PURPOSE OF THE STUDY: The purpose of this study was to compare the functional results obtained when an external extra-articular plasty was added to an anterior cruciate ligament (ACL) reconstruction using an autologous bone tendon-bone patellar tendon graft. MATERIAL AND METHODS: The authors analyzed two consecutive series of 60 and 50 patients operated by the same surgeon for a chronic rupture of the anterior cruciate ligament, one by reconstruction of the cruciate ligament with a free graft of the patellar tendon supplemented by an external extra-articular plasty made with a quadriceps tendon graft and the second with an isolated free patellar tendon graft. Anterior laxity was measured before and after surgery, by dynamic X-rays and by the Medmetric KT-1000 arthrometer. Functional results were evaluated four years after operation, with the French A.R.P.E.GE score based on sport activity level and intensity. RESULTS: Anterior laxity was not different before operation in both groups and there was no difference between males and females. Medmetric KT-1000 arthrometer showed the same negative differential laxity immediately after surgery in both groups and the same evolution during the first 4 years, without any significant difference on laxity on the middle aspect of the knee. Radiological results were different. After a 4 years follow-up, anterior laxity did not show significant difference on the medial compartment of the knee (5.3 +/- 2.3 mm and 5.5 +/- 1.7 mm), but there was a significant minor laxity in the lateral compartment for the lateral extra-articular plasty group (11.0 +/- 2.3 mm against 14.8 +/- 3.8 mm)(p = 0.002). Functional results and sport activity were similar in both groups. Examination showed 4 positive pivot shift tests (2 "sliding" and 2 positive) in the group with extra-articular plasty, even though 8 positive pivot shift tests in the isolated ACL group (5 "sliding" and 3 positive) were found. DISCUSSION: This study, as well as five others studies found in literature, was not randomized. In all these series, the surgical techniques, the rehabilitation programs and the functional score evaluation were too different to allow any pertinent comparison. Extra-articular plasty helps to control the laxity of the lateral compartment of the knee which is incompletely controlled by ACL reconstruction, particularly in chronic cases. This is proved by radiological measurements and pivot shift tests. Jensen in 1983, about 205 patients with a 4 year follow-up and Noyes, which used an allograft patellar tendon, found an advantage to do extra-articular plasty. But Strum (in 1989), as O'Brien (in 1991) and Roth (in 1987), did not found any advantage with extra-articular plasty. CONCLUSION: It is therefore obvious, after a four-year follow-up, that extra-articular supplementation presents an advantage for reconstruction of the ACL. by a free graft of the patellar tendon in chronic cases. Further randomized study will confirm that isolated ACL reconstruction is possible in some well defined categories of anterior laxity.
Adolescent↗
[Experiences with the surgical extra-articular cruciate ligament replacement at the knee joint (pes-anserius-transfer)].
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Adolescent↗
Arthrography of the contralateral, asymptomatic wrist in patients with unilateral wrist pain.
To determine the significance of arthrographic abnormalities in patients with unilateral wrist pain, the authors compared the prevalence and site of intra-articular ligament perforation in asymptomatic and symptomatic wrists of the same group of patients and correlated asymptomatic perforation with age, hand dominance and hand overuse. Thirty-seven patients (29 men and 8 women ranging in age from 19 to 61 years) who had unilateral wrist pain and positive arthrographic findings for the symptomatic wrist underwent radiocarpal arthrography of the asymptomatic wrist. Three radiologists blinded as to the clinical findings examined the images for perforation in the triangular fibrocartilage complex, the lunotriquetral ligament and the scapholunate ligament. Intra-articular ligament perforations were found in 33 (89%) of the 37 asymptomatic wrists. Seventeen (46%) of the 37 patients had symmetric sites of perforation in the two wrists. Perforation of the triangular fibrocartilage complex occurred in 22 (59%) and 19 (51%) of the symptomatic and asymptomatic wrists respectively, of the lunotriquetral ligament in 13 (35%) and 7 (19%) respectively and of the scapholunate ligament in 13 (35%) and 11 (30%) respectively. No significant correlation between asymptomatic perforation and age or hand overuse was found (chi 2 test, Fisher's exact test). The authors conclude that asymptomatic perforation is common, even in young patients, so ligament perforation is not necessarily the cause of wrist pain in patients with such pain. However, for patients with the appropriate clinical findings, arthrography can be used to confirm or exclude ligament perforation.
Adult↗
[Acute cervical syndrome in chondrocalcinosis. 3 elderly patients with calcifications of the transverse atlantis ligament].
Articular chondrocalcinosis, or pseudogout, is characterized by the deposition of calcium pyrophosphate dehydrate (CPPD) crystals. Vertebral involvement in CPPD crystal deposition disease is known and includes in particular the ligamentum flavum, the posterior longitudinal ligament and the intervertebral disc. We report on 3 elderly patients with peracute cervical syndrome. Plain radiographs showed the usual degenerations. Computerized tomography scans revealed a calcified transverse atlas ligament. The erythrocyte sedimentation rate was elevated. Plain radiographs showed chondrocalcinosis of the hands and knees. The symptoms subsided after 2 days' therapy with antiinflammatory drugs. We conclude that chondrocalcinosis may often be an undetected cause of acute cervical vertebral pain in the elderly patient.
Aged↗
Ligaments and articular contact guide passive knee flexion.
The aim of this study was to test the hypothesis that the coupled features of passive knee flexion are guided by articular contact and by the isometric fascicles of the ACL, PCL and MCL. A three-dimensional mathematical model of the knee was developed, in which the articular surfaces in the lateral and medial compartments and the isometric fascicles in the ACL, PCL and MCL were represented as five constraints in a one degree-of-freedom parallel spatial mechanism. Mechanism analysis techniques were used to predict the path of motion of the tibia relative to the femur. Using a set of anatomical parameters obtained from a cadaver specimen, the model predicts coupled internal rotation and ab/adduction with flexion. These predictions correspond well to measurements of the cadaver specimen's motion. The model also predicts posterior translation of contact on the tibia with flexion. Although this is a well-known feature of passive knee flexion, the model predicts more translation than has been reported from experiments in the literature. Modelling of uncertainty in the anatomical parameters demonstrated that the discrepancy between theoretical predictions and experimental measurement can be attributed to parameter sensitivity of the model. This study shows that the ligaments and articular surfaces work together to guide passive knee motion. A principal implication of the work is that both articular surface geometry and ligament geometry must be preserved or replicated by surgical reconstruction and replacement procedures to ensure normal knee kinematics and by extension, mechanics.
Anterior Cruciate Ligament↗
Expression of decorin mRNA in the skin of patients with ossification of the posterior longitudinal ligament.
Ossification of the posterior longitudinal ligament (OPLL) is an intractable disease developing into severe myelopathy and often accompanied by ossification of several other spinal ligaments and articular ligaments. Therefore, it is highly probable that predisposition to systemic ossification underlies the onset of this disease. Terayama et al(1981) reported that the nuchal skin of OPLL patients tended to be tougher than that of healthy individuals. Decorin is a component of the extracellular matrix which antagonistically regulates the action of Transforming growth factor-beta (TGF-beta). Imamura et al(1995) demonstrated immunohistochemically that decorin increased in the epidermis of the nuchal skin of OPLL patients. This suggests an abnormal expression of the extracellular matrix in the skin of OPLL patients. In the present study, in situ hybridization with non-radioactive synthetic oligodeoxynucleotide probes revealed an enhanced expression of decorin mRNA in the epidermal keratinocytes of OPLL patients. The increased expression of decorin mRNA in the epidermis of OPLL patients may be interpreted as reflecting abnormalities of the matrix associated with ossification of the ligaments. Studies on the role of decorin in ossification will contribute to clarification of the pathophysiology and pathogenesis of OPLL.
Adult↗
Articular and ligamentous contributions to the stability of the elbow joint.
This preliminary study of four elbow specimens investigates the relationship of articular geometry and ligamentous structures in providing stability to the elbow joint. A technique is presented that describes the constraining features of varus-valgus and distraction in extension and at 90 degree of elbow flexion. Valgus stability is equally divided among the medial collateral ligament, anterior capsule, and bony articulation in full extension; whereas, at 90 degrees of flexion the contribution of the anterior capsule is assumed by the medial collateral ligament which provides approximately 55% of the stabilizing contribution to valgus stress. Varus stress is noted to be resisted primarily by the anterior capsule (32%) and the joint articulation (55%) with only a small (14%) contribution from the radial collateral ligament. At 90 degrees of flexion, little change is noted in the contribution to the radial collateral ligament (9%), but the anterior capsule offers only 13%, with the remaining stability (75%) arising from the joint articulation. In extension, the soft tissue resistance to distraction is provided minimally by either the radial (5%) or the medial (5%) collateral ligaments, and thus primarily originates from the anterior capsule (85%). At 90 degrees of flexion, however, the capsule offers virtually no resistance to distraction (8%). The radial collateral ligament contributes 10% of the stability, while the medial collateral ligament accounts for 78% of the resistance to distraction in this position. Too few specimens have been studied to form any conclusions for direct clinical applications at this time. However, the technique provides a reliable tool with additional studies for different positions and loading conditions underway. These efforts should disclose useful information that might be applied to the management of chronic elbow instability, radial head or olecranon fracture, the design and implantation of elbow prostheses, or provide a rationale for other reconstructive procedures.
Biomechanical Phenomena↗
[A contribution to the treatment of the torn lateral knee ligament using articular active movement].
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Adult↗
Lipid composition of the tissues of human knee joints. I. Observations in normal joints (articular cartilage, meniscus, ligaments, synovial fluid, synovium, intra-articular fat pad and bone marrow).
The composition and lipid profiles of the following tissues of the human knee joint were determined: articular cartilage, meniscus, ligaments, synovial fluid, synovium, intra-articular fat pad and bone marrow. The tissues were obtained from fresh cadavers and from surgical specimens. The lipid profiles of articular cartilage, meniscus and ligaments were similar to reported analyses of other tissues that are also rich in collagen. The lipid profiles for the remaining tissues were more like the profiles found in the fat depots and fatty tissues of the human body. Both the phospholipid and fatty acid patterns of these tissues were similar within statistical deviation. These results suggest that the per cent compositions of fatty acids and the phospholipid family profile ratios have limited range variability in the "normal" tissues of the human knee. On the other hand, the per cent neutral lipid compositions and their individual profiles showed great variations among the different tissue tissues of the knee.
Adipose Tissue↗
Carbon-PGLA prostheses for ligament reconstruction. Experimental basis and short-term results in man.
The efficiency of a pure carbon prosthesis to reconstruct intra-articular ligamentous loss of substance was evaluated on 14 sheep with an 18-month follow-up study of recent and old ACL experimental injuries. Functional results showed a correlation between a tightened implant, the stability of the knee, and the absence of severe arthritis. The rupture strength of the newly formed ligament amounts to about 300 Newtons (N). That of the normal ACL amounts to 250-550 N. The structure gives a viscoelastic behavior to the prosthesis. This tissue was made of collagen fibers surrounding the carbon fibers and running generally in the direction of the ligament. In the osseous tunnels, the newly formed lamellar bone invaded and surrounded the implant. Carbon fiber fragmentation occurred, and fibers were found in the synovia and in the homolateral, inguinal, and paraaortic lymph nodes. No degeneration, necrosis of tissue, or cellular toxicity was found. On these bases, the carbon prosthesis was modified by adding a resorbable copolymer of polyglycollic (PGA) and polylactic acid (PLA) around the fibers and a resorbable sheath of the same polymer. This carbon-PGA/PLA prosthesis was used in 23 patients with a three- to 12-month follow-up period. Patients were evaluated by clinical tests and by functional control of the ligament. The indications for prosthetic replacement were: recent mop-end tears of the ACL, cruciate ligament reconstruction in chronic knee instability, and wide rotator cuff loss of substance. Five complications occurred because of hematomas and/or sepsis and prosthesis breakage. Eighteen of 23 patients had good clinical results with good function in five. The conclusions are that PGA/PLA produces a clean and flexible ligament, thus eliminating carbon fiber articular deposits and allowing a normal function. Inflammatory postoperative reactions seem to be more frequent than with other procedures and call for operative and clinical care in order to eliminate hematoma and sepsis. The efficiency of a rehabitable carbon-PGA/PLA prosthesis in intra-articular ligamentous defects in man will be confirmed only by controlled long-term clinical observations.
Adult↗
Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature.
There exists a substantial group of patients with unsatisfactory results following anterior cruciate ligament (ACL) reconstructions. This may be attributable to graft failure. Revision surgery, for the correction of abnormal anterior translation of laxity, requires a careful analysis of the causes of failure to ensure the success of the salvage procedure. This review attempts to present an overview of some of the important studies in the literature pertaining to the intraoperative and postoperative factors that probably cause graft failure. It was done by initial identification of the articles from a Medline database followed by the use of cross references. It shows that failures can be minimised by adhering to the correct operative and post-operative techniques wherein proper attention to the factors, such as: adequate notchplasty, proper tunnel placements, proper tensioning, adequate fixation, optimal selection and harvest of the graft, and rehabilitation, are ensured.
Anterior Cruciate Ligament↗
[Surgical experiences in fresh complex injury of the articular meniscus and ligaments of the knee].
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Adult↗
Replacing the medial collateral ligament with an allogenic tendon graft. An experimental canine study.
In order to determine whether an allogeneic tendon could be used to replace an extra-articular ligament, the right medial collateral ligament from 11 adult dogs was replaced with a fresh-frozen allogeneic patellar tendon. At each of 3, 6, 15, 30 and 52 weeks postoperatively, one dog was killed for micro-angiographical and histological studies; at 52 weeks the remaining six dogs were killed for tensile testing. Micro-angiograms showed that the allogeneic tendon was revascularised with infiltration of the mesenchymal cells from the surrounding tissues and both ends of the graft. Histologically, the alignment of the fibroblasts and collagen bundles became more regular over time, without any immunological rejection. A biomechanical study performed at 52 weeks found no significant difference in stiffness or ultimate load between normal and reconstructed ligaments. Fresh-frozen allogeneic tendons are therefore considered useful for extra-articular ligament reconstruction.
Angiography↗