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The anatomy of the posterior attachment was described in the first part of this paper (J Craniomandib Disord Facial Oral Pain 1991;5:83-95). In part 2, the appearance of the posterior attachment in imaging studies and inferences on its function are discussed.
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The knee joint ligaments contain Ruffini, Pacinian, Golgi, and free-nerve endings with different capabilities of providing the CNS with information about movement and position as well as about noxious events. Skeletomotor neurons (alpha-motoneurons) are known to be influenced only very rarely and weakly from low-threshold mechanoreceptors in the ligaments, while the effects on the tau-muscle-spindle system in the muscles around the knee are so potent that even ligament stretches at very low loads may induce major changes in the responses of the muscle spindle afferents. Since the primary muscle spindle afferents participate in the regulation of muscular stiffness, the receptors in the knee joint ligaments probably contribute, via the tau-muscle-spindle system, to preparatory adjustment (pre-setting) of the stiffness of the muscles around the knee joint, and thereby to the joint stiffness and the functional joint stability.
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The surgical treatment of SADAM concerns patients with irreversible lesions who continue to complain (disk displacement with pain and limited opening, painful arthrosis) after all the other therapeutic options have been unsuccessful and when no long-lasting improvement can be reasonable expected. Indications for surgery have declined with progress in aetiological treatment, particularly of occlusion, and arthroscopic treatment, but arthrotomy is the only remaining technique feasible in certain cases. SADAM should be a conservative surgery, protecting the disk (repositioning displaced disks, repairing perforated disks) and the articular surfaces (correcting bone irregularities). Anatomic and functional reconstruction of the joint cannot be successful unless the cause of the dysfunction is treated at the same time.
MR imaging is able to demonstrate both the structural changes that occur in rheumatoid arthritis and the inflammatory changes, including synovial proliferation and joint effusion. MR imaging can demonstrate erosion before it is visible on radiographs. Although MR imaging appears to be very helpful in assessing the severity of rheumatoid arthritis and its response to therapy, the optimal technique for this assessment and the ultimate clinical value of MR imaging have yet to be determined.
MR imaging is an excellent modality with which to diagnose injuries of the major knee ligaments preoperatively. Strict attention to the mechanism of injury and physical examination findings and to MR imaging acquisition and section selection are essential to diagnostic success.
A hybrid acromioclavicular joint fracture-dislocation in which an intra-articular fracture of the distal clavicle coexisted with a coracoclavicular ligament injury is described. The proposed mechanism of injury is a fall on the point of the shoulder that simultaneously drives the scapula both anteriorly and inferiorly. Forced anterior scapular protraction caused a displaced horizontal plane fracture of the inferior half of the distal clavicle, which was separated from the remainder of the clavicle. The inferiorly acromioclavicular ligament was still attached to this distal clavicle fragment. The inferiorly directed force ruptured the coracoclavicular and superior acromioclavicular ligaments.
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