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PubMed1994

[Heterogeneity of the anterior and middle talar articular faces of calcaneus and their associated ligaments in the human foot].

The human talocalcaneonavicular joint was dissected and structural heterogeneity of their articular faces and associated ligaments were observed. The facies articulatio talaris anterior and media were either separated from each other (separate type), bordered by narrowing (constricted type) or continuous without any border (continuous type). In the separate type, the superficial layer of plantar calcaneonavicular ligament entered the grave between the anterior and middle articular faces. In the constricted type, the superficial layer of plantar calcaneonavicular ligament entered the neck of two articular faces from the medial side, and a part of the calcaneonavicular interosseous talocalcaneo ligament entered the neck from the lateral side. In the continuous type, the deep layer of calcaneonavicular ligament attached to the base of these articular faces. Furthermore, we observed mobility of the talotarsal joint, and found tendencies that feet of the separate type showed the smallest mobility and those of continuous type the largest mobility. It was concluded that the structure of the articular faces of the talocalcaneonavicular joint were variable and were correlated not only with the structure of their associated ligaments, but also with their mobility.

Female↗
PubMed1996

Postoperative analgesic effects of an external cooling system and intra-articular bupivacaine/morphine after arthroscopic cruciate ligament surgery.

The aim of this study was to evaluate the analgesic effect of an external cooling system with or without the combined effect of intra-articularly administered bupivacaine/morphine after arthroscopic anterior cruciate ligament (ACL) reconstruction. Fifty patients with isolated ACL insufficiency operated on under general anaesthesia were randomized to three different postoperative treatment groups. Group I was treated with the cooling system during the first 24 h after surgery and an intra-articular injection of 20 ml of physiological saline given at the completion of surgery; in group II, the cooling system was combined with an intra-articular injection of 20 ml bupivacaine 3.75 mg/ml and 1 mg of morphine at the end of the operation; while group III (placebo group) received an intra-articular injection of 20 ml of physiological saline at the completion of surgery. Pain was assessed using a visual analogue scale (VAS) at 1, 2, 4, 6, 24 and 48 h postoperatively. Supplementary analgesic requirements were registered. In group I 80% (16/20) and in group II 90% (18/20) of the patients were satisfied with the postoperative pain control regimen (NS). This was significantly better than in group III, where 30% (3/10) were satisfied. The pain scores were significantly lower in the two treatment groups compared with the placebo group during the entire postoperative period. The pain score was significantly lower in group II than in group I at 24 and 48 h after surgery. The supplementary analgesic requirements were also lower in the two treatment groups compared with the placebo group. No complications due to the use of the cooling system or the intra-articular injections of bupivacaine/morphine were observed. The external cooling system used in this study provides an effective method of obtaining pain relief after arthroscopic surgery. The combination with an intra-articular injection of morphine and bupivacaine results in a slightly greater analgesic effect than the cooling system alone.

Adolescent↗
PubMed1990

[Allogeneic lyophilized fascia lata "soft" as extra-articular stabilizer in simple and complex knee joint instability].

50 operative procedures in capsular-ligamentous apparatus of knee joint were done from 1.9.1988 until 31.12.1989 among 209 in charged treated sports injuries. The multiplicity in pattern of injuries is the reason for individual procedure in reconstructive joint-surgery and because of this various indications for auto- and allogenic eg. synthetic materials, static and dynamic procedures else free or vascularized grafts. The lyophylized fascia lata "soft" is used in case of anteromedial instability, isolated medial rupture of collateral ligament of the first degree else for augmentation after primary treated medial injury of collateral ligament. Early results are proving the histocompatibility, the healing without complications else timely stability and recommending the fascia lata-plasty in given indications.

Adolescent↗
PubMed1995

Fluoroscopic analysis of kinematics after posterior-cruciate-retaining knee arthroplasty.

We used fluoroscopy to study the kinematics of the knee in 47 patients with total knee arthroplasty (TKA) and four control subjects with normal knees while performing a single-leg deep-knee bend. The videos were analysed using still photographs taken at 5 degrees increments of flexion. Femorotibial contact points, patellar ligament rotation, and patellar rotation were calculated from each image. Maximum weight-bearing flexion was determined for each knee. Compared with the control group, posterior-cruciate-retaining TKA did not reproduce normal knee kinematics in any case, but showed a starting point posterior to the tibial midline which translated anteriorly with flexion. The curves from successive knee bends could not be consistently reproduced. Under weight-bearing conditions, the maximum flexion for any PCR TKA was 98 degrees and several patients could not flex beyond 70 degrees.

Aged↗
PubMed2005

[The effect of rupture and reconstruction of posterior cruciate ligament on the degeneration of articular cartilage in rabbit knee].

OBJECTIVE: To investigate the effect of rupture and reconstruction of the posterior cruciate ligament (PCL) on the degeneration of rabbit knee joint. METHODS: Thirty-three mature New Zealand white rabbits were divided into 3 groups. In experiment group I, the PCL of the right knees in 21 rabbits were resected, the contralateral joints as control group, in which only a medial arthrotomy was performed. In experiment group II, the PCL of the right knees in 12 rabbits were immediately reconstructed after PCL were resected. In experiment group I and control group the rabbits were respectively killed 6, 12 and 26 weeks after the operation. In experiment group II the rabbits were respectively killed 12, 26 weeks after the operation. The methods of ink staining, histology, immunohistochemistry and SEM were used to analyze the changes of articular cartilage of the joints. RESULTS: In experiment group I, the knee joints had obvious degeneration of articular cartilage at 26 weeks. The quantitative analysis of the results of the ink staining method showed the degeneration of knee articular cartilage was more serious at 26 weeks than that at 26 weeks in control group. Histological results demonstrated: the large area of fibrosis of cartilage could be seen in the medial condyle at 26 weeks; the fibrosis was deep into the deep layer of cartilage and the number of cells decreased; the average Mankin's score was 7.7. At 26 weeks, type I and III collagen were detected in fibrotic cartilage, while the staining of type II collagen was slight. In experiment group I, the injuries of cartilage in medial condyle could be seen at every stage through SEM, while the surface of cartilage demonstrated disorder in control group through SEM. In experiment group II, only a few specimens had mild injuries of cartilage, the degeneration of cartilage in medial condyle and trochlea were slighter at 26 weeks than that in experiment group I. CONCLUSIONS: PCL rupture can result in articular cartilage degeneration, which develops as time goes on. The degeneration of articular cartilage is more serious in medial compartment and patellofemoral joint than those in other positions. Immediate reconstruction of PCL can effectively prevent articular cartilage degeneration.

Animals↗
PubMed2006

Avoidance and management of intra-articular complications of anterior cruciate ligament reconstruction.

An estimated 70,000 to 100,000 anterior cruciate ligament reconstructions are performed each year in the United States. With the increasing number of anterior cruciate ligament surgeries being performed, a concomitant increase in intraoperative complications can be expected. Complications include those associated with tunnel placement, notchplasty, graft fixation and advancement, suture laceration, graft laceration, guidewire insertion and removal, intra-articular hardware, posterior cruciate ligament laceration, compartment syndrome, and vascular injury.

Anterior Cruciate Ligament↗
PubMedDate not supplied

The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation.

To study the structural and functional properties of the human posterior cruciate ligament complex, we measured the cross-sectional shape and area of the anterior cruciate, posterior cruciate, and meniscofemoral ligaments in eight cadaveric knees. The posterior cruciate ligament increased in cross-sectional area from tibia to femur, and the anterior cruciate ligament area decreased from tibia to femur. The meniscofemoral ligaments did not change shape in their course from the lateral meniscus to their femoral insertions. The posterior cruciate ligament cross-sectional area was approximately 50% and 20% greater than that of the anterior cruciate ligament at the femur and tibia, respectively. The meniscofemoral ligaments averaged approximately 22% of the entire cross-sectional area of the posterior cruciate ligament. The insertion sites of the anterior and posterior cruciate ligaments were evaluated. The insertion sites of the anterior and posterior cruciate ligaments were 300% to 500% larger than the cross-section of their respective midsubstances. We determined, through transmission electron microscopy, fibril size within the anterior and posterior cruciate ligament complex from the femur to the tibia. The posterior cruciate ligament becomes increasingly larger from the tibial to the femoral insertions, and the anterior cruciate ligament becomes smaller toward the femoral insertion. We evaluated the biomechanical properties of the femur-posterior cruciate ligament-tibia complex using 14 additional human cadaveric knees. The posterior cruciate ligament was divided into two functional components: the anterolateral, which is taut in knee flexion, and the posteromedial, which is taut in knee extension. The anterolateral component had a significantly greater linear stiffness and ultimate load than both the posteromedial component and meniscofemoral ligaments. The anterolateral component and the meniscofemoral ligaments displayed similar elastic moduli, which were both significantly greater than that of the posteromedial component.

Adult↗
PubMed2004

Non-contrast MR imaging of the glenohumeral joint. Part I. Normal anatomy.

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved.

Cartilage, Articular↗
PubMed1991

A histological and histometric study of the periosteum in mandibular ramal and condylar areas of the rabbit.

These structures were investigated with various histological stains and by polarization microscopy. The width of the periosteal layers was measured in nine ramal and condylar areas at five different ages (0, 2, 6, 12 and 30 weeks). The total periosteal width changed during growth, as did the absolute and relative thickness of its cellular and fibrous layers. The results suggest that in these areas periosteal tension may influence growth of the condylar cartilage, and that this may vary during growth.

Aging↗
PubMed2004

A comparison of combined arthroscopic triangular fibrocartilage complex debridement and arthroscopic wafer distal ulna resection versus arthroscopic triangular fibrocartilage complex debridement and ulnar shortening osteotomy for ulnocarpal abutment syndrome.

PURPOSE: Treatment of ulnocarpal abutment (UAS) syndrome involves decompression of the pressure and impingement, or abutment of the ulnocarpal articulation. Debridement of triangular fibrocartilage complex (TFCC) tears alone in the patient with UAS may have a failure rate of as much as 25% to 30%. Ulnar shortening osteotomy (USO) can be an effective treatment of failed TFCC debridement. Good results have been reported with combined arthroscopic TFCC debridement and mechanical arthroscopic distal ulnar resection. Similar results have been reported with both ulnar shortening osteotomy and open wafer distal ulnar resections in the UAS patient. Because all of these treatment choices appear to yield similar relief of symptoms, determination of the optimal treatment protocol remains a point of debate. The purpose of this study was to evaluate 2 different surgical treatments for UAS. TYPE OF STUDY: Retrospective review. METHODS: Eleven combined arthroscopic TFCC debridement and arthroscopic distal ulna resections (arthroscopic wafer procedures; AWP) were compared with 16 arthroscopic TFCC debridement and USOs. All patients had diagnostic wrist arthroscopy and arthroscopic TFCC debridement. All patients presented with ulnar wrist pain or neutral or positive ulnar variance, and all experienced at least 3 months of failed conservative management. RESULTS: At mean follow-up times of 21 and 15 months, respectively, 9 of 11 patients showed good to excellent results after arthroscopic TFCC debridement and AWP compared with 11 of 16 after arthroscopic TFCC debridement and USO. A statistically significant difference (P <.05) in the complication rates was identified, including secondary procedures and tendonitis. One secondary procedure and 2 cases of tendonitis were seen in the arthroscopic wafer group. CONCLUSIONS: Combined arthroscopic TFCC debridement and arthroscopic wafer procedure provides similar pain relief and restoration of function with fewer secondary procedures and tendonitis when compared with arthroscopic TFCC debridement and USO, for the treatment of UAS. LEVEL OF EVIDENCE: Level III.

Adult↗
PubMed2006

Analysis of meniscofemoral ligament tension during knee motion.

PURPOSE: The goal of this study was to show a functional role for the meniscofemoral ligaments (MFL) by analyzing MFL tension change through the full range of flexion and extension found at the human knee joint. METHODS: Ten fresh-frozen human knees containing both the anterior and posterior MFLs (aMFL and pMFL) were studied. An analysis of ligament tension during passive motion was undertaken using an isometric transducer. RESULTS: The MFLs functioned in a nonisometric and reciprocal manner. The aMFL developed tension with flexion and the pMFL tension with extension. The aMFL tension increased with tibial external rotation compared with internal rotation. Combined MFL tension was greater in flexion (P < .001) and increased as the tibia was externally rotated (P = .008). CONCLUSIONS: The MFL tension changes identified through knee flexion and extension support the theory that the MFLs have a functional role in knee stability and protection. This warrants their consideration in the clinical management of meniscal and PCL injuries. CLINICAL RELEVANCE: This cadaver study of the lateral MFLs indicates that the anterior and posterior portions work in a reciprocal manner with flexion and extension and supports the fact that these ligaments have a functional role in the human knee joint.

Anthropometry↗
PubMed2005

The influence of patellofemoral joint contact geometry on the modeling of three dimensional patellofemoral joint forces.

The purpose of this study was to determine the influence of patellofemoral joint contact geometry on the modeling of three-dimensional patellofemoral joint forces. To achieve this goal, patellofemoral joint reaction forces (PFJRFs) that were measured from an in-vitro cadaveric set-up were compared to PFJRFs estimated from a computer model that did not consider patellofemoral joint contact geometry. Ten cadaver knees were used in this study. Each was mounted on a custom jig that was fixed to an Instron frame. Quadriceps muscle loads were accomplished using a pulley system and weights. The force in the patellar ligament was obtained using a buckle transducer. To quantify the magnitude and direction of the PFJRF, a six-axis load cell was incorporated into the femoral fixation system so that a rigid body assumption could be made. PFJRF data were obtained at 0 degrees , 20 degrees , 40 degrees and 60 degrees of knee flexion. Following in vitro testing, SIMM modeling software was used to develop computational models based on the three-dimensional coordinates (Microscribe digitizer) of individual muscle and patellar ligament force vectors obtained from the cadaver knees. The overall magnitude of the PFJRF estimated from the computer generated models closely matched the direct measurements from the in vitro set-up (Pearson's correlation coefficient, R(2)=0.91, p<0.001). Although the computational model accurately estimated the posteriorly directed forces acting on the joint, some discrepancies were noted in the forces acting in the superior and lateral directions. These differences however, were relatively small when expressed as a total of the overall PFJRF magnitude.

Biomechanical Phenomena↗
PubMed2006

MRI protocols for whole-organ assessment of the knee in osteoarthritis.

One of the critical challenges in developing structure-modifying therapies for arthritis, especially osteoarthritis (OA), is measuring changes in progression of joint destruction. Magnetic resonance imaging (MRI) offers considerable promise in this regard. Not only can MRI quantify articular cartilage volume and morphology with high precision and accuracy, but it can also examine several other important articular components, and thus offer a unique opportunity to evaluate the knee and other joints as whole organs. On December 5 and 6, 2002, OMERACT (Outcome Measures in Rheumatology Clinical Trials) and OARSI (Osteoarthritis Research Society International), with support from various pharmaceutical companies listed at the beginning of this supplement, held a Workshop for Consensus on Osteoarthritis Imaging in Bethesda, MD. The aim of the Workshop was to provide a state-of-the-art review of imaging outcome measures for OA of the knee to help guide scientists and pharmaceutical companies who want to use MRI in multi-site studies of OA. Applications of MRI were initially reviewed by a multidisciplinary, international panel of expert scientists and physicians from academia, the pharmaceutical industry and regulatory agencies. The findings of the panel were then presented to a wider group of participants for open discussion. The following report summarizes the results of these discussions with respect to MRI acquisition techniques for whole-organ assessment of the knee in OA. The discussion reviews the selection and qualification of imaging sites for clinical trials, designing imaging protocols for whole-organ assessment of OA, and key considerations in image quality (IQ) control and data management.

Bone Marrow↗
PubMed1998

The histologic anatomy of the volar plate.

The volar plate (VP) is critical to the stability of the proximal interphalangeal joint. This study clarifies the macro- and micro-architectural structure of the VP and correlates these findings with its functional properties. Microscopic evaluation of cadaver specimens revealed a trilaminar structure of the VP with differential orientation and organization of collagen fibers in the volar, central core, and dorsal check rein sections of the plate. This description differs from the existing literature and adds to the understanding of the functional properties of the VP. The most important finding is a dense "basket weave" of collagen fibers oriented in 2 perpendicular planes within the central core of the VP. This orientation may contribute primarily to the resistance of the VP to both longitudinal and torsional stress. This study adds to the understanding of the histologic basis for the function of the VP and the mechanisms involved in its injury.

Cadaver↗
PubMed2002

Comparison of two methods for reconstruction of the posterior cruciate ligament using a computer based method: quantitative evaluation of laxity, three-dimensional kinematics and ligament deformation measurement in cadaver knees.

The aim of this paper is to present a biomechanical comparison of two different methods for reconstruction of the posterior cruciate ligament in cadaver knees. We used an original computer-based method allowing precise calculation of three-dimensional (3D) knee kinematic parameters as well as the estimation of combined graft deformation (elongation-flexion-torsion). After isolated posterior cruciate ligament (PCL) dissection, double bundle and 'over-the-bottom' methods were performed successively on each knee using synthetic polyester ligaments. The effect of pre-tensioning was tested with the 'over-the-bottom' method. antero-posterior (A-P) and rotational laxity as well as 3D kinematics were recorded and analysed. Our computer based method allowed us to show that both reconstruction methods were equivalent in restoring A-P and rotational laxity as well as kinematic curves. Combined deformation of the prostheses was equivalent for both ligaments.

Aged↗
PubMed2003

Avulsion fracture of the posterior oblique ligament associated with acute tear of the medial collateral ligament.

The term posterior oblique ligament was proposed in 1973 but the specific anatomy of this region has been controversial. It has been concluded that the posterior oblique ligament is separated from the medial collateral ligament, each with distinctly different bony attachment points. In this article, we report a posterior oblique ligament avulsion fracture associated with a medial collateral ligament rupture.

Accidents, Traffic↗