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At least 667 records · Page 37Linked to original sources
PubMed2005

The role of autologous chondrocyte implantation in the patellofemoral joint.

UNLABELLED: In a prospective study to determine the clinical effectiveness of autologous chondrocyte implantation, 45 patients reached a minimum followup of 2 years (range, 2-7 years; average, 46.4 months) after treatment involving the patellofemoral articulation. There were 28 men (61%) and 17 women (39%) and the average age of the patients was 37.5 years (range, 15-55 years). The treatment groups included (I) isolated patella, n = 8; (II) isolated trochlea, n = 9; (III) patella plus trochlea, n = 4; (IV) weightbearing condyle plus patella n = 2; (V) weightbearing condyle plus trochlea, n = 2; and (VI) weightbearing condyle plus patella plus trochlea n = 20. The average surface area per patella (n = 34) was 4.86 cm2 and per trochlea (n = 34) it was 5.22 cm2. The average resurfacing per knee (n = 45) was 10.45 cm2. We showed a postoperative improvement in quality of life as measured by the Short Form-36; Western Ontario and McMaster University Score, Knee Society Score, modified Cincinnati Score, and a patient satisfaction survey. There were eight failures (18%) as a result of a patella or trochlea failure. Seventy-one percent of patients rated their outcomes as good or excellent, 22% rated outcome as fair, and 7% rated outcome as poor. LEVEL OF EVIDENCE: Therapeutic Study, Level II-1 (prospective cohort study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMedDate not supplied

Magnetic resonance imaging of the knee.

Magnetic resonance imaging (MRI) is an accepted non-invasive modality for evaluation of soft tissue pathology without exposure to ionizing radiation. Current applications demonstrate excellent visualization of the anatomy and pathology of various organs. Preliminary studies in the knee reveal fine resolution of anatomy and pathology involving the meniscus. The purpose of this study is to determine a prospective correlation between MRI scans and actual meniscal pathology as documented at the time of arthroscopy. MRI scans were obtained in 155 patients, on 156 knees (one patient with bilateral scans), with 86 patients (87 knees) eventually undergoing diagnostic and operative videoarthroscopy performed by the same surgeon (DWJ). All images were obtained on the same high-resolution 1.5 Tesla GE Signa Magnetic Resonance Scanner with the same radiologist performing all readings (PEB). The knees were studied in the coronal and sagittal plane using a spin echo sequence and 5 mm slice thicknesses. The menisci were described as having Grade 1, 2, or 3 changes, with Grade 3 reserved for complete tears. Using arthroscopy as the diagnostic standard, the accuracy of MRI in diagnosing medial and lateral meniscal tears was 93.1% and 96.6%, respectively with a Grade 3 MRI reading. For tears of the ACL, the accuracy was 96.6% as confirmed at arthroscopy. Five tears of the PCL were also documented by MRI and correlated with clinical evaluation. Other abnormalities seen were articular cartilage and osteochondral defects, bone tumors, tibial plateau fractures, Baker's cysts, and meniscal cysts. The MRI scan is a highly accurate, noninvasive modality for documentation of meniscal pathology as well as cruciate ligament tears in the knee.

Arthroscopy↗
PubMed2006

Three-dimensional regular arrangement of the annular ligament of the rat stapediovestibular joint.

The stapes footplate articulates with the vestibular window through the annular ligament. This articulation is known as the stapediovestibular joint (SVJ). We investigated the ultrastructure of adult rat SVJ and report here on the characteristic ultrastructure of the corresponding annular ligament. Transmission electron microscopy showed that this annular ligament comprises thick ligament fibers consisting of a peripheral mantle of microfibrils and an electron-lucent central amorphous substance that is regularly arranged in a linear fashion, forming laminated structures parallel to the horizontal plane of the SVJ. Scanning electron microscopy revealed that transverse microfibrils cross the thick ligament fibers, showing a lattice-like structure. The annular ligament was vividly stained with elastica van Gieson's stain and the Verhoeff's iron hematoxylin method. Staining of the electron-lucent central amorphous substance of the thick ligament fibers by the tannate-metal salt method revealed an intense electron density. These results indicate that the annular ligament of the SVJ is mainly composed of mature elastic fibers.

Animals↗
PubMed1975

[Accidental immobilization of the proximal joint of the index finger].

In connexion with one case a rare clinical picture is described by the authors. The stoppage of movement observed in young individuals in the MP articulation of the forefinger occurs under the effect of trauma, - under normal articular conditions, - on strongly flexed finger, under the effect of powerful ulnar duction.

Accidents↗
PubMed2004

Surgical treatment of persistent dislocation or subluxation of the ulnohumeral joint after fracture-dislocation of the elbow.

PURPOSE: To review the results of surgical reconstruction of posttraumatic elbow instability in the setting of either intact or repaired olecranon process using a protocol incorporating hinged elbow fixation. METHODS: Thirteen consecutive patients with ulnohumeral instability after a fracture-dislocation of the elbow, adequate articular surfaces, and adequate, stable alignment of the olecranon were treated with temporary hinged external fixation, preservation, or reconstruction of both the coronoid process and radiocapitellar contact and with repair or reconstruction of the lateral collateral ligament complex. There were 9 men and 4 women with an average age of 45 years. Seven patients had a terrible triad pattern injury and 6 had a posterior Monteggia pattern injury. All 13 patients had fracture of the radial head and 10 patients had fracture of the coronoid process. RESULTS: At an average follow-up period of 57 months stability was restored in every patient. The average Disabilities of the Arm, Shoulder, and Hand questionnaire score was 15 and the average Mayo score was 84, with 6 excellent, 4 good, and 3 fair results. The average arc of ulnohumeral motion was 99 degrees. Six patients had radiographic signs of arthrosis including 5 of 6 patients with olecranon fracture-dislocations. CONCLUSIONS: A stable, functional elbow can be restored in most patients with persistent instability after fracture-dislocation of the elbow using a treatment protocol incorporating hinged external fixation.

Adult↗
PubMed2006

A critical ligamentous mechanism in the evolution of avian flight.

Despite recent advances in aerodynamic, neuromuscular and kinematic aspects of avian flight and dozens of relevant fossil discoveries, the origin of aerial locomotion and the transition from limbs to wings continue to be debated. Interpreting this transition depends on understanding the mechanical interplay of forces in living birds, particularly at the shoulder where most wing motion takes place. Shoulder function depends on a balance of forces from muscles, ligaments and articular cartilages, as well as inertial, gravitational and aerodynamic loads on the wing. Here we show that the force balance system of the shoulder evolved from a primarily muscular mechanism to one in which the acrocoracohumeral ligament has a critical role. Features of the shoulder of Mesozoic birds and closely related theropod dinosaurs indicate that the evolution of flight preceded the acquisition of the ligament-based force balance system and that some basal birds are intermediate in shoulder morphology.

Alligators and Crocodiles↗
PubMed1991

Magnetic resonance imaging of the knee.

Magnetic resonance imaging of the knee was the first successful application of this technique to the articular system. The advantages of magnetic resonance imaging over arthrography include its noninvasive nature, the ability to evaluate the knee in multiple planes without patient repositioning, the absence of ionizing radiation, the capacity to evaluate the joint even in the presence of joint effusion, and the ability to examine the inner structure of the meniscus as well as its surface. Although magnetic resonance imaging initially was used to study the menisci and cruciate ligaments, the technique has been expanded to include the evaluation of various conditions and all the structures of the knee joint and surrounding soft tissues.

Anterior Cruciate Ligament↗
PubMed2001

Familial calcium crystal diseases: what have we learned?

The spectrum of heterotopic calcification or ossification is expanding because of the reports of several kindreds with calcium pyrophosphate deposition disease, apatite deposition disease, and others with less common syndromes associated with extracellular matrix calcification, such as fibrodysplasia ossificans progressiva and related syndromes. Genomic DNA studies in both humans and mice provide a shortcut to understanding the genetic basis of promotion and prevention of ECM calcification. Mutation in the COL2A1 gene has been identified in one family with spondyloepiphyseal dysplasia and calcium pyrophosphate and apatite crystalline deposits. In another kindred with precocious osteoarthritis without spondyloepiphyseal dysplasia, the phenotype was linked to markers of chromosome 8. In four other kindreds, the phenotypes were linked to an area of chromosome 5p. Two genes located in this region, which are expressed in articular cartilage, are being investigated as possible calcium pyrophosphate deposition disease genes. The results of linkage studies in three kindreds with articular/periarticular ADD with the COL2A1 gene were noninformative. Two different mouse mutations, the ank/ank and the ttw/ttw mice, are associated with intra-articular and ligament apatite deposits caused by a decrease in extracellular pyrophosphate concentrations, mimicking human arthritis caused by apatite deposition disease. Mutations in the matrix GLA protein, both in mice and in humans, are also associated with vascular and articular calcification. These mouse mutations provide cutting-edge information in the investigation of the mechanisms of apatite deposition in humans.

Calcinosis↗
PubMed1984

A new surgical approach to fractures of the lateral tibial plateau.

We are reporting on a previously undescribed surgical approach and postoperative protocol for the treatment of fractures of the lateral tibial plateau in which there is a split pattern and depression of the articular surface. In this approach the anterior horn of the lateral meniscus is incised and detached so that the split fragment can be opened like a book. Detachment and incision of the anterior horn minimizes the need to free the lateral meniscus from its tibial attachment. The postoperative protocol includes continuous passive motion followed by non-weight-bearing in a toe-to-groin plaster cast for three months. Our preliminary results have been encouraging, and arthroscopic examination in the seven knees so studied indicated a healed fracture, restoration of the tibial articular surface, and a healed lateral meniscus.

Adult↗
PubMed1989

A mathematical model for the evaluation of the behaviour during flexion of condylar-type knee prostheses.

A 3D knee model was developed in order to evaluate the mechanical behaviour during flexion of condylar-type knee prosthesis. Based on the total energy minimization principle, it takes into account the articular surfaces (the tibial surface being deformable), the body weight, and the patello femoral joint. It generates the kinematics of the joint, the motion of the centre of contact, the quadriceps forces, the pressure distribution on the tibial plateau, and ligament lengths and forces between 0 and 120 degrees of flexion. The results for ten digitized knees and the commercially available prostheses are presented. They are in general agreement with experimental results published in the literature. It is concluded that this computer program may be, within its limitations, a useful tool in the preliminary evaluation of new condylar-type knee prosthesis designs.

Biomechanical Phenomena↗
PubMed1993

Acute traumatic knee hemarthrosis.

A rapidly developing hemarthrosis in an acutely injured knee is reported to be associated with "surgically significant" lesions, such as anterior cruciate ligament tears, meniscus tears, and osteochondral fractures, in < or = 90% of cases. We report two cases of adult men who showed signs of such acute hemarthroses in stable knees after significant trauma. Neither had significant intraarticular pathology, such as meniscal, articular, or ligamentous injury, at arthroscopy. Persistent postarthroscopic bleeding led to additional diagnostic testing that found mild factor VIII deficiency. Hemophilia A and other clotting disorders should be considered by arthroscopic surgeons as a possible cause of a posttraumatic hemarthrosis.

Accidental Falls↗
PubMed2006

[Relationship between anatomy of knee collateral ligament and geometry of posterior femoral condylar articular surface].

OBJECTIVE: To analyze the relationship between the collateral ligament attachment and the epicondylar axis with rotational alignment of the femoral component in the total knee arthroplasty(TKA). METHODS: Twenty normal cadaver knee joints were anatomized and 2 holes were drilled on the distal femur from the deep and superficial insertions of the medial collateral ligaments to the lateral condylar part, respectively. Then, all the knees were scanned by MRI on the sagittal plane, making the drilled hole located relatively to the posterior condylar joint surface on the axial plane, and the posterior condylar angle (PCA) and the condylar twist angle (CTA) were measured. RESULTS: The collateral ligament had the deep and superficial parts, and the deep part was strained during the knee flexing. PCA and CTA were 4.50 +/- 1.26 degrees and 7.10 +/- 0.30 degrees respectively, and there was a significant difference between them (P < 0.05), which were significantly greater than those reported abroad. On the sagittal plane, there was no significant difference between the radius of the posterior medial and lateral condylar circles (P > 0.05). The distance from the center of the posterior condylar circle to the deep insertion of the medial collateral ligament (MCL) (dl) was 4.22 +/- 0.20 mm, and the distance to the superficial insertion of MCL (d2) was 7.36 +/- 0.13 mm. The difference between dl and d2 was significant (P < 0.05). CONCLUSION: The center of the posterior condylar circle passes from the deep insertion of the collateral ligament, which can be regarded as a fixed flexion-extension axis of the knee. By releasing the different parts of the collateral ligaments, the balance of the flexion and extension gap can be obtained, and then varus, valgus or flexed contracture deformity of the knee can be realigned. Besides, the rotational orientation of the femoral prosthesis can be made by a reference to the epicondylar insertion of the collateral ligament.

Adult↗
PubMed1991

[Avulsion fractures of the knee and upper ankle joint. Classification and therapy].

Injuries of the joint surface interfere with joint mechanics. Avulsed fragments should be reattached to prevent development of arthrosis. Of 150 fractures of the knee joint 72% were osteochondral and 28% chondral avulsion. About half of the chondral lesions could be refixed successfully. If replantation is impossible, this cartilage defect has to be smoothed and, when indicated, connected to spongy bone by subchondral drilling.

Arthroscopy↗