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PubMed1989

[The lateral capsule sign in the traumatized knee joint].

The lateral capsular sign is a simple radiographic finding visible on routine anteroposterior knee x-ray near the tibial articular surface at the lateral point of the lateral tibial plateau. The lateral capsular sign is a flake of bone superior and posterior to the insertion of the iliotibial tract, and represents an avulsion of the meniscotibial portion of the lateral capsular ligament. A positive lateral capsular sign implies disruption of the lateral capsule and a tear of the anterior cruciate ligament. These findings are illustrated by clinical examples.

Humans↗
PubMed1975

Lateral knee compartment osseous pseudoligamentous instability.

Five occurrences of intra-articular lateral knee compartment osseous pseudoligamentous instability associated with three cases of fractures of the posterior lateral femoral condyle are reported. The instability being located within the knee joint region was termed false in that it was due to fracture instability rather than the usual ligamentous, or true, instability. The main clinical diagnostic guide to this type of instability was a positive manual straight-knee adduction snap-click test that consisted of an initial snap followed in sequence by a click on release of adduction. The positive adduction snap-click test is an adjunct to the roentgenographic recognition of lateral knee compartment osseous pseudoligamentous instability.

Adult↗
PubMedDate not supplied

Shoulder arthroscopy: its role in evaluating shoulder disorders in the athlete.

We retrospectively reviewed 100 initial shoulder arthroscopies from a general sports medicine orthopaedic practice to determine if arthroscopy is helpful diagnostically and to see if specific lesions correlate well with specific diagnoses. Seventy-two percent of the patients in the review had glenoid labral tears. Ninety-two percent of patients who had a diagnosis of either recurrent anterior dislocation or recurrent anterior subluxation demonstrated a tear of the anterior inferior margin of the glenoid labrum. Sixty-eight percent of patients with a diagnosis of impingement demonstrated tears at the superior margin of the labrum. There was a significant difference between throwing and nonthrowing athletes. Partial rotator cuff tears were noted in 18 patients, the majority occurring in throwing athletes. Other abnormalities, such as degenerative joint changes and biceps tendon lesions, were also noted at the time of arthroscopy. A large number of glenoid labral tears found at the time of arthroscopy appeared to be associated with conditions other than instability, which may or may not affect the throwing athlete. There also appeared to be a high correlation between tears in the anterior inferior glenoid labrum and anterior instability. Arthroscopy enabled us to identify other significant information about the status of the biceps tendon or the undersurface of the rotator cuff. These are areas in which problems might otherwise have been missed. Degenerative changes of the articular surface, not apparent on plain radiographs, may also be better evaluated arthroscopically.

Adolescent↗
PubMed2004

Results of transphyseal anterior cruciate ligament reconstruction using patellar tendon autograft in tanner stage 3 or 4 adolescents with clearly open growth plates.

BACKGROUND: Drilling across the physes for intra-articular anterior cruciate ligament reconstruction is considered risky for skeletally immature patients. HYPOTHESIS: Skeletally immature patients with clearly open growth plates can safely undergo intra-articular anterior cruciate ligament reconstruction with patellar tendon autograft without suffering growth plate disturbance. STUDY DESIGN: Retrospective review of prospectively collected data. METHODS: Surgery involved drilling tunnels through the tibial and femoral physes, the bone plugs were placed proximal to the physes, and button fixation was placed on the cortex. Of 272 skeletally immature patients, 16 had clearly open growth plates. Tanner stage of physical development was evaluated. Follow-up evaluation included objective and subjective data. RESULTS: At the time of surgery, 7 patients were Tanner stage 3 and 9 were Tanner stage 4. Clinical follow-up (mean, 3.4 years after surgery) showed that the mean growth after surgery was 11.7 +/- 4.2 cm for boys and 6.6 +/- 2.3 cm for girls. No patients had growth plate disturbances, gross leg deformities, or gross leg-length discrepancies. Subjective results (mean, 5.6 years after surgery) showed a mean total score of 97.6 +/- 2.9 for the modified Noyes survey and 95.4 +/- 6.9 for the International Knee Documentation Committee survey. All patients returned to competitive sports after surgery. CONCLUSION: In 16 skeletally immature patients with clearly open growth plates who were Tanner stage 3 or 4, an intra-articular anterior cruciate ligament reconstruction was performed using a patellar tendon autograft with no gross growth disturbance; however, the surgical technique was meticulous for placing the bone plugs proximal to the physes, and the graft was not overtensioned.

Adolescent↗
PubMedDate not supplied

Ultrasonography of capsular morphology in normal and traumatic ankle joints.

Ultrasonography was used to inspect the ankle anatomy of 20 healthy volunteers. The images produced were correlated with anatomical structures by examining three dissected cadaver ankles. The anterolateral pouch of the articular capsule was identified by ultrasonography in 91% of the normal ankle joints as a hypoechoic area. The posterolateral pouch of the articular capsule also could be identified by ultrasonography as a hypoechoic area in 84% of the normal ankles examined. The lateral aspect of 105 traumatized ankles was examined subsequently. The ultrasound results agreed in 100% of the cases with the operative findings for the anterior talofibular ligament and in 92% for the calcaneofibular ligament.

Adult↗
PubMed1992

Biomechanics of the distal radioulnar joint.

The distal radioulnar joint (DRUJ) is a complex joint involved in pronosupination and ulnocarpal motion and support. The ulnar head, in a rolling, sliding motion, moves from the dorsal to the volar rim of the sigmoid notch as the joint moves from pronation to supination. The triangular fibrocartilage (TFC) is taut first dorsally and then volarly in the same sequence. The ulnar carpus is supported variably, as a function of ulnar length relative to the radial articular surface, by the pole of the distal ulna through the TFC. The TFC does not resist the pistonlike movement of the DRUJ, which occurs under dynamic loading. The coronal alignment of the DRUJ minimizes shear stress on the articular surfaces because of its alignment with the rotational axis of the forearm. Ulnar variance is a factor in the development of several clinical conditions.

Biomechanical Phenomena↗
PubMedDate not supplied

Magnetic resonance imaging diagnosis, sonographically directed percutaneous aspiration, and arthroscopic treatment of a painful shoulder ganglion cyst associated with a SLAP lesion.

A 30-year-old, right-handed man presented with the insidious onset of right shoulder pain associated with overhead activities. Magnetic resonance imaging revealed a perilabral ganglion cyst associated with a SLAP lesion (lesion of the superior labrum, both anterior and posterior). After unsuccessful treatment with sonographically directed percutaneous aspiration of the cyst, arthroscopic techniques were employed to intra-articularly decompress the cyst and stabilize the labral tear.

Adult↗
PubMed2004

Treatment of shoulder instability caused by medial glenohumeral ligament rupture with thermal capsulorrhaphy.

A three-year-old, male springer spaniel had chronic left forelimb lameness with a medial glenohumeral ligament tear and articular cartilage damage diagnosed on arthroscopy. The animal failed to respond to conservative therapy of rest and an intra-articular injection of methylprednisolone. The use of thermal capsulorrhaphy using bipolar radiofrequency bought about a return of joint stability and resolution of the lameness.

Animals↗
PubMed2003

Intra-articular ganglion cysts of the cruciate ligaments: case report and review of the literature.

BACKGROUND: A ganglion can arise as a cystic lesion from a tendon sheath or a joint capsule and contain a glassy, clear, and jelly-like fluid. They can occur within muscles, menisci, and tendons. Intra-articular ganglion cysts of the knee joint are rare. We report on three ganglion cysts of the cruciate ligaments: Two were intercruciate, and one was located around the posterior cruciate ligament. METHODS: The clinical diagnosis was established using magnetic resonance imaging. All patients were treated successfully using arthroscopic debridement by basket punch and shaver. Subsequent histological examination confirmed the diagnosis. RESULTS: All three patients were asymptomatic at the postoperative follow-up of 16-36 months. CONCLUSION: A review of the literature reveals a controversial discussion about the clinical significance as well as the etiology of ganglion cysts arising from the cruciate ligaments. These case reports show that an intra-articular ganglion cyst of the cruciate ligaments is difficult to diagnose. A cyst does not necessarily have to be associated with specific clinical symptoms or a previous trauma. Preoperatively, MRI is essential when diagnosing ganglion cysts of the knee joint. An intra-articular ganglion cyst of the knee joint can be successfully treated by arthroscopy.

Adult↗
PubMed1994

[Triple and quadruple images in scan of fractures of the articular processes of the lower cervical spine].

The authors describe the triple and quadruple image aspects of the articular pillar, which are encountered respectively in one-sided uni- and biarticular fractures of the lower cervical spine, and they have analysed these images' specificity from a retrospective study. This study concerned 52 cases out of a group of 220 patients hospitalised between 1979 and 1992, with an injury of the lower cervical spine and who underwent a CT-scan examination in addition to the conventional radiographic check-up. Among a total of 70 lesions, 14 uniarticular and 4 biarticular one-sided fractures were recorded. All presented these characteristic aspects, formed by the separated fragment of the articular process; the unseparated component of the process and, concerning the triple image the intact process, or concerning the quadruple image the fragments of the second fractured process. An only case of a transisthmian fracture associated with a fracture of the lower articular process showed a similar aspect, which underlines the high specificity of these images.

Cervical Vertebrae↗
PubMedDate not supplied

Mechanoreceptors and reflex arc in the feline shoulder.

A reflex arc from the glenohumeral capsule to the biceps, infraspinatus, supraspinatus, and subscapular muscles was shown in a feline preparation. Branches of the suprascapular and subscapular nerves terminating in the capsule were identified and then stimulated with a 100 microseconds supramaximal pulse at 10 pulses per second. Stimulation of the suprascapular articular nerve elicited electromyographic discharge in the biceps and infraspinatus muscles, whereas stimulation of the subscapular articular nerve elicited electromyographic discharge in the biceps, subscapularis, infraspinatus, and supraspinatus muscles. When the articular nerves were transected between their emergence from the main nerve trunk and the stimulation electrodes, the electromyographic discharge was abolished confirming the afferent nature of the nerves. The mean time delay ( +/- SD) from application of the stimulus to the peak of the recorded electromyographic activity was 3.2 +/- 0.27 msec. Anatomic dissection and staining of the capsule segments where the articular nerves terminated revealed mechanoreceptors consisting primarily of free nerve endings and Golgi tendon organs, Ruffini's endings, and pacinian corpuscles. The existence of a ligamento-muscular reflex arc in the glenohumeral joint extends the concept of passive and active restraints of a joint by virtue of the synergy between ligaments and muscles. That such a reflex exists may advocate modification of surgical repairs of the capsule, leading to preservation of as many neurologic structures as possible; it may also form the foundation for new postsurgical therapeutic modalities.

Animals↗
PubMed1975

[Closed complete dislocations of the crus and the result of their treatment].

Based on the analysis of treatment of 22 patients with complete closed crural dislocations, it is emphasized that this trauma is associated with extensive and specific injuries to the articular elements. Concomitant injuries of popliteal vessels were found in 4 (of 22) cases. Timely performed operative restoration of the arterial integrity yielded favourable late results in 2 patients. Two patients admitted in later terms were subjected to a high amputation of the leg. In 15 patients the knee joint instability developed due to ligamental rupture in crural dislocation. Eleven patients from this group were operated upon, plastic reconstruction of ruptured lateral and crucial ligaments and the removal of injured meniscuses being accomplished in them. Persistant good and satisfactory functional results were gained in 10 cases. Only one poor issue was noted.

Adolescent↗
PubMed1991

[Results following the surgical treatment of acromioclavicular joint dislocations. A comparison of direct trans- and extra-articular fixation].

During the years 1985-1988, a total of 41 patients were treated for acromioclavicular dislocations. 25 (61%) were followed postoperatively for an average of 21 months. Two different methods of direct fixation of the AC-joint were compared: in 13 patients the transarticular fixation with two Kirschner wires and a 7.5 mm biodegradable Polydioxanon band (group I); in 12 patients an extraarticular fixation with PDS-band alone (group II). In both groups the ruptured ligament were sutured. In the first group physiotherapy was instituted immediately with limitation in abduction range to ninety degrees. After six weeks the Kirschner wires were removed under local anaesthesia and physiotherapy progressed to full range of motion. The shoulders of the second group patients were immobilized for 4 weeks. All of the patients were evaluated at follow-up on a subjective (pain, stiffness), objective (strength, range of motion, stability of the AC-joint) and roentgenographic (degree of displacement, posttraumatic arthritis, calcifications around the injured ligaments) basis. In both groups we saw good and satisfying results in more than 90%. A significant difference exists only as far as rehabilitation time is concerned. It was shorter in group I. In spite of the complications we observed with the metallic implants, which didn't have any negative influence on the results, we prefer the transarticular fixation method, because an immobilization postoperatively is not necessary and the time of rehabilitation is shortened.

Acromioclavicular Joint↗