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At least 73 records · Page 4Linked to original sources

PubMed2005

Anterior cruciate ligament regeneration using braided biodegradable scaffolds: in vitro optimization studies.

The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee, and limitations in existing reconstruction grafts have prompted an interest in tissue engineered solutions. Previously, we reported on a tissue-engineered ACL scaffold fabricated using a novel, three-dimensional braiding technology. A critical factor in determining cellular response to such a graft is material selection. The objective of this in vitro study was to optimize the braided scaffold, focusing on material composition and the identification of an appropriate polymer. The selection criteria are based on cellular response, construct degradation, and the associated mechanical properties. Three compositions of poly-alpha-hydroxyester fibers, namely polyglycolic acid (PGA), poly-L-lactic acid (PLLA), and polylactic-co-glycolic acid 82:18 (PLAGA) were examined. The effects of polymer composition on scaffold mechanical properties and degradation were evaluated in physiologically relevant solutions. Prior to culturing with primary rabbit ACL cells, scaffolds were pre-coated with fibronectin (Fn, PGA-Fn, PLAGA-Fn, PLLA-Fn), an important protein which is upregulated during ligament healing. Cell attachment and growth were examined as a function of time and polymer composition. While PGA scaffolds measured the highest tensile strength followed by PLLA and PLAGA, its rapid degradation in vitro resulted in matrix disruption and cell death over time. PLLA-based scaffolds maintained their structural integrity and exhibited superior mechanical properties over time. The response of ACL cells was found to be dependent on polymer composition, with the highest cell number measured on PLLA-Fn scaffolds. Surface modification of polymer scaffolds with Fn improved cell attachment efficiency and effected the long-term matrix production by ACL cells on PLLA and PLAGA scaffolds. Therefore based on the overall cellular response and its temporal mechanical and degradation properties in vitro, the PLLA braided scaffold pre-coated with Fn was found to be the most suitable substrate for ACL tissue engineering.

Absorbable Implants↗

PubMed2006

Tissue engineering of the anterior cruciate ligament using a braid-twist scaffold design.

The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee. The insufficient vascularization of this tissue prevents it from healing completely after extreme tearing or rupture, creating a need for ACL grafts for reconstruction. The limitations of existing grafts have motivated the investigation of tissue-engineered ACL grafts. A successful tissue-engineered graft must possess mechanical properties similar to the ACL; to date no commercially available synthetic graft has achieved this. To accomplish this goal we have combined the techniques of polymer fiber braiding and twisting to design a novel poly L-lactic acid (PLLA) braid-twist scaffold for ACL tissue engineering. The scaffold is designed to accurately mimic the biomechanical profile and mechanical properties of the ACL. In this study, braid-twist scaffolds were constructed and compared to braided scaffolds and twisted fiber scaffolds. The addition of fiber twisting to the braided scaffold resulted in a significant increase in the ultimate tensile strength, an increase in ultimate strain, and an increase in the length of the toe region in these constructs over scaffolds that were braided. Based on the findings of this study, the braid-twist scaffold studied was found to be a promising construct for tissue engineering of the ACL.

Anterior Cruciate Ligament↗

PubMed2002

The science of anterior cruciate ligament rehabilitation.

This review of the literature assessed what is known about the biomechanics of the normal anterior cruciate ligament during rehabilitation exercises, the biomechanical behavior of the anterior cruciate ligament graft during healing, and clinical studies of rehabilitation after anterior cruciate ligament replacement. After anterior cruciate replacement, immobilization of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the ligamentous, articular, and muscular structures that surround the joint. It is clear that rehabilitation that incorporates early joint motion is beneficial for reducing pain, minimizing capsular contractions, decreasing scar formation that can limit joint motion, and is beneficial for articular cartilage. There is evidence derived from randomized controlled trials that immediately after anterior cruciate ligament reconstruction, weightbearing is possible without producing an increase of anterior knee laxity and is beneficial because it lowers the incidence of patellofemoral pain. Rehabilitation with a closed kinetic chain program results in anteroposterior knee laxity values that are closer to normal, and earlier return to normal daily activities, compared with rehabilitation with an open kinetic chain program. This review revealed that more randomized, controlled trials of rehabilitation are needed. These should include the clinicians' and patients' perspective of the outcome, and biomarkers of articular cartilage metabolism.

Anterior Cruciate Ligament↗

PubMed2007

Three-dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints.

The purpose of this study is to clarify, measure, and show the anatomic locations and areas of specific ligamentous attachments and paths of the second through fifth carpometacarpal (CMC) joints on a three-dimensional (3D) surface model. Ten fresh-frozen cadaver wrists were used to dissect and identify the second through fifth CMC ligaments. Their ligamentous attachments and whole bone surfaces were digitized three-dimensionally and their areas calculated. The attachments of each ligament were represented in a model combining CT surfaces overlaid by a digitized 3D surface, and were also visually demonstrated with a specific color on 3D images of the bones. Nine dorsal and 11 palmar CMC ligaments and one CMC interosseous ligament were identified in the second through fifth CMC joints. An intra-articular ligament between the third metacarpal (MC), the fourth MC, capitate, and hamate was also identified. Five dorsal and five palmar intermetacarpal ligaments and three intermetacarpal interosseous ligaments were also identified in the second through fifth intermetacarpal joints. A previously undescribed palmar intermetacarpal ligament was located between the third, fourth, and fifth MC bases. The anatomic 3D attachment sites of the second through fifth CMC ligaments were visually depicted qualitatively, and their areas quantified. This 3D information will not only afford a better understanding of the anatomy and mechanics of the second through fifth CMC joints, but will also assist in the assessment of radiographic images and treatment of various injuries.

Aged↗

PubMed1989

The temporomandibular ligament and the articular eminence as constraints during jaw opening.

It is generally thought that during symmetrical jaw opening the mandible rotates about an axis passing through the centres of the two mandibular condyles, and translates down the articular eminence. The author argues that there are no data to support this assumption. The true combination of movements can only be understood by understanding the constraints that operate during jaw opening and these are the articular eminence and the temporomandibular (TM) ligament. The TM ligament is pulled taut during jaw opening, and so acts like the chains of a swing: the mandible rotates about the lowest attachment of the TM ligament to the condyle and swings about the most posterior attachment to the articular tubercle. The effects of combining the swing and rotation are demonstrated by a simple mechanical model. The functional advantage of the TM ligament is that it keeps the condyle close to the temporal bone during jaw opening, until the condyle passes under the articular eminence. The constraints described in this paper may have important implications related to the diagnosis and treatment of some disorders of the TM joint (to be described in a later paper).

Facial Muscles↗

PubMed2001

Biomechanical properties of braided polyester tapes intended for use as intra-articular cranial cruciate ligament prostheses in dogs.

OBJECTIVE: To determine the in vitro structural and material properties of braided, multifilament, nonabsorbable polyester tapes, used for intra-articular stabilization of cranial cruciate ligament- (CCL-) deficient stifle joints in dogs, and compare those with properties of multifilament polyamide tapes. SAMPLE POPULATION: 30 polyester tapes (width, 4 mm), 10 polyester tapes (width, 7 mm), and 30 polyamide tapes (width, 4 mm) were tested to failure. Cyclic loading experiments were also performed, using 3 polyester tapes of each width. PROCEDURE: Tapes were mounted in a tensile tester as single loops, simulating intra-operative conditions, and elongated to failure at 1,000 mm/min. Additionally, the behavior of polyester tapes was tested at different elongation rates. In a second series of experiments, biomechanical variables of the polyester tapes were measured after 25 sets of 2,000 cycles between physiologic force limits. RESULTS: Mean (+/- SD) ultimate loads of the 4-mm wide polyamide tapes, 4-mm wide polyester tapes, and 7-mm wide polyester tapes were 266.48 +/- 13.19 301.78 +/- 16.92, and 726.40 +/- 37.74 N, respectively. Corresponding stiffnesses were 15.57 +/- 0.49, 21.63 +/- 2.19, and 34.85 +/- 2.66 N/mm, respectively. Failure properties of polyester tapes were affected by previous cyclic loading. CONCLUSIONS AND CLINICAL RELEVANCE: Polyester tapes of 4- or 7-mm widths should be able to resist forces resulting from weight bearing in dogs, suggesting that these tapes will be effective for stabilization of the stifle joint in dogs with a ruptured CCL.

Animals↗

PubMed2000

Nitric oxide metabolite production in the cranial cruciate ligament, synovial membrane, and articular cartilage of dogs with cranial cruciate ligament rupture.

OBJECTIVE: To measure concentrations of nitric oxide metabolites (nitrite-nitrate [NOt]) in cartilage, synovial membrane, and cranial cruciate ligament (CCL) in dogs and evaluate associations with osteoarthritis in dogs with CCL rupture. ANIMALS: 46 dogs with CCL rupture and 54 control dogs without joint disease. PROCEDURE: Tissue specimens for histologic examination and explant culture were harvested during surgery in the CCL group or immediately after euthanasia in the control group; NOt concentrations were measured in supernatant of explant cultures and compared among dogs with various degrees of osteoarthritis and between dogs with and without CCL rupture. RESULTS: Osteoarthritic cartilage had significantly higher NOt concentration (1,171.6 nmol/g) than did healthy cartilage (491.0 nmol/g); NOt concentration was associated with severity of macroscopic and microscopic lesions. Synovial membrane NOt concentration did not differ between dogs with and without CCL rupture. Ruptured CCL produced less NOt than did intact ligaments. In control dogs, NOt concentrations were similar for intact ligaments (568.1 nmol/g) and articular cartilage (491.0 nmol/g). Synthesis of NOt was inhibited substantially by coincubation with inhibitors. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that NOt in canine joint tissues originates from the inducible nitric oxide synthase pathway. Nitric oxide metabolite production in cartilage was greater in dogs with osteoarthritis than in healthy dogs and was associated with lesion severity, suggesting that nitric oxide inhibitors may be considered as a treatment for osteoarthritis. The CCL produces substantial concentrations of NOt; the importance of this finding is unknown.

Animals↗

PubMed2006

Developmental expression of the chick four-jointed homologue.

Four-jointed is a type II transmembrane protein that is thought to be cleaved to give rise to a secreted protein. In Drosophila, four-jointed controls outgrowth, vein patterning, and bristle polarity in the developing limb together with the polarity of the ommatidia in the developing eye. In Drosophila and mice, Fj is regulated by notch signaling. Here, we have determined the expression of the chick four-jointed (fjx) homologue during embryonic development. We show that fjx is expressed in the limb bud; facial primordia; the proliferating zone of the lens, feather buds, the neural tube; and neural crest derivatives such as the dorsal root ganglia. Analysis of the fjx expression in the developing limb bud showed that initially fjx is expressed throughout the limb bud, but as the limb develops, highest levels of fjx transcripts are found distally. However, by stage 27, fjx expression is predominantly found in the central core of the limb bud. Finally, fjx expression becomes confined to the developing tendons, ligaments, articular cartilage, and arteries but not the veins. Comparison with scleraxis (scx), a marker of tendons and ligaments, revealed that they are coexpressed in the majority of tendons but that fjx is expressed after scx, when the tendons have begun to differentiate. These data suggest that fjx has two roles during limb development: the first controlling outgrowth and the second tissue differentiation.

Amino Acid Sequence↗

PubMed2005

Ligament tissue engineering: an evolutionary materials science approach.

The anterior cruciate ligament (ACL) is important for knee stabilization. Unfortunately, it is also the most commonly injured intra-articular ligament. Due to poor vascularization, the ACL has inferior healing capability and is usually replaced after significant damage has occurred. Currently available replacements have a host of limitations, this has prompted the search for tissue-engineered solutions for ACL repair. Presently investigated scaffolds range from twisted fiber architectures composed of silk fibers to complex three-dimensional braided structures composed of poly (L-lactic acid) fibers. The purpose of these tissue-engineered constructs is to apply approaches such as the use of porous scaffolds, use of cells, and the application of growth factors to promote ligament tissue regeneration while providing mechanical properties similar to natural ligament.

Absorbable Implants↗

PubMed2001

The effect of weightbearing and external loading on anterior cruciate ligament strain.

A force balance between the ligaments, articular contact, muscles and body weight maintains knee joint stability. Thus, it is important to study anterior cruciate ligament (ACL) biomechanics, in vivo, under weightbearing conditions. Our objective was to compare the ACL strain response under weightbearing and non-weightbearing conditions and in combination with three externally applied loadings: (1) anterior-posterior shear forces, (2) internal-external torques, and (3) varus-valgus moments. A strain transducer was implanted on the ACL of 11 subjects. All joint loadings were performed with the knee at 20 degrees of flexion. A significant increase in ACL strain was observed as the knee made the transition from non-weightbearing to weightbearing. During anterior shear loading, the strain values produced during weightbearing were greater than those of the non-weightbearing knee (shear loads <40N). At higher shear loads, the strain values became equal. During axial torsion, an internal torque of 10Nm strained the ACL when the knee was non-weightbearing while an equivalent external torque did not. Weightbearing significantly increased ACL strain values in comparison to non-weightbearing with the application of external torques and low internal torques (<3Nm). The strains became equal for higher internal torques. For V-V loading, the ACL was not strained in the non-weightbearing knee. However, weightbearing increased the ACL strain values over the range of moments tested. These data have important clinical ramifications in the development of rehabilitation protocols following ACL reconstruction since weightbearing has been previously thought to provide a protective mechanism to the healing graft.

Adult↗

PubMed1996

Anterior cruciate ligament injury rehabilitation in athletes. Biomechanical considerations.

Postoperative rehabilitation is a major factor in the success of an anterior cruciate ligament (ACL) reconstruction procedure. Clinical investigations of patients after ACL reconstruction have shown that immobilisation of the knee, or restricted motion without muscle contraction, leads to undesired outcomes for the articular, ligamentous, and musculature structures that surround the knee. Early joint motion is beneficial for; reducing pain, capsular contractions, articular cartilage, and for minimising scar formation that limit joint motion. These findings, combined with graft materials that have biomechanical properties similar to the normal ACL, and adequate fixation strength, have led many to recommend aggressive rehabilitation programmes that involve contraction of the dominant quadriceps muscles. Recently, a prospective, randomised study of rehabilitation following ACL reconstruction has presented evidence that a closed kinetic chain exercise programme (foot fixed against a resistance) results in anterior-posterior knee laxity values that are similar to the contralateral normal knee. Also, open kinetic chain exercises (foot not fixed against a resistance) result in increased anterior-posterior knee laxity compared with the normal knee. Criteria must be observed because the relationship between rehabilitation exercises and the healing response of an ACL graft is unknown at present. Biomechanical studies of healing ACL grafts performed in animals have shown that the graft requires a long time to revascularise and heal, and that the biomechanical behaviour of the graft never returns to normal. Functional knee braces provide a protective strain-shielding effect on the ACL when anterior shear loads and internal torques are applied to the knee in the non-weight-bearing condition. However, the strain shielding effect of functional braces decrease as the magnitude of anterior shear and internal torque applied to the knee increase. Future studies should strive to determine the actual loads transmitted across the knee and ACL graft strain during various rehabilitation exercises and relate these to the healing response of the knee and graft.

Anterior Cruciate Ligament Injuries↗

PubMed2002

Dynamic simulation of the natural and replaced human ankle joint.

Disappointing results for total ankle replacement have been explained by poor knowledge of the mechanics of the intact and replaced joints. Dynamic simulation tools have the capacity to simulate dynamic conditions that occur in human joints. The Working Model 2D tool was used to simulate the mechanics of the intact and replaced ankle joints, based on previously validated mathematical models. Elementary objects were used to model ligaments, articular surfaces, retinacula and muscle-tendon units. The performance of several pairs of prosthetic articular surfaces was also analysed. According to the results of these simulations, rolling as well as sliding motion occurs in the natural ankle, governed by a ligamentous linkage. Elongation of the tibiocalcaneal and calcaneofibular ligaments was found to be 1.5% and 4.8%, respectively. A 13% change in lever arm length occurred for both the tibialis anterior and gastrocnemius muscles during ankle flexion. Unlike the currently available three-component designs, the newly proposed convex-tibial ligament-compatible prosthesis was found to be able to restore the original mobility and physiological function of the ligaments. This prosthesis combines freedom from restraint with congruity of the components throughout the range of flexion.

Ankle Joint↗

PubMed1994

Retrospective comparison of four intra-articular anterior cruciate ligament reconstructions using three evaluation systems.

In a retrospective study, 57 patients were examined following an intra-articular cruciate ligament reconstruction. The patients were divided into four groups according to the type of repair and the lapse of time between injury and operation. Twenty-five patients had undergone reconstruction with a semitendinosus tendon after acute instability (AST) and six, after chronic instability (CST). Eleven patients had received an acute reconstruction using the middle third of the patellar tendon (APT), as had 15 with chronic instability (CPT). The mean follow-up time was 48 months for the AST group, 60 months for the CST, 33 months for the APT, and 36 months for the CPT. In order to compare the groups, we used the Lysholm and OAK scores and the IKDC evaluation system. The only statistically significant difference found involved the IKDC evaluation system between the AST and CST groups. No significant decrease in activity level was noted in any of the groups. With the exception of the CST group, the preoperative Lachman test disappeared significantly at follow-up in all groups. The side-to-side difference of anterior tibial displacement measured with the KT 2000 at 25 degrees knee flexion and a load of 89 newtons was 1.32 mm for the APT group, 2.44 mm for the AST group, 2.47 mm for the CPT group, and 3.33 mm for the CST group. This side-to-side difference was not significant in the APT group. In the CPT group, arthrofibrosis was found in 27% of the patients, which led to reoperation. Reconstruction of the anterior cruciate ligament using the semitendinosus is no longer indicated for chronic instability. ACL-plasty with the middle third of the patellar tendon restored practically normal stability in acute ACL insufficiency.

Acute Disease↗

PubMed1987

Hemodialysis-associated amyloidosis and beta-2 microglobulin. Clinical and immunohistochemical study.

The beta-2 microglobulin type of amyloidosis was identified in articular and para-articular tissues of 14 patients with non-amyloid nephropathies undergoing long-term hemodialysis. Ten patients had carpal tunnel syndrome, 13 had juxta-articular radiolucent cysts (complicated by spontaneous fractures of the femoral neck in three), and six had destructive arthropathies of the large joints of the limbs. Massive amyloid deposits were found in the synovium, capsule, ligaments, articular cartilage, and/or bone. They were characterized by Congo red-induced green birefringence that was sensitive to potassium permanganate treatment. They reacted with anti-beta-2 microglobulin antiserum, whereas they did not react with antibodies directed against AA protein, prealbumin, or immunoglobulins. These data suggest that the potentially disabling arthropathy of hemodialysis is due to amyloid lesions. The persistently elevated plasma beta-2 microglobulin levels may play a role in the pathogenesis of this recently recognized complication, and if so, this complication should be preventable.

Aged↗

PubMed1997

Hyper-elastic model analysis of anterior cruciate ligament.

The objectives of this study were to theoretically analyze changes in shape and stress distribution which occur over the entire surface of the anterior cruciate ligament (ACL). While many studies on the cruciate ligaments' tensile characteristics have been conducted, the length patterns and the differential function of the ACL are still controversial issues for two reasons. Highly variable deformations of the ligaments (which are not uniaxial structures such as a bundle of separate fibres) cannot be adequately quantified by one-dimensional and/or localized measurements. Furthermore, it is impossible to directly measure in situ, non-uniform distribution of biaxial strain over the entire surface of the intra-articular ligaments. We employed an alternative approach which may have the potential to solve some of these difficulties. Using the finite element method, in which the ligament was treated as an incompressive hyper-elastic membrane, the finite deformation of the ligament was theoretically analyzed. Boundary conditions were applied by prescribing the displacements at the boundary nodes corresponding to the insertions. Special attention was paid to the distribution of longitudinal strain. The following values were obtained as a function of knee flexion: three-dimensional change in shape and strain distribution, length change of each fibre, length changes in positions along a fibre, resultant pull force on the tibial insertion, and change of strain pattern by anterior-posterior displacement of the tibia. The results demonstrated that strain distribution varied, even along the fibre run, and large strain gradients were observed in the regions near the insertions. It was found that distance between insertions introduced noticeable discrepancies from the length along a curved fibre. The net resultant force at the tibial insertion of the ligament was maximum at 0 degree of flexion, decreased until 50 degrees of flexion, then slightly increased up to 120 degrees of flexion. Predominantly, the anterior and the posterior displacements of the tibia, respectively, increased and decreased strain in the ligament, however, some portions were even more stretched by the posterior displacement.

Anterior Cruciate Ligament↗

PubMed1972

The pathogenesis of chronic inflammation in experimental antigen-induced arthritis. II. Preferential localization of antigen-antibody complexes to collagenous tissues.

In an experimental arthritis induced by injection of bovine serum albumin or egg albumin into the joints of previously immunized animals, it has been demonstrated that the major portion of the radioactively labeled antigens injected was localized to avascular collagenous tissues in the joint, i.e., articular cartilage, menisci, and intra-articular ligaments. The antigens were partially eluted from the tissues with 5 M guanidine solution, but not with acid buffers or by 3 M magnesium chloride. The radioactive material eluted with guanidine was at least 80% precipitable by specific antisera. The radioactively labeled-inducing antigen was identified on the surface of articular collagenous tissues from arthritic joints by radioautography and immunofluorescence. Rabbit immunoglobulin and C3 were demonstrated in the same sites by immunofluorescence. The presence of specific antibody in collagenous tissues was demonstrated by the selective in vitro binding of (125)I-labeled-inducing antigen to menisci from arthritic joints of immunized animals. The evidence obtained indicates that in this model of chronic arthritis, the inducing antigen persists for long periods of time in the form of immune complexes in the surface layers of the intra-articular collagenous tissue. The antigen retained in this form may be responsible for the chronicity of the synovitis by serving as a direct stimulus for the maintenance of prolonged antibody synthesis in the synovium and by providing a source of complement-fixing antigen-antibody complexes for the mediation of joint inflammation.

Animals↗

PubMed1993

Contractile properties of the articular capsule or ligament, in the primary spines of the sea-urchin Eucidaris tribuloides.

1. The articular capsule or ligament, of the primary spines of the sea-urchin Eucidaris tribuloides behaves as a classical excitable tissue, responding with a shortening or contracture to a variety of stimuli including the cholinergic agonists acetylcholine (ACh), methacholine (MeACh), carbamylcholine (CCh) and nicotine. 2. d-Tubocurarine failed to decrease the amplitude of the acetylcholine-induced contractures, while the contractures elicited by methacholine were blocked by atropine. Neostigmine, but not eserine, increased the amplitude of ACh-induced contractures, suggesting the presence of AChE in the preparation. 3. The cholinergic agonists induced contracture of the ligament, but had quite different kinetics, the rate of rise of the contracture being fastest for ACh and decreasing in the following order: CCh, MeACh and nicotine. 4. Tyramine and octopamine exert an inhibitory action on "catch" and a relaxing effect on the contracting ligament. 5. The time courses of the contractures elicited in the same preparation were virtually identical to those of "catch". Therefore, we propose that "catch" and contracture are only two different aspects of the same phenomenon; namely the contracture of the muscle fibers present in the ligament.

Acetylcholine↗

PubMedDate not supplied

Effect of intra-articular corticosteroids on ligament properties: a biomechanical and histological study in rhesus knees.

The effect of intra-articular corticosteroid injections (methylprednisolone acetate) on the mechanical properties of anterior cruciate bone-ligament-bone units was determined. Fifty-one wild rhesus animals provided 88 knee ligaments units that were loaded in tension to failure under fast strain-rate conditions. Alterations in ligament strength and load-elongation properties were found to depend upon corticosteroid dosage and time after injection. Fifteen weeks after the higher drug dosage (methylprednisolone acetate, 6 mg/kg; three injections, spaced weekly) significant decreases occurred in the maximum failure load (20%), energy absorption prior to failure (11%) and linear stiffness (11%) of the ligament unit. In contrast, only minimal non-significant alterations in ligament strength properties occurred at the higher drug usage after 6 weeks in a second group of animals. this strong time-dependence may partially explain the negative findings reported in short term studies. The higher drug dosage used is approximately 10 times an equivalent human dose on a body mass basis and indicates the ability of this class of drugs to significantly alter the mechanical properties of a ligament unity. A third group of animals received a total of two intra-articular coticosteroid injections (single injections spaced two weeks apart) at a dosage (0.6 mg/kg) equivalent to that commonly used clinically in humans. Statistically significant decreases occurred in maximum failure load (9%) and energy absorption (8%); however, this change is believed of little importance to the projected functional capacity of the ligament unit. No detectable systemic effect of the intra-articular corticosteroid injections was found on the mechanical properties of the ligament unit in the extremity opposite to that which received the drug injection. Histological examination after failure showed normal cellularity and staining characteristics of the ligament, fibrocartilage junction and underlying bone. No bone resorptive changes were observed beneath the ligament insertion site. Failure by a ligamentous mode remained the most common mechanism of specimen failure. Scanning Electron Microscopy showed failure of collagen fibers at multiple levels throughout the ligament indicative of a serial pull-apart failure process. A rich supply of vessels to the anterior cruciate ligament was demonstrated and failure of the vessels occured by a necking down process. Insofar as the results apply to humans, they infer the potential for high and frequent doses of intra-articular slightly soluble corticosteroids to produce alterations in ligament strength and function. A single intra-articular injection or one repeated at intervals of several months probably carries little risk to ligament properties.

Adrenal Cortex Hormones↗