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PubMed1986

Microcirculation of the juvenile knee in chronic arthritis.

In order to investigate pathogenetic factors in growth abnormalities of the knee in hemophilic arthropathy and juvenile rheumatoid arthritis, the hemodynamic changes of the knee following chronic synovial inflammation and elevated joint pressure were studied in puppies. Unilateral arthritis was induced by intraarticular injections of carrageenan solution. Regional blood flow (RBF) was measured by tracer microsphere technique. Microvascular volume (VV) was estimated from the distribution volumes of Cr51-labelled erythrocytes and I125 fibrinogen. Mean transit times (TT) of blood components were calculated from volume/flow ratios. The arthritic joint capsules were characterized by high RBF rates, increased VV, low tissue hematocrit (HCT) and short TT of blood. In the juxtaarticular epiphyses and the patella, RBF was largely unchanged, whereas VV was significantly elevated and TT of blood prolonged. The growth plates formed borders for the extension of these changes. The increased permeability and surface area between blood and bone in arthritis may accelerate the resorption and subsequent destruction of subchondral bone in chronic arthropathies of the juvenile knee.

Animals↗

PubMed1982

[Biomechanical study of the ankle joint].

The authors have studied the transmission of body weight in several positions. Two methods have been used - strain gauges and injection of dye into the joint capsules to show areas with contact during weight-bearing and non weight-bearing. The findings have shown the role of the fibula and of both malleoli during weight-bearing which causes a noticeable increase in the area of surface contact. The lateral aspect of the talus and the medial aspect of the lateral malleolus are always in contact in any position of the talus. The fundamental role of the tibio-fibular ligaments in the mechanics of the ankle is demonstrated.

Ankle Joint↗

PubMed2003

Suspected rotator cuff lesions: tissue harmonic imaging versus conventional US of the shoulder.

PURPOSE: To compare tissue harmonic imaging (THI) of the shoulder with conventional ultrasonography (US) in patients suspected of having rotator cuff lesions. MATERIALS AND METHODS: THI and conventional US images were obtained in 50 patients suspected of having rotator cuff lesions. Images were graded for visibility of acromioclavicular (AC) joint surfaces and rotator cuff tendon contours and substances: Grade 1 meant poor; grade 2, moderate; and grade 3, good visibility. Accuracy, sensitivity, and specificity of the diagnosis of AC joint osteoarthritis and accuracy of the diagnosis and rates of underestimation and overestimation of the extent of rotator cuff tears were evaluated. Visibility grade differences were evaluated with the Wilcoxon signed rank test. The McNemar test was used to assess differences in diagnoses. Magnetic resonance (MR) arthrography was the reference standard. RESULTS: Mean visibility grades for readers 1 and 2, respectively, were as follows: for AC joint bone surfaces, 2.1 and 2.0 with THI and 1.7 (P =.010) and 1.7 (P =.16) with conventional US; for AC joint capsule surfaces, 2.2 and 1.9 with THI and 1.8 (P =.005) and 1.8 (P =.34) with US; for supraspinatus tendon contour, 2.6 and 2.2 with THI and 2.1 (P =.001) and 1.9 (P =.055) with US; for supraspinatus tendon substance, 2.2 and 1.9 with THI and 2.0 (P =.036) and 1.7 (P =.070) with US; for subscapularis tendon contour, 2.4 and 2.1 with THI and 2.2 (P =.07) and 2.0 (P =.25) with US; and for subscapularis tendon substance, 1.8 and 1.7 with THI and 2.0 (P =.86) and 1.7 (P =.91) with US. Diagnostic accuracies for the supraspinatus tendon for readers 1 and 2, respectively, were 84% and 74% with THI and 86% and 70% with US (P >.99 for both readers). Corresponding values for the subscapularis tendon were 78% and 72% with THI and 64% (P =.27) and 52% (P =.006) with US. CONCLUSION: Joint and tendon surface visibility improves with THI, as compared with the visibility achieved with conventional US. THI is superior to conventional US for diagnosis of subscapularis tendon abnormalities.

Adult↗

PubMed1991

The microvasculature of the triangular fibrocartilage complex: its clinical significance.

The microvascular anatomy of the triangular fibrocartilage complex was investigated in 10 cadaver specimens by histology and tissue clearing (Spalteholz) techniques. It was found that the triangular fibrocartilage of the wrist is supplied by small vessels that penetrate the triangular fibrocartilage complex in a radial fashion from the palmar, ulnar, and dorsal attachments of the joint capsule and supply the peripheral 10% to 40%. The inner (horizontal) portion is avascular, and no vessels cross the radial attachment of the triangular fibrocartilage complex. The results of this study suggest that tears in the periphery of the triangular fibrocartilage complex may have sufficient blood supply to mount a reparative response and, in theory, can be repaired. However, tears that occur in the center and along the radial attachment do not have immediate access to a blood supply and are not likely to heal.

Cartilage, Articular↗

PubMed2003

Accuracy of ultrasound-guided intra-articular injection of cervical facet joints in horses: a cadaveric study.

REASONS FOR PERFORMING STUDY: Intra-articular facet joint injection is an established diagnostic procedure in human medicine but there are no reports on its reliability in equine practice. OBJECTIVES: To investigate the accuracy of ultrasound-guided intra-articular injections of the cervical facet joints and to estimate factors influencing the accuracy. METHODS: Sixty injections with blue dye were performed on the facet joints between 2nd and 7th cervical vertebra (C2-C7) on horses subjected to euthanasia for nonorthopaedic reasons. The facet joints were subsequently dissected to verify accuracy of deposition. RESULTS: Seventy-two percent of the injections were found to be intra-articular, 17% were intracapsular and a total of 98% were within 1 mm of the joint capsule. There was a marked effect of gained experience (P < 0.01), but not of other factors tested. CONCLUSIONS AND POTENTIAL RELEVANCE: The results of the present study do not translate directly to injections performed in live horses, but they indicate that the method can be applied as a diagnostic as well as therapeutic procedure in C2 to C7 and that is advisable to practise injections on cadaver specimens before applying the technique.

Animals↗

PubMed1995

Syndecan-3, tenascin-C, and the development of cartilaginous skeletal elements and joints in chick limbs.

The mechanisms by which the early limb cell condensations and interzone mesenchyme give rise to skeletal elements and joints are poorly understood. Previous work from this laboratory has shown that the extracellular matrix protein tenascin-C is associated with articular cartilage and joint tissue development; others have shown that tenascin-C may exert its biological activities via interactions with cell surface receptors, such as syndecans. To further analyze the roles of tenascin-C and its putative receptors in skeletal development, we carried out a detailed in situ hybridization analysis of tenascin-C and syndecan-3 gene expression during development of chick limb skeletal elements and joints. We found that as the early mesenchymal condensations chondrify around day 5 (E5) of development, they become surrounded by a thick syndecan-3 rich perichondrium while tenascin-C transcripts are much fewer and restricted to diaphyseal perichondrium and developing interzones. Similar patterns were observed as distal carpal and digit condensations formed in older embryos. As the cartilaginous long bone models elongated proximo-distally and joint formation proceeded with age, we observed that syndecan-3 transcripts decrease significantly along the diaphysis and remain very abundant along the metaphysis and in the epiphyseal articular cap and interzone. Conversely, tenascin-C RNAs remain abundant along the diaphysis and begin to increase at the epiphysis and in interzone-derived tissues, such as menisci and joint capsule. By E10, the skeletal elements have well-defined morphologies, endochondral ossification has initiated in their diaphysis, and diaphyseal perichondrium has become periosteum. These developmental changes were accompanied by equally marked changes in gene expression; these included a marked increase in tenascin-C gene expression in articular cap, fragmentation of tenascin-C gene expression along the periosteum, reinitiation of syndecan-3 gene expression in periosteum, and differential gene expression in osteoprogenitor cells. The sheer complexity of the gene expression patterns documented in this study attests to the complexity of processes that bring about normal skelatogenesis. Clearly, tenascin-C and syndecan-3 appear to be closely associated with several of these processes, particularly in establishing tissue boundaries (perichondrium and periosteum) between condensations and surrounding mesenchymal cells, in regulating perichondral cell differentiation and incorporation into the growing skeletal elements, and in the genesis of epiphyseal chondrocytes and associated joint tissues.

Animals↗

PubMed2003

Broad-spectrum matrix metalloproteinase inhibitor marimastat-induced musculoskeletal side effects in rats.

OBJECTIVE: To characterize the clinical and histopathologic changes in a rat model of broad-spectrum matrix metalloproteinase (MMP)-induced musculoskeletal syndrome (MSS), and to facilitate research into the causes and treatments of MSS in humans. METHODS: Male Lewis rats weighing 150-180 gm were administered 10-30 mg of the broad-spectrum MMP inhibitor marimastat over a 2-week period via surgically implanted subcutaneous osmotic pumps. The animals were monitored and scored for the onset and severity of MSS, using clinical and histologic parameters. RESULTS: Marimastat-treated rats exhibited various clinical signs, including compromised ability to rest on their hind feet, high-stepping gait, reluctance or inability to move, and hind paw swelling. Histologically, marimastat-treated rat joints were characterized by soft tissue and bone changes, such as increased epiphyseal growth plate, synovial hyperplasia, and increased cellularity in the joint capsule and extracapsular ligaments. The severity of MSS, as judged by clinical criteria (2 blinded observers using 3 clinical parameters), paw volume, and histologic score, was nearly identical. The observed changes were indistinguishable from those reported for primate models and mimic MSS in humans. CONCLUSION: This simple and sensitive model of MSS is an attractive alternative for studying the pathology of MSS.

Animals↗

PubMed1991

Experience with a modified posterior approach to the hip joint. A technical note.

A modified posterior approach to the hip joint is described with particular applicability to revision or complex primary hip arthroplasty. The procedure involves osteotomy of the posterior one-third of the greater trochanter with posterior reflection of a full-thickness flap, consisting of the posterior trochanteric fragment, short external rotators, joint capsule, and posterior portion of the gluteus medius. The approach allows for excellent exposure of the acetabulum and femoral canal, with minimal disruption of the gluteal muscle insertions. The majority of the greater trochanter is left intact, enhancing femoral component stability. Closure is accomplished by suture of soft tissues and reattachment of the posterior trochanteric fragment with bone screws. An intact soft tissue envelope is thereby restored around the prosthetic components. A limited clinic series has identified no problem referable to this exposure. No loss of reduction or nonunion has been encountered.

Acetabulum↗

PubMed1991

Cationic Yersinia antigen-induced chronic allergic arthritis in rats. A model for reactive arthritis in humans.

Cationic antigens are known to have considerable arthritogenic potential in experimental systems. During a systematic search for suitable, naturally occurring candidates an intracellular protein was isolated from the ribosomal pellet of Yersinia enterocolitica 0:3, a bacterial strain associated with reactive arthritis in humans. The protein is highly cationic, contains two 19-kD polypeptide chains linked by a disulfide bond, and reveals a strong tendency for spontaneous aggregation. It is suggested to be a nucleic acid binding protein. We tested this antigen for its ability to induce arthritis after intra-articular challenge in preimmunized rats. An acute inflammatory phase followed by transition to chronicity was observed both by technetium-99m scintigraphy and from histology. Massive polymorphonuclear leucocyte infiltration of the synovium was seen early on and fibrosis and thickening of the joint capsule occurred in later stages. Control groups showed no evidence of inflammation. Western blot and ELISA analysis of unselected sera from Yersinia enterocolitica 0:3-infected patients revealed antibodies to the antigen in the majority of cases, whereas healthy individuals rarely reacted. This is the first report of a naturally occurring cationic antigen capable of inducing immunologic tissue injury; it justifies the speculation that cationic antigens from prokaryotic cells could trigger reactive arthritis in humans.

Animals↗

PubMed2001

Healing of full-thickness tears of avian supracoracoid tendons: in situ hybridization of alpha1(I) and alpha1(III) procollagen mRNA.

Although clinically significant, much remains unknown about the healing of the torn rotator cuff tendon, because of unavailability of appropriate animal model. The human supraspinatus tendon faces the subacromial bursa superiorly, and the joint capsule inferiorly, while the digital flexor tendon is surrounded by the synovium. We hypothesized that the supraspinatus tendon heals by the process which is different from that observed with digital flexor tendons, in which epitenon cells migrate into the torn portion circumferentially. The avian supracoracoid tendon was adopted for this experiment because of its similarity to the human supraspinatus tendon. We developed a full-thickness tendon laceration followed by primary suture. The objective of this study was to detect localization of the responsible cells for repair of the tendon. We examined the process using histology and in situ hybridization. Starting at week 1 the peritendon cells of the bursal side proliferated and migrated into the laceration site. At week 6, the tendon stumps were continuous with new connective tissue. High-level expression of procollagen mRNA in the proliferating peritendon cells on the bursal side demonstrates to contribute to the reparative process, which progressed to the joint side. This mode of repair is different from that of the digital flexor tendon.

Animals↗

PubMed1975

Cobalt toxicity after McKee hip arthroplasty.

The significance of cobalt as a cause of symptoms after McKee hip arthroplasty is discussed. Seven patients are described in whom such arthroplasties. became unsatisfactory after periods varying from nine months to four years. Six of these patients were cobalt-positive but nickel- and chrome-negative on patch testing. Macroscopic and histological necrosis of bone, muscle and joint capsule around the prostheses was found in five patients whose hips were explored. The symptoms were progressive pain, a feeling of instability, and in two cases spontaneous dislocation. Radiological features included acetabular fracture, bone resorption, loosening and dislocation of the prosthesis. Increased cobalt concentrations (determined by atomic absorption spectrophotometry) in the urine of four patients and in a variety of tissues in one patient are presented. Patch testing is recommended in the investigation of patients with troublesome McKee hip arthroplasties

Aged↗

PubMed1993

The lateral atlanto-axial joints and their synovial folds: an in vitro study of soft tissue injuries and fractures.

Thirty victims of blunt cervical trauma, who did not survive (acute death group), were studied at autopsy as were 11 patients who survived trauma for more than 1 month and ten controls without any known cervical trauma. All specimens were sagitally sectioned in 2-mm slices and carefully examined for injuries to the lateral parts of the atlanto-axial joints. In the acute death group, five cases showed a rupture of the joint capsule, three of these with a massive hemarthrosis. In 17 cases there was bruising around the second cervical spinal nerve. Bruising of the intra-articular synovial fold was present in 15 cases, the posterior synovial fold being most commonly affected. There were five intra-articular fractures of the lateral masses, in three cases combined with a dens fracture. In two cases a bone fragment from the fracture compressed and obliterated the lumen of the vertebral artery. The findings are discussed in relation to pain after cervical trauma.

Adolescent↗

PubMed2001

Origins and insertions of the triangular fibrocartilage complex: a histological study.

The origins and insertions of the triangular fibrocartilage complex (TFCC) were examined histologically in serially sectioned fresh-frozen cadaver wrists. The radioulnar ligament arose vertically through Sharpey's fibres from a broad area in the ulnar fovea and more horizontally from a narrow area at the base of the ulnar styloid. The floor of the extensor carpi ulnaris sheath also originated firmly from the dorsal side of the fovea of the ulna, through an arrangement of Sharpey's fibres. Loose ulnocarpally oriented fibres, corresponding to a thickened ulnar joint capsule, arose from the hyaline-like cartilage matrix at the tip of the ulnar styloid and inserted onto the triquetrum without Sharpey's fibres. The ulnolunate and ulnotriquetral ligaments originated not from the ulna, but from the palmar side of the TFCC. The insertion of the TFCC into the sigmoid notch of the radius demonstrated a central transition from the fibrocartilaginous disc into hyaline cartilage and a firmer fibroosseous transition of the dorsal and palmar portions of the radioulnar ligament at the periphery.

Adolescent↗

PubMed2005

Minimally invasive endoscopic reconstruction technique of acute AC-joint dislocations: a cadaver study.

The treatment of acute Rockwood type III AC-joint dislocations is controversial. Problems related to open surgery are soft tissue healing, residual instability and the necessity of hardware removal. After non-operative therapy the cosmetic result may be problematic and in some cases symptomatic instabilities occur. The goal of the present cadaver study was to develop a new, minimally invasive technique for acute AC-joint reconstructions and to analyse its potential risk for neurovascular injuries. The surgical technique was based on an arthroscopically assisted reconstruction of the coracoclavicular ligaments with a suture anchor (Arthrex, Naples, FL, USA) and a supplemental stabilization of the AC-joint capsule with a suture cerclage (Fibre Wire 2, Arthrex) performed on ten cadaveric shoulder specimens. After surgery all specimens were dissected to analyse the anatomy of the coracoclavicular ligament complex, the position of anchors and sutures and to measure the distance to the neurovascular structures at risk. The supraspinatus muscle was never injured by the Neviaser approach. The insertion of the suture anchors never failed, resulting in a secure and reproducible anchor position. The mean distance between the coracoid and suprascapular nerve was 1.8 cm (1.5-2.2), between the coracoid and the suprascapular artery 1.5 cm (1.3-1.9). These structures were never injured. The resulting force vector of the suture located between the anchor and the drill hole was close to the anatomic force vector of the coracoclavicular ligament complex. The suture cerclage was always correctly positioned. The presented technique is at minimal risk for the surrounding neurovascular structures and allows for a minimally invasive and anatomically correct reconstruction of the AC-joint. Further biomechanical analysis is needed to evaluate the strength of the reconstruction technique. The proposed technique might be a reasonable alternative to existing invasive techniques of open reconstruction of acute type III AC-joint dislocations in high-demand patients.

Arthroscopy↗

PubMedDate not supplied

Anatomy and functional aspects of the rotator interval.

The anatomy of the region between the supraspinatus and subscapularis tendons, called the rotator interval, was studied in 22 shoulders of 12 cadavers. Its function was then examined by sequential cutting of tendon or rotator interval structures. The rotator interval was found to be composed of parts of the supraspinatus, subscapularis, coracohumeral ligament, superior glenohumeral ligament, and glenohumeral joint capsule. A medial part composed of 2 layers was defined and distinguished from a more lateral part composed of 4 layers. The most superior 3 layers of the lateral part formed a fibrous plate. The medial part was found to primarily limit inferior translation and, to a lesser extent, external rotation. The fibrous plate of the lateral part of the rotator interval mainly limited external rotation of the adducted arm. The coracohumeral ligament played a key role in external rotation as well as in inferior translation.

Adolescent↗

PubMed1986

Functional evaluation of latissimus dorsi donor site.

A study was undertaken to determine the cosmetic and functional problems associated with the latissimus dorsi muscle donor site. Twenty-four patients undergoing both free and pedicle muscle and myocutaneous flap procedures for a wide variety of reconstructive problems were studied. All patients had a contour defect at the donor site, a scar which varied with the patient's age and whether overlying skin had been taken with the muscle flap. Mild to moderate shoulder weakness and some loss of motion were noted in most patients which improved over the course of several months. An upper extremity disability in strength and shoulder motion should be anticipated following latissimus dorsi transfer, which in most cases is minimized by the recruitment of synergistic muscle units. Vigorous range-of-motion exercises following surgery should be encouraged to minimize adhesions and joint capsule stiffness. Social changes in occupation and daily living activities were noted which were not a problem for most patients. Twenty-three of 24 patients were pleased with the overall outcome of their surgery and would recommend the procedure to others. A prospective study before and after latissimus dorsi transfer followed by a second evaluation 2 to 3 years postoperatively would help to clarify the role synergistic muscle units play in "taking over" latissimus dorsi function.

Adolescent↗

PubMed1994

Neural and vascular complications of arthroscopic meniscal surgery.

Injuries to vessels and nerves are very rare complications of arthroscopic meniscal surgery. The clinical development and diagnosis of such complications are described and illustrated by cases described in the literature and by two of our own cases. Typical patterns of injury are simulated by dissection of cadaver knees. To avoid neural complications in suturing the menisci, on the medial side the joint capsule has to be prepared when using the inside-out or the outside-in technique. On the lateral side of the outside-in technique can be performed by small suture incisions in this area when the lateral knee structures can be palpated. When using the inside-out technique the peroneal nerve must be dissected free. When resecting the posterior horn of the medial meniscus forced external rotation of the knee should be avoided because in this position the popliteal artery and the medial inferior genicular artery lie close to the posterior horn.

Aneurysm, False↗

PubMed1984

The role of arthroscopy in the management of knee injuries in the athlete.

The athlete who has an acute knee injury requires early diagnosis and treatment, an accurate estimate of the extent of the injury and the time required for rehabilitation, and an ultimate prognosis for function. Arthroscopic evaluation is extremely useful in these persons because it allows an accurate early diagnosis of injuries to the menisci, cruciate ligaments, articular cartilage, joint capsule, and synovium. Early diagnosis allows selection of the treatment modalities that will permit the most rapid return of the athlete to sports activities in the minimal amount of time. The concept of temporizing rather than early diagnosis is not a viable technique in the athlete. A review of 63 bucket-handle tears of the medial meniscus which were treated arthroscopically revealed a rapid return to function. Athletic endeavors could be performed competitively an average of 4 weeks after arthroscopic treatment. Arthroscopy is a valuable agent in the evaluation and management of acute knee injuries in athletes. An aggressive program of diagnosis should be pursued.

Arthroscopy↗