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At least 145 records · Page 8Linked to original sources
PubMed2006

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: a finite element analysis.

BACKGROUND: Intra-articular techniques (single and double bundles) are the most widely used procedures for the anterior cruciate ligament reconstruction. Lemaire introduced in 1967 the extra-articular techniques, and combined intra-articular and extra-articular reconstruction, to better restore the stability of the knee. However, the effectiveness of these procedures (intra-articular, extra-articular combined or not with intra-articular) seems to be controversial. METHODS: In the present study, we developed numerical models of a knee joint to evaluate the effects of these different procedures on the kinematics and biomechanics of the knee during an internal rotation test. Six cases were simulated: intact anterior cruciate ligament, intra-articular reconstructed anterior cruciate ligament (single and double bundles), extra-articular reconstructed anterior cruciate ligament alone, and combination of extra- and intra-articular reconstructions. The loading condition was an internal tibial torque of 2 N m at 0 degrees, 15 degrees, 30 degrees and 45 degrees of knee flexion. Internal rotation of the tibia and forces within the grafts and the ligaments were calculated. FINDINGS: This study showed that both single and double bundles intra-articular reconstructions restore similar internal rotation control and biomechanics of the soft structures as the intact anterior cruciate ligament situation. On the other hand, our results indicate that extra-articular reconstruction reduces appreciably the internal rotation and modifies the charges distribution in the soft structures when compared to the intact anterior cruciate ligament. INTERPRETATION: The extra-articular procedure alters the kinematics of the knee, which might overconstraint the ligaments and the femorotibial joints, leading to the failure of the anterior cruciate ligament reconstruction.

Anterior Cruciate Ligament↗
PubMed2004

The incidence of wrist interosseous ligament and triangular fibrocartilage articular disc disruptions: a cadaveric study.

PURPOSE: The purpose of this cadaveric wrist study was to determine the incidence and size of defects of the scapholunate interosseous ligament (SLIL), lunotriquetral interosseous ligament (LTIL), and triangular fibrocartilage (TFC) articular disc, and to determine their relationship to wrist arthrosis. METHODS: The status of the SLIL, LTIL, and the TFC articular disc was determined in 96 cadaveric wrists with an average age of 75 years (range, 61-92 y). The location and length of the SLIL and LTIL ligament disruptions and the site of ligament detachment were noted. Ligament disruptions were classified into 1 of 3 grades based on the size of the ligament disruption and the absence (grade 1 and 2 disruptions) or presence (grade 3 disruption) of wrist arthrosis. The location, size, and configuration of the TFC articular disc disruptions also were noted. RESULTS: Disruptions of the SLIL were noted in 34 wrists (35%). There were 20 grade 1, 4 grade 2, and 10 grade 3 ligament disruptions. The average length of ligament disruption was 10.9 mm, or 40% of the length of the ligament. Twenty-four of 34 SLIL disruptions occurred without wrist arthrosis. Disruptions of the LTIL were noted in 47 wrists (49%). There were 23 grade 1, 10 grade 2, and 14 grade 3 ligament disruptions. The average length of ligament disruption was 7.6 mm, or 52% of the ligament length. Thirty-three of 47 LTIL disruptions occurred without wrist arthrosis. Disruptions of the TFC articular disc were noted in 58 wrists (60%). The most common patterns of disruption were either a linear defect at the radial attachment of the articular disc or a centrally located oval defect. Thirty-seven of the 58 TFC articular disc disruptions were noted in wrists without distal radioulnar joint (DRUJ) arthrosis. CONCLUSIONS: There is a high incidence of SLIL, LTIL, and TFC articular disc disruptions in the cadaveric model. Large ligament and TFC articular disc disruptions without wrist arthrosis are very common.

Aged↗
PubMed1985

Extra-articular reconstruction of the anterior cruciate ligament: lateral procedures.

Several extra-articular procedures have been shown to be successful in controlling anterolateral rotatory instability. These procedures are performed as an extra-articular reconstruction alone or are combined with an intra-articular reconstruction. The common goal of these extra-articular procedures is the control of the abnormal anterior subluxation of the lateral tibial plateau and, thus, the elimination of the lateral pivot shift phenomenon. This goal is achieved most readily by placing some portion of the iliotibial tract posterior to the transverse center of rotation of the knee in order to provide a check-rein effect on the lateral tibial plateau to prevent anterior subluxation as the knee approaches terminal extension.

Acute Disease↗
PubMed1995

Postoperative analgesic effects of intra-articular bupivacaine and morphine after arthroscopic cruciate ligament surgery.

Intra-articular administration of local anaesthetics such as bupivacaine can produce short-term postoperative analgesia in patients undergoing diagnostic arthroscopy or arthroscopic meniscectomy. A peripheral anti-nociceptive effect may also be induced by the administration of intra-articular opiates interacting with local opioid receptors in inflamed peripheral tissue. In the present study we aimed to study the analgesic effects of intra-articularly given bupivacaine and morphine sulphate (as well as the combination of both drugs) on postoperative pain. In a prospective, randomized, double-blind manner 40 patients received one of the following: (a) morphine (1 mg in 20 ml NaCl), (b) bupivacaine (20 ml, 0.375%), (c) combination of both or (d) saline (20 ml, control group) intra-articularly at the end of arthroscopic anterior cruciate ligament (ACL) reconstruction. The postoperative pain was assessed via a visual analogue scale (VAS) during the first 48 h after surgery, and supplemental analgesic requirements were noted. All comparisons were made versus the control group receiving saline. The pain scores were significantly lower in the morphine group at 24 and 48 h, and in the bupivacaine group at 2, 4 and 6 h after surgery. In the group that received a combination of both bupivacaine and morphine, the pain scores were significantly reduced throughout the whole postoperative observation period. No side-effects or complications from therapy were seen in any of the groups. The conclusion of this study is that intra-articular morphine is effective in the postoperative period after arthroscopic ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

[Rheumatic diseases of the ankle joint and tarsus].

Diseases of the hindfoot are associated with considerable functional impairment and therefore may hamper patients' movements during gait considerably. Because of biomechanical overload, articular structures, tendons and ligaments are prone to early degenerative changes during the course of rheumatic diseases as visible with plain film radiography, sonography (US), or magnetic resonance imaging (MRI). Findings may occur as arthritis of major joints or in the form of fibroostitis and bursitis of the os calcis. Despite the progressive course of rheumatic diseases and characteristic imaging findings, high variability of X-ray signs may occur. Plain film radiograms and high-resolution ultrasonography play a key role in imaging rheumatic diseases of the hindfoot. MRI supports imaging diagnosis in selected cases. The principal goals of diagnostic imaging are precise and reproducible documentation of morphologic abnormalities and differentiated analysis for planning proper conservative or surgical treatment.

Ankle↗
PubMed2001

[Anatomy and biomechanics of the upper ankle joint].

The ankle joint as a component within the construction of the foot must be seen as a compromise between the static and dynamic demands made upon it. In this article the structure and function of the ankle joint are described with special reference to the formation of morphological parameters such as the distribution of subchondral mineralization, cartilage thickness, subarticular cancellous bone and mechanical properties. These parameters could be seen as a biological reflection of the individual mechanical conditions.

Ankle Joint↗
PubMed1999

Fat suppression magnetic resonance imaging of the triangular fibrocartilage complex. Comparison with spin echo, gradient echo pulse sequences and histology.

Magnetic resonance imaging (MRI) of the triangular fibrocartilage complex (TFCC) of the wrist was performed in ten healthy volunteers using spin echo T1-weighted (SE-T1), fast spin echo T2-weighted (FSE-T2), gradient echo T2-weighted (GRE-T2) and fat suppression spin echo T1-weighted (FS-T1) images. The images were obtained in the coronal plane and were compared to the corresponding histological coronal sections obtained from five fresh frozen cadavers. In our analysis, the FS-T1 pulse sequence visualized the details of the TFCC best, followed by the GRE-T2 images. Delineation of the TFCC on the SE-T1 and the FSE-T2 was poor. The coronal morphology of the TFCC represented on the fat suppression image was almost identical to the corresponding histological sections. We conclude that the fat suppression MRI clearly shows the complex structure of the TFCC and is useful for the morphological evaluation of the TFCC.

Adult↗
PubMed1987

Load transfer characteristics of the wrist. Part I. The normal joint.

A static positioning frame allows the positioning of unembalmed human upper extremities in any combination of wrist flexion/extension, radio/ulnar deviation, and pronation/supination. Pressure-sensitive film (Fuji) was used to study the contact areas, scaphoid-lunate area ratios, average high pressures, centroid positions, and intercentroid distances of five wrist joints under a uniform load of 103 Newtons (N) in 36 different positions. The contact areas accounted for only 20.6% of the available joint surface. They shift from a primarily palmar location to a primarily dorsal location when the wrist changes from flexion to extension. Overall the scaphoid contact area was 1.47 times that of the lunate and was generally greatest with the wrist in ulnar deviation. The scapho-lunate contact area ratio increased as wrist position changed from radial to ulnar deviation and/or from flexion to extension. For the constant load of 103 Newtons the high pressure averaged 3.17 megapascals (MPa). The scaphoid and lunate high pressure centroids shifted palmar when wrist position changed from 20 degrees of flexion to 20 degrees of extension and then shifted dorsal with further extension of the wrist. The intercentroid distance averaged 14.91 mm and ranged from 10 to 20 mm.

Biomechanical Phenomena↗
PubMed1992

The structure and function of the temporomandibular joint.

Although characterised by having a synovial membrane lining the nonarticulating surfaces within the joint capsule, in some ways the temporomandibular joint (TMJ) is an atypical joint. This paper highlights the differences between the TMJ and other movable joints with a description of the structure, innervation blood supply and musculature. Also included are details of how the TMJ moves--the effectors of movement and the various reflexes controlling movement of the joint.

Cartilage, Articular↗
PubMed2003

Arthroscopic posterior cruciate ligament reconstruction using the posterior trans-septal portal.

We describe an arthroscopic technique for the reconstruction of the posterior cruciate ligament (PCL), while preserving the remnant bundle of the original PCL and meniscofemoral ligament, using the posterior trans-septal portal. The posterior trans-septal portal provides an excellent visualization of the PCL tibial attachment and an easy access to the tibial tunnel without injuring any neurovascular structure. The remnant bundle of the original PCL and meniscofemoral ligament, which significantly contributes to the posterior stability of the knee joint, are preserved to be healed with a graft and subsequently form an integrated structure. We report a new arthroscopic technique for an effective reconstruction of the PCL, using the posterior trans-septal portal.

Achilles Tendon↗
PubMed1990

[Load capacity of capsule and tendon tissue].

The data referred to in this article show that the load capacity values of capsular and tendinous tissue are significantly higher than had been assumed so far; this applies to the macroscopic as well as the microscopic and submicroscopic ranges and is also based on our own experimental studies, which were mainly focussed on load capacity and tissue damage. For example, the tear resistance to static load is 50% higher and to dynamic load 100% higher than most of the maximum load data known so far. Thus, the dynamic tear resistance exceeds the static resistance by one third. The maximum load capacity decreases with increasing age; the peak value is attained at about the third decade of life. Tear resistance is related to the smallest cross-section of the tendon. It has been safely established that cross-section and tear resistance decrease with advancing age. There is definite mathematical and histological proof that even a healthy tendon can tear under unfavourable load conditions and can thus well be the weakest link in a healthy muscle-tendon-bone system. This fact assumes increasing importance in these times of increasing leisure and sports activities practised by persons of all age brackets. The commonly used terms of "load" and "load capacity" thus acquire a new dimension. We know that the load exercised on a tendon is permanently increased especially in sports activities. We also know that load capacity can be promoted. Hence, it depends on us to learn how to master the functioning of the tendon and to develop measures to help to avoid acute and chronic tendon damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Achilles Tendon↗
PubMedDate not supplied

[Arthroscopic diagnosis of disk injury of the wrist joint].

Arthrography of the wrist joint is a possibility to show a disc lesion by demonstrating a communication between the radioulnar and -carpal space in cases of persistent wrist pain after an accident without any bone disorders in x-ray. For differentiation between a pre-existent disc variety with a central whole and a real traumatic tear or degenerative alterations arthroscopy is the method of choice. Furthermore other changes of the wrist as free bodies and chondropathy can be seen. The indication for an arthrotomy and a causal treatment are more exact and were proved by a follow-up of 10 patient between 1985-1987 at the orthopedic university clinic Berlin.

Arthrography↗