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At least 19 recordsLinked to original sources
PubMedDate not supplied

Anterior cruciate ligament-medial collateral ligament injury: nonoperative management of medial collateral ligament tears with anterior cruciate ligament reconstruction. A preliminary report.

We present the results of a series of patients who had nonoperative management of the medial collateral ligament with anterior cruciate ligament reconstruction. From February 1983 through December 1989, 84 of 90 consecutive patients were available for followup (minimum, 1 year; mean, 3.1 years) with a combined anterior cruciate ligament-medial collateral ligament injury (anterior cruciate ligament rupture and medial collateral ligament tear) received surgical management by the same physician. The last 68 of these 84 patients who met the inclusion criteria underwent patellar tendon graft for anterior cruciate ligament reconstruction, with concomitant nonoperative management of medial collateral ligament tears. Follow-up evaluation consisted of physical examination for medial laxity, range of motion, and isokinetic and KT-1000 testing. Brace use and postoperative level of competition were also recorded. In addition, the patients completed a subjective assessment questionnaire rating pain, swelling, and stability. They also rated overall activity level, and any changes in their ability to do the activities tested: walk, climb stairs, run, jump, or twist. Our results indicate that proper reconstruction of the anterior cruciate ligament, in conjunction with nonoperative management of tears of the medial collateral ligament in combined anterior cruciate ligament-medial collateral ligament injuries, can given excellent stability and good to excellent functional outcome in patients with combined anterior cruciate ligament-medial collateral ligament injuries.

Adolescent↗
PubMed1996

Biomechanics of the intact and surgically repaired proximal interphalangeal joint collateral ligaments.

Collateral ligament injuries to the proximal interphalangeal joint are common. When the collateral ligament is completely ruptured, surgical repair may be required. The strength of the lateral collateral ligaments of the proximal interphalangeal joint was examined using axial distraction on an electrohydraulic testing apparatus. Eighty-five fresh human adult cadaver fingers were assessed; 38 intact ligaments were first examined. The strength of the native ligament was 162.5 N. Forty-seven ligament repair preparations were tested: suture repair (27.8 N), pull-out wire repair (35.9 N), and repair using a Mitek suture anchor (38.4 N). The breaking strength of the intact ligaments was significantly greater than that of any repair. All repaired ligaments failed at the site of the repair. The ligaments repaired by the pull-out wire and Mitek anchor technique were significantly stronger than those repaired with the suture technique.

Adult↗
PubMedDate not supplied

Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries. The effect of medial collateral ligament rupture location.

Twenty consecutive patients with combined anterior cruciate/medial collateral ligament injuries were analyzed to determine if a correlation exists between the location of medial collateral ligament disruption and postoperative return of motion. All patients were treated operatively by autogenous patellar tendon anterior cruciate ligament reconstruction and primary medial collateral ligament repair. The mean followup was 379 days. The patients (12 men and 8 women; mean age, 23 years) were divided into two groups based on the location of superficial medial collateral ligament rupture. Group P consisted of 13 patients with lesions at or proximal to the joint line; Group D consisted of 7 patients with disruptions distal to the joint line. Group D patients had a more rapid return of motion for both flexion and extension. At the conclusion of followup, patients from Group D also achieved 8 degrees more flexion and 3 degrees more extension. There were eight additional procedures performed on five patients, all from Group P, required to treat difficulty regaining motion. Among these patients with anterior cruciate/medial collateral ligament injuries there are two distinct groups, each with different prognoses related to return of motion based on the location of the medial collateral ligament disruption. We suggest that patients with double-ligament injuries, where the medial collateral ligament lesion is proximal, should be managed very aggressively to regain motion.

Adolescent↗
PubMed1980

[Importance of damage to the medial fascia of the external lateral ligament (radial collateral ligament) in the mechanisms of luxations of the elbow. Study on the cadaver (author's transl)].

A study of 18 elbows in the cadaver allowed the medial fascia of the radial collateral ligament of the articular capsule to be clearly separated. Section of this ligament associated with that of the anterior fascia, without section of the ulnar collateral ligament always produces luxation of the elbow if it is in flexion. The integrity of the insertion surface of the epicondyles does not stop this luxation. This therefore confirms the arthrographic and operative observations recently published.

Cadaver↗
PubMed1998

[Diagnosis and therapy of the rupture of both cruciate ligaments, the medial collateral ligament and abscission of both menisci in a ram. A case report].

This report describes the case history of a 1.5-year-old ram admitted to the Clinic for Food Animals and Horses, University of Berne, Switzerland, because of an acute severe lameness of the left rear limb. Clinical and radiographic examination revealed disruption of the stifle joint with rupture of both cruciate ligaments, the medial collateral ligament, and disruption of both menisci from their attachments. The ruptured ligaments were replaced by synthetic ligament prostheses. Long-term examination at 12 months after implantation revealed slight instability of the stifle joint, caused by degeneration of the medial meniscus, and signs of arthrosis deformans. The new formed periarticular connective tissue contributed to the stability of the stifle joint, so that a good functional result was achieved. Necropsy findings at 14 months after implantation confirmed that the synthetic ligament prostheses were intact and the medial meniscus was detached from its insertion and incorporated into the joint capsule. At microscopic examination of the synthetic band prosthesis, ingrowth of collagen and fibrous tissue was evident.

Animals↗
PubMed1990

Characterization and synthesis of macromolecules by adult collateral ligament.

Bovine collateral ligament was found to have a water content of 67.5 +/- 2.5%, the tissue was highly collagenous containing 100.3 +/- 15.1 micrograms hydroxyproline/mg dry weight. Type I collagen was the major collagen present with small amounts of Type III and V. The hexuronate content of the tissue was found to be 2.62 +/- 0.40 micrograms hexuronate/mg dry weight of tissue. On incubation in vitro collateral ligament incorporated [35S]sulfate and [3H]acetate into proteoglycans and [3H]acetate into hyaluronate and glycoproteins. The rate of synthesis of proteoglycans by collateral ligament was shown on a weight basis to be greater than that of tendon but lower than that of articular cartilage. Analysis of the proteoglycans present in collateral ligament showed two populations of proteoglycans to be present. Approx. 20% of the total proteoglycans present were large chondroitin- and keratan sulfate-containing proteoglycans capable of forming aggregates with hyaluronate. The major species of proteoglycan present were small dermatan sulfate proteoglycans made up of a core protein with a molecular mass of 45,000 daltons with one dermatan/chondroitin sulfate glycosaminoglycan chain of 30,000 daltons attached. The N-terminal amino acid sequence of the core protein of this proteoglycan showed it to be analogous to the core protein of dermatan sulfate proteoglycan II.

Amino Acid Sequence↗
PubMed1995

Healing of the medial collateral ligament after a combined medial collateral and anterior cruciate ligament injury and reconstruction of the anterior cruciate ligament: comparison of repair and nonrepair of medial collateral ligament tears in rabbits.

The optimal treatment for a combined injury of the medial collateral and anterior cruciate ligaments is controversial, and the question remains as to whether repair of the medial collateral ligament and reconstruction of the anterior cruciate ligament improves healing of the medial collateral ligament. We compared reconstruction of the anterior cruciate ligament with and without repair of the medial collateral ligament in a rabbit model of a combined injury of these two ligaments. The anterior-posterior translation and varus-valgus rotation of the knee, the structural properties of the femur-medial collateral ligament-tibia complex, and the mechanical properties of the midsubstance of the medial collateral ligament were evaluated immediately after surgery and at 6 and 12 weeks postoperatively. Repair of the medial collateral ligament led to significantly less varus-valgus rotation of the knee than did no repair, but the anterior-posterior translation of the knees in the repair and nonrepair groups were not significantly different at any study time. At 12 weeks, the cross-sectional area and ultimate load in the repair group were 60 and 53% greater, respectively, than in the nonrepair group. Among 12 specimens that were repaired (six specimens at 6 weeks and six specimens at 12 weeks), failure occurred within the midsubstance in four (two at each time period); in all of the specimens that were not repaired, failure occurred at the tibial insertion site. There was no significant difference between the modulus of the modulus of the midsubstance in the repaired and the nonrepaired medial collateral ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Medial collateral ligament healing one year after a concurrent medial collateral ligament and anterior cruciate ligament injury: an interdisciplinary study in rabbits.

The optimal treatment for concurrent injuries to the medial collateral and anterior cruciate ligaments has not been determined, despite numerous clinical and laboratory studies. The objective of this study was to examine the effect of surgical repair of the medial collateral ligament on its biomechanical and biochemical properties 52 weeks after such injuries. In the left knee of 12 skeletally mature New Zealand White rabbits, the medial collateral ligament was torn and the anterior cruciate ligament was transected and then reconstructed. This is an experimental model previously developed in our laboratory. In six rabbits, the torn ends of the medial collateral ligament were repaired, and in the remaining six rabbits, the ligament was not repaired. Fifty-two weeks after injury, we examined varus-valgus and anterior-posterior knee stability; structural properties of the femur-medial collateral ligament-tibia complex; and mechanical properties, collagen content, and mature collagen crosslinking of the medial collateral ligament. We could not detect significant differences between repair and nonrepair groups for any biomechanical or biochemical property. Our data support clinical findings that when the medial collateral and anterior cruciate ligaments are injured concurrently and the anterior cruciate ligament is reconstructed, conservative treatment of the ruptured medial collateral ligament can result in successful healing.

Animals↗
PubMed1996

Characterization of a large chondroitin sulfate proteoglycan present in bovine collateral ligament.

Bovine collateral ligament synthesized a 35S-labeled large proteoglycan species which eluted with a Kav of approximately 0.27 on Sepharose CL-2B and contained only chondroitin sulfate chains with a molecular mass of approximately 32 kDa. Fluorography of the 35S-labeled core proteins derived from the large ligament proteoglycan revealed a broad range of molecular masses above approximately 200 kDa, which was of comparable size to the four major endogenous core protein bands derived from this proteoglycan detected with 5/6/3-B-3, an antibody directed against terminal unsaturated chondroitin-6-sulfate disaccharides. The core proteins derived from the large ligament proteoglycan exhibited immunoreactivity of 12/21/1-C-6, an antibody specific for a peptide epitope common to both the G1 and G2 domains of aggrecan. Four major core protein bands with molecular masses greater than approximately 200 kDa derived from the large ligament proteoglycan, were detected using the antibodies raised against versican from bovine aorta or human fibroblasts. Compared with aggrecan, the 35S-labeled large ligament proteoglycan was distributed over a broader range of buoyant densities in an associative caesium chloride density gradient. This polydispersity may be indicative of differences in the degree of glycosylation as well as heterogeneity in the size of the large ligament proteoglycan core proteins. The 35S-labeled large ligament proteoglycan also demonstrated the ability to form complexes with an aggrecan aggregate preparation, the majority of which could not be dissociated by the presence of HA10-50. These findings indicate that the large chondrotin sulfate proteoglycan synthesized by bovine collateral ligament may be a versican-like proteoglycan which exhibited the potential to form like protein-stabilized complexes.

Aggrecans↗
PubMed1992

[Combined injury of the anterior cruciate ligament and the medial collateral ligament of the knee joint--results of two to six years follow-up of surgical treatment].

A retrospective study of 148 combined acute knee injuries with anterior cruciate and medial collateral ligament injuries was performed. Follow-up included 115 patients, 95 of whom were personally examined two to six years postoperatively. Proximal anterior cruciate ligament ruptures were treated with reinsertion in 96 patients, in case of intraligamentous lesions (44 times), augmentation with the semitendinosus tendon was performed. Medial collateral ligament lesions were explored during the operation. Reconstruction of intraligamentous ruptures was performed with sutures (120 times). Distal lesions were refixed with Burri plate or staple. A modified Ellison procedure was routinely performed. Postoperative treatment was cast-free and included immediate physiotherapy using a functional brace. Between the two groups with anterior cruciate ligament reinsertion and augmentation, no significant differences were observed in subjective evaluation (Lysholm score 85 vs. 88), activity level (Tegner score 5.5 vs. 5.4) or anterior stability (KT 1000 at 89 N 6.6 vs. 6.1 mm displacement). A clear pivot shift sign was noted in two knees with reinsertion and in none of the augmented group. Medial stability was reestablished almost completely, independent of the site of lesion or the reconstruction technique (average valgus movement at 30 degrees flexion 0.7+ vs. 0.5+ on injured/contralateral side). We conclude that reinsertion of femoral anterior cruciate ligament ruptures will reestablish anterior stability in most cases, although semitendinosus augmentation appears to give slightly more reliable results. Medial stability is gained by the site-depending reconstruction techniques. Whether intraligamentous medial collateral ligament lesions can be left alone with only the anterior cruciate ligament being reconstructed, cannot be answered by this study.

Adolescent↗
PubMed1986

[Biomechanical studies of the ligaments of the knee joint (anterior cruciate ligament and medial collateral ligament) using amputated limbs].

In order to study the biomechanical behavior of the ligaments around the knee joint (anterior cruciate ligament-ACL and medial collateral ligament-MCL), experiments were carried out using ten human amputated specimens. Specially designed small omega-shaped transducers were attached on the selected surface of the ligaments, and elongation of the ligaments were measured under valgus or anterior drawer stress in various flexion or rotation of the joint which was made by specific jig sets. The results showed that the load-elongation response varied depending on the sites of the ligaments and that the anterior instability caused by transection of the ACL gave definite effect on the strain behavior of the MCL and, vice versa, the medial instability caused by transection of the MCL gave considerable effect on that of the ACL. This experiment demonstrated a quantitative relationship between these ligaments which suggests the clinical importance of these ligaments for the knee joint stability.

Animals↗
PubMed1994

An in vitro assay of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) cell migration.

Explants from rabbit anterior cruciate ligaments (ACL) and medial collateral ligaments (MCL) were utilized to compare the relative rates that fibroblasts migrate onto glass and plastic culture surfaces in vitro. During the first two weeks in culture, a monolayer of cells appeared on the periphery of all the ACL and MCL explants. From 45 to 134 hrs in culture, the mean total MCL cell count per explant was 6-12 times greater than that for the ACL on the plastic culture dishes, and this difference was even greater for the cells attached to the glass cover slides over the explants. These differences were significant at the p < .005 level. The rates of cell proliferation were quite similar for primary cultures of ACL and MCL grown in the same medium as that used for the migration assay. The large difference in cell number at early times of culture is thus due to the more rapid MCL cell migration out of the explants, and not to a difference in the rate of cell proliferation. These data support the hypothesis that differences in cell migration rate play a role in the greater healing capacity of the MCL as compared with the ACL. The assay described in this work may then be useful in assessing factors that promote wound healing.

Animals↗
PubMed1990

The effects of transection of the anterior cruciate ligament on healing of the medial collateral ligament. A biomechanical study of the knee in dogs.

The effect of concurrent injury to the anterior cruciate ligament on the healing of injuries of the medial collateral ligament was studied in dogs. In Group I, isolated transection of the medial collateral ligament was performed; in Group II, transection of the medial collateral ligament with partial transection of the anterior cruciate ligament; and in Group III, complete transection of both the medial collateral ligament and the anterior cruciate ligament. The three groups of animals were examined six and twelve weeks postoperatively with respect to varus-valgus rotation of the knee and tensile properties of the femur-medial collateral ligament-tibia complex. The varus-valgus rotation of the knee was found to be the largest in Group-III specimens at all time-periods and was 3.5 times greater than the control values at twelve weeks. Group-I and Group-II specimens also showed large varus-valgus rotations at time zero, but the rotations returned to the control values by twelve weeks. For the structural properties of the femur-medial collateral ligament-tibia complex, the values for ultimate load for Groups I and II reached the control values by twelve weeks, while that for Group III remained at only 80 per cent of the control value. Both energy absorbed at failure and linear stiffness for all three groups were less than those for the controls at six weeks, and only linear stiffness returned to the control values by twelve weeks. For the mechanical (material) properties of the healed ligament substance, the values for modulus and tensile strength were markedly lower than the control values for all groups at six weeks. By twelve weeks, the tensile strength of Group-I specimens had increased to 52 per cent of the control value, while those of Groups II and III were only 45 and 14 per cent, respectively. Our results demonstrate that healing of the transected medial collateral ligament is adversely affected by concomitant transection of the anterior cruciate ligament. Both varus-valgus rotation and mechanical properties of the healed ligament failed to recover in knees that had combined transection of the anterior cruciate and medial collateral ligaments. The structural properties of the femur-medial collateral ligament-tibia complex in tension recovered more rapidly as a consequence of the large mass of reparative tissue that formed in the medial collateral ligament of the anterior cruciate-deficient knees.

Animals↗
PubMed1994

Abnormality of the contralateral ligament after injuries of the medial collateral ligament. An experimental study in rabbits.

The right medial collateral ligament of ninety-four adult, female rabbits was transected operatively. At three, six, fourteen, or forty weeks after the operation, the uninjured, contralateral (left) medial collateral ligaments of seventy-eight of the animals were tested biomechanically and compared with the left medial collateral ligaments of thirty-three normal female rabbits. The diameters of the mid-substance collagen fibrils in the medial collateral ligaments were also measured in the uninjured, contralateral hindlimbs of four animals at each interval and compared with the fibril diameters in three normal animals at each of three corresponding intervals. Subtle but significant differences between the uninjured, contralateral and the normal medial collateral ligaments with regard to biomechanical properties of collagen fibril diameters were found at all time-intervals. These results support the notion of a significant effect on the contralateral ligament after an injury to the medial collateral ligament and suggest that contralateral ligaments cannot be considered as a normal control group even in this relatively benign model of knee injury.

Analysis of Variance↗
PubMed1998

Quantitative evaluation of nutritional pathways for the posterior cruciate ligament and the lateral collateral ligament in rabbits.

The cruciate ligament of the knee receives its nutrition from a direct vascular supply and by permeation of nutrients from the synovial fluid. The contributions of these two routes as nutritional pathways are not known in detail. In this study, we injected [3H]methyl glucose as a tracer intravenously or directly into the knee of rabbits. Tracer concentrations in plasma, synovial fluid, the posterior cruciate ligament (PCL), and the lateral collateral ligament (LCL) were analysed by a pharmacokinetic compartment model. The contribution of [3H]methyl glucose permeation from the synovial fluid during steady state was calculated at 44.3% in the PCL and at 39.0% in the LCL. Although these results indicated that more than half the nutrition for both ligaments is provided by its vascular supply, synovial fluid permeation is also an important transport route for small molecules for the PCL and the LCL, which is an extra-articular structure.

Animals↗