Primary repair of the cruciate and collateral ligaments after traumatic dislocation of the knee.
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The management of traumatic dislocation of the knee in 40 patients (41 knees) with a mean age of 26.3 years is described. They were treated by primary repair and reconstruction with autologous grafting of the anterior (ACL) and posterior cruciate ligaments (PCL) and repair injuries to the collateral ligament and soft-tissue. The ACL and PCL were reconstructed using the patellar tendon and the gracilis and semitendinosus tendons, respectively. Early mobilisation using a continuous-passive-movement machine and active exercises was started on the second day after operation. At a mean follow-up of 39 months no patient reported 'giving way' and all except one had good range of movement. Of the 41 knees, 21 were rated as excellent, 15 good, four fair and one poor. Early reconstruction of the cruciate ligaments and primary repair of the collateral ligaments followed by an aggressive rehabilitation programme are recommended for these young, active patients. (+info)
Variations in the normal anatomy of the collateral ligaments of the human elbow joint.
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The variations which occur in the medial and lateral ligament complexes of the elbow were investigated. These occurred frequently with the standard appearances occurring in no more than half the specimens on the medial side and one quarter of those on the lateral side. Surgeons who regularly perform elbow arthroplasty must be aware of these considerations, especially with the introduction of unconstrained prostheses which rely upon the ligament complex for their postoperative stability. (+info)
Repair of collateral ligament instability in 2 foals by using suture anchors.
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Instability of the collateral ligaments of the carpal or metacarpophalangeal joint occurred in 2 foals. The instability was repaired using commercial suture anchors. In foals, commercial suture anchors combined with external coaptation can be used successfully to repair collateral ligament instability of the carpus or the metacarpophalangeal joint. (+info)
Reconstruction of chronic collateral ligament injuries to fingers by use of suture anchors.
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AIM: To evaluate the effectiveness of suture anchors in the reconstruction of chronic collateral ligaments of fingers. METHODS: We treated 8 patients, 6 with chronic instability of the collateral ligament of the thumb and 2 with the instability of the fifth finger, using the Statak suture anchor. A stable joint was achieved in each case, with no recurrent instability or pain within a mean of 14 months of the follow up. RESULTS: Postoperatively, each patient returned to his or her original job, their daily activities, and sports. There was no significant difference on manual stress testing measurements between operated and uninjured fingers. Mean pinch strength and range of motion were 90% (range, 78-104%) and 94% (range, 70-100%), respectively, compared to uninjured fingers. CONCLUSION: Suture anchor technique can be recommended as a simple and effective method of repairing the collateral ligament of fingers. (+info)
Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Plaster or functional splint in gamekeepers thumb.
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A short cut review was carried out to establish whether a plaster of Paris or functional splint was better for treatment of ulnar collateral ligament rupture. Altogether 50 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. A clinical bottom line is stated. (+info)
Induction of osteoarthritis in the rat by surgical tear of the meniscus: Inhibition of joint damage by a matrix metalloproteinase inhibitor.
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OBJECTIVE: Characterize a model of osteoarthritis (OA) induced by a surgically transecting the medial collateral ligament and meniscus. Evaluate the effectiveness of a matrix metalloproteinase (MMP) inhibitor in this model. METHODS: The medial collateral ligament of the right knee of rats was transected and a single full thickness cut was made through meniscus. Rats were sacrificed at various times after the surgery to assess the severity of gross cartilage damage using an image analyser and microscopically by histology. The effect of an MMP inhibitor in this model was assessed by administering compound twice daily for the 21 days and evaluating gross and histological joint damage at day 21. The in vitro potency of the MMP inhibitor (MMPI) against a panel of human recombinant MMPs was assessed kinetically using a quenched fluorescent substrate. RESULTS: Surgical transection of the medial collateral ligament and meniscus resulted in a time dependent increase in the severity of the cartilage lesion (depth) as measured histologically but only a slight increase in the area of the lesion as assessed grossly by image analysis. Administration of a MMPI orally twice daily (b.i.d.) at 25mg/kg to rats in the meniscal tear model resulted in significant inhibition of cartilage degradation and osteophyte formation (total joint score) of 39+/-7% (mean+/-S.E.M., from four separate experiments). CONCLUSION: These results demonstrate that MMP inhibition is effective in reducing the joint damage that occurs in the meniscal tear model of OA and support a potential therapeutic role for MMP inhibition in the treatment of human OA. (+info)
The lateral collateral ligament complex and related muscles act as a dynamic stabilizer as well as a static supporting structure at the elbow joint: an anatomical and experimental study.
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Among 71 osteoligamentous elbow joint specimens from Japanese subjects, 66% of the lateral ulnar collateral ligaments (LUCLs) were in an incomplete form, such as a fibrous intermuscular septum lying between the anconeus, supinator and extensors, and terminated on the annular ligament. The 'typical' complete ligament, extending from the lateral epicondyle and over the radial collateral ligament (RCL) to the crista spinatoris, appeared in only 20% of the elbows examined. This observation suggests that, in Japanese subjects, the LUCL is not usually a simple ligamentous static stabilizer, but acts as a dynamic stabilizer, together with its related muscles. In addition, when the elbow was flexed by more than 90 degrees, the distance between the lateral epicondyle and the radial head became almost 1.5 mm larger than the distance from the epicondyle to the annular ligament. We therefore consider that, in the overflexed position, the radial head moves slightly distal while the length of the RCL remains almost constant. This morphometrical observation suggests that the annular ligament needs to be supported by the LUCL-muscle complex from the distal side, as well as by the RCL from the proximal side. This extended definition of the lateral collateral ligament complex and its associated muscular function is discussed. (+info)
Hyperextension trauma to the elbow: radiological and ultrasonographic evaluation in handball goalkeepers.
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OBJECTIVE: To detect elbow lesions produced by hyperextension in 30 elite handball goalkeepers. METHODS: Conventional radiographs, stress radiographs, and ultrasound examination of both elbows were used. As a control group, 30 male volunteers from the general population within the same age group with no history of elbow injury were used. RESULTS: Radiographic findings in the goalkeepers were osteophyte formation in 67%, loose bodies in 5.5%, and periarticular calcification in 5.5%. Significantly greater differences in medial joint space opening between stressed and unstressed elbows were measured in both elbows than in the control group. Ultrasonographic findings showed thickening of the medial collateral ligament in 50%, thickening of the tricipital tendon in 11%, and signs of ulnar neuritis in 22%. An intra-articular effusion was found in 66% and small loose bodies in 33%. No significant differences were found between the dominant and non-dominant elbows at radiological and ultrasound examination. The findings in the control group were normal. CONCLUSIONS: The findings support the theory that repetitive hyperextension trauma to the elbow in handball goalkeepers results in pathological changes. (+info)