Severe degeneration of the medial collateral ligament in hallux valgus: a histopathologic study in 12 consecutive patients.
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OBJECTIVE: To determine the degree and location of degenerative changes of the medial collateral ligament of the first metatarsophalangeal joint, using the lateral collateral ligament as a control, in patients undergoing hallux valgus correction. MATERIALS AND METHODS: A strip of medial and lateral collateral ligaments were biopsied from 12 consecutive patients (age 45 +/- 4.8 years) with symptomatic hallux valgus. A blinded analysis of histopathology was performed by an experienced pathologist. RESULTS: The medial collateral ligament was significantly more degenerated compared to the lateral collateral ligament (x(2) = 23.41, DF = 2, p < 0.0001). There was no significant difference in degeneration between different parts of each ligament. CONCLUSION: Our study found generalized severe degeneration in the medial collateral ligament without proximal-distal predilection. This information may have implications in the management of medial soft tissue repair in hallux valgus correction. The Authors received no financial support for this study. (+info)
Surgical repair of traumatic medial disruption of the elbow in competitive athletes.
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Five active athletes with acute medial elbow rupture were treated with muscle-ligamentous repair and a spiked washer. All patients regained full strength as well as stability of the elbow, and resumed previous sporting activities within 3 months of surgery. Early surgical repair of the ligament and flexor mass should be considered for active athletes who exhibit gross instability of the elbow on a valgus stress test without anaesthesia. (+info)
Badminton injuries--a prospective epidemiological and socioeconomic study.
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During a 1-year period 100 badminton players were registered and treated in the casualty ward of Randers City Hospital, Denmark. The injuries to the badminton players constituted 5% of all sports injuries registered during the same period in the casualty ward. At follow-up questionnaires were sent to all participants. Replies were received from 89 patients. Over the same period all sports participants in the hospital catchment area (30,254) were registered according to their sport affiliation (2620 badminton players-1650 men and 970 women). Of those injured 58% were men (mean age 31 years) and 42% were women (mean age 25 years). Of the injuries 55% occurred in club players, the remainder occurring during company and school sports activities. The active players were classified into three groups according to age: Group 1 under 18 years (31%); Group 2 18-25 years (16%); Group 3 more than 25 years (53%). According to the Abbreviated Injury Scale (AIS) 17% of the injuries were classified as minor, 56% as moderate, and 27% as severe, respectively. Of the severe injuries (AIS = 3) 56% were found in the oldest age group. AIS correlated with time absent from sport (P < 0.001). Nine players (9%) reported that earlier injuries had influenced the actual accident. Most players (96%) trained one to three times a week. Sprains were the injury most commonly diagnosed (56%), fractures accounted for 5%, torn ankle ligaments were found in 10%, and 13% had ruptures to the Achilles tendon. Overall, 21% were admitted to hospital. None of the patients treated as inpatients was kept in hospital for more than 7 days. The injury caused 56% of players to be absent from work of whom 23% were absent for more than 3 weeks. After the injury 12% of the players gave up their sport, and only 4% restarted their training/sport within 1 week. As many as 28% had to avoid training and playing in matches for 8 weeks or more. (+info)
Morphological and immunohistochemical examination of nerves in normal and injured collateral ligaments of rat, rabbit, and human knee joints.
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BACKGROUND: Knee joints possess an abundant nerve supply that relays sensory and motor information on such aspects as proprioception, nociception, and vasoregulation. Although synovial innervation has been well documented, little is known of the nerves that supply the collateral ligaments. METHODS: The morphology of rabbit and human collateral ligament nerves was examined by silver impregnation. Immunohistochemistry was performed on rabbit and rat collateral ligaments to determine the presence of peptidergic nerves in these tissues. A 6-week gap injury was performed on three rabbit medial collateral ligaments, and the localisation of peptidergic nerves in these tissues was determined. RESULTS: Irrespective of species or type of ligament examined, the greatest density of nerve fibres was found in the epiligament. Nerve fibres commonly accompanied blood vessels along the long axis of the ligament and then entered the substance of the tissue before ramifying in the deeper layers. Substance P and calcitonin gene-related peptide-immunoreactive nerve fibres were found in the collateral ligaments of the rat and rabbit. Injured ligaments showed a higher than normal level of immunoreactivity in and around the healing zone; however, the nerve fibres appeared tangled and truncated. CONCLUSIONS: Like other structures in knee joints, collateral ligaments possess a complex nerve supply. The presence of peptidergic nerves suggests that ligaments may be susceptible to neurogenic inflammation and may be centres of articular nociception. (+info)
Ultrasonographic stress testing of ulnar collateral ligament injuries of the thumb.
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We compared ultrasonographic stress test evaluation to clinical examination of ulnar collateral ligament injuries to the thumb. The results of the sonographic and clinical examinations were compared to either operative findings or clinical follow-up results if conservative treatment was elected. Of 25 patients, the clinical grade injury was identified correctly in 25 with ultrasonography compared to 24 with clinical examination. Of the grade III tears, ultrasonography missed two patients with Stener tears and physical examination misidentified or missed four patients with Stener tears. These results confirm the experience of others that ultrasonography is a useful method to evaluate injury to the ulnar collateral ligament of the thumb. (+info)
Spatial variation in sympathetic influences on the vasculature of the synovium and medial collateral ligament of the rabbit knee joint.
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1. Laser Doppler perfusion imaging was used to assess the role of the sympathetic nervous system in the control of blood flow to the medial collateral ligament and capsule (synovium and overlying fibrous tissues) of the rabbit knee joint. 2. Electrical stimulation of the saphenous nerve (width 1 ms; amplitude 20V; 1-30 Hz) produced a frequency-dependent vasoconstriction of knee joint vasculature. The response was maximal at 30 Hz and gave the greatest fall in perfusion at the femoral insertion of the ligament (by 33.8 +/- 7.4%, mean +/- S.E.M.; n = 5-6) and the smallest decrease at the tibial insertion of the ligament (by 10.6 +/- 2.9%). 3. Topical application of phentolamine (10(-6) mol) had no significant effect on basal knee joint blood flow. However, it abolished the nerve-mediated constrictor responses in all regions of the medial collateral ligament and synovium at all frequencies. 4. Topical administration of adrenaline (10(-14) to 10(-7) mol) caused a dose-dependent decrease in knee joint blood flow with the highest dose producing > 75% reduction in perfusion at all areas. 5. There was no evidence of a reactive hyperaemia in the 5 min following a 5 min period of femoral artery occlusion. Artificial manipulation of arterial blood pressure by intravenous infusion or withdrawal of blood caused a proportional change in ligament and synovial blood flow. These observations may indicate a lack of autoregulation in the joint and its exclusion from baroreflex modulation. 6. These results suggest a potential role for the sympathetic nervous system in the control of knee joint blood flow. Neuromodulation of ligament perfusion appears to predominate at the femoral insertion and this could prove to have functional significance. (+info)
Malignant giant cell tumour of the distal femur treated by excision, allografting and ligamentous reconstruction: an 18-year follow-up.
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Extensive osteoarticular allografts have been used for knee reconstruction, but because of their composite nature and the technical difficulty of the procedure, complication and failure rates have been high. There are few records of long-term results in the literature. In this report, a 19-year-old man with a large aggressive giant cell tumour of the left distal femur was treated in 1976 by en bloc resection, massive femoral allografting and ligamentous reconstruction. Follow-up after 18 years showed no recurrence of the tumour, excellent incorporation of the graft and good knee function, which allowed the patient to work 9 hours a day on his feet without pain. (+info)