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Sports Medicine and Arthroscopy Review Dec 2015The techniques utilized for the management of articular cartilage and labrum injuries during hip preservation surgery have changed dramatically recently. Conservative... (Review)
Review
The techniques utilized for the management of articular cartilage and labrum injuries during hip preservation surgery have changed dramatically recently. Conservative treatment may involve image-guided injection of cortisone or viscosupplementation in conjunction with oral NSAIDs and physical therapy. Damage to the labrum runs a broad spectrum, and the treatments are individualized, but span from debridement to repair and reconstruction. The overarching goal of labral treatment is to restore the native functions of the labrum to allow for more normal biomechanical function. Similarly, cartilage injuries can be managed a number of different ways, including with debridement, microfracture or drilling, cartilage transplants, and higher level restorative techniques. These cartilage restoration techniques have evolved rapidly as well, and may include the use of scaffolds, allograft cartilage cells, and other stem-cell-related procedures.
Topics: Acetabulum; Adrenal Cortex Hormones; Arthralgia; Arthroscopy; Cartilage, Articular; Debridement; Exercise Therapy; Female; Hip Injuries; Humans; Injections, Intra-Articular; Joint Capsule; Male; Organ Sparing Treatments; Prognosis; Range of Motion, Articular; Risk Assessment; Treatment Outcome
PubMed: 26524555
DOI: 10.1097/JSA.0000000000000093 -
British Medical Bulletin Sep 2021A major complication of total hip arthroplasty is dislocation. The hip joint capsule can be incised and repaired, or can be excised.
BACKGROUND
A major complication of total hip arthroplasty is dislocation. The hip joint capsule can be incised and repaired, or can be excised.
SOURCES OF DATA
We performed a systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines focusing on capsular repair and capsulectomy.
AREAS OF AGREEMENT
We identified 31 articles (17 272 patients). Capsular repair produced a lower blood loss (465.2 vs 709.2 ml), and the procedure lasted 102.5 vs 96.08 min in patients who underwent capsulectomy. The patients undergoing capsulectomy experienced a dislocation rate of 3.06%, whereas in the patients undergoing capsular repair, the dislocation rate was 0.65%.
AREAS OF CONTROVERSY
Most studies are retrospective observational studies, with no prospective randomized trials.
GROWING POINTS
Capsular preservation is association with a lower dislocation rate and a lower blood loss. Capsular excision does take statistically less time, but it is uncertain how a 6 min difference is clinically relevant.
AREAS TIMELY FOR DEVELOPING RESEARCH
Appropriately powered randomized clinical trials should be conducted to better define the association between the chosen implants, approach and outcome.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Joint Capsule; Joint Dislocations; Retrospective Studies
PubMed: 34426826
DOI: 10.1093/bmb/ldab011 -
MMW Fortschritte Der Medizin Sep 2017
Review
Topics: Ankle Injuries; Arthroscopy; Athletic Injuries; Casts, Surgical; Chronic Disease; Combined Modality Therapy; Humans; Joint Capsule; Joint Dislocations; Joint Instability; Ligaments, Articular; Magnetic Resonance Imaging; Orthotic Devices; Physical Therapy Modalities; Recurrence; Risk Factors; Tenodesis
PubMed: 29468515
DOI: 10.1007/s15006-017-0064-x -
Arthroscopy : the Journal of... Jun 2022To evaluate the outcomes of "tent form" triangular fibrocartilage complex (TFCC) repair combined with dorsal distal radioulnar joint (DRUJ) capsule imbrication for...
Midterm Results of Arthroscopy-Assisted "Tent Form" Triangular Fibrocartilage Complex Repair With Dorsal Distal Radioulnar Joint Capsule Imbrication for Posttraumatic Chronic Distal Radioulnar Joint Instability.
PURPOSE
To evaluate the outcomes of "tent form" triangular fibrocartilage complex (TFCC) repair combined with dorsal distal radioulnar joint (DRUJ) capsule imbrication for posttraumatic chronic DRUJ instability.
METHODS
All patients treated with arthroscopic "tent form" TFCC repair and DRUJ capsule imbrication from 2016 to 2019 were retrospectively reviewed. The inclusion criteria were symptomatic chronic DRUJ instability for >6 months and dorsal DRUJ subluxation on magnetic resonance imaging. The Disabilities of the Arm, Shoulder, and Hand score, Patient-Rated Wrist Evaluation, grip strength, Modified Mayo Wrist Score, range of motion, and distal radioulnar joint stability were assessed for a minimum of 2 years postoperatively.
RESULTS
Thirty-eight patients were included in the final analysis. The average follow-up duration was 35.6 months (range, 24-48 months). The 24-month postoperative grip strengths and 3-dimensional motions of wrist were not significantly different from that of the nonoperated wrist. Compared with their preoperative status, Disabilities of the Arm, Shoulder, and Hand score, Patient-Rated Wrist Evaluation, and Modified Mayo Wrist Score indicated the significant improvement with P values of .001, .001, and .002, respectively.
CONCLUSIONS
In chronic DRUJ instability with a loosening dorsal capsule, "tent form" TFCC transcapsular repair combined with DRUJ capsule imbrication restored the integrity of TFCC and dorsal DRUJ capsule and achieved a promising outcome. We recommend this procedure as an option of treatment for patients with posttraumatic chronic DRUJ instability.
LEVEL OF EVIDENCE
IV, case series.
Topics: Arthroscopy; Humans; Joint Capsule; Joint Instability; Retrospective Studies; Treatment Outcome; Triangular Fibrocartilage; Wrist Injuries; Wrist Joint
PubMed: 35042008
DOI: 10.1016/j.arthro.2022.01.009 -
The Journal of Hand Surgery Jul 2018To identify the layered relationship anatomically between the musculotendinous structures of the adductor pollicis, the ulnar collateral ligament, and the capsule of the...
Intramuscular Tendon of the Adductor Pollicis and Underlying Capsule of the Metacarpophalangeal Joint: An Anatomical Study With Possible Implications for the Stener Lesion.
PURPOSE
To identify the layered relationship anatomically between the musculotendinous structures of the adductor pollicis, the ulnar collateral ligament, and the capsule of the metacarpophalangeal joint in terms of understanding the pathomechanism of a Stener lesion.
METHODS
We macroscopically analyzed 37 cadaveric thumbs to identify the intramuscular tendon of the adductor pollicis and bony attachments of the joint capsule including the ulnar collateral ligament. In addition, we histologically analyzed 3 thumbs and made a 3-dimensional image of 3 other thumbs, using micro-computed tomography.
RESULTS
The adductor pollicis has 3 components of an intramuscular tendon (dorsal, palmar, and distal), which connect to form a lambda shape. The dorsal part inserts into the joint capsule dorsal to the ulnar sesamoid. The palmar part inserts into the ulnar sesamoid. The distal part inserts into the lateral tubercle of the proximal phalanx. The thickened and cord-like part of the joint capsule, which has generally been referred to as the proper ulnar collateral ligament, has a distinct bony attachment on the proximal slope of the lateral tubercle of the proximal phalanx separate from the adductor pollicis insertion.
CONCLUSIONS
Of the 3 components of the intramuscular tendon of the adductor pollicis muscle, the dorsal part inserted into not only the aponeurosis but also the joint capsule.
CLINICAL RELEVANCE
The results of the current study suggest the anatomic basis for a possible pathomechanism of the Stener lesion.
Topics: Aged, 80 and over; Cadaver; Collateral Ligament, Ulnar; Female; Humans; Imaging, Three-Dimensional; Joint Capsule; Male; Metacarpophalangeal Joint; Tendons; Thumb; X-Ray Microtomography
PubMed: 29395587
DOI: 10.1016/j.jhsa.2017.12.009 -
Clinical Anatomy (New York, N.Y.) Jul 2024The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The...
The posterolateral region of the knee has a complex and diverse anatomy. Hydrarthrosis of the knee can potentially communicate with other parts of the joint space. The joint fluid distribution reflects anatomical communications between synovial spaces. To observe the continuity between the knee joint cavity and the surrounding bursa, we devised a dissection method with a new injection agent, an eosin-containing congealed liquid that spreads uniformly over the entire space. The purpose of this study was to perform a detailed examination of the subpopliteal recess (SPR) where a bursa connects to the knee joint capsule. We also reported the advantages of this new injection agent compared with conventional materials (latex and epoxy resin). Twenty-two formalin-fixed cadavers (34 knees), two N-vinyl-pyrrolidone (NVP)-fixed cadavers (4 knees), and two cadavers (3 knees) fixed by Thiel's method were used. After filling the knee joint space and SPR with eosin congealed liquid, the specimens were dissected to investigate the morphology of the SPR. In addition, three different types of injection agents were assessed. The SPR extended distally along the popliteus tendon. The SPR length was 22.64 ± 11.38 mm from the upper end of the lateral tibial condyle to the lower end of the depression. The existence of a fabellofibular ligament made the SPR significantly longer, but abrasion of the femoral articular cartilage did not affect the SPR. Furthermore, the relationship between the popliteus muscle and the SPR was classified into three types (types 1-3). Types 2 and 3 in which the SPR extended to the proximal tibiofibular joint may cause instability of the knee joint. The eosin congealed liquid was highly useful in many aspects, such as fluidity and injection workability. The new dissection method with eosin congealed liquid provides insights into the anatomy of the posterior lateral knee, which are useful for radiological diagnoses and clinical treatments.
Topics: Humans; Cadaver; Dissection; Eosine Yellowish-(YS); Joint Capsule; Knee Joint
PubMed: 38419377
DOI: 10.1002/ca.24144 -
Arthroscopy : the Journal of... Jan 2020Advances in the understanding of femoroacetabular impingement syndrome and advancements in hip arthroscopic techniques, including chondrolabral preservation and labral... (Review)
Review
Advances in the understanding of femoroacetabular impingement syndrome and advancements in hip arthroscopic techniques, including chondrolabral preservation and labral repair, have led to improvements in success rates, functional outcomes, and return to sports over the past several years. This improvement in outcomes also is attributed to the increased awareness of performing capsular closure after addressing intra-articular hip pathology, to preserve the biomechanical properties of the hip. A number of biomechanical studies have demonstrated that the iliofemoral ligament is a critical component of hip biomechanics, providing stability and limiting joint translation, distraction, and rotation within the normal range of hip motion. The interportal and T-capsulotomy are the most commonly used methods for accessing intra-articular pathology; both techniques require transection of the iliofemoral ligament perpendicular to its fibers, which may lead to micro- and macroinstability if left unrepaired at the end of the procedure. Several clinical studies have been published in the recent literature demonstrating that patients who undergo hip arthroscopy for femoroacetabular impingement syndrome and have an unrepaired capsule have lower functional outcome scores, achievement of meaningful outcomes, success rates, as well as greater failure rates and reported pain when compared with patients who have complete capsular closure. Capsular plication of the vertical T-limb and closure of the interporal limb via plication have been reported to improved outcomes. Degree of plication is dependent on dynamic, intraoperative assessment of hip range of motion. The senior author recommends reflecting of the medial and lateral leaflets after T-capsulotomy with polyethylene sutures to provide better exposure of the peripheral compartment, which can be used for closure. The remainder of the closure is performed with a suture-passing device and approximately 2 to 3 interrupted stitches per limb.
Topics: Arthroscopy; Femoracetabular Impingement; Hip Joint; Humans; Joint Capsule; Range of Motion, Articular
PubMed: 31864606
DOI: 10.1016/j.arthro.2019.10.028 -
The American Journal of Sports Medicine Apr 2016The role of the anterolateral capsule in knee stability has recently been advocated by studies reporting that a distinct ligament exists in this area. Defining the...
BACKGROUND
The role of the anterolateral capsule in knee stability has recently been advocated by studies reporting that a distinct ligament exists in this area. Defining the structural properties of the anterolateral capsule can provide insight into its contribution to joint stability. The structural properties of the iliotibial band also need to be determined, as it is a common graft used for extra-articular tenodesis.
PURPOSE/HYPOTHESIS
The purpose of this study was to determine the structural properties of the anterolateral capsule and iliotibial band. The hypothesis was that the iliotibial band will have comparable structural properties to the anterolateral capsule because it is generally an accepted graft for extra-articular reconstruction surgeries.
STUDY DESIGN
Controlled laboratory study.
METHODS
Nine human cadaveric knees (average age, 57 ± 10 years) were dissected to assess the presence of a discrete capsular thickness originating from the lateral femoral epicondyle to the lateral tibial plateau between the Gerdy tubercle and the fibular head. For each knee, 2 constructs were prepared: (1) a bone-anterolateral capsule-bone specimen and (2) a strip of iliotibial band attached to the Gerdy tubercle. Structural properties, including ultimate load, ultimate elongation, and stiffness, were determined for the anterolateral capsule and the iliotibial band. After tensile testing, plain radiographs were obtained for evaluation of the Segond fracture. A paired t test was used to compare the structural properties of the anterolateral capsule with the iliotibial band. Significance was set at P < .05.
RESULTS
Two of the 9 specimens were found to have a discrete thickening of the anterolateral capsule. The iliotibial band had almost 50% higher ultimate load and nearly 3 times higher stiffness (487.9 ± 156.9 N and 73.2 ± 24.1 N/mm, respectively) compared with the anterolateral capsule (319.7 ± 212.6 N and 26.0 ± 11.5 N/mm, respectively) (P < .05 for both). The anterolateral capsule had about double the ultimate elongation compared with the iliotibial band (15.5 ± 7.3 and 8.6 ± 1.4 mm, respectively; P < .05).
CONCLUSION
The anterolateral capsule demonstrated significantly reduced structural properties compared with the iliotibial band. The anterolateral capsule did not have a higher ultimate load compared with the posteromedial capsule as reported in the literature.
CLINICAL RELEVANCE
The decision to perform an extra-articular reconstruction using an iliotibial band graft should be considered carefully. Unnecessary reconstructions using soft tissue grafts with structural properties that far exceed that of the anterolateral capsule may result in overconstraint of the ACL-reconstructed knee.
Topics: Biomechanical Phenomena; Cadaver; Connective Tissue; Fascia Lata; Female; Humans; Joint Capsule; Knee Joint; Male; Middle Aged
PubMed: 26811306
DOI: 10.1177/0363546515623500 -
Medicine and Science in Sports and... Dec 2018Knee injuries are common in sports, and postinjury immobilization is often required to protect healing tissues and alleviate pain, but both the injury and the...
INTRODUCTION
Knee injuries are common in sports, and postinjury immobilization is often required to protect healing tissues and alleviate pain, but both the injury and the immobilization can lead to a knee contracture. Knee flexion contractures limit performance. Previous research has identified posterior knee capsule fibrosis as a contributor to immobility-induced knee flexion contractures. This study aims to measure posterior knee capsule length at various durations of remobilization after knee immobilization and to correlate with the recovery of knee range of motion.
METHODS
Two hundred fifty-nine male Sprague-Dawley rats had one knee extra-articularly immobilized in flexion with a Delrin® plate at a 45° angle for one of six durations: 1, 2, 4, 8, 16, or 32 wk, followed by spontaneous remobilization after plate removal, which lasted zero, one, two, and four times the duration of immobilization. The contralateral knees served as controls. The posterior knee capsule length was measured by histomorphometry. These measures were correlated with previously published range of motion data from the same cohort of specimens.
RESULTS
Knees immobilized for 1 and 2 wk partially recovered posterior capsule length (P > 0.05). Knees immobilized beyond 2 wk failed to recover posterior capsule length, irrespective of the duration of remobilization (P < 0.05). The residual posterior capsule shortening correlated with the lack of knee extension (P < 0.003).
CONCLUSIONS
For knee injuries requiring more than 2 wk of immobilization, unassisted remobilization will not restore posterior knee capsule shortening and the reduction in knee extension. These results support the role of the posterior capsule in knee joint contracture and the need to minimize the duration of immobility and to assist the recovery of the range of knee extension after a sport injury.
Topics: Animals; Contracture; Immobilization; Joint Capsule; Knee Injuries; Male; Range of Motion, Articular; Rats, Sprague-Dawley; Recovery of Function
PubMed: 30113525
DOI: 10.1249/MSS.0000000000001741 -
Scientific Reports Nov 2021Recently, pathological changes in the fat pad on the anterior inferior iliac spine (AIIS), between the proximal rectus femoris and joint capsule, have been highlighted...
Recently, pathological changes in the fat pad on the anterior inferior iliac spine (AIIS), between the proximal rectus femoris and joint capsule, have been highlighted as a cause of anterior hip pain. However, precise fat pad features, such as the spatial distribution distal to the AIIS, histological features, and in vivo tissue elasticity, remain unclear. This study aimed to investigate the morphological characteristics of the fat pad on the AIIS. Four hips from four cadaveric donors were both macroscopically and histologically investigated, and eight hips from four volunteers were assessed using ultrasonography. The fat pad on the AIIS was also surrounded by the iliopsoas and gluteus minimus, extending distally to the superficial portion of the vastus lateralis, and the anterior portion of the gluteus maximus tendon. Histological analysis revealed that the fat pad was composed of loose connective tissue. Based on the ultrasonography, the shear wave velocity in the fat pad was significantly lower than that in the joint capsule. Conclusively, the pathological adhesion between the joint capsule and pericapsular muscles, if caused by fat pad fibrosis, may occur following the abovementioned fat pad spatial distribution.
Topics: Adipose Tissue; Adult; Aged; Anatomic Landmarks; Cadaver; Elasticity Imaging Techniques; Female; Hip Joint; Humans; Joint Capsule; Male; Predictive Value of Tests
PubMed: 34819610
DOI: 10.1038/s41598-021-02381-1