-
Clinics in Podiatric Medicine and... Jul 2022Pes planovalgus is a multiplanar deformity consisting of a combination of hindfoot valgus, collapse of the medial longitudinal arch, forefoot varus, and forefoot... (Review)
Review
Pes planovalgus is a multiplanar deformity consisting of a combination of hindfoot valgus, collapse of the medial longitudinal arch, forefoot varus, and forefoot abduction. This deformity is often associated with posterior tibial tendon dysfunction. Collapse of the medial longitudinal arch increases stress to the static stabilizers of the medial column including the deltoid ligament, spring ligament, plantar fascia, plantar and talocalcaneal interosseous ligaments, as well as the talonavicular and naviculocuneiform capsules. There is a higher incidence of concomitant spring ligament pathology in pes planovalgus deformity and posterior tibial tendon dysfunction based on magnetic resonance imaging and intraoperative observation than in other static stabilizers.
Topics: Flatfoot; Foot; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Posterior Tibial Tendon Dysfunction
PubMed: 35717066
DOI: 10.1016/j.cpm.2022.02.010 -
Seminars in Musculoskeletal Radiology Apr 2021Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided... (Review)
Review
Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called "scapholunate complex" has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).
Topics: Humans; Ligaments; Ligaments, Articular; Magnetic Resonance Imaging; Triangular Fibrocartilage; Wrist; Wrist Injuries; Wrist Joint
PubMed: 34374066
DOI: 10.1055/s-0041-1731653 -
Clinics in Podiatric Medicine and... Apr 2023The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot... (Review)
Review
The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot deformity. Discussion includes the normal and abnormal biomechanical forces that extend through these ligaments in normal and flatfoot deformity. Current literature related to spring ligament repair as part of the flatfoot deformity reconstruction is also reviewed.
Topics: Adult; Humans; Flatfoot; Foot; Ligaments, Articular; Foot Deformities, Acquired
PubMed: 36841581
DOI: 10.1016/j.cpm.2022.11.008 -
Clinics in Podiatric Medicine and... Jul 2022The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and... (Review)
Review
The fibrocartilage within the superomedial calcaneonavicular (spring) ligament is part of an interwoven complex of ligaments that span the ankle, subtalar, and talonavicular joints. Acute isolated rupture of the spring ligament has been reported in association with an eversion ankle sprain. Attenuation and failure of the spring ligament causes complex 3D changes called the progressive collapsing foot deformity (PCFD). This deformity is characterized by hindfoot eversion, forefoot supination, collapse of the medial longitudinal arch, and forefoot abduction. Nonoperative treatment of an isolated spring ligament rupture and PCFD using various designs of orthoses have shown promising results.
Topics: Ankle; Flatfoot; Foot; Foot Deformities, Acquired; Humans; Ligaments, Articular
PubMed: 35717063
DOI: 10.1016/j.cpm.2022.02.007 -
Skeletal Radiology Jan 2020The distal tibiofibular joint is a fibrous joint that plays a crucial role in the stability of the ankle joint. It is stabilized by three main ligaments: the anterior... (Review)
Review
The distal tibiofibular joint is a fibrous joint that plays a crucial role in the stability of the ankle joint. It is stabilized by three main ligaments: the anterior inferior tibiofibular ligament, the posterior inferior tibiofibular ligament, and the interosseous tibiofibular ligament, which are well delineated on magnetic resonance imaging. Pathology of the distal tibiofibular joint is mostly related to trauma and the longer-term complications of trauma, such as soft tissue impingement, heterotopic ossification, and synostosis. This review article outlines the MRI anatomy and pathology of this joint.
Topics: Ankle Injuries; Ankle Joint; Arthrography; Chronic Disease; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Patient Positioning
PubMed: 31289899
DOI: 10.1007/s00256-019-03260-7 -
The Journal of Knee Surgery Apr 2020Irreducible knee dislocations are a small subset of acute knee dislocations and are extremely rare. The most common type of irreducible knee dislocation is...
Irreducible knee dislocations are a small subset of acute knee dislocations and are extremely rare. The most common type of irreducible knee dislocation is posterolateral, which can be challenging to diagnose both clinically and on plain radiographs. Vascular injury is uncommon and closed reduction is seldom possible due to medial femoral condyle buttonholing through soft tissues requiring open or arthroscopic reduction. Ligament injuries mostly include medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Literature has numerous case reports with a couple of small series giving short- to mid-term outcomes of posterolateral knee dislocations. There is, however, no consensus on management of ligament injuries with case reports showing good outcomes in early or delayed ligament reconstruction. This article sheds light on previous case reports and describes how to identify irreducible knee dislocations and provides an algorithm on how to manage ligament injuries in posterolateral dislocations.
Topics: Algorithms; Arthroscopy; Humans; Knee Dislocation; Ligaments, Articular; Patient Selection; Plastic Surgery Procedures
PubMed: 31756734
DOI: 10.1055/s-0039-1698749 -
Plastic and Reconstructive Surgery Apr 2022Numerous surgical reconstructive techniques have been described for chronic scapholunate and lunotriquetral interosseous ligament instability.
BACKGROUND
Numerous surgical reconstructive techniques have been described for chronic scapholunate and lunotriquetral interosseous ligament instability.
METHODS
The authors retrospectively reviewed 16 consecutive patients who underwent bone-ligament-bone reconstruction for scapholunate or lunotriquetral intraosseous ligament predynamic and dynamic instability at a single tertiary care institution from 2013 to 2019. Clinical and radiographic outcomes, and complications, were recorded.
RESULTS
Eleven patients had bone-ligament-bone reconstruction for scapholunate ligament injuries and five for lunotriquetral instability. Fourteen patients (87.5 percent) underwent diagnostic arthroscopy before bone-ligament-bone reconstruction, with nine of 14 having grade 3 and four of 14 having grade 4 injury. Capitohamate bone-ligament-bone grafts were used in nine patients (56 percent) and the graft was taken from Lister tubercle in seven (44 percent). The average age at surgery was 37 years. The average follow-up was 60.6 weeks. There were no significant differences between preoperative and postoperative radiographic parameters. Median postoperative wrist flexion was 45 degrees, and mean postoperative wrist extension was 53 degrees, which were significantly less than contralateral flexion (85 degrees; p < 0.0001) and extension (78 degrees; p < 0.0001). Thirty-eight percent of patients complained of persistent pain at final follow-up, and two patients (13 percent) underwent salvage procedures, both at approximately 6.5 months after the index reconstruction.
CONCLUSION
Short-term outcomes of bone-ligament-bone reconstruction for early-stage scapholunate and lunotriquetral ligament injuries reveal many patients with residual postoperative wrist pain and disability, and almost uniform limitations in flexion-extension motion.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Arthralgia; Humans; Joint Instability; Ligaments, Articular; Lunate Bone; Retrospective Studies; Scaphoid Bone; Wrist Injuries; Wrist Joint
PubMed: 35157627
DOI: 10.1097/PRS.0000000000008955 -
Clinics in Sports Medicine Oct 2021Preoperative and postoperative imaging of knee ligament injury hinges on the appropriate use of available modalities. Knowledge of injury patterns as well as the... (Review)
Review
Preoperative and postoperative imaging of knee ligament injury hinges on the appropriate use of available modalities. Knowledge of injury patterns as well as the surgical significance of certain image findings enhances injury detection and supports appropriate preoperative planning. The radiologist must be familiar with the strengths and weaknesses of each modality for evaluating specific aspects of ligamentous pathology. This article focuses on preoperative and postoperative imaging of knee ligament injury. Basic topics pertaining to preoperative image modality selection and isolated injury detection are addressed. More advanced areas including ligamentous injury patterns, surgical indications, and postoperative imaging are also discussed.
Topics: Anterior Cruciate Ligament Injuries; Humans; Knee Injuries; Knee Joint; Ligaments, Articular; Magnetic Resonance Imaging; Soft Tissue Injuries
PubMed: 34509204
DOI: 10.1016/j.csm.2021.05.005 -
Plastic and Reconstructive Surgery Jan 2023Intercarpal ligament injuries such as scapholunate and lunotriquetral tears are common causes of wrist pain. There is no shortage of surgical techniques to address these...
Intercarpal ligament injuries such as scapholunate and lunotriquetral tears are common causes of wrist pain. There is no shortage of surgical techniques to address these injuries, nor is there a lack of literature exploring this topic. However, research progress has not led to a consensus regarding the optimal management of subacute and chronic injuries without articular wear. The senior author (K.C.C.) has performed the spectrum of reconstructive techniques, including dorsal and volar approaches, tendon weaves, ligament tenodesis procedures, reduction and association procedures, and bone-ligament-bone techniques. In the absence of convincing, consistent outcomes, the authors began investigating a novel all-dorsal reconstructive technique using the Arthrex InternalBrace system. The complexity and unpredictable outcomes associated with traditional ligament tenodesis procedures led them to adopt the all-dorsal InternalBrace technique as their primary reconstructive approach. The authors have performed more than 20 procedures with this technique since 2019. In an average tourniquet time of under 60 minutes, they are able to achieve predictable carpal stabilization, pain relief, and restoration of motion. This is the preferred reconstructive approach of the senior author.
Topics: Humans; Wrist Joint; Carpal Bones; Tenodesis; Ligaments, Articular; Arthralgia; Lunate Bone; Joint Instability; Scaphoid Bone
PubMed: 36219862
DOI: 10.1097/PRS.0000000000009786 -
The Journal of Hand Surgery Dec 2023Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this... (Review)
Review
Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this Current Concepts article reviewed the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical stabilizers. In this section, we provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. These updates clarify the importance of the critical stabilizers of the scapholunate interval, ligament-specific considerations in scapholunate ligament reconstruction, and the risks of ligament disinsertion when surgically exposing the dorsal wrist. We propose a ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
Topics: Humans; Scaphoid Bone; Lunate Bone; Joint Instability; Wrist Joint; Ligaments, Articular
PubMed: 37578401
DOI: 10.1016/j.jhsa.2023.06.016