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Arthroscopy : the Journal of... Jun 2023The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the...
The medial patellofemoral complex (MPFC) is the term used to describe the primary soft tissue stabilizer of the patella, which consists of fibers that attach to the patella (medial patellofemoral ligament, or MPFL), and the quadriceps tendon (medial quadriceps tendon femoral ligament, or MQTFL). Despite the variability of its attachment on the extensor mechanism, the midpoint of this complex is consistently at the junction of the medial quadriceps tendon with the articular surface of the patella, indicating that either patellar or quadriceps tendon fixation can be used for anatomic reconstruction. Multiple techniques exist to reconstruct the MPFC, including graft fixation on the patella, quadriceps tendon, or both structures. Various techniques using several graft types and fixation devices have all reported good outcomes. Regardless of the location of fixation on the extensor mechanism, elements critical to the success of the procedure include anatomic femoral tunnel placement, avoiding placing undue tension on the graft, and addressing concurrent morphological risk factors when present. This infographic reviews the anatomy and techniques for the reconstruction of the MPFC, including graft configuration, type, and fixation, while addressing common pearls and pitfalls in the surgical treatment of patellar instability.
Topics: Humans; Patellofemoral Joint; Joint Instability; Ligaments, Articular; Patella; Tendons
PubMed: 37147068
DOI: 10.1016/j.arthro.2023.01.006 -
Radiologic Clinics of North America Sep 2019Repetitive microtrauma in the elbow from chronic overuse occurs in athletes and nonathletes. Although the diagnosis is often made clinically, imaging is helpful to... (Review)
Review
Repetitive microtrauma in the elbow from chronic overuse occurs in athletes and nonathletes. Although the diagnosis is often made clinically, imaging is helpful to confirm the diagnosis, grade the injury, and guide treatment. MR imaging is particularly helpful in evaluating overuse injuries in the elbow, as tendons, ligaments, and bones/cartilage can be assessed. Tendinopathy can be distinguished from partial- or full-thickness tears, and reactive changes in the bone marrow can be easily identified. This article focuses on the MR imaging appearance of overuse injuries of the elbow involving tendons, ligaments, and bones.
Topics: Cumulative Trauma Disorders; Diagnostic Imaging; Elbow Joint; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Radiography; Tendon Injuries; Tomography, X-Ray Computed; Elbow Injuries
PubMed: 31351542
DOI: 10.1016/j.rcl.2019.03.005 -
Hand Clinics Aug 2023Scapholunate and lunotriquetral instability are common causes of chronic, debilitating wrist pain and functional impairment. In the setting of subacute or chronic... (Review)
Review
Scapholunate and lunotriquetral instability are common causes of chronic, debilitating wrist pain and functional impairment. In the setting of subacute or chronic injuries with predynamic or dynamic instability, the ideal surgical approach remains unclear. In January 2020 the authors started enrolling patients with predynamic and dynamic instability in an Institutional Review Board-approved prospective study, aimed at meticulously studying outcomes using the all-dorsal InternalBrace reconstruction technique. The all-dorsal technique described herein is straightforward, efficient, and easy to learn, with early outcomes equivalent or superior to those of other techniques.
Topics: Humans; Lunate Bone; Prospective Studies; Joint Instability; Wrist Joint; Ligaments, Articular
PubMed: 37453765
DOI: 10.1016/j.hcl.2023.02.008 -
The Journal of Foot and Ankle Surgery :... 2023Lisfranc injuries are complicated injuries of the tarsometatarsal joint with high rates of sequelae. Both anatomy and injury of the Lisfranc joint are variably...
Lisfranc injuries are complicated injuries of the tarsometatarsal joint with high rates of sequelae. Both anatomy and injury of the Lisfranc joint are variably documented. Descriptions of these injuries and their associated structures vary greatly. The most injured structures are those of the Lisfranc joint complex, which involves the medial cuneiform, second and third metatarsals, and the dorsal, interosseous, and plantar Lisfranc ligaments. This study sought to examine morphology of the Lisfranc joint in cadavers. Twenty-two embalmed cadaveric feet were dissected (13 male, 9 female, 80.3 years ± 14.03) to isolate the bones and ligaments of the Lisfranc joint complex. The dorsal, interosseous, and plantar Lisfranc ligaments were present in each specimen. Each ligament was measured and morphology noted. The dissected dorsal Lisfranc ligament had consistent morphology (mean = 10.8 mm ± 1.79). The interosseous Lisfranc ligament had a consistent path, but 11/17 of specimens possessed a connection to the plantar Lisfranc ligament. The plantar Lisfranc ligament demonstrated wide variability with a Y-variant (n = 3) and a fan-shaped variant (n = 14). Ligament thickness was greatest in the interosseous Lisfranc ligament (mean = 13.74 ± 3.08) and least in the dorsal Lisfranc ligament (mean = 1.36 ± 0.42). While the objective of defining joint and ligament morphology was achieved, further questions were raised. Variations of the interosseous and plantar Lisfranc ligament may play a role in susceptibility to joint injury, and arthritic changes to the joints examined raise questions regarding the prevalence of arthritis in the uninjured Lisfranc joint.
Topics: Humans; Male; Female; Metatarsal Bones; Foot Joints; Ligaments, Articular; Plantar Plate; Tarsal Bones; Cadaver
PubMed: 35973899
DOI: 10.1053/j.jfas.2022.07.004 -
Acta Bio-medica : Atenei Parmensis May 2020The medial patellofemoral ligament (MPFL) is the most important structure commonly injured during lateral patellar dislocation and its rupture accounts for 3% of total... (Review)
Review
BACKGROUND AND AIM
The medial patellofemoral ligament (MPFL) is the most important structure commonly injured during lateral patellar dislocation and its rupture accounts for 3% of total knee injuries. MPFL reconstruction (MPFLR) is a reliable procedure with good results but variable rates of recurrent instability. The aim of this study is to underline the proper indications for the MPFLR reconstruction and to explain all the pearls and pitfalls regarding the MPFLR both in our experience and found in the latest literature.
METHODS
A comprehensive search in the latest literature using various combinations of the keywords MPFL, MPFLR, dislocation, treatment was performed. The following data were extracted: diagnosis methods, indications and contraindications for isolated MPFLR, type of management, recurrence of instability, outcomes and complications.
RESULTS
History of multiple patellar dislocations is the most relevant indication for ligament reconstruction especially after a failed course of conservative treatment in presence of persistent patello-femoral instability. Gold standard technique for MPFLR has not been clearly defined yet.
CONCLUSIONS
There is still poor literature about outcome comparisons, therefore it is challenging to decide which technique is the most appropriate as surgical procedures are continuously developing. The ideal candidates for MPFLR have to be decided after a throughout evaluation and careful planning and, with nowadays knowledge, it is possible to put indication for a reconstruction exposing the patient to minimal risks.
Topics: Humans; Joint Instability; Ligaments, Articular; Orthopedic Procedures; Patellofemoral Joint; Treatment Outcome
PubMed: 32555079
DOI: 10.23750/abm.v91i4-S.9669 -
The Orthopedic Clinics of North America Jan 2020Scapholunate ligament injuries are common and can lead to a predictable pattern of arthritis (scaphoid lunate advanced collapse wrist) if unrecognized or untreated. This... (Review)
Review
Scapholunate ligament injuries are common and can lead to a predictable pattern of arthritis (scaphoid lunate advanced collapse wrist) if unrecognized or untreated. This article describes the relevant anatomy, biomechanics, and classification system, and provides an up-to-date literature-based review of treatment options, including acute repair and various reconstruction techniques. It also helps guide surgeons in making decisions regarding a systematic treatment algorithm for these injuries.
Topics: Arthritis; Biomechanical Phenomena; Carpal Joints; Humans; Ligaments, Articular; Lunate Bone; Radiography; Range of Motion, Articular; Plastic Surgery Procedures; Scaphoid Bone; Treatment Outcome; Wrist Injuries; Wrist Joint
PubMed: 31739882
DOI: 10.1016/j.ocl.2019.09.002 -
Hand Clinics Aug 2023Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury.... (Review)
Review
Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion.
Topics: Humans; Wrist; Ligaments, Articular; Wrist Joint; Upper Extremity; Wrist Injuries; Thumb; Metacarpophalangeal Joint
PubMed: 37453764
DOI: 10.1016/j.hcl.2023.03.002 -
Surgical and Radiologic Anatomy : SRA Feb 2023To address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe...
PURPOSE
To address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe their insertions and morphology.
METHODS
The ligaments were removed during the standard autopsy procedures with a use of an oscillating saw, a chisel and a scalpel. The specimens were photographed before the extraction and measured alongside their anterior margin. Next, they were preserved in formaldehyde, stripped of other soft tissues and then examined, photographed and described.
RESULTS
The mean length of the ligaments was 31.7 mm. 44 specimens were described as single-banded, 13 as double-banded and 3 as other. In 24 cases costal process of L has been fixed to the iliac plate by short ligamentous bands. In 38 cases there was a thick fibrous membrane connected to the ligament. No legitimate insertions on L vertebra were observed.
CONCLUSIONS
Typical iliolumbar ligament consists of a single ligamentous band. Most common variability of the ligament consist of two bands. In approximately 40% of cases the costal process of L can be additionally stabilized to the iliac plate by short, strong ligamentous bands. In 63% of cases a connection between the iliolumbar ligament and a fibrous membrane placed in the frontal plane, superiorly to the ligament, has been observed. There seems to be no convincing proof of existence of the insertion of the iliolumbar ligament on the L vertebra.
Topics: Humans; Lumbar Vertebrae; Ligaments, Articular; Sacroiliac Joint; Ilium; Cadaver
PubMed: 36592184
DOI: 10.1007/s00276-022-03070-y -
The Journal of Hand Surgery Nov 2023Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left... (Review)
Review
Injuries to the scapholunate joint are the most frequent cause of carpal instability. The sequelae of these injuries account for considerable morbidity, and if left untreated, may lead to scapholunate advanced collapse and progressive deterioration of the carpus. Rupture of the scapholunate interosseous ligament and its critical stabilizers causes dyssynchronous motion between the scaphoid and lunate. Additional ligament injury or attenuation leads to rotary subluxation of the scaphoid and increased scapholunate gap. Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. In the first section of this review, we discuss the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical ligament stabilizers. We provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. The purpose is to provide an update regarding the anatomy of the scapholunate ligament complex, importance of the critical ligament stabilizers of the proximal carpal row, introduction of safe technique to surgically expose the scaphoid and lunate, as well as pathoanatomy as it pertains to the treatment of scapholunate dissociation. In the second section of this review, we propose a novel ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
Topics: Humans; Biomechanical Phenomena; Carpal Joints; Wrist Joint; Wrist; Lunate Bone; Scaphoid Bone; Ligaments, Articular; Joint Instability
PubMed: 37452815
DOI: 10.1016/j.jhsa.2023.05.013 -
Clinical Anatomy (New York, N.Y.) Apr 2022The purpose of this study was to characterize the morphological variations in the distal attachment of the popliteofibular ligament (PFL) and create an accurate...
The purpose of this study was to characterize the morphological variations in the distal attachment of the popliteofibular ligament (PFL) and create an accurate classification for use in planning surgical procedures in this area and in evaluating radiological imaging. One hundred and thirty-seven lower limbs of body donors fixed in 10% formalin solution were examined for the presence and course of the PFL. The PFL was present in 88.3% of cases. We propose the following three-fold classification: type I (72.3%), the most common type, characterized by the attachment onto the apex of the head of the fibula, type II (8.7%), characterized by a bifurcation, with the dominant band inserting on the anterior slope of the styloid process of the fibula and the smaller band onto the posterior surface of the styloid process of the fibula and type III (7.3%), characterized by a double PFL: the first PFL (main) originated from the popliteus tendon and inserted onto the anterior slope of the styloid process of the fibula, while the second originated from the musculotendinous junction of the popliteus muscle and inserted on the posterior surface of the styloid process of the fibula. The PFL was characterized by high morphological variation, as reflected in our proposed classification. This variation may present clinical and biomechanical issues for both medical personnel and researchers. Our proposed classification may be valuable for clinicians who evaluate and perform surgical procedures within the knee joint area.
Topics: Cadaver; Fibula; Humans; Knee Joint; Leg; Ligaments, Articular; Tendons
PubMed: 35119143
DOI: 10.1002/ca.23842