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Foot and Ankle Clinics Jun 2023Understanding of the ankle and subtalar joint ligaments is essential to recognize and manage foot and ankle disorders. The stability of both joints relies on the... (Review)
Review
Understanding of the ankle and subtalar joint ligaments is essential to recognize and manage foot and ankle disorders. The stability of both joints relies on the integrity of its ligaments. The ankle joint is stabilized by the lateral and medial ligamentous complexes while the subtalar joint is stabilized by its extrinsic and intrinsic ligaments. Most injuries to these ligaments are linked with ankle sprains. Inversion or eversion mechanics affect the ligamentous complexes. A profound knowledge of the ligament's anatomy allows orthopedic surgeons to further understand anatomic or nonanatomic reconstructions.
Topics: Humans; Ankle; Ankle Injuries; Ankle Joint; Joint Instability; Ligaments, Articular; Subtalar Joint
PubMed: 37137619
DOI: 10.1016/j.fcl.2022.12.003 -
The Veterinary Clinics of North... Jan 2020Articular fractures are common injuries in veterinary medicine. The principles of articular fracture repair are anatomic reduction and rigid fixation in order to... (Review)
Review
Articular fractures are common injuries in veterinary medicine. The principles of articular fracture repair are anatomic reduction and rigid fixation in order to optimize joint function. Fluoroscopy and arthroscopy are tools commonly used to allow for anatomic reduction with a minimally invasive approach. Minimally invasive techniques can decrease morbidity and promote an early return to function. Different types of articular fractures and options for minimally invasive repair are reviewed in this article.
Topics: Animals; Fracture Fixation, Internal; Fractures, Bone; Joints; Minimally Invasive Surgical Procedures
PubMed: 31635914
DOI: 10.1016/j.cvsm.2019.08.012 -
Hand (New York, N.Y.) Sep 2023Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result...
BACKGROUND
Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity.
METHODS
Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA).
RESULTS
Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion.
CONCLUSIONS
Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.
Topics: Humans; Finger Joint; Ligaments, Articular; Collateral Ligament, Ulnar; Finger Phalanges; Range of Motion, Articular
PubMed: 35156413
DOI: 10.1177/15589447211060419 -
Foot & Ankle International Nov 2020
Topics: Ankle Joint; Congresses as Topic; Foot Joints; Humans; Information Dissemination; Orthopedic Surgeons
PubMed: 33181039
DOI: 10.1177/1071100720967059 -
The Journal of Hand Surgery Mar 2022We report 8 cases of acute or subacute unilateral nondissociative carpal instability (CIND) in the context of nondisplaced scaphoid fractures.
PURPOSE
We report 8 cases of acute or subacute unilateral nondissociative carpal instability (CIND) in the context of nondisplaced scaphoid fractures.
METHODS
Eight patients from 3 centers developed abnormal volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) following the diagnosis of a nondisplaced scaphoid fracture. An operative inspection in each patient confirmed intact scapholunate and lunotriquetral interosseous ligaments. We outline the demographic characteristics of our patient cohort, radiologic and operative findings of CIND-DISI and CIND-VISI, and the outcomes of acute and delayed treatment.
RESULTS
Two patients were diagnosed with CIND-DISI and 6 with CIND-VISI associated with ipsilateral nondisplaced scaphoid fractures. The average time from injury to diagnosis of CIND was 11 weeks, and the mean clinical and radiographic follow-up was 18 months. Rapid healing of the scaphoid fractures was achieved in all patients (4 open reduction internal fixation, 4 cast). All patients underwent surgery to improve proximal carpal row alignment: in 3 of the 4 patients who were diagnosed and treated surgically within 12 weeks of injury, the radiolunate angle (RLA) was successfully restored. A contracture release and ligament repair or reconstruction with tendon graft 12 or more weeks following injury was unsuccessful in restoring proximal row alignment in all 4 patients. Two patients in the delayed treatment group required secondary surgery for partial fusion.
CONCLUSIONS
Based on the arthroscopic, imaging, and operative findings, we propose that the ligamentous restraints to CIND-VISI are dorsal at the radiocarpal joint and volar at the midcarpal joint. Conversely, the ligamentous restraints to CIND-DISI are dorsal at the midcarpal joint and volar at both the radiocarpal and midcarpal joints. In our series, a delayed diagnosis and late reconstructive surgery were associated with no improvement in RLA. We recommend early recognition of traumatic CIND and prompt treatment of injured ligaments prior to the development of a fixed deformity.
TYPE OF STUDY/LEVEL OF EVIDENCE
Therapeutic V.
Topics: Carpal Joints; Fractures, Bone; Humans; Joint Instability; Ligaments, Articular; Scaphoid Bone; Wrist Joint
PubMed: 34176708
DOI: 10.1016/j.jhsa.2021.04.024 -
Aerospace Medicine and Human Performance Jan 2021The aim of this study was the analysis of human musculoskeletal system energy costs of normal walking and walking under reduced weight loading. There were 15 subjects...
The aim of this study was the analysis of human musculoskeletal system energy costs of normal walking and walking under reduced weight loading. There were 15 subjects who participated in the study. We analyzed the biomechanical parameters of walking under different musculoskeletal system loads. The subjects walked on a treadmill at a pace of 90 steps/min under various loading conditions: 1) 100% bodyweight loading, corresponding to the terrestrial surface; 2) 38% bodyweight loading, corresponding to the surface of Mars; and 3) 17% bodyweight loading, corresponding to the surface of the Moon. Joint angles and angular velocities were recorded from the hip, knee, and ankle. We analyzed changes in joint phase trajectories and the ratio of kinetic extension energy to kinetic flexion energy in the joints. We observed changes in kinetic energy parameters associated with both flexion and extension motions in the joints of the feet while walking under various loads. In terrestrial conditions (walking under 100% bodyweight), flexion kinetic energy in the hip joint prevailed over extension kinetic energy by 90%, with a small variation equal to 22%. If weight loading decreased up to 17% (lunar conditions), the difference between flexion and extension kinetic energies diminished, and eventually reached only 9%. The ratio of flexion energy and extension energy in the ankle joint equalized under lower loading conditions. Thus, 38% bodyweight loading was sufficient for approximation of flexion and extension energy values. Our results revealed that phase trajectories shifted toward smaller joint angles and a decreased ratio between extension kinetic energy and flexion kinetic energy in the knee joint of all subjects. However, significant differences in the ratio of flexion and extension kinetic energy in the knee joint under bodyweight support were not found. The methods used for musculoskeletal system assessments that were proposed in our work can be used in clinical practice to evaluate the effectiveness of rehabilitation measures in a patients musculoskeletal system disorders.
Topics: Ankle Joint; Biomechanical Phenomena; Gait; Hip Joint; Humans; Knee Joint; Locomotion; Walking
PubMed: 33357266
DOI: 10.3357/AMHP.5609.2021 -
The Journal of Hand Surgery Feb 2023Although midcarpal instability was first described almost 45 years ago, this uncommon condition is still poorly understood by most clinicians today. Adding to the... (Review)
Review
Although midcarpal instability was first described almost 45 years ago, this uncommon condition is still poorly understood by most clinicians today. Adding to the confusion, it is known by 2 different names: midcarpal instability and carpal instability nondissociative. In this article, we describe the history of the recognition of instability of the midcarpal joint, including its pathomechanics, classification, and treatment. We hope that a more complete understanding of the etymology and kinematics of the disorder will facilitate its future recognition and assist in appropriate treatment decision making.
Topics: Humans; Biomechanical Phenomena; Carpal Bones; Carpal Joints; Joint Instability; Wrist Joint
PubMed: 36334992
DOI: 10.1016/j.jhsa.2022.09.023 -
Cell Reports. Medicine May 2021Although the knee joint and temporomandibular joint (TMJ) experience similar incidence of cartilage ailments, the knee orthopedics field has greater funding and more... (Review)
Review
Although the knee joint and temporomandibular joint (TMJ) experience similar incidence of cartilage ailments, the knee orthopedics field has greater funding and more effective end-stage treatment options. Translational research has resulted in the development of tissue-engineered products for knee cartilage repair, but the same is not true for TMJ cartilages. Here, we examine the anatomy and pathology of the joints, compare current treatments and products for cartilage afflictions, and explore ways to accelerate the TMJ field. We examine disparities, such as a 6-fold higher article count and 2,000-fold higher total joint replacement frequency in the knee compared to the TMJ, despite similarities in osteoarthritis incidence. Using knee orthopedics as a template, basic and translational research will drive the development and implementation of clinical products for the TMJ. With more funding opportunities, training programs, and federal guidance, millions of people afflicted with TMJ disorders could benefit from novel, life-changing therapeutics.
Topics: Cartilage, Articular; Humans; Knee Joint; Osteoarthritis; Temporomandibular Joint; Temporomandibular Joint Disc; Temporomandibular Joint Disorders
PubMed: 34095872
DOI: 10.1016/j.xcrm.2021.100241 -
Seminars in Musculoskeletal Radiology Oct 2019Synovial plicae are vestigial folds of synovium in a joint, most widely recognized in the knee and also in the elbow and hip joints. The most commonly shared theory on... (Review)
Review
Synovial plicae are vestigial folds of synovium in a joint, most widely recognized in the knee and also in the elbow and hip joints. The most commonly shared theory on the origin of plicae is that they are the remnants of the membranes that divide the synovial cavitations during normal joint development. Synovial folds do not generally cause any symptoms. However, they can become inflamed, thickened, fibrosed, and also impinged in the joint, leading to mechanical symptoms and chondral damage. This article presents an overview of the embryological origin of plicae, their anatomy, pathologies, and appearances on imaging. We also discuss the lesser known plicae in various other areas.
Topics: Diagnostic Imaging; Elbow Joint; Hip Joint; Humans; Joint Capsule; Joint Diseases; Knee Joint
PubMed: 31556089
DOI: 10.1055/s-0039-1693979 -
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