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The Journal of the American Academy of... Jul 2019The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the... (Review)
Review
The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction. Retraction of the deltoid with subsequent healing in a nonanatomic position theoretically may cause instability, persistent medial gutter pain, and loss of function with risk of early arthritis. In mild cases, deltoid injury may not be obvious, and potential diagnostic techniques include preoperative and intraoperative stress radiography, MRI, and ultrasonography. The most common injury pattern is avulsion from the medial malleolus, and most current repair techniques involve direct repair of the capsular and deltoid injuries involving suture anchors in the medial malleolus and imbrication of the superficial and deep deltoid fibers. To date, there is limited evidence of superior clinical outcomes with the addition of deltoid repair compared with open reduction and internal fixation of the fibula alone.
Topics: Ankle Fractures; Ankle Injuries; Biomechanical Phenomena; Diagnostic Imaging; Female; Fracture Fixation, Internal; Humans; Ligaments, Articular; Male; Open Fracture Reduction; Orthopedic Procedures; Rupture; Treatment Outcome
PubMed: 30475279
DOI: 10.5435/JAAOS-D-18-00198 -
The Journal of Bone and Joint Surgery.... May 2010*The superficial medial collateral ligament and other medial knee stabilizers-i.e., the deep medial collateral ligament and the posterior oblique ligament-are the most... (Review)
Review
*The superficial medial collateral ligament and other medial knee stabilizers-i.e., the deep medial collateral ligament and the posterior oblique ligament-are the most commonly injured ligamentous structures of the knee. *The main structures of the medial aspect of the knee are the proximal and distal divisions of the superficial medial collateral ligament, the meniscofemoral and meniscotibial divisions of the deep medial collateral ligament, and the posterior oblique ligament. *Physical examination is the initial method of choice for the diagnosis of medial knee injuries through the application of a valgus load both at full knee extension and between 20 degrees and 30 degrees of knee flexion. *Because nonoperative treatment has a favorable outcome, there is a consensus that it should be the first step in the management of acute isolated grade-III injuries of the medial collateral ligament or such injuries combined with an anterior cruciate ligament tear. *If operative treatment is required, an anatomic repair or reconstruction is recommended.
Topics: Animals; Dogs; Female; Humans; Knee; Knee Injuries; Knee Joint; Ligaments, Articular; Male; Medial Collateral Ligament, Knee; Rabbits; Wound Healing
PubMed: 20439679
DOI: 10.2106/JBJS.I.01229 -
Knee Surgery, Sports Traumatology,... Apr 2017This article reviews the evidence for the roles of the anterolateral soft-tissue structures in rotatory stability of the knee, including their structural properties,... (Review)
Review
This article reviews the evidence for the roles of the anterolateral soft-tissue structures in rotatory stability of the knee, including their structural properties, isometry, and contributions to resisting tibial internal rotation. These data then lead to a biomechanical demonstration that the ilio-tibial band is the most important structure for the restraint of anterolateral rotatory instability. Level of evidence V.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Biomechanical Phenomena; Humans; Joint Deformities, Acquired; Joint Instability; Knee Joint; Ligaments, Articular; Rotation
PubMed: 28299387
DOI: 10.1007/s00167-017-4494-x -
JBJS Reviews Jun 2020The femoral attachment of the anterolateral ligament (ALL) of the knee is still under debate, but the tibial attachment is consistently between Gerdy's tubercle and the... (Review)
Review
The femoral attachment of the anterolateral ligament (ALL) of the knee is still under debate, but the tibial attachment is consistently between Gerdy's tubercle and the fibular head. The structure is less identifiable and more variable in younger patients. The ALL likely plays a role in rotational stability, but its impact on anterior stability is less clear. Numerous ALL reconstruction techniques have been described. Biomechanical analysis of these techniques has not shown clear benefits, but this literature is limited by the heterogeneity of techniques, graft choices, and study methodology. Clinical studies of combined anterior cruciate ligament (ACL) and ALL reconstruction are few but promising in lowering the risk of an ACL reinjury. To our knowledge, there are no studies showing the clinical outcomes of combined ACL and ALL reconstruction in pediatric patients, who are at higher risk for ACL graft failure than adults.
Topics: Humans; Knee Injuries; Knee Joint; Ligaments, Articular; Tenodesis; Treatment Outcome
PubMed: 33006459
DOI: 10.2106/JBJS.RVW.19.00136 -
The Journal of Hand Surgery Aug 2015Injury to the scapholunate interosseous ligament is one of the most common causes of carpal instability and can impart considerable compromise to the patient's hand... (Review)
Review
Injury to the scapholunate interosseous ligament is one of the most common causes of carpal instability and can impart considerable compromise to the patient's hand function. However, the management of scapholunate ligament injuries remains a dynamic concept, especially with regard to the multitude of options and techniques that exist for its surgical treatment. We present a thorough review of scapholunate anatomy and morphology, and the role of the scapholunate articulations in the kinetics and pathomechanics of wrist instability. We also review the current literature on the biomechanical properties of the scapholunate ligament and its subcomponents. A sound understanding of the anatomy and biomechanics of the scapholunate ligament can clarify its instability and may better orient current reconstructive procedures or pioneer better future techniques.
Topics: Carpal Joints; Humans; Ligaments, Articular; Lunate Bone; Range of Motion, Articular; Scaphoid Bone; Wrist Joint
PubMed: 26143029
DOI: 10.1016/j.jhsa.2015.03.032 -
Clinics in Sports Medicine Jan 2018The anterolateral ligament (ALL) is a capsular structure of the knee that is the subject of increasing academic interest. This article reviewed recent ALL literature in... (Review)
Review
The anterolateral ligament (ALL) is a capsular structure of the knee that is the subject of increasing academic interest. This article reviewed recent ALL literature in terms of subject matter and quality. Although current literature focusing on the ALL is small and limited to level 4 and 5 evidence, it is rapidly expanding. Cadaveric studies describing ALL biomechanics are the most common study design, followed by radiographic studies. The methodologic quality of cadaveric studies focusing on the ALL is high. Clinically oriented research pertaining to the diagnosis, therapy, prevalence, or prognosis of injury to the ALL is presently lacking.
Topics: Biomechanical Phenomena; Biomedical Research; Cadaver; Humans; Knee Joint; Ligaments, Articular; Radiography; Research Design
PubMed: 29173553
DOI: 10.1016/j.csm.2017.07.013 -
Foot and Ankle Clinics Sep 2018The subtalar joint is divided into the talocalcaneonavicular and the talocalcaneal joint, separated by a conical interosseous tunnel (canalis and sinus tarsi). The... (Review)
Review
The subtalar joint is divided into the talocalcaneonavicular and the talocalcaneal joint, separated by a conical interosseous tunnel (canalis and sinus tarsi). The talocalcaneonavicular joint is a ball-and-socket articulation (coxa pedis). An important part of the coxa pedis is the spring ligament. The canalis and sinus tarsi are occupied by the roots of the inferior extensor retinaculum, cervical ligament, interosseous talocalcaneal ligament, and anterior talocalcaneal ligament. Three-dimensional motion in the subtalar joint complex (eversion/inversion) is guided by the axial alignment of the talus, calcaneus, and navicular; the ligaments; and the shape of the articular surfaces.
Topics: Humans; Ligaments, Articular; Subtalar Joint
PubMed: 30097077
DOI: 10.1016/j.fcl.2018.04.001 -
Foot and Ankle Clinics Jun 2023Ankle microinstability results from the superior fascicle of anterior talofibular ligament (ATFL) injury and is a potential cause of chronic pain and disability after an... (Review)
Review
Ankle microinstability results from the superior fascicle of anterior talofibular ligament (ATFL) injury and is a potential cause of chronic pain and disability after an ankle sprain. Ankle microinstability is usually asymptomatic. When symptoms appear, patients describe a subjective ankle instability feeling, recurrent symptomatic ankle sprains, anterolateral pain, or a combination of them. A subtle anterior drawer test can usually be observed, with no talar tilt. Ankle microinstability should be initially treated conservatively. If this fails, and because superior fascicle of ATFL is an intra-articular ligament, an arthroscopic procedure is recommended to address.
Topics: Humans; Ankle; Ankle Joint; Joint Instability; Lateral Ligament, Ankle; Ligaments, Articular; Sprains and Strains
PubMed: 37137627
DOI: 10.1016/j.fcl.2023.01.008 -
Clinical Radiology Dec 2020The iliofemoral ligament is strongest ligament of the body. We review the magnetic resonance imaging (MRI) appearances of the iliofemoral ligament, and discuss the... (Review)
Review
The iliofemoral ligament is strongest ligament of the body. We review the magnetic resonance imaging (MRI) appearances of the iliofemoral ligament, and discuss the disease entities that may affect this region.
Topics: Hip Joint; Humans; Ligaments, Articular; Magnetic Resonance Imaging
PubMed: 32718743
DOI: 10.1016/j.crad.2020.06.025 -
Clinics in Sports Medicine Jan 2018With the recent "description" of the anterolateral ligament (ALL) of the knee, its role in controlling rotational stability has reemerged. An improved understanding of... (Review)
Review
With the recent "description" of the anterolateral ligament (ALL) of the knee, its role in controlling rotational stability has reemerged. An improved understanding of the anatomy of the anterolateral complex of the knee has led to an expansion of the literature on the biomechanics of many structures, including the contribution of the iliotibial band and its deep (Kaplan) fibers, the capsulo-osseous layer, the ALL, and the lateral meniscal posterior root to knee stability. This article describes the primary and secondary roles of key anatomic structures at the anterolateral aspect of the knee.
Topics: Biomechanical Phenomena; Cadaver; Humans; Joint Instability; Knee Joint; Ligaments, Articular; Rotation; Terminology as Topic; Tibia
PubMed: 29173555
DOI: 10.1016/j.csm.2017.07.003