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The Journal of Bone and Joint Surgery.... Dec 2019➤. Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤. The zona... (Review)
Review
➤. Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤. The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ➤. To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ➤. It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ➤. During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
Topics: Arthroplasty, Replacement, Hip; Cadaver; Dissection; Female; Hip Joint; Humans; Imaging, Three-Dimensional; Joint Capsule; Joint Instability; Male; Orthopedic Procedures; Range of Motion, Articular
PubMed: 31800428
DOI: 10.2106/JBJS.19.00346 -
Regional Anesthesia and Pain Medicine May 2018The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in...
BACKGROUND AND OBJECTIVES
The knee joint is the most common site of osteoarthritis. While joint replacement is considered an ultimate solution, radiofrequency denervation may be contemplated in some cases. Radiofrequency ablation requires precise localization of the articular branches innervating the joint capsule. The objective of this cadaveric study was to determine the source, course, relationships, and frequency of articular branches innervating the anterior knee joint capsule.
METHODS
Fifteen knees were meticulously dissected. The number and origin of the articular branches were recorded, and their distribution defined by quadrants. Their relationships to anatomical landmarks were identified.
RESULTS
The articular branches terminated in 1 of the 4 quadrants with minimal overlap. In all specimens, the superolateral quadrant was innervated by the nerve to vastus lateralis, nerve to vastus intermedius, superior lateral genicular and common fibular nerves; inferolateral by the inferior lateral genicular and recurrent fibular nerves; superomedial by the nerve to vastus medialis, nerve to vastus intermedius and superior medial genicular nerve; and inferomedial by the inferior medial genicular nerve. In 3 specimens, the inferomedial quadrant also received innervation from the infrapatellar branch of saphenous nerve. All articular branches except the nerves to vastus lateralis and medialis course at the periosteal level.
CONCLUSIONS
The frequency map of the articular branches provides an anatomical basis for the development of new clinical protocols for knee radiofrequency denervation and perioperative pain management.
Topics: Aged; Aged, 80 and over; Anatomic Landmarks; Female; Humans; Joint Capsule; Knee Joint; Male; Radiofrequency Ablation; Ultrasonography, Interventional
PubMed: 29557887
DOI: 10.1097/AAP.0000000000000778 -
Surgical and Radiologic Anatomy : SRA Dec 2019Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee...
BACKGROUND
Despite their emerging therapeutic relevance, there are many discrepancies in anatomical description and terminology of the articular nerves supplying the human knee capsule. This cadaveric study aimed to determine their origin, trajectory, relationship and landmarks for therapeutic purpose.
METHODS
We dissected 21 lower limbs from 21 cadavers, to investigate the anatomical distribution of all the articular nerves supplying the knee joint capsule. We identified constant genicular nerves according to their anatomical landmarks at their entering point to knee capsule and inserted Kirschner wires through the nerves in underlying bone at those target points. Measurements were taken, and both antero-posterior and lateral radiographs were obtained.
RESULTS
The nerve to vastus medialis, saphenous nerve, anterior branch of obturator nerve and a branch from sciatic nerve provide substantial innervation to the medial knee capsule and retinaculum. The sciatic nerve and the nerve to the vastus lateralis supply sensory innervation to the supero-lateral aspect of the knee joint while the fibular nerve supplies its infero-lateral quadrant. Tibial nerve and posterior branch of obturator nerve supply posterior aspect of knee capsule. According to our findings, five constant genicular nerves with accurate landmarks could be targeted for therapeutic purpose.
CONCLUSION
The pattern of distribution of sensitive nerves supplying the knee joint capsule allows accurate and safe targeting of five constant genicular nerves for therapeutic purpose. This study provides robust anatomical foundations for genicular nerve blockade and radiofrequency ablation.
Topics: Aged; Aged, 80 and over; Anatomic Landmarks; Arthralgia; Cadaver; Catheter Ablation; Dissection; Female; Humans; Joint Capsule; Knee Joint; Male; Nerve Block; Obturator Nerve; Peroneal Nerve; Quadriceps Muscle; Radiography; Sciatic Nerve; Ultrasonography, Interventional
PubMed: 31338537
DOI: 10.1007/s00276-019-02291-y -
Journal of Anatomy Jun 1994The joint capsule is vital to the function of synovial joints. It seals the joint space, provides passive stability by limiting movements, provides active stability via... (Review)
Review
The joint capsule is vital to the function of synovial joints. It seals the joint space, provides passive stability by limiting movements, provides active stability via its proprioceptive nerve endings and may form articular surfaces for the joint. It is a dense fibrous connective tissue that is attached to the bones via specialised attachment zones and forms a sleeve around the joint. It varies in thickness according to the stresses to which it is subject, is locally thickened to form capsular ligaments, and may also incorporate tendons. The capsule is often injured, leading to laxity, constriction and/or adhesion to surrounding structures. It is also important in rheumatic disease, including rheumatoid arthritis and osteoarthritis, crystal deposition disorders, bony spur formation and ankylosing spondylitis. This article concentrates on the specialised structures of the capsule--where capsular tissues attach to bone or form part of the articulation of the joint. It focuses on 2 joints: the rat knee and the proximal interphalangeal (PIP) joint of the human finger. The attachments to bone contain fibrocartilage, derived from the cartilage of the embryonic bone rudiment and rich in type II collagen and glycosaminoglycans. The attachment changes with age, when type II collagen spreads into the capsular ligament or tendon, or pathology--type II collagen is lost from PIP capsular attachments in rheumatoid arthritis. Parts of the capsule that are compressed during movement adapt by becoming fibrocartilaginous. Such regions accumulate cartilage-like glycosaminoglycans and may contain type II collagen, especially in aged material.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Aging; Animals; Humans; Joint Capsule; Joint Diseases; Rats
PubMed: 7928639
DOI: No ID Found -
Journal of the American Veterinary... May 1997Present knowledge of the complexity of joint diseases makes it difficult to investigate the causes and early pathogenesis of canine hip dysplasia. Clinical signs of... (Review)
Review
Present knowledge of the complexity of joint diseases makes it difficult to investigate the causes and early pathogenesis of canine hip dysplasia. Clinical signs of canine hip dysplasia including joint laxity may be a result of primary or secondary alterations of the joint. We already know that joint laxity is related to effusive synovitis (ie, accumulation of synovial fluid) and to other primary collagenous diseases. Canine hip dysplasia may be a third collagenous disease associated with joint laxity. This paper summarizes some of the studies that investigated the relationship between joint laxity and a defect in collagen metabolism and the influence that alterations in transsynovial flow have on joint laxity.
Topics: Animals; Biomarkers; Biomechanical Phenomena; Breeding; Collagen; Dogs; Hip Dysplasia, Canine; Humans; Joint Capsule; Joint Instability; Peptide Fragments; Permeability; Procollagen; Synovial Fluid
PubMed: 9154198
DOI: No ID Found -
Anatomical Record (Hoboken, N.J. : 2007) Dec 2019This observational study was conducted to evaluate the anatomic relationship between the proximocaudal femoral joint capsule insertion and the femoral caudolateral...
This observational study was conducted to evaluate the anatomic relationship between the proximocaudal femoral joint capsule insertion and the femoral caudolateral curvilinear osteophyte (CCO), across ancient and modern domestic and non-domestic canids. Museum specimens of proximal femora were screened for presence of remnant enthesophytes of the caudal joint capsule insertion (first inclusion criterion) and then for the CCO (second inclusion criterion). The initially screened population included 267 dry bone specimens: Six Canis species, hybrid coyote × domestic dog, and five vulpines (three Vulpes species, one Urocyon, and one Nyctereutes). Proximocaudal joint capsule insertion remnant enthesophytes were limiting at n = 19 specimens: Seven ancient domestic dogs, four modern coyotes, two ancient coyotes, two modern hybrid coyote × dog, two modern red foxes, and two modern raccoon dogs. The joint capsule enthesophytes are associated with inflammation, but are observed far less frequently than the CCO. The CCO is seen radiographically but is visible more frequently by direct inspection. The primary inclusion criterion necessarily was a visible caudal joint capsule insertion; spatial relationships of the CCO can be assigned with confidence only when a capsule insertion line can be recognized clearly. We demonstrate that the anatomic CCO associates with the joint capsule insertion being nonspecific and species-independent. A joint capsule insertion-CCO spatial relationship across species is an important new observation, strongly indicating that both are pathological features. Our data indicate need for new research to characterize the canid coxofemoral joint and its overt and incipient pathology in a phylogenetic context. Anat Rec, 302:2164-2170, 2019. © 2019 American Association for Anatomy.
Topics: Animals; Coyotes; Dogs; Femur; Foxes; Hip Joint; Joint Capsule
PubMed: 31433562
DOI: 10.1002/ar.24231 -
Ultrasound in Medicine & Biology Dec 2023The aim of the work described here was to investigate the efficacy and potential mechanisms of low-intensity pulsed ultrasound (LIPUS) for the treatment of arthrogenic...
OBJECTIVE
The aim of the work described here was to investigate the efficacy and potential mechanisms of low-intensity pulsed ultrasound (LIPUS) for the treatment of arthrogenic contracture induced by immobilization in rabbits.
METHODS
The left knee joint of rabbits was immobilized for 6 wk to establish the model of extending knee joint contracture. The rabbits were divided into a control group (C), a group immobilized for 6 wk (IM-6w), a group remobilized for 1 wk (RM-1w), a group subjected to LIPUS intervention for 1 wk (LIPUS-1w), a group remobilized for 2 wk (RM-2w) and a group subjected to LIPUS intervention for 2 wk (LIPUS-2w). The degrees of arthrogenic contracture and joint capsule fibrosis were assessed, as were the levels of reactive oxygen species (ROS) and the activation status of the TGF-β1/Smad signaling pathway in the joint capsule.
RESULTS
After immobilization for 6 wk, the degrees of arthrogenic contracture and joint capsule fibrosis increased. The ROS level increased, as evidenced by an increase in malondialdehyde content and a decrease in superoxide dismutase content. In addition, the TGF-β1/Smad signaling pathway was significantly activated. The degrees of knee joint contracture increased in the first week after remobilization and decreased in the second week. Furthermore, joint capsule fibrosis continued to develop during the 2 wk of remobilization, and the ROS level increased, while the TGF-β1/Smad signaling pathway was significantly activated. LIPUS effectively reduced the level of ROS in the joint capsule, which further inhibited activation of the TGF-β1/Smad signaling pathway, thereby improving joint capsule fibrosis and reducing arthrogenic contracture.
CONCLUSION
The high ROS levels and overactivation of the TGF-β1/Smad signaling pathway may be reasons why immobilization induces knee joint capsule fibrosis. LIPUS can alleviate the degree of knee joint capsule fibrosis induced by immobilization by inhibiting the production of ROS and the activation of the TGF-β1/Smad signaling pathway.
Topics: Animals; Rabbits; Contracture; Fibrosis; Joint Capsule; Knee Joint; Reactive Oxygen Species; Signal Transduction; Transforming Growth Factor beta1; Ultrasonic Waves; Smad Proteins
PubMed: 37714800
DOI: 10.1016/j.ultrasmedbio.2023.08.014 -
Anatomia, Histologia, Embryologia Nov 2020Both cats and dogs belong to animals with the same type of limb support but have different nature of movement. Despite belonging to digitigrade animals, cats and dogs...
Both cats and dogs belong to animals with the same type of limb support but have different nature of movement. Despite belonging to digitigrade animals, cats and dogs have a different nature of motion. While moving, the medial joint surface in cats and lateral surface in dogs carry the larger pressure. The aim of the study was to compare the similar surfaces of the cat's and dog's tarsal joint capsule and to detect differences in its histostructure and vascularisation. For the study, we used the capsule of the tarsal joint of five cats and five dogs dissected with accordance to anatomical surfaces. Sections of the capsule joint were stained with haematoxylin-eosin. The sections were examined with a microscope at magnification ×250 and ×400. The statistical analysis of the results was done using Student's t test. During the research, a difference in histostructure and vascularisation of tarsal joint capsule in cats and dogs on respective surfaces were found. The medial surface of the tarsal joint capsule was the most saturated with hemomicrocirculatory bed structures in cats, whereas this was the lateral surface in dogs. The most active metabolic processes also take place in these areas of the joint capsule, which is important to know when prescribing therapeutic procedures and determining an optimal surgical access.
Topics: Animals; Cats; Dogs; Joint Capsule; Movement; Tarsal Joints
PubMed: 32602572
DOI: 10.1111/ahe.12589 -
BMC Veterinary Research May 2021Capsulitis leads to the release of inflammatory mediators in the joint, causing capsular fibrosis and osteoarthritis (OA). Strain elastosonography (SE) measures the...
BACKGROUND
Capsulitis leads to the release of inflammatory mediators in the joint, causing capsular fibrosis and osteoarthritis (OA). Strain elastosonography (SE) measures the elasticity of tissue by evaluating its strain in operator-dependent deformation. The aims of the study were to assess the feasibility, repeatability, and reproducibility of SE for imaging the distal attachment of the joint capsule (DJC) of metacarpophalangeal joints in sound horses (Group S) and in horses with metacarpophalangeal OA (Group P) and to evaluate differences in the elastosonographic patterns of these horses. After a whole lameness examination, fore fetlock DJCs were assigned to Group S and Group P and were thereafter examined by two operators using SE. Qualitative (i.e., colour grading score) and semi-quantitative (i.e., elasticity index (EI) and strain ratio (SR)) methods were used to evaluate the elastograms. The inter-rater reliability (IRR), intraclass correlation coefficient (intra-CC) and interclass correlation coefficient (inter-CC) were used to compare colour grading scores and the repeatability and reproducibility of EI and SR outcomes. The same parameters were compared between groups. P < 0.05 indicated a significant finding.
RESULTS
Forty-one horses were included: 11 were in Group S and 30 were in Group P (16 with bilateral OA, 8 with left OA and 6 with right OA). IRR outcomes ranged from good to excellent. For transverse and longitudinal ultrasound scans, the colour grading score of Group S was significantly higher than the metacarpophalangeal DJCs of Group P. Both Inter-CC and intra-CC were higher in Group S than in Group P, with values always > 0.8. Significative differences in EI and SR were detected between groups and between Group S and the affected limb of Group P; values were lower in Group S than in Group P.
CONCLUSIONS
SE can be a useful technique for evaluating DJCs, with good repeatability and reproducibility. DJCs appear softer in sound horses.
Topics: Animals; Elasticity Imaging Techniques; Feasibility Studies; Female; Horse Diseases; Horses; Joint Capsule; Lameness, Animal; Male; Osteoarthritis; Prospective Studies; Reproducibility of Results
PubMed: 34051815
DOI: 10.1186/s12917-021-02897-8 -
The Journal of Knee Surgery Jan 2020This study aimed to develop a rabbit model of knee contracture in extension and investigate the natural history of motion loss and time-dependent changes in the joint...
This study aimed to develop a rabbit model of knee contracture in extension and investigate the natural history of motion loss and time-dependent changes in the joint capsule after immobilization. We immobilized the unilateral knee joints of 32 rabbits by maintaining the knee joint in a plaster cast at full extension. Eight rabbits were euthanized at 2, 4, 6, and 8 weeks after casting, respectively, and the lower extremities were disarticulated at the hip joint. Eight control group rabbits that did not undergo immobilization were also examined. We assessed the progression of joint contracture by measuring the joint range of motion, evaluating the histologic alteration of the capsule, and assessing the mRNA levels of transforming growth factor β1 (TGF-β1) in the anterior and posterior joint capsules. After 2 weeks of joint immobilization, the knee joint range of motion was limited, the synovial membrane of the suprapatellar and posterior joint capsules was thickened, the collagen deposition was increased, and the mRNA levels of TGF-β1 were elevated in the anterior and posterior joint capsules. These changes progressed rapidly until 6 weeks of immobilization and may advance slowly after 6 weeks. Joint contracture developed at the early stage of immobilization and progressed over time. The changes in the anterior and posterior joint capsules after joint immobilization may contribute to the limitation in flexion. The elevated mRNA expression of TGF-β1 may be related to joint capsule fibrosis and may be one of the causes of joint contracture.
Topics: Animals; Arthrometry, Articular; Casts, Surgical; Collagen; Contracture; Disease Models, Animal; Disease Progression; Fibrosis; Hindlimb; Hindlimb Suspension; Immobilization; Joint Capsule; Male; RNA, Messenger; Rabbits; Range of Motion, Articular; Synovial Membrane; Transforming Growth Factor beta1
PubMed: 30562834
DOI: 10.1055/s-0038-1676502