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Medicine Jan 2022Reconstruction of the medial patellofemoral ligament (MPFL) is an effective surgical method for the treatment of lateral patellar instability. At present, there is not... (Review)
Review
INTRODUCTION
Reconstruction of the medial patellofemoral ligament (MPFL) is an effective surgical method for the treatment of lateral patellar instability. At present, there is not much controversies regarding the femoral attachment, however, the controversies regarding patellar attachment versus attachment, number of graft strands, tension, isometry and so on. The following electronic databases will be searched: PubMed, the Cochrane Library, Embase, Web of Science, Medline. We will consider articles published between database initiation and March 2021. MPFL in the subject heading will be included in the study. Language is limited to English. Research selection, data extraction, and research quality assessment were independently completed by 2 researchers.
CONCLUSIONS
MPFL reconstruction is a reliable technique for the treatment of patellofemoral instability. The Schöttle point is still the mainstream method for locating the femoral attachment, the patellar attachment for single-bundle is located at the junction of the proximal one third and the distal two third of the longitudinal axis of the patella. For double-bundles, one is located in the proximal one third of the medial patellar edge and another is in the center of the patellar edge. Meanwhile, the adjustment of graft tension during operation is very important.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Patella; Patellar Dislocation; Patellofemoral Joint
PubMed: 35029909
DOI: 10.1097/MD.0000000000028511 -
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 -
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 -
Foot and Ankle Clinics Jun 2021The most common injury mechanism for ankle fractures with concomitant deltoid ligament injury is a supination external rotation type 4 trauma. In the acute setting,... (Review)
Review
The most common injury mechanism for ankle fractures with concomitant deltoid ligament injury is a supination external rotation type 4 trauma. In the acute setting, malalignment, ecchymosis, and profound edema of the affected ankle can be found. Clinical examination is a poor indicator for deltoid ligament injury. There is a lack of high-quality studies with suturing the deltoid as the primary question. The authors found 4 comparative studies that found it unnecessary to explore and to reconstruct the deltoid ligament and 4 comparative studies that find it unnecessary to explore and to reconstruct the deltoid ligament.
Topics: Ankle Fractures; Ankle Injuries; Humans; Ligaments, Articular; Rupture; Supination
PubMed: 33990258
DOI: 10.1016/j.fcl.2021.03.009 -
Orthopaedics & Traumatology, Surgery &... Oct 2018Long-term follow-up of patients with adhesive capsulitis (AC) reveals that approximately half of them suffer from a limited range of shoulder motion, particularly...
Long-term follow-up of patients with adhesive capsulitis (AC) reveals that approximately half of them suffer from a limited range of shoulder motion, particularly external and/or internal rotation. We report the surgical technique and short-term clinical outcomes of ultrasound-guided release of the thickened coracohumeral (CH) ligament in 8 patients (9 shoulders) with AC. Passive external rotation with the arm by the side significantly increased from an average of 18° preoperatively to 47° immediately after CH ligament release. VAS and ASES scores were improved at 3months follow-up in all 9 shoulders, and maintained at 6months follow-up in 6 shoulders. No procedure-related adverse events developed over the 6-month follow-up period. Ultrasound-guided release for thickened CH ligament is a reliable and effective minimally invasive surgery for persistent limited external rotation due to AC of the shoulder.
Topics: Adult; Aged; Bursitis; Coracoid Process; Female; Humans; Humerus; Ligaments, Articular; Male; Middle Aged; Range of Motion, Articular; Rotation; Shoulder Joint; Shoulder Pain; Surgery, Computer-Assisted; Ultrasonography
PubMed: 29567320
DOI: 10.1016/j.otsr.2018.01.016 -
Hand Clinics Aug 2015Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal... (Review)
Review
Carpal instability is a complex array of maladaptive and posttraumatic conditions that lead to the inability of the wrist to maintain anatomic relationships under normal loads. Many different classification schemes have evolved to explain the mechanistic evolution and pathophysiology of carpal instability, including 2 of the most common malalignment patterns: volar intercalated segment instability and the more common dorsal intercalated segment instability. Recent classifications emphasize the relationships within and between the rows of carpal bones. Future research is likely to unify the disparate paradigms used to describe wrist instability.
Topics: Biomechanical Phenomena; Bone Malalignment; Carpal Bones; Carpal Joints; Humans; Joint Instability; Ligaments, Articular
PubMed: 26205700
DOI: 10.1016/j.hcl.2015.04.011 -
Journal of Foot and Ankle Research Jul 2020This study aimed to clarify the morphological characteristics of the Lisfranc ligament and the cuneiform 1-metatarsal 2&3 plantar ligament (CMPL).
BACKGROUND
This study aimed to clarify the morphological characteristics of the Lisfranc ligament and the cuneiform 1-metatarsal 2&3 plantar ligament (CMPL).
METHODS
Forty legs from 20 cadavers were examined. Classification proceeded according to the number of fiber bundles in the Lisfranc ligament and the CMPL. Morphological features measured were fiber bundle length, width, thickness, and angle.
RESULTS
In Type I-a, the Lisfranc ligament and the CMPL were a single fiber bundle; in Type I-b, the Lisfranc ligament was a single fiber bundle, and the CMPL was two fiber bundles; in Type II-a, the Lisfranc ligament was a two fiber bundle, and the CMPL was a single fiber bundle; in Type II-b, the Lisfranc ligament and the CMPL were two fiber bundles; in Type III-a, the Lisfranc ligament was three fiber bundles, and the CMPL was a single fiber bundle; in Type III-b, the Lisfranc ligament was three fiber bundles, and the CMPL was two fiber bundles; in Type IV, the Lisfranc ligament and the CMPL could not be separated. Type I-a was seen in 37.5%, Type I-b in 10%, Type II-a in 30%, Type II-b in 7.5%, Type III-a in 7.5%, Type III-b in 2.5%, and Type IV in 5%. The Lisfranc ligament was significantly larger than the CMPL in total fiber bundle width, total fiber bundle thickness, and total fiber bundle angle.
CONCLUSION
The Lisfranc ligament had up to 3 fiber bundles and the CMPL had one or two fiber bundles; classifications were four types and two subgroups.
Topics: Cadaver; Female; Foot; Foot Injuries; Humans; Ligaments, Articular; Male; Metatarsus; Plantar Plate; Tarsal Bones
PubMed: 32677989
DOI: 10.1186/s13047-020-00412-0 -
Surgical and Radiologic Anatomy : SRA Feb 2022The spring ligament complex (SL) is the chief static stabilizer of the medial longitudinal foot arch. The occurrence of normal anatomical variants may influence...
PURPOSE
The spring ligament complex (SL) is the chief static stabilizer of the medial longitudinal foot arch. The occurrence of normal anatomical variants may influence radiological diagnostics and surgical treatment. The aim of this study was to evaluate anatomical variants of the part of SL located inferior to the talar head (i-SL), medioplantar oblique ligament (MPO) and inferoplantar longitudinal ligament (IPL).
METHODS
We included 220 MRI examinations of the ankle performed on a 3.0 T engine. Only patients with a normal SL were included. Two musculoskeletal radiologists assessed the examinations and Cohen's kappa was used to assess agreement. Differences between groups were assessed using the chi-squared test; p < 0.05 was considered as significant. The final decision was made by consensus.
RESULTS
Most commonly, i-SL was composed of the two ligaments IPL and MPO n = 167 (75.9%); in this group, bifid ligaments occurred in 19.2%, most commonly in the MPO. A branch to the os cuboideum was seen in n = 17 (10.2%). Three ligaments were seen in n = 52 (23.6%). In this group, bifid ligaments occurred in 13.5%; most commonly, the IPL was bifid and a branch to the os cuboideum was noted in n = 6 (11.5%). In one case, n = 1 (0.04%), we identified MPO, IPL and two accessory ligaments. No significant relationship was noted between the number of ligaments, the presence of bifid ligaments and side or gender (p > 0.05).
CONCLUSION
More than two aligaments were seen in 24.1% of examined cases, the most common variant was the presence of MPO, IPL and one accessory ligament.
Topics: Ankle; Foot; Humans; Ligaments, Articular; Longitudinal Ligaments; Magnetic Resonance Imaging
PubMed: 34800154
DOI: 10.1007/s00276-021-02860-0 -
Canadian Association of Radiologists... Nov 2016One of the most common knee injuries is ligament tear, which may initially manifest as an osseous injury in radiographs. Radiologists should therefore be able to... (Review)
Review
One of the most common knee injuries is ligament tear, which may initially manifest as an osseous injury in radiographs. Radiologists should therefore be able to recognize ligament tears of the knee as osseous abnormalities in images. This review focuses on the imaging features of knee ligament injuries and their related osseous injuries: anterior cruciate ligament (ACL) tear with Segond fracture; associated marrow contusion; ACL avulsion fracture; posterior cruciate ligament (PCL) tear with osseous avulsion of the ligament including arcuate sign; reverse Segond fracture; PCL avulsion fracture; medial collateral ligament tear with Pellegrini-Stieda disease; lateral collateral ligament tear with avulsion fracture of the fibular head; and patellar ligament injuries with Osgood-Schlatter and Sinding-Larsen-Johansson.
Topics: Femur; Fibula; Humans; Knee Joint; Ligaments, Articular; Magnetic Resonance Imaging; Patella; Radiography; Rupture; Tibia
PubMed: 27499452
DOI: 10.1016/j.carj.2016.02.002 -
Journal of Digital Imaging Dec 2022Several studies have investigated the relationship between the thickness of the posterior meniscofemoral ligament (pMFL) and the presence of a discoid meniscus. We...
Several studies have investigated the relationship between the thickness of the posterior meniscofemoral ligament (pMFL) and the presence of a discoid meniscus. We investigated the correlation between meniscal pathology and anatomic features of pMFL such as attachment type, thickness, and volume. We retrospectively evaluated 191 patients who underwent knee MRI. MR images were reviewed to assess the attachment type of the pMFL on the medial femoral condyle (high vs. low), the thickness of the pMFL, and the presence of a meniscal tear or a discoid meniscus. The pMFL volume was quantified by using three-dimensional (3D) segmentation software. The relationship between the frequency of medial or lateral meniscal tear and anatomic features of pMFL were analyzed using Chi-square, Fisher's exact, or Mann-Whitney U test. High type pMFLs had significantly greater thickness and volume than low type pMFLs (p < 0.001). Patients with degenerative lateral meniscal tear had significantly higher thickness and volume of the pMFL than patients with intact lateral meniscus (p < 0.05). The pMFL thickness and volume were not significantly related to traumatic lateral meniscal tear, medial meniscal tear, and discoid meniscus. High type pMFLs tended to be thicker and larger than low type pMFLs and higher thickness and volume of the pMFL was significantly related to the degenerative lateral meniscal tear. However, the attachment type of the pMFL itself was not significantly related to the lateral meniscal tear as well as the medial meniscal tear.
Topics: Humans; Tibial Meniscus Injuries; Retrospective Studies; Menisci, Tibial; Ligaments, Articular; Knee Joint; Magnetic Resonance Imaging
PubMed: 35668218
DOI: 10.1007/s10278-022-00651-6