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Ugeskrift For Laeger Sep 2017First-time patellar luxation appears typically in teenagers and young adults below the age of 16 years, with a prevalence of 45/100,000/year. This luxation is treated... (Review)
Review
First-time patellar luxation appears typically in teenagers and young adults below the age of 16 years, with a prevalence of 45/100,000/year. This luxation is treated with brief limited mobility in a bandage, and with a complementary physiotherapy if the mobility is influenced afterwards. Risk factors for patellar instability are patellofemoral dysplasia, hyperlaxity, patella alta and valgus malalignment in the knee joint. In case of repeated luxation the treatment is surgical, i.e. reconstruction of the medial patellofemoral ligament recreating the medial patella-stabilizing structures. If the dysplasia is severe, tuberositas tibiae-osteotomy and trochlea plastic can correct a lateral tracking of the knee joint. Generally, patella-stabilizing surgery is successful with a reluxation rate of only a few per cent.
Topics: Adolescent; Humans; Joint Instability; Ligaments, Articular; Magnetic Resonance Imaging; Patellar Dislocation; Patellofemoral Joint; Recurrence; Treatment Outcome
PubMed: 28918784
DOI: No ID Found -
Journal of Orthopaedic Research :... Dec 2022An adequate soft tissue balance is important in total hip arthroplasty (THA). This study assessed the contribution of the iliofemoral ligament, ischiofemoral ligament,...
An adequate soft tissue balance is important in total hip arthroplasty (THA). This study assessed the contribution of the iliofemoral ligament, ischiofemoral ligament, and conjoined tendon to the range of hip rotation after THA and hip stability in response to axial traction. THA was performed in eight fresh-frozen cadaveric specimens via an anterolateral approach using a navigation system. The ischiofemoral ligament, the medial arm of the iliofemoral ligament, and the conjoined tendon were resected in that order. The ranges of external and internal rotation and the amount of movement of the femoral head in response to axial traction were measured with the hip in 10° of extension, the neutral position, and in 10°, 30°, and 60° of flexion. Resection of the medial arm of the iliofemoral ligament significantly increased the range of external rotation in 10° of extension, the neutral position, and in 10°, 30°, and 60° of flexion. The conjoined tendon was the most important inhibitor of internal rotation from 10° of extension to 30° of flexion. Although each single element had a minor role in stabilizing the hip when axial traction was applied, resection of two or more elements significantly affected joint stability. The iliofemoral ligament and conjoined tendon are the main inhibitors of external rotation and internal rotation, respectively, when THA is performed using an anterior or anterolateral approach. Resection of two or more elements could greatly affect hip stability when axial traction is applied.
Topics: Humans; Arthroplasty, Replacement, Hip; Biomechanical Phenomena; Cadaver; Ligaments, Articular; Range of Motion, Articular; Tendons
PubMed: 35266582
DOI: 10.1002/jor.25320 -
Journal of Orthopaedic Surgery and... Sep 2016Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand,... (Review)
Review
BACKGROUND
Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population.
MAIN BODY
The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided.
CONCLUSION
Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
Topics: Athletic Injuries; Cartilage, Articular; Fractures, Bone; Hand Injuries; Humans; Ligaments, Articular; Metacarpal Bones; Return to Sport; Rupture; Scaphoid Bone; Tendinopathy; Ulna; Wrist Injuries
PubMed: 27633260
DOI: 10.1186/s13018-016-0432-8 -
Journal of Orthopaedic Research :... Sep 2021Unfavorable clinical outcomes after medial patellofemoral ligament (MPFL) reconstruction, such as early osteoarthritis of the patellofemoral joint, were considered to be...
Unfavorable clinical outcomes after medial patellofemoral ligament (MPFL) reconstruction, such as early osteoarthritis of the patellofemoral joint, were considered to be associate with tunnel malpositioning. Length change studies have found that small changes in the femoral position can cause great changes in elongation trends. Further studying the MPFL kinematics may help us to understand the consequences of tunnel malpositioning and optimize the reconstruction techniques. Fifteen healthy subjects were studied with a combined computed tomography and biplane fluoroscopic imaging technique during a lunge motion. Five femoral and three patellar attachments were used to simulate different MPFL bundles. Kinematics of MPFL was defined as elongation and orientation changes (i.e., deviation angle and elevation angle). The mean deviation angle was 28.7° (95% confidence interval, 28.0°-29.4°) at full extension and remained nearly unchanged up to 60° of flexion, and increased to 56.5° (54.1°-58.9°) at 110°. The elevation angle decreased linearly from 12.6° (9.3°-15.9°) at full extension to -86.2° (-92.7-79.7°) at 110° of flexion. The MPFL was most stretched anteriorly and laterally relative to femur from full extension to 30° of flexion and remained near isometric beyond 30°. The current study found that proximal and anterior femoral attachments caused excessive lateral stretching of the MPFL at deeper flexion angles. Such abnormal MPFL kinematics may subsequently cause overconstraint and increased cartilage pressures of the medial patellofemoral joint.
Topics: Cadaver; Femur; Humans; Knee Joint; Ligaments, Articular; Patella; Patellofemoral Joint; Range of Motion, Articular
PubMed: 33002242
DOI: 10.1002/jor.24872 -
Journal of ISAKOS : Joint Disorders &... Aug 2023Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material.... (Review)
Review
IMPORTANCE
Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material. During the last decade, LATs have increased in prevalence in clinical practice and academic literature. Observing the trends in LAT publications can be used to identify clusters of strong evidence for clinical practice and to highlight areas of the literature which need further development.
OBJECTIVE
This article aims to define ligament augmentation as a technique category, observe anatomical, procedural, and temporal trends in LAT publication, and report on the state of current research in this field.
EVIDENCE REVIEW
Primary literature in the English language, which describes ligament augmentation and reports on human, cadaveric, or biomechanical models, and published prior to May 24th, 2022, was targeted for analysis. PubMed, Embase, and Cochrane CENTRAL databases were explored using a focused keyword search strategy, and the resulting publications were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected and analysed using descriptive statistics.
FINDINGS
Two hundred eighty-three publications reporting ligament augmentation techniques, published from May 1989 to May 2022, were included for final analysis. A wide technical and anatomical variety of procedures are reported. 36.8% of LAT publications describe knee ligaments, among which the anterior cruciate ligamenthas the highest focus in ligament augmentation publications (31.8% of articles). LAT literature has recently expanded in anatomical scope, with many contemporary articles describing the usage of a LAT in the ankle syndesmosis and coracoclavicular ligaments. 60.4% of LAT literature has been published since 2017. There has been an 11% average increase in the rate of LAT publication reports since 2015. Novel fixation devices-suture buttons and suture anchors-have gained wide popularity in the literature.
CONCLUSIONS AND RELEVANCE
In this review, we define LATs and quantitatively describe the expansion of LAT use reported in the literature. This data will provide physicians an overview of the history of these methods, as well as illustrate the broad range of applications available for the use of LATs.
Topics: Humans; Knee Joint; Ankle Joint; Ligaments, Articular; Suture Anchors
PubMed: 37105381
DOI: 10.1016/j.jisako.2023.04.003 -
Journal of Biomechanics Sep 2023The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional...
The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion-extension, radial-ulnar deviation and dart-thrower's motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.
Topics: Humans; Wrist; Biomechanical Phenomena; X-Rays; Lunate Bone; Scaphoid Bone; Wrist Joint; Ligaments, Articular; Fluoroscopy
PubMed: 37573806
DOI: 10.1016/j.jbiomech.2023.111685 -
Orthopaedics & Traumatology, Surgery &... Feb 2016Various treatments for patellofemoral instability have been proposed, such as lowering or medialization of the tibial tubercle, division of the lateral retinaculum,... (Review)
Review
Various treatments for patellofemoral instability have been proposed, such as lowering or medialization of the tibial tubercle, division of the lateral retinaculum, plication of the medial retinaculum, lowering of the vastus medialis, and trochleoplasty. However, it has been difficult to analyze the outcomes of each technique because they are often performed in combination. Recent anatomical and biomechanical studies have shown that the medial patellofemoral ligament (MPFL) is the primary stabilizer of the patella between full extension and 30° flexion. For this reason, reconstructing this ligament is relevant, reinforced by promising early clinical results. MPFL reconstruction techniques differ in the graft used and the fixation method. They will be described here as a function of their fixation method, either into bone or soft tissue. The technical challenges, advantages and disadvantages of these different techniques are reviewed in detail, along with the postoperative rehabilitation protocol. Strict technique is needed to prevent postoperative complications, with flexion contracture due to excessive graft tension being the most common complication. Recurrence of the instability is rare after surgery, proof of the dependable nature of these reconstruction procedures.
Topics: Contracture; Femur; Humans; Joint Instability; Knee Joint; Ligaments, Articular; Patella; Postoperative Complications; Quadriceps Muscle; Range of Motion, Articular; Plastic Surgery Procedures; Recurrence; Tibia
PubMed: 26797001
DOI: 10.1016/j.otsr.2015.06.030 -
Connective Tissue Research 2012Injuries to connective tissues are painful and disabling and result in costly medical expenses. These injuries often require reattachment of an unmineralized connective... (Review)
Review
Injuries to connective tissues are painful and disabling and result in costly medical expenses. These injuries often require reattachment of an unmineralized connective tissue to bone. The uninjured tendon/ligament-to-bone insertion (enthesis) is a functionally graded material that exhibits a gradual transition from soft tissue (i.e., tendon or ligament) to hard tissue (i.e., mineralized bone) through a fibrocartilaginous transition region. This transition is believed to facilitate force transmission between the two dissimilar tissues by ameliorating potentially damaging interfacial stress concentrations. The transition region is impaired or lost upon tendon/ligament injury and is not regenerated following surgical repair or natural healing, exposing the tissue to risk of reinjury. The need to regenerate a robust tendon-to-bone insertion has led a number of tissue engineering repair strategies. This review treats the tendon-to-bone insertion site as a tissue structure whose primary role is mechanical and discusses current and emerging strategies for engineering the tendon/ligament-to-bone insertion in this context. The focus lies on strategies for producing mechanical structures that can guide and subsequently sustain a graded tissue structure and the associated cell populations.
Topics: Bone and Bones; Cartilage, Articular; Extracellular Matrix; Fibrocartilage; Humans; Ligaments, Articular; Stress, Mechanical; Tendon Injuries; Tendons; Tissue Engineering; Weight-Bearing; Wound Healing
PubMed: 22185608
DOI: 10.3109/03008207.2011.650804 -
The Kurume Medical Journal Mar 2022This paper aimed to better describe the anatomy of the superficial anterior atlanto-occipital ligament of the craniocervical junction and discuss this ligament's... (Review)
Review
This paper aimed to better describe the anatomy of the superficial anterior atlanto-occipital ligament of the craniocervical junction and discuss this ligament's potential function and clinical implications. A broad literature review on the anatomical features and findings of the superficial anterior atlanto-occipital ligament was performed. The superficial anterior atlanto-occipital ligament is located anterior to the anterior atlanto-occipital membrane. However, the physiological role of the superficial anterior atlanto-occipital ligament is still unclear due to a lack of anatomical and biomechanical studies although one study has suggested that this ligament is a secondary stabilizer of the craniocervical junction. Further studies are needed to clarify the function and anatomy of the superficial anterior atlanto-occipital ligament.
Topics: Atlanto-Occipital Joint; Humans; Ligaments, Articular
PubMed: 35095017
DOI: 10.2739/kurumemedj.MS671005 -
The American Journal of Sports Medicine Dec 2012The adverse effects of smoking on various health conditions such as cancer, diabetes, and cardiovascular disease have been well documented. Many orthopaedic conditions,... (Review)
Review
BACKGROUND
The adverse effects of smoking on various health conditions such as cancer, diabetes, and cardiovascular disease have been well documented. Many orthopaedic conditions, such as fracture healing, wound repair, and bone mineral density, have been reported to be adversely affected by smoking. However, no known systematic reviews have investigated the effects of smoking on ligament and cartilage knee surgery.
PURPOSE
We hypothesized that smoking would have a negative influence from both a basic science and clinical outcome perspective on these types of knee surgeries.
STUDY DESIGN
Systematic review.
METHODS
A systematic review of multiple medical databases was performed evaluating clinical and basic science studies to determine the effects of smoking on ligament and cartilage knee surgery.
RESULTS
Fourteen studies were found for inclusion and analysis. Eight of these studies addressed the relationship between smoking and knee ligaments, and 6 investigated the relationship between smoking and articular cartilage. With the exception of 1, all of the basic science and clinical studies exploring the relationship between smoking and knee ligaments found a negative association of smoking, either molecularly, biomechanically, or clinically. One basic science and 3 clinical studies found a negative influence of smoking on articular cartilage of the knee. No studies were found that investigated the relationship of smoking and menisci.
CONCLUSION
The current literature reveals a negative influence of smoking on the results of knee ligament surgery, both from a basic science and clinical perspective, implying that smoking cessation would benefit patients undergoing these procedures. The association between smoking and knee articular cartilage was less clear, although the literature still suggests an overall negative influence and highlights the need for further investigation.
Topics: Cartilage, Articular; Humans; Knee Injuries; Ligaments, Articular; Smoking
PubMed: 22972849
DOI: 10.1177/0363546512458223