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Journal of Orthopaedic Surgery and... Jan 2022This study examined the biomechanics of preventing excessive internal hip joint rotation related to the hip flexion angle.
BACKGROUND
This study examined the biomechanics of preventing excessive internal hip joint rotation related to the hip flexion angle.
METHOD
An intramedullary nail with a circular plate equipped with a protractor was installed in the femur of nine normal hips. The circular plate was pulled by 3.15 Nm of force in the internal rotation direction. The external rotators were individually resected, finally cutting the ischiofemoral ligament. The cutting order of the external rotators differed on each side to individually determine the internal rotation resistance. The external rotators were resected from the piriformis to the obturator externus in the right hips and the reverse order in the left hips. Traction was performed after excising each muscle and ischiofemoral ligament. Measurements were taken at 0°, 30°, and 60° of hip flexion, and the differences from baseline were calculated.
RESULTS
For the right hip measurements, the piriformis and ischiofemoral ligament resection significantly differed at 0° of flexion (p = 0.02), each external rotator and the ischiofemoral ligament resections significantly differed at 30° of flexion (p < 0.01), and the ischiofemoral ligament and piriformis and inferior gemellus resections significantly differed at 60° of flexion (p = 0.04 and p = 0.02, respectively). In the left hips, the ischiofemoral ligament and obturator externus, inferior gemellus, and obturator internus resections significantly differed at 0° of flexion (p < 0.01, p < 0.01, and p = 0.01, respectively), as did each external rotator and the ischiofemoral ligament resections at 30° of flexion (p < 0.01).
CONCLUSION
The ischiofemoral ligament primarily restricted the internal rotation of the hip joint. The piriformis and obturator internus may restrict internal rotation at 0° and 60° of flexion.
Topics: Aged; Aged, 80 and over; Biomechanical Phenomena; Cadaver; Female; Hip; Hip Joint; Humans; Ligaments, Articular; Male; Range of Motion, Articular
PubMed: 34983573
DOI: 10.1186/s13018-021-02873-w -
The British Journal of Radiology Jan 2020To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate... (Observational Study)
Observational Study
OBJECTIVE
To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate examination protocol.
METHODS
Patients with an acute ankle injury who presented to the John Radcliffe Hospital Emergency Department with a normal radiographic examination were eligible for the study. They were invited to receive a cone beam CT and ultrasound examination at a local radiology department within 5 days of their ankle injury.
RESULTS
Of the 100 patients recruited to the study, 19 patients were found to have major fractures and 42 patients had small avulsion fractures. Additionally, 42 patients had ankle effusions and there were a large number of soft tissue injuries. There were 83 acute injuries of the anterior talofibular ligament, 19 of the anterior tibiofibular ligaments, 26 of the calcaneofibular ligament, 39 of the deltoid ligament complex, 21 of the talonavicular ligament, 14 of the spring ligament and 3 of the calcaneocuboid ligament.
CONCLUSION
Conventional radiographic examination misses significant fractures of the foot and ankle and the presence of an ankle effusion does not relate to the severity of injury. Ultrasound is a useful imaging technique that can supplement clinical practice, but it is unlikely to replace current protocols alone. Cone beam CT is an appropriate alternative to plain radiography, being more sensitive in detecting fractures and delivering a similar dose of radiation. However, neither CT or ultrasound examination can detect all avulsion fractures. Simple anterior process fractures of the calcaneus are associated with talonavicular ligament injuries and the medial ligaments are injured in almost 50% of cases when there is a lateral ligament injury.
ADVANCES IN KNOWLEDGE
Fractures in the foot and ankle are detected more precisely with cone beam CT compared to radiographs. Cone beam CT delivers similar doses of to conventional radiographs which is around 10% of that resulting from conventional CT. Ultrasound examination is an effective assessment tool to detect ligamentous injuries. The absence of an ankle effusion does not exclude a major fracture.
Topics: Adolescent; Adult; Aged; Ankle Injuries; Cone-Beam Computed Tomography; Female; Fractures, Bone; Humans; Ligaments, Articular; Male; Middle Aged; Prospective Studies; Soft Tissue Injuries; Ultrasonography
PubMed: 31742428
DOI: 10.1259/bjr.20180989 -
Medical Science Monitor : International... Apr 2021BACKGROUND The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on...
Anatomy and Correlation of the Coracoid Process and Coracoclavicular Ligament Based on Three-Dimensional Computed Tomography Reconstruction and Magnetic Resonance Imaging.
BACKGROUND The anatomy of the coracoid process and coracoclavicular (CC) ligament have been described and the correlation between them has been assessed based on 3-dimensional computed tomography (CT) reconstruction and magnetic resonance imaging (MRI), which provide a guide for coracoclavicular ligament reconstruction. MATERIAL AND METHODS Data were collected from 300 patients who underwent both CT and MRI of the shoulder joint from January 2017 to January 2019 at the Jiang'an Hospital of Traditional Chinese Medicine. The coracoid process was observed and classified and parameters of the CC ligament were measured according to different corneal types. All of the statistics were collected and classified by 2 radiologists, and average values were determined.Measurements of segments were taken as follows: ab - In the coronal plane, the length of the CC ligament from the central point of the CC ligament at the clavicular attachment to the CC ligament at the center of the CC attachment); ac - The distance from the center point of the CC ligament at the supraclavicular attachment to the acromioclavicular joint; de - In the sagittal plane, the length of the CC ligament from the center of the clavicular attachment to the coracoid attachment point; fg - The maximum diameter of the CC ligament at the anterior and posterior margins of the clavicle attachment; hi - The largest diameter of the CC ligament at the anterior and posterior edge of the coracoid process attachment; dj - The distance of the coracoclavicular ligament from the center point of the coracoid process attachment to the coracoid process tip; kl - The distance in the supraclavicular plane from the coracoclavicular ligament to the subcoracoid process. RESULTS The analysis showed that there are 5 types of coracoid process: gourd (31%), short rod (20%), long rod (22.3%), wedge (10.3%), and water drop (6.3%). There were statistically significant differences between the lengths of the ac and hi segments in the among the wedge and gourd-type and the short rod and water drop-type coracoid processes. There were statistically significant differences between the lengths of the ab, de, and fg segments in the short rod, gourd, and long rod-type coracoid processes. There were statistically significant differences between the lengths of the ac, fg, hi, dj, and kl segments in the water drop, gourd, and long rod-type coracoid processes. CONCLUSIONS The present study indicated that measurement of the CC ligament and the different shapes of the coracoid process provide an anatomical basis for the diagnosis and treatment of shoulder diseases and the data can be used to improve the safety of CC ligament reconstruction.
Topics: Acromioclavicular Joint; Adult; Clavicle; Coracoid Process; Female; Humans; Imaging, Three-Dimensional; Ligaments, Articular; Magnetic Resonance Imaging; Male; Retrospective Studies; Shoulder Joint; Tomography, X-Ray Computed
PubMed: 33947821
DOI: 10.12659/MSM.930435 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Aug 2018To review the influencing factors of medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. (Review)
Review
OBJECTIVE
To review the influencing factors of medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation.
METHODS
The literature of MPFL reconstruction for patellar dislocation at home and abroad in recent years were summarized and analyzed.
RESULTS
The influencing factors such as the location of the femoral insertion point, the tension and the fixed angle of the grafts, the dysplasia of the femoral trochlear before operation, the abnormal tuberositas tibiae-trochlear groove value, the high position of the patellar, and the tilting angle of the patellar, are all the factors affecting the effectiveness of MPLF reconstruction.
CONCLUSION
During MPFL reconstruction, the surgical techniques and elimination of other factors that caused patellar instability need to be focused in order to reduce the complications and operation failure.
Topics: Humans; Joint Instability; Knee Joint; Ligaments, Articular; Patella; Patellar Dislocation; Patellar Ligament; Plastic Surgery Procedures
PubMed: 30238733
DOI: 10.7507/1002-1892.201710049 -
The British Journal of Radiology Jul 2021Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies... (Review)
Review
Pathologies of the posterior labrocapsular structures of the shoulder joint are far less common than anterior labrocapsuloligamentous lesions. Most of these pathologies have been associated with traumatic posterior dislocation. A smaller portion of the lesions include posterior extension of superior labral anteroposterior lesions, posterior superior internal impingement, and damage to the posterior band of the inferior glenohumeral ligament. Labrocapsular anatomic variations of the posterior shoulder joint can mimic labral pathology on conventional MR and occasionally on MR arthrographic images. Knowledge of this variant anatomy is key to interpreting MR images and studying MR arthrography of the posterior labrocapsular structure to avoid misdiagnosis and unnecessary surgical procedures. In this article, we review normal and variant anatomy of the posterior labrocapsular structure of the shoulder joint based on MR arthrography and discuss how to discriminate normal anatomic variants from labrocapsular damage.
Topics: Anatomic Variation; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Ligaments, Articular; Magnetic Resonance Imaging; Shoulder Injuries; Shoulder Joint
PubMed: 33989028
DOI: 10.1259/bjr.20201230 -
British Journal of Sports Medicine Mar 1997
Review
Topics: Ankle Injuries; Biomechanical Phenomena; Braces; Clinical Protocols; Humans; Joint Instability; Ligaments, Articular; Physical Examination; Rupture
PubMed: 9132202
DOI: 10.1136/bjsm.31.1.11 -
BMC Musculoskeletal Disorders Nov 2017Isolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate...
BACKGROUND
Isolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability.
METHODS
Five fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction.
RESULTS
Lateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions.
CONCLUSION
The direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.
Topics: Biomechanical Phenomena; Cadaver; Elbow Joint; Female; Humans; Joint Dislocations; Joint Instability; Ligaments, Articular; Male; Middle Aged; Pronation; Radius; Plastic Surgery Procedures; Rotation
PubMed: 29157249
DOI: 10.1186/s12891-017-1829-1 -
Journal of Orthopaedic Surgery (Hong... Jan 2017The purpose of this study was to analyze the dynamic motion of the first carpometacarpal (CMC) ligaments on a three-dimensional (3-D) surface model and to examine the...
PURPOSE
The purpose of this study was to analyze the dynamic motion of the first carpometacarpal (CMC) ligaments on a three-dimensional (3-D) surface model and to examine the changes in the ligament lengths during the motion of the first CMC joint.
METHODS
Six fresh-frozen cadaver wrists were used to analyze the motion of the first CMC ligaments on a 3-D coordinate system using a digitizer. Four ligaments, namely, dorsoradial ligament (DRL), posterior oblique ligament (POL), superficial anterior oblique ligament (SAOL), and deep anterior oblique ligament (dAOL), were dissected and identified. Their attachments were digitized and represented on 3-D bone images. The distances between the ligament attachments of the first metacarpal and the trapezium, which were the ligament lengths, were measured during the extension-flexion and adduction-abduction of the first CMC joint.
RESULTS
Both the DRL and POL lengthened during flexion of the first CMC joint, and both the SAOL and dAOL lengthened during extension. Both the DRL and SAOL lengthened during adduction, and both the POL and dAOL lengthened during abduction. The DRL alone lengthened significantly at flexion and adduction when the first CMC joint was in dorsoradial dislocation.
CONCLUSIONS
The lengths of four ligaments changed significantly during first CMC joint motion. This study suggested that the DRL contributes substantial stability to the first CMC joint, preventing dorsoradial dislocation. This 3-D information improves the knowledge and understanding of the function of individual ligaments and their roles in the stability of the first CMC joint.
Topics: Aged; Cadaver; Carpometacarpal Joints; Female; Humans; Imaging, Three-Dimensional; Ligaments, Articular; Male; Middle Aged; Range of Motion, Articular
PubMed: 28142349
DOI: 10.1177/2309499016684752 -
Journal of Anatomy Aug 2018The anterolateral ligament, a distinct structure connecting the lateral femoral epicondyle to the anterolateral proximal tibia, is gaining attention because of its...
The anterolateral ligament, a distinct structure connecting the lateral femoral epicondyle to the anterolateral proximal tibia, is gaining attention because of its possible function in ensuring internal rotational stability of the tibia. To study the prevalence and precise anatomical characteristics of the anterolateral ligament and its relationship to adjacent structures in a Chinese population, a total of 20 amputated knee specimens were collected. The anterolateral regions of the knees underwent detailed surgical dissection, followed by precise measurement of the anterolateral ligament and its adjacent structures. Histological analysis of the anterolateral ligament was performed using hematoxylin and eosin (H&E) staining. A thin soft tissue deep to the iliotibial band running obliquely across the lateral fibula ligament and connecting the lateral head of the gastrocnemius with the tibia, termed the 'gastrocnemius-tibial ligament' or superficial layer of the anterolateral ligament, was observed in 18 of the 20 specimens, corresponding to a prevalence of 90%. Furthermore, a well-defined anterolateral ligament deep to the gastrocnemius-tibial ligament and distinct from the lateral fibula ligament was found in all 20 knees (prevalence, 100%). The independent gastrocnemius-tibial ligament and anterolateral ligament had separate femoral originations at the lateral head of the gastrocnemius and the lateral femoral epicondyle, and the same osseous tibial insertion at the midpoint between Gerdy's tubercle and the most lateral aspect of the fibular head. H&E staining showed that both the anterolateral ligament and gastrocnemius-tibial ligament were ligaments consisting of collagenous bundles. In the Chinese Han population, the gastrocnemius-tibial ligament and anterolateral ligament may form a complex at the anterolateral aspect of the knee, which is likely involved in ensuring the internal rotational stability of the tibia.
Topics: Adult; Aged; Anatomic Variation; Asian People; Female; Humans; Knee Joint; Ligaments, Articular; Male; Middle Aged
PubMed: 29797320
DOI: 10.1111/joa.12826 -
PloS One 2014Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was...
Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1-C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal.
Topics: Cerebrospinal Fluid; Cervical Vertebrae; Epidural Space; Female; Humans; Ligaments; Ligaments, Articular; Male
PubMed: 25084162
DOI: 10.1371/journal.pone.0103451