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Journal of Experimental Orthopaedics Jul 2020Multiligament injuries of the knee (MLKI), remain an infrequent pathology especially in developed countries compared to mono-ligament lesions. In Colombia, MLKI is... (Review)
Review
Multiligament injuries of the knee (MLKI), remain an infrequent pathology especially in developed countries compared to mono-ligament lesions. In Colombia, MLKI is frequent due to the high accident rate on motorcycles. In the city of Bogota alone, about 160 motorcycle accidents have been estimated daily, being one of the cities that proportionately use this means of transport less compared to small cities. The term MLKI, include all ruptures of two or more major ligaments and therefore it has a broad spectrum of clinical presentation which creates a great challenge for the orthopedists and the surgeons envolved in this topic. The literature is rich in studies level IV but very poor in level I and level II, which generates controversies and little consensus in the diagnosis and treatment of this pathology. However there has been a gradual and better understanding of all factors involved in the treatment of MLKI that has improved the functional results of these knees in our patients, in fact we currently are more precise to achieve accurate diagnosis, evolved from not surgical approach to operate most, applying new anatomical and biomechanical concepts, with specialized and skill surgical techniques with more stable and biocompatible fixation implants, which allow in most cases to initiate an early integral rehabilitation program. Nevertheless due to the complexity and severity of the lesions, in some patients the functional results are poor. The goal of this revision is to identify the most frequent controversies in the diagnosis and treatment of MLKI, defining which of them are agreed according to what is reported in the literature and share some concepts based from the experience of more than 25 years of the senior author (MM) in the management of these injuries. LEVEL OF EVIDENCE: V - Expert Opinion.
PubMed: 32715370
DOI: 10.1186/s40634-020-00260-8 -
Scientific Reports May 2022Currently, there are no effective approaches for differentiating ovarian fibrothecoma (OF) from broad ligament myoma (BLM). This retrospective study aimed to construct a...
Currently, there are no effective approaches for differentiating ovarian fibrothecoma (OF) from broad ligament myoma (BLM). This retrospective study aimed to construct a nomogram prediction model based on MRI to differentiate OF from BLM. The quantitative and qualitative MRI features of 41 OFs and 51 BLMs were compared. Three models were established based on the combination of these features. The ability of the models to differentiate between the two cancers was assessed by ROC analysis. A nomogram based on the best model was constructed for clinical application. The three models showed good performance in differentiating between OF and BLM. The areas under the curve (AUC) of the models based on quantitative and qualitative variables were 0.88 (95% CI: 0.79-0.96) and 0.85 (95% CI: 0.76-0.93), respectively. The combined model designed from the significant variables exhibited the best diagnostic performance with the highest AUC of 0.92 (95% CI: 0.86-0.98). Calibration of the nomogram showed that the predicted probability matched the actual probability well. Analysis of the decision curve demonstrated that the nomogram was clinically useful. Relative T1 value, stone paving sign, enhancement patterns, and ascites were identified as valuable predictors for identifying OF or BLM. The MRI-based nomogram can serve as a preoperative tool to differentiate OF from BLM.
Topics: Broad Ligament; Female; Humans; Magnetic Resonance Imaging; Myoma; Nomograms; Retrospective Studies
PubMed: 35581254
DOI: 10.1038/s41598-022-12218-0 -
Revista de La Facultad de Ciencias... Dec 2023The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging...
The paraovarian or paratubarian cysts are both situated in the broad ligament between the ovary and fallopian tube. The diagnosis of adnexal torsion is challenging since both symptoms and physical examination are nonspecific. In most cases, the patient presents abdominal pain, followed by nausea and vomiting. Imaging tests, such as ultrasound, are very useful to elucidate the cause of the symptoms in those patients.
Topics: Female; Humans; Ovarian Torsion; Cysts; Abdominal Pain
PubMed: 38150207
DOI: 10.31053/1853.0605.v80.n4.40830 -
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 -
Sports Health 2020Distinct from the muscle atrophy that develops from inactivity or disuse, atrophy that occurs after traumatic joint injury continues despite the patient being actively... (Review)
Review
CONTEXT
Distinct from the muscle atrophy that develops from inactivity or disuse, atrophy that occurs after traumatic joint injury continues despite the patient being actively engaged in exercise. Recognizing the multitude of factors and cascade of events that are present and negatively influence the regulation of muscle mass after traumatic joint injury will likely enable clinicians to design more effective treatment strategies. To provide sports medicine practitioners with the best strategies to optimize muscle mass, the purpose of this clinical review is to discuss the predominant mechanisms that control muscle atrophy for disuse and posttraumatic scenarios, and to highlight how they differ.
EVIDENCE ACQUISITION
Articles that reported on disuse atrophy and muscle atrophy after traumatic joint injury were collected from peer-reviewed sources available on PubMed (2000 through December 2019). Search terms included the following: OR OR OR AND OR OR OR OR OR .
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 5.
RESULTS
We highlight that (1) muscle atrophy after traumatic joint injury is due to a broad range of atrophy-inducing factors that are resistant to standard resistance exercises and need to be effectively targeted with treatments and (2) neurological disruptions after traumatic joint injury uncouple the nervous system from muscle tissue, contributing to a more complex manifestation of muscle loss as well as degraded tissue quality.
CONCLUSION
Atrophy occurring after traumatic joint injury is distinctly different from the muscle atrophy that develops from disuse and is likely due to the broad range of atrophy-inducing factors that are present after injury. Clinicians must challenge the standard prescriptive approach to combating muscle atrophy from simply prescribing physical activity to targeting the neurophysiological origins of muscle atrophy after traumatic joint injury.
Topics: Anterior Cruciate Ligament Injuries; Cytokines; Exercise; Humans; Muscle Fibers, Skeletal; Muscle Proteins; Muscle, Skeletal; Muscular Atrophy; Myostatin; Proteolysis; Satellite Cells, Skeletal Muscle
PubMed: 32866081
DOI: 10.1177/1941738120944256 -
Scandinavian Journal of Medicine &... Aug 2014Relaxin is a hormone structurally related to insulin and insulin-like growth factor, which exerts its regulatory effect on the musculoskeletal and other systems through... (Review)
Review
Relaxin is a hormone structurally related to insulin and insulin-like growth factor, which exerts its regulatory effect on the musculoskeletal and other systems through binding to its receptor in various tissues, mediated by different signaling pathways. Relaxin alters the properties of cartilage and tendon by activating collagenase. This hormone is also involved in bone remodeling and healing of injured ligaments and skeletal muscle. In this review, we have summarized the literature on the effect of relaxin in musculoskeletal system to provide a broad perspective for future studies in this field.
Topics: Bone and Bones; Cartilage; Humans; Ligaments; Muscle, Skeletal; Relaxin; Signal Transduction; Synovial Membrane; Tendons
PubMed: 24283470
DOI: 10.1111/sms.12149 -
Current Reviews in Musculoskeletal... Mar 2019Injury to the ulnar collateral ligament is the most common, significant injury affecting the medial elbow of the overhead athlete. However, there are many other... (Review)
Review
PURPOSE OF REVIEW
Injury to the ulnar collateral ligament is the most common, significant injury affecting the medial elbow of the overhead athlete. However, there are many other significant sources of pathology that should be considered. This review seeks to present a broad range of conditions that providers should consider when evaluating the overhead athlete with medial elbow pain.
RECENT FINDINGS
Recent biomechanical studies have deepened understanding of the anatomy and function of the anterior bundle of the ulnar collateral ligament germane to the overhead athlete. Orthobiologics hold potential for expanding the role of non-operative treatment for ulnar collateral ligament injuries. In addition to injury to the ulnar collateral ligament, providers should be prepared to diagnose and treat valgus extension overload, proximal olecranon stress fracture, ulnar nerve pathology, common flexor - pronator mass injury, and, in adolescents, medial epicondylar avulsion, when managing medial elbow pain in the overhead athlete.
PubMed: 30739248
DOI: 10.1007/s12178-019-09534-w -
Veterinary World Oct 2023The association between bacterial DNA in stifle joints, including those with cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), and...
BACKGROUND AND AIM
The association between bacterial DNA in stifle joints, including those with cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), and osteoarthritis in dogs remains elusive. This study investigated the potential association between the detection of bacterial DNA and osteoarthritis in dogs using a broad-range polymerase chain reaction technique targeting the 16S ribosomal RNA gene.
MATERIALS AND METHODS
Synovial fluid (35 samples) and knee tissue samples (32 samples) were obtained from 35 dogs diagnosed with CCLR (n = 20; 11 males and nine females) or MPL (n = 15; five males and 10 females) who underwent a surgical operation between October 2014 and April 2015.
RESULTS
Dogs with CCLR had a higher average osteoarthritis score than those with MPL (2.0 ± 0.9 vs. 0.5 ± 0.9; p = 0.005). Bacterial DNA was detected in the stifle joints of 60.71% of dogs with MPL. spp. (25.00%), spp. (17.86%), and 5 other species (17.86%) were the most frequently identified bacteria. Bacterial DNA was detected in 41.03% of dogs with CCLR. spp. (15.38%), spp. (10.26%), spp. (5.13%), and 4 other species (10.26%) were the most frequently identified bacteria. No significant difference was observed in the prevalence of bacterial DNA obtained from tissue samples (46.88%) or joint fluid samples (51.43%). The presence of bacterial DNA was not associated with the type of knee injury (MPL or CCLR; p = 1.000). There was a higher prevalence of bacterial DNA in samples from dogs with moderate-to-severe osteoarthritis (94.44%) than in those with minimal osteoarthritis (41.18%), and a significant association between the presence of bacterial DNA and moderate-to-severe osteoarthritis was identified (p < 0.01).
CONCLUSION
Dogs with moderate-to-severe osteoarthritis were more likely to have bacterial DNA in their stifle joints than those with no or minimal osteoarthritis. These findings provide valuable insight into the potential role of bacterial DNA in joint tissue or joint fluid and the development of osteoarthritis in dogs.
PubMed: 38023283
DOI: 10.14202/vetworld.2023.2049-2054 -
Case Reports in Women's Health Jan 2017Broad ligament pregnancy is also known as inter ligamentous pregnancy which is a rare form of ectopic pregnancy. Very few successful live births have been reported in...
Broad ligament pregnancy is also known as inter ligamentous pregnancy which is a rare form of ectopic pregnancy. Very few successful live births have been reported in this condition, where such pregnancies reached term and with live birth of a baby. A case of 28 year old primigravida of 35 weeks gestation with oligoamnios was referred to our hospital. A right broad ligament pregnancy was confirmed after an ultrasound and an MRI. She was taken up for surgery and an incision was given on the anterior leaf of the broad ligament and a male live fetus was extracted. Placenta was found on the posterior leaf of the broad ligament and it was removed without any undue haemorrhage. Uterus was lying medial to the sac and was around ten weeks in size. Both mother and baby were discharged on seventh postoperative day in good health condition.
PubMed: 29593985
DOI: 10.1016/j.crwh.2016.10.003 -
Therapeutics and Clinical Risk... 2022Paraovarian cysts (POCs) develop within the broad ligament of the uterus. POCs are considered to be giant when the threshold of 150 mm is exceeded. Clinical signs and... (Review)
Review
Paraovarian cysts (POCs) develop within the broad ligament of the uterus. POCs are considered to be giant when the threshold of 150 mm is exceeded. Clinical signs and symptoms occur as a consequence of the pressure effect on adjacent organs or due to complications. Abdominal ultrasonography, computed tomography or magnetic resonance imaging are useful imaging tools, but most often the exact origin of such voluminous cysts is revealed only by surgical exploration. The review aims to appraise and update the diagnostic, the histological aspects and the treatment of the giant POCs in rare cases. We carried out a systematic search in Medline-PubMed, Google Scholar and ResearchGate electronic databases. Twenty-seven papers fulfilling the selection criteria were included in the review. The data extracted included information about first author, year of publication, country, patient age, size and side of the POCs, symptoms, tumoral markers, imaging methods, preoperative diagnosis, surgical management and histopathological findings. Although not very numerous, all the studies highlighted the low incidence of giant POCs, the impossibility of establishing the origin of the cystic mass by clinical and imaging methods even with advanced technical tools and the low risk of torsion (11.1%). Despite the recognized benign nature of POCs, we found an unexpected high percent (25.9%) of borderline giant POCs. Surgical excision is the only treatment option. Ovarian-sparing surgery was performed in 85.1% of the cases, and minimally invasive techniques were applied in only 42.9% of the patients, which demonstrates the need of a high-level laparoscopic expertise. Knowledge of this pathology, its recognition as a possible etiology of an abdominopelvic cyst, and a higher awareness of the possibility of a borderline histology in giant POCs are required for the proper management of these particular cases.
PubMed: 35516165
DOI: 10.2147/TCRM.S361476