WorldWideScience

Sample records for broad ligament mimicking

  1. Broad ligament ectopic pregnancy

    OpenAIRE

    Rama C; Lepakshi G; Raju SN

    2015-01-01

    Pregnancy in the broad ligament is a rare form of ectopic pregnancy with a high risk of maternal mortality. Ultrasonography may help in the early diagnosis but mostly the diagnosis is established during surgery. We report the case of a patient with broad ligament ectopic pregnancy diagnosed intraoperatively. The patient had uneventful postoperative recovery.

  2. Rare case of giant broad ligament fibroid with myxoid degeneration

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    R R Godbole

    2012-01-01

    Full Text Available Giant fibroids are known to arise from the uterus, although very rarely from extra-uterine sites. Among extra-uterine fibroids, broad ligament fibroids generally achieve enormous size and generally present with pressure symptom like bladder and bowel dysfunction. Myxoid degeneration is a rare complication of benign fibroid, where presence of cystic changes mimics the metastatic malignant ovarian tumor. We report a case of true broad ligament fibroid measured about 13 kg. This case is reported for its rarity and the diagnostic difficulties in differentiating malignant ovarian tumor and benign fibroid with myxoid degeneration.

  3. Extra Ovarian Serous Cystadenocarcinoma in the Broad Ligament ...

    African Journals Online (AJOL)

    The embryonic remnants of the gonadal ridge and the genital duct apparatus, the Mullerian apparatus, remain atretic throughout the life of a woman. The definitive organs arising from these, the Ovary, Fallopian tubes, Uterus, Cervix and the Broad ligaments share common coelomic origin. Epithelial metaplasia in any of ...

  4. Post abortal broad ligament. abscess: report of a case

    African Journals Online (AJOL)

    infrequently with endotoxic shock, pelvic abscess, anaemia. cervical incompetence, chronic pelvic pain, ectopic pregnancy and infertility. Deaths from unsafe abortions are principally attributed to haemorrhage, anaemia, sepsis and renal failure. 7'8. Broad ligament abscess is rare. lntraligamentous haematoma is however ...

  5. Mesothelial Cyst of the Round Ligament Mimicking a Metastasis: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bo Mi; Lee, Ji Young; Han, Yoon Hee; Kim, Su Young; Seo, Jung Wook; Kim, Yong Hoon; Cha, Soon Joo; Hur, Gham; Joo, Mee; Lee, Eung Soo [Ilsan Paik Hospital, Inje University, School of Medicine, Goyang (Korea, Republic of)

    2010-06-15

    A mesothelial cyst of the round ligament is a rare cause of an inguinal mass. Clinically, it is frequently misdiagnosed as one of commoner diseases such as an inguinal hernia, femoral hernia, lipoma, and lymphadenopathy upon physical examination. Some previous reports elaborated the sonographic features of a mesothelial cyst of the round ligament. However, to our knowledge, few reports have described the CT features of a mesothelial cyst. We illustrated here the sonographic and multidetector CT features of a case of a mesothelial cyst of the round ligament that presented as an inguinal palpable mass and mimicked a metastasis in a patient with a Sertoli-Leydig cell tumor of the ovary.

  6. Full term viable secondary broad ligament pregnancy – A rare case

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    CH. Sheethal, Dr.

    2017-01-01

    Full Text Available 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.

  7. A postmenopausal woman with sciatica from broad ligament leiomyoma: a case report.

    Science.gov (United States)

    Tsai, Ya-Chu May

    2016-10-31

    Unilateral lower abdominal pain and/or sciatic nerve pain is a common presentation in the elderly population. The prevalence of broad ligament leiomyoma is <1 % with the prevalence declining after the menopause and it is rare for broad ligament leiomyomas to be clinically significant. Thus, we highlight a case of symptomatic broad ligament leiomyoma in a postmenopausal woman whose symptoms improved after definitive treatment. A 62-year-old postmenopausal Macedonian woman was referred to our gynecological department with unexplained pain in her left leg and left iliac fossa region on walking. There was minimal relief with increasing analgesia use prescribed by the family physician. Investigations revealed an ipsilateral adnexal mass and subsequent treatment with laparoscopic broad ligament myomectomy helped to alleviate her symptoms. Our case highlights the importance of staying mindful of alternate diagnoses when presented with a common presentation of iliac fossa pain and pain in the leg. Although broad ligament leiomyomas are benign tumors, the uncommon symptomatic presentation led us to report and focus some attention on this type of tumor.

  8. Leiomyosarcoma of the Broad Ligament With Fever Presentation: A Case Report and Review of Literature.

    Science.gov (United States)

    Chaichian, Shahla; Mehdizadehkashi, Abolfazl; Tahermanesh, Kobra; Moazzami, Bahram; Jesmi, Fatemeh; Rafiee, Moezedinjavad; Goharimoghaddam, Katayoun

    2016-04-01

    Leiomyosarcoma is a rare gynecologic malignancy that accounts for less than 1% of gynecological malignancies. Leiomyosarcoma of the broad ligament is an even rarer condition. According to Gardner's criteria, the diagnosis is made when the mass is completely separated from the uterus and adnexa. So far, 23 cases of primary leiomyosarcoma of the broad ligament have been reported in the literature published in English. In September 2014, a 55-year-old, gravida 3, para 3 woman with a BMI of 30 and a chief complaint of fever and dizziness was admitted to the infectious-diseases ward of the Pars general hospital affiliated with Iran University of Medical Sciences in Tehran, Iran. Her symptoms had begun two weeks before. The results of a fever workup and examination for infectious, metabolic, and immunologic problems were all negative. Imaging modalities revealed an endometrial polyp, two calcified myoma in the body of the uterus, and a solid, heterogeneous 70-mm mass in the right para-cervical space, posterior to the broad ligament, and far from the ovary. After surgery, a histologic report revealed leiomyosarcoma. Although a leiomyosarcoma of the broad ligament is rare, practitioners should consider it when dealing with masses in the region of the broad ligament. If there is any suspicion of malignancy, especially in the presence of fever, it is recommended to avoid morcellation during laparoscopy.

  9. Primary leiomyosarcoma of the broad ligament: A case report with review of literature

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    Devika Gupta

    2015-09-01

    Full Text Available Primary leiomyosarcoma of the broad ligament is a very rare and highly malignant tumour with very few cases being reported in literature. They have an aggressive course and occur usually in postmenopausal women. We herein report a rare case of primary leiomyosarcoma of the broad ligament which was diagnosed based on imaging, the classical histomorphological and immunohistochemistry features and subsequently treated by complete surgical resection. Primary leiomyosarcoma of the broad ligament is a rapidly progressive and highly malignant gynaecological tumour. It requires complete surgery (hysterectomy with bilateral salpingoophorectomy for all cases. Adjuvant chemotherapy or radiotherapy is used in selected cases. Low to intermediate grade tumours with no evidence of metastasis are treated surgically only, with advice for a close follow-up.

  10. Mesonephric (Wolffian) Pseudoendometrioid Carcinoma of the Broad Ligament, Arising From a Papillary Cystadenoma.

    Science.gov (United States)

    Moerman, Philippe; Amant, Frederic; Vergote, Ignace

    2016-10-01

    This article describes the case of a 70-year-old woman with an adnexal cystadenocarcinoma located in the right broad ligament and displaying a striking resemblance to a well-differentiated endometrioid adenocarcinoma. The uniqueness of this pseudoendometrioid carcinoma lies in the fact that its mesonephric nature is revealed by the origin from a papillary cystadenoma of the broad ligament, where remnants of the mesonephric duct are seated, and the immunohistochemical profile, particularly a uniform negativity for estrogen and progesterone receptors, apical-luminal positivity for CD10, and strong nuclear positivity for GATA3. © The Author(s) 2016.

  11. A patient presenting with a perivascular epithelioid cell tumor in the broad ligament: a case report

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    Ross Claire

    2011-08-01

    Full Text Available Abstract Introduction Perivascular epithelioid cell tumors are a family of rare mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. They can originate in any visceral organ or soft tissue and include a range of lesions such as angiomyolipoma, clear cell 'sugar' tumor of the lung, lymphangioleiomyomatosis and clear cell myomelanocytic tumors of the falciparum ligament/ligament teres. Due to their rarity and varied sites and presentation, management of these tumors remains highly challenging. Case Presentation A 46-year-old para 2 Caucasian woman initially presented to the general surgeons at our hospital in North West London with abdominal pain. Laparoscopy revealed a right broad ligament hematoma, which was thought to be iatrogenic in origin, from insertion of the Veress needle at the time of surgery, and was managed conservatively. Upon her re-presentation two months later with severe pain, ultrasound scanning revealed the hematoma had increased in size and she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology results from necrotic tissue from the hematoma led to a diagnosis of perivascular epithelioid cell tumor. She was then referred to a tertiary oncology center, where she underwent several further operations in an attempt to debulk the tumor for symptomatic relief of her pain, with limited success. She is now taking the immunosuppressive drug sirolimus, which has produced a modest reduction in tumor size. She is now 47 months on from initial presentation. Conclusions A literature search has revealed only six other case reports of broad ligament perivascular epithelioid cell tumors, with varied presentations and management. The longest duration of follow-up was 21 months. Only five other cases of perivascular epithelioid cell tumor managed with sirolimus have been reported. We therefore feel that this report highlights some of the

  12. Ultrasonographic diagnosis of round ligament varicosities mimicking inguinal hernia: report of two cases with literature review

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Kyeong Hwa; Yoon, Jung Hee [Dept. of Radiology, Inje University Haeundae Paik Hospital, College of Medicine, Busan (Korea, Republic of)

    2014-10-15

    Round ligament varicosities are rare, and the mass mimics an inguinal hernia. Round ligament varicosities should be considered in the differential diagnosis of a groin swelling in a female, especially during pregnancy. The diagnosis of round ligament varicosities can be established on grayscale and color Doppler ultrasonography. We report two cases of round ligament varicosities in a 33-year-old non pregnant woman and a 28-year-old pregnant woman, and these patients were diagnosed using ultrasonography. We also reviewed the literature on round ligament varicosities including the present cases. Ultrasonography is diagnostic and can prevent unnecessary surgical intervention and associated morbidity.

  13. Primary malignant lymphoma of the uterus and broad ligament: a case report and review of literature

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    Chen R

    2015-01-01

    Full Text Available Runzhe Chen, Zhengping Yu, Hongming Zhang, Jiahua Ding, Baoan Chen Department of Hematology and Oncology (Key Department of Jiangsu Medicine, Zhongda Hospital, Medical School, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China Abstract: Primary malignant lymphoma of the uterus and broad ligament is rare. Here, we present a rare case of primary diffuse large B-cell lymphoma (DLBCL of uterus and broad ligament in a 63-year-old female. The patient presenting with lower abdominal distention was referred to our hospital. Subsequent abdominal and pelvic ultrasound revealed the presence of a large mass, which was highly suspected as subserosal uterine leiomyoma. A large tumor was found with unclear boundary with right posterior wall, broad ligament and bilateral adnexa during surgery. Her uterus and the tumor of a broad ligament and bilateral adnexa were all excised as a result. Postoperative pathological examination showed DLBCL in uterus and broad ligament. Further examinations excluded metastatic diseases, which supported the diagnosis of primary DLBCL of the uterus and broad ligament. The patient received six cycles of R-CHOP (21 days regimen. During the 8 months follow-up, no evidence of disease recurrence was identified. As the prevalence of primary extranodal lymphoma is increasing, the details of this rare case may highlight the importance and facilitate treatment of similar diseases. A summary focusing on the presentation and prognosis as well as a review of current management is also discussed. Keywords: diffuse large B-cell lymphoma, primary uterine and broad ligament lymphoma, extranodal lymphoma, diagnosis, therapy

  14. A rare presentation of ruptured interstitial ectopic pregnancy with broad ligament hematoma: A case report

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    Ahmed M. Abbas

    2017-03-01

    Full Text Available Ectopic pregnancy is a major cause of maternal morbidity and mortality in the first trimester. Interstitial type is the most dangerous variety with a high risk of life-threatening internal hemorrhage. Obstetricians need a high index of suspicion to diagnose such rare type. We are reporting a rare case of ruptured interstitial ectopic pregnancy presented with a large broad ligament hematoma early in the first trimester. A 25-year-old woman was presented with gradual onset of increasing abdominal pain after 6 weeks of amenorrhea. She had a positive urinary pregnancy test. Abdominal ultrasound revealed bulky empty uterus and ill-defined mass at the right side of the uterus. On exploration, incision and drainage of broad ligament hematoma were performed in addition to right salpingectomy. Interstitial ectopic pregnancy represents a diagnostic and therapeutic challenge and frequently constitutes an obstetrical emergency. Its rupture early in the first trimester should be expected. Early diagnosis and proper management are the most important issues to avoid its catastrophic consequences.

  15. A case of neuroendocrine carcinoma developing from the broad ligament of the uterus

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    Yui Itonaga

    2017-07-01

    Full Text Available Neuroendocrine carcinoma (NEC, also called small cell carcinoma or large cell carcinoma, is a rare and aggressive tumor that develops mainly in the lung and intestine. More rarely, NEC develops in gynecologic organs, with poor prognoses. We experienced a case of NEC in the broad ligament of the uterus. The patient was a 74-year-old woman with symptoms of abdominal distension and constipation. Ultrasound sonography detected an abdominal tumor larger than 10 cm. She was then admitted to our hospital. She underwent surgery under the diagnosis of ovarian cancer, but the bilateral ovaries and uterus were normal in appearance, and a tumor was developing instead from the broad ligament of the uterus. The patient then received a hysterectomy, salpingo- oophorectomies, and lymphadenectomy, and the peritoneal membrane was stripped around the pelvic space. Despite our suggestion, she never accepted the adjuvant treatment. She discontinued her periodic follow-up with us and was followed in another hospital. Generally, the prognosis of NEC is poor, and there is no established treatment for a tumor in a gynecologic lesion. However, we anticipate that the accumulation of experience treating such cases will eventually lead to a standard treatment for NEC.

  16. Unruptured retroperitoneal pregnancy implanted in the left broad ligament: A case report

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    Kutlešić Ranko M.

    2017-01-01

    Full Text Available Introduction. Retroperitoneal ectopic pregnancy is extremely rare, but potentially fatal condition due to possible massive hemorrhage, representing a great challenge to clinicians. Case report. We presented early retroperitoneal pregnancy in a patient with previous caesarean section, diagnosed at the sixth gestational week, located in the left broad ligament, primary treated by laparoscopy, which had to be converted to laparotomy due to massive intraoperative bleeding from the implantation site. Conclusion. High index of suspicion, combined with carefully interpreted clinical and ultrasound findings are crucial for the timely diagnosis of retroperitoneal pregnancy, before the occurrence of severe bleeding. The rising, even plateau of serum β-human chorionic gonadotropin (β-HCG levels without identification of uterine or ectopic (tubal pregnancy should cause suspicion on ectopic pregnancy in unusual location.

  17. MYOMA OF THE ROUND LIGAMENT MIMICKING THE CLINICAL APPEARANCE OF THE INGUINAL HERNIA – A CASE REPORT

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    Aleš Pišek

    2004-12-01

    Full Text Available Background. Myomas are the most frequent gynecological tumors. They first occur during puberty; however, they are most frequent among aged between 35 and 50. In this age group their incidence is 15–20%. They are rare after menopause. The majority of myomas arise in the uterus, but they may arise from other extrauterine sites such as the fallopian tubes, ovaries, round ligament, ligamentum latum, sacrouterine ligament, vagina and even the urethra. Most authors agree that there are numerous causes for the occurrence of myomas; however, they have not yet been clearly proven. They however agree that the myomas appear most frequently in the reproductive age, when the ovarian hormone levels are high and they diminish after menopause. They equally agree that the risk factors for the clinically significant myomas are nulliparity, obesity, a positive family history of myomas and African racial origin.Patients and methods. A 43-year-old patient was referred to our institution for operative treatment by her personal gynaecologist who clinically and sonografically verified a solid tumor situated to the right side of the uterus. The size of the tumor was that of a newborn’s head. The patient, however, had been observing a reponible inguinal hernia the size of a female fist for a period of four years. A solid tumor (22×6×7 cm arising from the right round ligament, was remowed during surgery. Half of its size was situated in the inguinal canal thus mimicking the clinical appearance of the inguinal hernia. After the tumor was removed the inner door of the inguinal canal closed by itself, no surgical repair was necessary. On histological examination the tumor was classified as a leiomyoma.Conclusions. Although the leiomyoma of the round ligament is the most frequent tumor of that region it is a rare gynecological tumor. The described case is especially interesting due to the unusual position of the tumor. It was situated partly intraabdominally and partly

  18. The Ultrasound Diagnosis of Round Ligament Varices That Mimicked Inguinal Hernias During Pregnancy:A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Hyung Jo; Shin, Hyun Woong; Kim, Seong Hun [Daegu Fatima Hospital, Daegu (Korea, Republic of); Cho, Sang Hee; Byun, Kyung Hwan [CHA Gumi Medical Center, CHA University, Gumi (Korea, Republic of)

    2010-03-15

    Round ligament varices during pregnancy are an important part of the differential diagnosis of inguinal hernia as they may cause symptoms and clinical features that are similar to those of inguinal hernia. When this condition is correctly diagnosed, an unnecessary operation may be prevented. The diagnosis of round ligament varices should be considered for pregnant women who present with a palpable mass in the groin. We describe here a case of round ligament varices that presented during pregnancy and this was readily diagnosed with Doppler sonography

  19. Synthetic RNAs Mimicking Structural Domains in the Foot-and-Mouth Disease Virus Genome Elicit a Broad Innate Immune Response in Porcine Cells Triggered by RIG-I and TLR Activation.

    Science.gov (United States)

    Borrego, Belén; Rodríguez-Pulido, Miguel; Revilla, Concepción; Álvarez, Belén; Sobrino, Francisco; Domínguez, Javier; Sáiz, Margarita

    2015-07-17

    The innate immune system is the first line of defense against viral infections. Exploiting innate responses for antiviral, therapeutic and vaccine adjuvation strategies is being extensively explored. We have previously described, the ability of small in vitro RNA transcripts, mimicking the sequence and structure of different domains in the non-coding regions of the foot-and-mouth disease virus (FMDV) genome (ncRNAs), to trigger a potent and rapid innate immune response. These synthetic non-infectious molecules have proved to have a broad-range antiviral activity and to enhance the immunogenicity of an FMD inactivated vaccine in mice. Here, we have studied the involvement of pattern-recognition receptors (PRRs) in the ncRNA-induced innate response and analyzed the antiviral and cytokine profiles elicited in swine cultured cells, as well as peripheral blood mononuclear cells (PBMCs).

  20. Posterior Cruciate Ligament Injury

    Science.gov (United States)

    Posterior cruciate ligament injury Overview Posterior cruciate ligament (PCL) injury happens far less often than does injury to the knee's more vulnerable counterpart, the anterior cruciate ligament (ACL). The posterior cruciate ...

  1. Gastro-Pancreatic and Gastro-Duodenopancreatic Ligaments: A ...

    African Journals Online (AJOL)

    This paper reports a cadaveric case of two unusual peritoneal structures; namely, the gastro-pancreatic and gastro-duodeno-pancreatic ligaments. The gastropancreatic ligament is a broad peritoneal structure that holds the stomach and the pancreas together and has occasionally been reported while ...

  2. Lateral collateral ligament (image)

    Science.gov (United States)

    The lateral collateral ligament connects the end of the femur (thigh) to the top of the fibula (the thin bone that runs next to the shin bone). The lateral collateral ligament provides stability against varus stress. Varus stress is ...

  3. Ultrasonography of ankle ligaments

    Energy Technology Data Exchange (ETDEWEB)

    Peetrons, P.A. [C.H. Moliere-Longchamp, Dept. of Radiology, Brussels (Belgium); Silvestre, A. [Hopital Militaire Laveran, Dept. of Radiology, Marseilles (France); Cohen, M. [Hoptial Saint-Joseph, Dept. of Radiology, Marseilles (France); Creteur, V. [C.H. Moliere-Longchamp, Dept. of Radiology, Brussels (Belgium)

    2002-02-01

    The lateral collateral ligament of the ankle is a complex of 3 ligaments: The anterior and posterior talofibular ligaments and the calcaneofibular ligament; these ligaments work together to support the lateral aspect of the ankle. The anterior talofibular (ATF) ligament (Fig. 1) runs from the anterior of the talus. The probe is placed in a slightly oblique position from the malleolus toward the forefoot. The ligament is hyperechoic when its fibres are perpendicular to the ultrasound beam (anisotropy artifact is present in ligaments as well as in tendons). It is approximately 2 mm thick and, during examination, must be straight and tight from one insertion point to the other, as seen in Fig. 2. The posterior talofibular (PTF) ligament, which runs from the posterior part of the malleolus to the posterior part of the talus, is difficult to see on US, being partially or sometimes completely hidden by the malleolus. The calcaneofibular ligament forms the middle portion of the lateral collateral ligament. It is tight between the inferior part of the lateral malleolus and the calcaneus, and runs in a slightly posterior oblique direction toward the heel (Fig. 3). The ligament lies on the deep surface of the fibular tendons, forming a hammock to fall deep on the calcaneus surface (Fig. 4). The calcaneofibular ligament is approximately 2-3 nun thick and is hyperechoic in the distal two-thirds only because of the obliquity of the proximal part. When examining this ligament, it is mandatory that the ankle be flexed dorsally; this stretches the ligament so that it can be seen clearly. (author)

  4. Artificial Ligaments: Promise or Panacea?

    Science.gov (United States)

    Lubell, Adele

    1987-01-01

    The Food and Drug Administration has approved a prosthetic ligament for limited use in persons with damaged anterior cruciate ligaments (ACL). This article addresses ligament repair, ACL tears, current treatment, development of the Gore-Tex artificial ligament, other artificial ligaments in process, and arguments for and against their use.…

  5. Hypertrophy of Ligament of Treitz

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    Siddharth P. Dubhashi

    2015-04-01

    Full Text Available Congenital duodenal obstruction commonly occurs due to malrotation, atresia, stenosis and annular pancreas in decreasing order of frequency. This is a case report of a 12 year old male child who presented with complaints of non-projectile vomiting and abdominal distension and pain after meals since 7 years. Barium study showed narrowing of the Duodeno-jejunal(DJ junction due to hypertrophied ligament of Treitz. Exploratory laparotomy revealed a dilated stomach and collapsed bowel loops. There were adhesions at DJ junction and other parts of the small intestine. Adhesiolysis was done. The followup revealed a weight gain of 2 kg. The barium study was repeated which also revealed a normal study. Congenital obstruction of duodeno-jejunal junction due to extrinsic band or due to narrower attachment of ligament of Treitz at duodeno-jejunal flexure is a rare cause of bilious vomiting in the newborn period. A broad attachment of the ligament of Treitz makes a smooth obtuse angle at the duodeno-jejunum junction whereas a narrower insertion creates an acute angle that predisposes to obstruction.Duodenal obstruction may rarely occur in the presence of a normally rotated gut.

  6. Anatomy of the Lateral Ankle Ligaments

    OpenAIRE

    SİNDEL, Muzaffer

    1998-01-01

    The lateral ligaments of talocrural articulation, namely anterior talofibular ligament, posterior talofibular ligament and cal-caneofibular ligament, are important in an-atomic reconstruction. If reconstructed improperly, they are known to limit the movements of talocrural articulation and subtalar articulation (talocalcaneal articulation) Studies on anatomy of anterior talofibular ligament, posterior talofibular ligament and calcaneofibular ligament known as the lateral ligaments ...

  7. Anterior cruciate ligament (ACL) injury

    Science.gov (United States)

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... knee. It prevents the knee from bending out. Anterior cruciate ligament (ACL) is in the middle of the knee. ...

  8. Anterior cruciate ligament repair - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100230.htm Anterior cruciate ligament repair - Series—Normal anatomy To use the sharing ... to slide 5 out of 5 Overview The anterior cruciate ligament (ACL) is a ligament in the center of ...

  9. Torn lateral collateral ligament (image)

    Science.gov (United States)

    ... LCL), is an injury to the lateral collateral ligament, a ligament extending from the top-outside surface of the ... the bottom-outside surface of the femur. The ligament prevents the knee joint from side-to-side ( ...

  10. Torn medial collateral ligament (image)

    Science.gov (United States)

    ... MCL), is an injury to the medial collateral ligament. This ligament extends from the upper-inside surface of the ... the bottom-inside surface of the femur. The ligament prevents the knee joint from medial instability, that ...

  11. [Posterior cruciate ligament injuries].

    Science.gov (United States)

    Schüttler, K F; Ziring, E; Ruchholtz, S; Efe, T

    2017-01-01

    Posterior cruciate ligament (PCL) injuries are still often overlooked and treatment of a ruptured PCL is inherently different in comparison to anterior cruciate ligaments (ACL). Conservative treatment is the first-line therapy for acute isolated PCL injuries leading to good clinical and biomechanical results. Injuries to the PCL combined with rupture of other stabilizing ligaments, such as the collateral ligaments or the posterolateral corner of the knee joint are treated surgically. The same is true for high grade chronic PCL insufficiency. Meticulous classification of PCL injuries taking all stabilizing factors of the knee joint as well as the time from injury into account are essential for successful treatment of PCL injuries.

  12. Tendon and ligament imaging

    Science.gov (United States)

    Hodgson, R J; O'Connor, P J; Grainger, A J

    2012-01-01

    MRI and ultrasound are now widely used for the assessment of tendon and ligament abnormalities. Healthy tendons and ligaments contain high levels of collagen with a structured orientation, which gives rise to their characteristic normal imaging appearances as well as causing particular imaging artefacts. Changes to ligaments and tendons as a result of disease and injury can be demonstrated using both ultrasound and MRI. These have been validated against surgical and histological findings. Novel imaging techniques are being developed that may improve the ability of MRI and ultrasound to assess tendon and ligament disease. PMID:22553301

  13. Urticaria mimickers in children.

    Science.gov (United States)

    Mathur, Anubhav N; Mathes, Erin F

    2013-01-01

    Acute urticaria is a self-limited cutaneous condition marked by transient, erythematous, and pruritic wheals. It is a hypersensitivity response that is often secondary to infection, medications, or food allergies in children. In contrast, the urticarial "mimickers" described in this review article are often seen in the context of fever and extracutaneous manifestations in pediatric patients. The differential diagnosis ranges from benign and self-limited hypersensitivity responses to multisystem inflammatory diseases. Establishing the correct diagnosis of an urticarial rash in a pediatric patient is necessary to both prevent an unnecessary work up for self-limited conditions and to appropriately recognize and evaluate multisystem inflammatory disorders. Herein, we describe two cases to illustrate the clinical manifestations, laboratory findings, histopathology and differential diagnoses for several mimickers of acute urticaria including: urticaria multiforme, serum sickness like reaction, Henoch-Schönlein purpura, acute hemorrhagic edema of infancy, systemic onset juvenile idiopathic arthritis, cryopyrin associated periodic syndromes, and urticarial vasculitis. © 2013 Wiley Periodicals, Inc.

  14. Cruciate ligament reflexes

    DEFF Research Database (Denmark)

    Krogsgaard, Michael R; Dyhre-Poulsen, Poul; Fischer-Rasmussen, Torsten

    2002-01-01

    the anterior cruciate ligament (ACL) was pulled, and tension in the ligament caused activity of the gamma motor neurones of the muscles around the knee. Impulses from the sensory nerves in ACL were activated during motion of the knee, in particular overstretching and combined extension and rotation. In humans......The idea of muscular reflexes elicited from sensory nerves of the cruciate ligaments is more than 100 years old, but the existence of such reflexes has not been proven until the recent two decades. First in animal experiments, a muscular excitation could be elicited in the hamstrings when...... in humans makes it unlikely that it is a directly protective reflex. Instead it may be involved in the updating of motor programs. Further research may characterize the reflex in details and map its pathways. The existence of this reflex indicate that the cruciate ligaments have an afferent function, which...

  15. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Anterior Cruciate Ligament (ACL) Injuries KidsHealth / For Teens / Anterior Cruciate Ligament (ACL) Injuries What's in this article? What Are ...

  16. Ankle ligament injuries

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    Per A.F.H. Renström

    1998-06-01

    Full Text Available Acute ankle ligament sprains are common injuries. The majority of these occur during athletic participation in the 15 to 35 year age range. Despite the frequency of the injury, diagnostic and treatment protocols have varied greatly. Lateral ligament complex injuries are by far the most common of the ankle sprains. Lateral ligament injuries typically occur during plantar flexion and inversion, which is the position of maximum stress on the anterotalofibular liagment (ATFL. For this reason, the ATFL is the most commonly torn ligament during an inversion injury. In more severe inversion injuries the calcaneofibular (CFL, posterotalofibular (PTFL and subtalar ligament can also be injured. Most acute lateral ankle ligament injuries recover quickly with nonoperative management. The treatment program, called "functional treatment," includes application of the RICE principle (rest, ice, compression, and elevation immediately after the injury, a short period of immobilization and protection with an elastic or inelastic tape or bandage, and early motion exercises followed by early weight bearing and neuromuscular ankle training. Proprioceptive training with a tilt board is commenced as soon as possible, usually after 3 to 4 weeks. The purpose is to improve the balance and neuromuscular control of the ankle. Sequelae after ankle ligament injuries are very common. As much as 10% to 30% of patients with a lateral ligament injury may have chronic symptoms. Symptoms usually include persistent synovitis or tendinitis, ankle stiffness, swelling, and pain, muscle weakness, and frequent giving-way. A well designed physical therapy program with peroneal strengthening and proprioceptive training, along with bracing and/or taping can alleviate instability problems in most patients. For cases of chronic instability that are refractory to bracing and external support, surgical treatment can be explored. If the chronic instability is associated with subtalar instability

  17. MORPHOMETRIC STUDY OF MEDIAL COLLATERAL LIGAMENTS OF ANKLE

    Directory of Open Access Journals (Sweden)

    Neelu Prasad

    2016-06-01

    is very poorly understood. The ligament in case of tear or injury has to be repaired which is impossible to do so if a proper morphometric knowledge is not known. So a sincere effort has been put in the study to find the morphometry of the deltoid ligament. METHODS  One hundred specimens were dissected. In this, fifty belonged to the right and fifty belonged to the left side.  The study was done in the Department of Anatomy, Nalanda Medical College, Patna.  The study was done from June 2015 to April 2016.  The morphometry was seen and the comparisons were done.  The dissection was done to expose the deltoid ligament. The anterior, middle and posterior length was taken. Then, the superior, middle and inferior width was taken. Then, the thickness was measured.  Then, the presence or absence of the deep part was noted. RESULTS Irrespective of the side and sex to which the ligaments belong, the mean value of the length of the deltoid ligaments in the anterior, middle and posterior parts are 24.40 mm, 21.53 mm and 17.20 mm. The widths in the superior, middle and inferior parts are 19.94 mm, 22.59 mm and 27.45 mm. The thickness mean measurement is 6.94 mm. Deep Part was found in 100% of cases. The superficial part trapezoid in shape wide anteriorly and narrow posteriorly, also is narrow superiorly where it arises and broad inferiorly where it gets inserted. CONCLUSION The ligaments of the talocrural joint are one of the most difficult ligaments to study. A sincere effort has been put in this study to find the morphometry of ligaments of ankle joint. The same has been studied and reported successfully to help the surgeons to understand and help the needful in a better way.

  18. MR Imaging of Wrist Ligaments.

    Science.gov (United States)

    Ringler, Michael D; Murthy, Naveen S

    2015-08-01

    This article discusses the normal anatomy and pathologic appearances of the intrinsic and extrinsic wrist ligaments using MR Imaging. Technological advances in surface coil design and higher magnetic field strengths have improved radiologists' ability to consistently visualize these small ligaments in their entirety. Wrist ligament anatomy, in the context of proper physiologic function, is emphasized, including common normal variants, and their appearances on MR imaging. The spectrum of disorders, incorporating overlapping appearances of senescent degenerative changes, and destabilizing ligament tears, is outlined. The diagnostic performance of MR imaging to date for various ligament abnormalities is discussed, along with significant limitations. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Hypothyroid myopathy mimicking postpolio syndrome.

    Science.gov (United States)

    Verma, Rajesh; Lalla, Rakesh; Sahu, Ritesh

    2012-08-24

    Hypothyroidism can have diverse neurological manifestations. Myopathy may rarely be the sole manifestation of autoimmune thyroiditis. We hereby report an atypical manifestation of severe hypothyroidism in a middle-aged woman with childhood onset of paralytic polio involving her right leg presenting with a recent onset of increased weakness in the right leg mimicking postpolio syndrome.

  20. Thoracic and lumbar intraforaminal ligaments.

    Science.gov (United States)

    Akdemir, Gökhan

    2010-09-01

    The author conducted a study to investigate the anatomy of the intraforaminal ligaments of the thoracic and lumbar nerve roots and describe their anatomical relationships and functional properties. This anatomical study performed on the intervertebral foramina, intraforaminal ligaments, transforaminal ligaments, and nerve roots of the thoracic and lumbar spine was performed in human cadavers. The foraminal anatomy was studied in 11 whole cadavers (5 females, 6 males) previously prepared with formaldehyde, whose ages at the time of death ranged from 16 to 71 years. The thoracic and lumbar spinal columns were separated from the cervical and sacral segments en bloc using an electric band saw. The paraspinal muscles and their attachments were removed by sharp and meticulous dissection, and the thoracic and lumbar intervertebral foramina were examined under a surgical microscope. The intervertebral foraminal ligaments and nerve roots were exposed. The foraminal contents were identified and studied in detail. The intraforaminal ligaments were stained using H & E to determine ligamentous fiber. Intraforaminal ligaments connect the periosteum and transforaminal ligaments to the nerve root sleeves and vessels within the fatty areolar tissue. Histologically, the ligamentous attachment of the nerve roots within the foramina consists of adipose and connective tissue. The nerve roots are surrounded by intraforaminal ligaments, which may act in conjunction with the dura and periosteum to protect the nerve roots mechanically.

  1. Bioengineered anterior cruciate ligament

    Science.gov (United States)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  2. Coracoclavicular Ligament Reconstruction

    Science.gov (United States)

    Li, Qi; Hsueh, Pei-ling; Chen, Yun-feng

    2014-01-01

    Abstract Operative intervention is recommended for complete acromioclavicular (AC) joint dislocation to restore AC stability, but the best operative technique is still controversial. Twelve fresh-frozen male cadaveric shoulders (average age, 62.8 ± 7.8 years) were equally divided into endobutton versus the modified Weaver-Dunn groups. Each potted scapula and clavicle was fixed in a custom made jig to allow translation and load to failure testing using a Zwick BZ2.5/TS1S material testing machine (Zwick/Roell Co, Germany). A systematic review of 21 studies evaluating reconstructive methods for coracoclavicular or AC joints using a cadaveric model was also performed. From our biomechanical study, after ligament reconstruction, the triple endobutton technique demonstrated superior, anterior, and posterior displacements similar to that of the intact state (P > 0.05). In the modified Weaver-Dunn reconstruction group, however, there was significantly greater anterior (P ligament reconstruction. In addition, there was no significant difference after reconstruction between failure load of the triple endobutton group and that of the intact state (686.88 vs 684.9 N, P > 0.05), whereas the failure load after the modified Weaver-Dunn reconstruction was decreased compared with the intact state (171.64 vs 640.86 N, P ligament is superior to the modified Weaver-Dunn reconstruction in controlling both superior and anteroposterior displacements with a failure load that approximates the intact ligament. PMID:25526435

  3. Incidental Anterior Cruciate Ligament Calcification: Case Report.

    Science.gov (United States)

    Hayashi, Hisami; Fischer, Hans

    2016-03-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding.

  4. Multicystic Hepatocarcinoma Mimicking Liver Abscess

    Directory of Open Access Journals (Sweden)

    Evangelos Falidas

    2013-01-01

    Full Text Available The diagnosis of hepatocellular carcinoma (HCC became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC.

  5. Fragmentation of stretched liquid ligaments

    NARCIS (Netherlands)

    Marmottant, P.G.M.; Villermaux, Emmanuel

    2004-01-01

    The dynamics and fragmentation of stretched liquid ligaments is investigated. The ligaments are produced by the withdrawal of a tube initially dipping at a free surface. Time resolved high speed motion experiments reveal two different elongation behaviors, depending on the nondimensional number t,

  6. Recruitment of knee joint ligaments

    NARCIS (Netherlands)

    Blankevoort, L.; Huiskes, R.; de Lange, A.

    1991-01-01

    On the basis of earlier reported data on the in vitro kinematics of passive knee-joint motions of four knee specimens, the length changes of ligament fiber bundles were determined by using the points of insertion on the tibia and femur. The kinematic data and the insertions of the ligaments were

  7. Anterior cruciate ligament - updating article

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Malheiros Luzo

    2016-08-01

    Full Text Available ABSTRACT This updating article on the anterior cruciate ligament (ACL has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.

  8. The 2010 Broad Prize

    Science.gov (United States)

    Education Digest: Essential Readings Condensed for Quick Review, 2011

    2011-01-01

    A new data analysis, based on data collected as part of The Broad Prize process, provides insights into which large urban school districts in the United States are doing the best job of educating traditionally disadvantaged groups: African-American, Hispanics, and low-income students. Since 2002, The Eli and Edythe Broad Foundation has awarded The…

  9. Propionic acidemia mimicking diabetic ketoacidosis.

    Science.gov (United States)

    Dweikat, Imad M; Naser, Enas N; Abu Libdeh, Abdulsalam I; Naser, Osama J; Abu Gharbieh, Najwan N; Maraqa, Nizar F; Abu Libdeh, Bassam Y

    2011-05-01

    Propionic acidemia manifesting with hyperglycemia is rare. Few cases have been reported mainly of the neonatal-onset form associated with high mortality. We report a 9-month-old Palestinian boy who manifested with coma, severe hyperglycemia and ketoacidosis mimicking diabetic ketoacidosis. Family history of unexplained infant deaths was helpful in reaching the correct diagnosis. In response to therapy, the patient regained consciousness without neurologic deficits and had normal examination. This is, to our knowledge, the first case report of late-onset propionic acidemia that had this presentation and survived. Copyright © 2010 The Japanese Society of Child Neurology. All rights reserved.

  10. Ocular Argyrosis Mimicking Conjunctival Melanoma.

    Science.gov (United States)

    Tendler, Irwin; Pulitzer, Melissa P; Roggli, Victor; Abramson, David H; Marr, Brian P

    2017-06-01

    To present a novel case of ocular argyrosis mimicking conjunctival melanoma. A 48-year-old man who is a jewelry manufacturer presented with raised pigmented lesions in the inferior fornices of both eyes. Brown-black colored, follicle-like, masses were observed in both fornices. An incisional biopsy confirmed the presence of silver and the diagnosis of ocular argyrosis. Despite its limited negative health effects, ocular argyrosis should be considered in the differential diagnosis of conjunctival pigmented lesions because of the potential for misidentification of neoplastic growth.

  11. Oral candidiasis mimicking tongue cancer.

    Science.gov (United States)

    Shibata, Tomohisa; Yamashita, Daisuke; Hasegawa, Shingo; Saito, Miki; Otsuki, Naoki; Hashikawa, Kazunobu; Tahara, Shinya; Nibu, Ken-ichi

    2011-06-01

    Candida species inhabit the mucosal surfaces of healthy individuals. Major forms of oral candidiasis are pseudomembranous and atrophic form, but chronic hyperplastic candidiasis (CHC) is rarely seen. We encountered a nodule caused by candidal infection on a forearm flap in the oral cavity mimicking a recurrent tongue cancer, which revealed as CHC by histopathological examination. Like other forms of oral candidiasis, the nodule well responded to the treatment of antifungal agents and eventually disappeared. When an intraoral nodule is observed, the possibility of CHC should be taken into consideration. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  12. MRI of knee ligament injury and reconstruction.

    Science.gov (United States)

    Farshad-Amacker, Nadja A; Potter, Hollis G

    2013-10-01

    Knee ligament instability may lead to meniscal and chondral damage, resulting in early osteoarthritis. Due to its superior soft tissue contrast and avoidance of harmful ionizing radiation, MRI has become the most important imaging modality for early recognition of structural defects of the knee joint. This review aims to the understanding of MRI appearances of knee ligament structures associated with knee instability, and to review the common patterns of altered knee mechanics that lead to ligament failure. Normal anatomy of the knee ligaments, pathologic conditions, and postsurgical appearances of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and posterolateral corner are described. Copyright © 2013 Wiley Periodicals, Inc.

  13. The anatomy of the coracohumeral ligament and its relation to the subscapularis muscle.

    Science.gov (United States)

    Arai, Ryuzo; Nimura, Akimoto; Yamaguchi, Kumiko; Yoshimura, Hideya; Sugaya, Hiroyuki; Saji, Takahiko; Matsuda, Shuichi; Akita, Keiichi

    2014-10-01

    Only a few reports describe the extension of the coracohumeral ligament to the subscapularis muscle. The purposes of this study were to histo-anatomically examine the structure between the ligament and subscapularis and to discuss the function of the ligament. Nineteen intact embalmed shoulders were used. In 9 shoulders, the expansion of the ligament was anatomically observed, and in 6 of these 9, the muscular tissue of the supraspinatus and subscapularis was removed to carefully examine the attachments to the tendons of these muscles. Five shoulders were frozen and sagittally sectioned into 3-mm-thick slices. After observation, histologic analysis was performed on 3 of these shoulders. In the remaining 5 shoulders, the coracoid process was harvested to investigate the ligament origin. The coracohumeral ligament originated from the horizontal limb and base of the coracoid process and enveloped the cranial part of the subscapularis muscle. The superficial layer of the ligament covered a broad area of the anterior surface of the muscle. Laterally, it protruded between the long head of the biceps tendon and subscapularis and attached to the tendinous floor, which extended from the subscapularis insertion. Histologically, the ligament consisted of irregular and sparse fibers abundant in type III collagen. The coracohumeral ligament envelops the whole subscapularis muscle and insertion and seems to function as a kind of holder for the subscapularis and supraspinatus muscles. The ligament is composed of irregular and sparse fibers and contains relatively rich type III collagen, which would suggest flexibility. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Structural properties of 6 forearm ligaments.

    Science.gov (United States)

    Werner, Frederick W; Taormina, Jennifer L; Sutton, Levi G; Harley, Brian J

    2011-12-01

    To first determine the structural properties of 6 forearm ligaments and then to create linear and nonlinear analytical models of each ligament from these properties. We nondestructively tested the annular ligament, dorsal and palmar radioulnar ligaments, and the distal, central, and proximal bands of the interosseous ligament from 7 fresh cadaver forearms in a servohydraulic testing apparatus. We performed testing with the bone-ligament-bone constructs positioned corresponding to neutral forearm rotation as well as in 45° of supination and 45° of pronation. Based on a mechanical creep test of each ligament, we computed a linear and nonlinear ligament stiffness value for each ligament. We then compared these computed analytical responses to loading with loading data when each ligament was tested at 1.0 and 0.05 mm/s. We analyzed differences among ligaments and forearm positions using 1-way and 2-way analyses of variance. The stiffnesses for the distal band and the dorsal radioulnar ligament were statistically less when the constructs were positioned in supination compared with neutral forearm rotation. At all forearm positions, the linear stiffness of the central band was greater than that for the distal band of the interosseous ligament, the proximal band of the interosseous ligament, and the dorsal radioulnar and palmar radioulnar ligaments. In neutral forearm rotation, the linear stiffness of the central band was statistically greater than the annular ligament. The experimental loading behavior of each ligament was better modeled by a nonlinear stiffness than a linear one. The central band of the interosseous membrane is the stiffest stabilizing structure of the forearm. Any structure used to replace the central band or other forearm ligaments should demonstrate a nonlinear response to loading. In considering a reconstruction for the forearm, the graft used should have a nonlinear response to loading and be one that is similar to the normal, original ligament

  15. Biofabrication of soft tissue templates for engineering the bone-ligament interface.

    Science.gov (United States)

    Harris, Ella; Liu, Yurong; Cunniffe, Grainne; Morrissey, David; Carroll, Simon; Mulhall, Kevin; Kelly, Daniel J

    2017-10-01

    Regenerating damaged tissue interfaces remains a significant clinical challenge, requiring recapitulation of the structure, composition, and function of the native enthesis. In the ligament-to-bone interface, this region transitions from ligament to fibrocartilage, to calcified cartilage and then to bone. This gradation in tissue types facilitates the transfer of load between soft and hard structures while minimizing stress concentrations at the interface. Previous attempts to engineer the ligament-bone interface have utilized various scaffold materials with an array of various cell types and/or biological cues. The primary goal of this study was to engineer a multiphased construct mimicking the ligament-bone interface by driving differentiation of a single population of mesenchymal stem cells (MSCs), seeded within blended fibrin-alginate hydrogels, down an endochondral, fibrocartilaginous, or ligamentous pathway through spatial presentation of growth factors along the length of the construct within a custom-developed, dual-chamber culture system. MSCs within these engineered constructs demonstrated spatially distinct regions of differentiation, adopting either a cartilaginous or ligamentous phenotype depending on their local environment. Furthermore, there was also evidence of spatially defined progression toward an endochondral phenotype when chondrogenically primed MSCs within this construct were additionally exposed to hypertrophic cues. The study demonstrates the feasibility of engineering spatially complex soft tissues within a single MSC laden hydrogel through the defined presentation of biochemical cues. This novel approach represents a new strategy for engineering the ligament-bone interface. Biotechnol. Bioeng. 2017;114: 2400-2411. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  16. Demonstrating the fibular collateral ligament.

    OpenAIRE

    Pridmore, S A

    1980-01-01

    A posture is described which allows palpation of the fibular collateral ligament of the knee as an isolated structure. Visual identification is also possible. This is of interest to the clinician and student of surface anatomy.

  17. Collateral ligament (CL) injury - aftercare

    Science.gov (United States)

    ... twisting injury. Skiers and people who play basketball, football, or soccer are more likely to have this ... PT will teach you exercises to strengthen the muscles, ligaments, and tendons around your knee. As your ...

  18. Cleland's ligaments and Dupuytren's disease.

    Science.gov (United States)

    Shewring, D J; Rethnam, U

    2014-06-01

    The aim of this study was to investigate whether Cleland's ligaments are affected by Dupuytren's disease and assess their contribution to the flexion contracture of the proximal interphalangeal (PIP) joint. Twenty patients with Dupuytren's disease undergoing fasciectomy for a PIP joint contracture > 40° (mean 61°, range 45°-100°) were included. After excision of all other identifiable digital disease, Cleland's ligaments were assessed. If they appeared to be macroscopically affected by Dupuytren's disease they were excised, sent for histological analysis, and any further improvement of PIP joint contracture was recorded. There were 14 males and six females with a mean age of 62 (range 40-79) years. Excision of Cleland's ligaments resulted in a mean further correction of 7° (range 0°-15°). Histological analysis indicated that Cleland's ligament was clearly involved with Dupuytren's disease in 12 patients, indicating that Cleland's ligaments can be affected by Dupuytren's disease. In the remaining specimens the histological findings were equivocal. As these structures are situated dorsal to the neurovascular bundles, a specific dissection has to be undertaken to identify them. Excision of Cleland's ligaments at digital fasciectomy further avoids leaving residual disease and may yield a worthwhile further correction of PIP joint flexion contracture. © The Author(s) 2013.

  19. A Soft Gripper with Rigidity Tunable Elastomer Strips as Ligaments.

    Science.gov (United States)

    Nasab, Amir Mohammadi; Sabzehzar, Amin; Tatari, Milad; Majidi, Carmel; Shan, Wanliang

    2017-12-01

    Like their natural counterparts, soft bioinspired robots capable of actively tuning their mechanical rigidity can rapidly transition between a broad range of motor tasks-from lifting heavy loads to dexterous manipulation of delicate objects. Reversible rigidity tuning also enables soft robot actuators to reroute their internal loading and alter their mode of deformation in response to intrinsic activation. In this study, we demonstrate this principle with a three-fingered pneumatic gripper that contains "programmable" ligaments that change stiffness when activated with electrical current. The ligaments are composed of a conductive, thermoplastic elastomer composite that reversibly softens under resistive heating. Depending on which ligaments are activated, the gripper will bend inward to pick up an object, bend laterally to twist it, and bend outward to release it. All of the gripper motions are generated with a single pneumatic source of pressure. An activation-deactivation cycle can be completed within 15 s. The ability to incorporate electrically programmable ligaments in a pneumatic or hydraulic actuator has the potential to enhance versatility and reduce dependency on tubing and valves.

  20. Estrogen inhibits lysyl oxidase and decreases mechanical function in engineered ligaments.

    Science.gov (United States)

    Lee, Cassandra A; Lee-Barthel, Ann; Marquino, Louise; Sandoval, Natalie; Marcotte, George R; Baar, Keith

    2015-05-15

    Women are more likely to suffer an anterior cruciate ligament (ACL) rupture than men, and the incidence of ACL rupture in women rises with increasing estrogen levels. We used an engineered ligament model to determine how an acute rise in estrogen decreases the mechanical properties of ligaments. Using fibroblasts isolated from human ACLs from male or female donors, we engineered ligaments and determined that ligaments made from female ACL cells had more collagen and were equal in strength to those made from male ACL cells. We then treated engineered ligaments for 14 days with low (5 pg/ml), medium (50 pg/ml), or high (500 pg/ml) estrogen, corresponding to the range of in vivo serum estrogen concentrations and found that collagen within the grafts increased without a commensurate increase in mechanical strength. Mimicking the menstrual cycle, with 12 days of low estrogen followed by 2 days of physiologically high estrogen, resulted in a decrease in engineered ligament mechanical function with no change in the amount of collagen in the graft. The decrease in mechanical stiffness corresponded with a 61.7 and 76.9% decrease in the activity of collagen cross-linker lysyl oxidase with 24 and 48 h of high estrogen, respectively. Similarly, grafts treated with the lysyl oxidase inhibitor β-aminoproprionitrile (BAPN) for 24 h showed a significant decrease in ligament mechanical strength [control (CON) = 1.58 ± 0.06 N; BAPN = 1.06 ± 0.13 N] and stiffness (CON = 7.7 ± 0.46 MPa; BAPN = 6.1 ± 0.71 MPa) without changing overall collagen levels (CON = 396 ± 11.5 μg; BAPN = 382 ± 11.6 μg). Together, these data suggest that the rise in estrogen during the follicular phase decreases lysyl oxidase activity in our engineered ligament model and if this occurs in vivo may decrease the stiffness of ligaments and contribute to the elevated rate of ACL rupture in women. Copyright © 2015 the American Physiological Society.

  1. LARS Artificial Ligament Versus ABC Purely Polyester Ligament for Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Iliadis, Dimitrios Ph.; Bourlos, Dimitrios N.; Mastrokalos, Dimitrios S.; Chronopoulos, Efstathios; Babis, George C.

    2016-01-01

    Background: Graft choice for anterior cruciate ligament (ACL) reconstruction is of critical importance. Various grafts have been used so far, with autografts long considered the optimal solution for the treatment of ACL-deficient knees. Limited data are available on the long-term survivorship of synthetic grafts. Purpose: To compare the functional outcome and survivorship of ACL reconstructions performed using the LARS (ligament augmentation and reconstruction system) ligament and the ABC (active biosynthetic composite) purely polyester ligament. Study Design: Case series; Level of evidence, 4. Methods: The results of 72 patients who underwent primary arthroscopic ACL reconstruction with the LARS ligament and 31 cases with an ABC purely polyester ligament were reviewed. The mean follow-up periods for the LARS and ABC groups were 9.5 and 5.1 years, respectively. A survivorship analysis of the 2 synthetic grafts was performed using the Kaplan-Meier method with a log-rank test (Mantel-Cox, 95% CI). Lysholm, Tegner activity, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores as well as laxity measurements obtained using a KT-1000 arthrometer were recorded for all intact grafts, and a Mann-Whitney U test was used for comparison reasons. Results: The rupture rates for LARS and ABC grafts were 31% (95% CI, 20%-42%) and 42% (95% CI, 25%-59%), respectively. For intact grafts, the mean Lysholm score was good for both groups (90 for the LARS group and 89 for the ABC group), with the majority of patients returning to their preinjury level of activities, and the mean IKDC score was 90 for the LARS group and 86 for the ABC group. Conclusion: The rupture rates of both LARS and ABC grafts were both high. However, the LARS ligament provided significantly better survivorship compared with the ABC ligament at short- to midterm follow-up (95% CI). PMID:27453894

  2. [Anterior cruciate ligament injuries].

    Science.gov (United States)

    Haim, Amir; Pritsch, Tamir; Yosepov, Lior; Arbel, Ron

    2006-03-01

    Anterior cruciate ligament (ACL) injuries are common, especially in young individuals who participate in sports activities associated with pivoting, decelerating and jumping. About 70% of ACL injuries do not result from direct contact. Establishing risk factors is important for prevention strategies. Risk factors for ACL injuries include environmental factors (e.g. high level of friction between shoes and the playing surface) and anatomical factors (e.g. narrow femoral intercondylar notch and increased joint laxity). History taking and physical examination provide the basis for diagnosis. Magnetic resonance imaging (MRI) is highly sensitive and specific and provides information about associated injuries such as meniscal tears. ACL-injury leads to knee instability which is associated with both acute dysfunction and long-term degenerative changes, such as osteoarthritis and meniscal damage. Surgical treatment of ACL-tears is effective in regard to short term rehabilitation but does not necessarily alter the natural course of this injury and its long-term complications. Therefore, surgical treatment should be reserved primarily for young individuals and for those who are high risk for ACL injury. ACL reconstruction is the standard surgery; however, a wide variety of reconstruction procedures is available and a gold standard procedure has not been defined. Nevertheless, arthroscopic reconstruction with either bone-patellar tendon-bone or a hamstring tendon graft is the most widely used method. Surgical timing is important. Early surgical intervention (i.e. within 4 weeks of injury) might increase complications.

  3. Anterior cruciate ligament (ACL) injury -- aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000681.htm Anterior cruciate ligament (ACL) injury - aftercare To use the sharing features ... that connects a bone to another bone. The anterior cruciate ligament (ACL) is located inside your knee joint and ...

  4. A study of pelvic ligament strength.

    Science.gov (United States)

    Cosson, Michel; Boukerrou, Malik; Lacaze, Sophie; Lambaudie, Eric; Fasel, Jean; Mesdagh, Henri; Lobry, Pierre; Ego, Anne

    2003-07-01

    To measure the strength at tearing of pelvic ligaments used in the cure of prolapse and urinary incontinence. We performed our measurements on pelvis ligaments from cadaveric specimens. We dissected 29 human female pelvis cadavers of which storage conditions differed. Ten were frozen, 10 fresh and 9 were stored in formalin. In each cadaver we dissected pre-vertebral ligaments at promontory and right and left symmetrical ligaments. These were the iliopectineal, sacrospinous and arcus tendineus of pelvic fascia. A subjective clinical evaluation of the ligament properties was performed by visual observation as well as finger palpation. Ligaments were classified into three groups. Group A contained high quality ligaments, in terms of thickness and apparent strength following finger palpation. Ligaments of doubtful quality were classified in group B and low apparent quality ligaments in group C. Then the ligaments were stitched by a suture taking the entire ligament and a force was applied on the vagina axis until tearing. The device used for strength measurement during traction was a SAMSON type force gauge, model EASY, serial number SMS-R-ES 300N manufactured by Andilog that was developed for the purpose of our study. Measurements were given in Newton (N). There was a great variability in the values obtained at tearing with minimal values at around 20N and maximal values at 200N. Individually measured, ligament strength varied between individuals, and for the same patient between the type of ligaments and the side. The pre-vertebral ligament was on average the strongest. There was no significant difference according to the storage condition except for the pre-vertebral ligament in formalin cadavers. For bilateral ligaments, there was no difference between the left and right side. The iliopectineal ligament was statistically significantly stronger than the sacrospinous and arcus tendineus of pelvic fascia. There was a correlation between subjective evaluation and

  5. Tracheobronchial Amyloidosis Mimicking Tracheal Tumor

    Directory of Open Access Journals (Sweden)

    Elif Tanrıverdi

    2016-01-01

    Full Text Available Tracheobronchial amyloidosis is a rare presentation and accounts for about 1% of benign tumors in this area. The diagnosis of disease is delayed due to nonspecific pulmonary symptoms. Therapeutic approaches are required to control progressive pulmonary symptoms for most of the patients. Herein, we report a case of a 68-year-old man admitted with progressive dyspnea to our institution for further evaluation and management. He was initially diagnosed with and underwent management for bronchial asthma for two years but had persistent symptoms despite optimal medical therapy. Pulmonary computed tomography scan revealed severe endotracheal stenosis. Bronchoscopy was performed and showed endotracheal mass obstructing 70% of the distal trachea and mimicking a neoplastic lesion. The mass was successfully resected by mechanical resection, argon plasma coagulation (APC, and Nd-YAG laser during rigid bronchoscopy. Biopsy materials showed deposits of amorphous material by hematoxylin and eosin staining and these deposits were selectively stained with Congo Red. Although this is a rare clinical condition, this case indicated that carrying out a bronchoscopy in any patient complaining of atypical bronchial symptoms or with uncontrolled asthma is very important.

  6. Humanlike Robots - Synthetically Mimicking Humans

    Science.gov (United States)

    Bar-Cohen, Yoseph

    2012-01-01

    Nature inspired many inventions and the field of technology that is based on the mimicking or inspiration of nature is widely known as Biomimetics and it is increasingly leading to many new capabilities. There are numerous examples of biomimetic successes including the copying of fins for swimming, and the inspiration of the insects and birds flight. More and more commercial implementations of biomimetics are appearing and behaving lifelike and applications are emerging that are important to our daily life. Making humanlike robots is the ultimate challenge to biomimetics and, for many years, it was considered science fiction, but such robots are becoming an engineering reality. Advances in producing such robot are allowing them to perform impressive functions and tasks. The development of such robots involves addressing many challenges and is raising concerns that are related to fear of their application implications and potential ethical issues. In this paper, the state-of-the-art of humanlike robots, potential applications and challenges will be reviewed.

  7. Liver actinomycosis mimicking liver tumor

    Directory of Open Access Journals (Sweden)

    Ćulafić Đorđe M.

    2009-01-01

    Full Text Available Background. The liver actinomycosis is a rare disease associated with complex differentiation from the liver metastases or hepatocellular carcinoma. Case report. A 50-year old immunocompetent female patient was admitted to the Surgical Department in an exhausted condition, with dyspnea, significant weight loss and intermittent fever in the recent two months. Diagnostic procedures that followed, including abdominal ultrasound and computed tomography led us to the diagnosis of metastatic liver disease of unknown etiology with pleural and pericardial effusion. Intraoperatively, the presence of liver pseudotumor without malignancy in the liver was confirmed. Histological examination confirmed the diagnosis of liver actinomycosis. Prolonged treatment with high dose penicillin was performed and all signs and symptoms resolved completely without further problems. The control abdominal ultrasound finding was normal. Conclusion. Liver actinomycosis has a nonspecific presentation, often mimicking liver tumor. A timely diagnosis as well as a combined surgical and antibiotic therapy is necessary in the treatment of patients with primary disease and prevention of complications.

  8. PELVIC HYDATID MIMICKING INGUINAL HERNIA

    Directory of Open Access Journals (Sweden)

    Ashwani Kumar Dalal

    2017-11-01

    Full Text Available PRESENTATION OF CASE The classical finding in hydatid disease caused by Echinococcus granulosus with liver or lung involvement is well known. However, diagnosing hydatid disease at unusual locations maybe challenging even in endemic areas causing diagnostic confusion as primary extrahepatic extrapulmonary hydatid cysts are rare and only a few sporadic cases have been reported. We present a case where a painless progressive cystic swelling was present in left inguinal region with positive cough impulse and irreducibility mimicking an inguinal hernia. CECT was done, which confirmed it to be multiple hydatid cysts. The patient underwent excision of the cysts with mesh repair and left inguinal orchiectomy as the cord structures couldn’t be separated from the cyst wall. Patient was discharged in satisfactory condition on oral antibiotics and albendazole. No recurrence noted on 6 months of follow up. So, a high suspicion for hydatid cyst should be kept in mind especially in endemic areas for any intra-abdominal swelling. The surgeon must keep in mind that this parasitosis can occur even in uncommon locations and therefore it should be regarded as a potentially systemic disease. In these cases, the diagnosis is challenging and can be achieved only through a complete interdisciplinary evaluation clinical, laboratory and radiological data.

  9. Lateral collateral ligament of the elbow joint

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Vaesel, M T; Søjbjerg, Jens Ole

    1996-01-01

    The structure and kinematics of the lateral collateral ligament of the elbow joint were investigated in 10 cadaveric specimens. The lateral collateral ligament was observed to be a distinct part of the lateral collateral ligament complex. It contains posterior fibers that pass through the annular...

  10. Sacroiliac part of the iliolumbar ligament

    NARCIS (Netherlands)

    Pool-Goudzwaard, A.L.; Kleinrensink, G.J.; Snijders, C.; Stoeckart, R.

    1999-01-01

    The iliolumbar ligament has been described as the most important ligament for restraining movement at the lumbosacral junction. In addition, it may play an important role in restraining movement in the sacroiliac joints. To help understand its presumed restraining effect, the anatomy of the ligament

  11. Biomechanical study on the bladder neck and urethral positions: simulation of impairment of the pelvic ligaments.

    Science.gov (United States)

    Brandão, Sofia; Parente, Marco; Mascarenhas, Teresa; da Silva, Ana Rita Gomes; Ramos, Isabel; Jorge, Renato Natal

    2015-01-21

    Excessive mobility of the bladder neck and urethra are common features in stress urinary incontinence. We aimed at assessing, through computational modelling, the bladder neck position taking into account progressive impairment of the pelvic ligaments. Magnetic resonance images of a young healthy female were used to build a computational model of the pelvic cavity. Appropriate material properties and constitutive models were defined. The impairment of the ligaments was simulated by mimicking a reduction in their stiffness. For healthy ligaments, valsalva maneuver led to an increase in the α angle (between the bladder neck-symphysis pubis and the main of the symphysis) from 91.8° (at rest) to 105.7°, and 5.7 mm of bladder neck dislocation, which was similar to dynamic imaging of the same woman (α angle from 80° to 103.3°, and 5mm of bladder neck movement). For 95% impairment, they enlarged to 124.28° and 12 mm. Impairment to the pubourethral ligaments had higher effect than that of vaginal support (115° vs. 108°, and 9.1 vs. 7.3mm). Numerical simulation could predict urethral motion during valsalva maneuver, for both healthy and impaired ligaments. Results were similar to those of continent women and women with stress urinary incontinence published in the literature. Biomechanical analysis of the pubourethral ligaments complements the biomechanical study of the pelvic cavity in urinary incontinence. It may be useful in young women presenting stress urinary incontinence without imaging evidence of urethral and muscle lesions or organ descend during valsalva, and for whom fascial damage are not expected. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Tumeur du ligament large : à propos d'un cas | Zongo | Revue ...

    African Journals Online (AJOL)

    The clinical examination and CT objectified a soft mass, giving a sciatic hernia. Surgical exploration noted a lobed mass of taking the uterus broad ligament sandwich. The section of the bridge linking the two lobes, and an installation double team enabled us to extract the mass and keep the uterus. The postoperative course ...

  13. Giant hydronephrosis mimicking progressive malignancy

    Directory of Open Access Journals (Sweden)

    Heidenreich Axel

    2003-10-01

    Full Text Available Abstract Background Cases of giant hydronephroses are rare and usually contain no more than 1–2 litres of fluid in the collecting system. We report a remarkable case of giant hydronephrosis mimicking a progressive malignant abdominal tumour. Case presentation A 78-year-old cachectic woman presented with an enormous abdominal tumour, which, according to the patient, had slowly increased in diameter. Medical history was unremarkable except for a hysterectomy >30 years before. A CT scan revealed a giant cystic tumour filling almost the entire abdominal cavity. It was analysed by two independent radiologists who suspected a tumour originating from the right kidney and additionally a cystic ovarian neoplasm. Subsequently, a diagnostic and therapeutic laparotomy was performed: the tumour presented as a cystic, 35 × 30 × 25 cm expansive structure adhesive to adjacent organs without definite signs of invasive growth. The right renal hilar vessels could finally be identified at its basis. After extirpation another tumourous structure emerged in the pelvis originating from the genital organs and was also resected. The histopathological examination revealed a >15 kg hydronephrotic right kidney, lacking hardly any residual renal cortex parenchyma. The second specimen was identified as an ovary with regressive changes and a large partially calcified cyst. There was no evidence of malignant growth. Conclusion Although both clinical symptoms and the enormous size of the tumour indicated malignant growth, it turned out to be a giant hydronephrosis. Presumably, a chronic obstruction of the distal ureter had caused this extraordinary hydronephrosis. As demonstrated in our case, an accurate diagnosis of giant hydronephrosis remains challenging due to the atrophy of the renal parenchyma associated with chronic obstruction. Therefore, any abdominal cystic mass even in the absence of other evident pathologies should include the differential diagnosis of a

  14. Extraforaminal ligament attachments of human lumbar nerves.

    Science.gov (United States)

    Kraan, G A; Delwel, E J; Hoogland, P V J M; van der Veen, M R; Wuisman, P I J M; Stoeckart, R; Kleinrensink, G J; Snijders, C J

    2005-03-15

    An anatomic study of the extraforaminal attachments of the lumbar spinal nerves was performed using human lumbar spinal columns. To identify and describe the existence of ligamentous structures at each lumbar level that attach lumbar spinal nerves to structures at the level of the extraforaminal region. During the last 120 years, several mechanisms to protect the spinal nerve against traction have been described. All these structures involved are located in the spinal canal, proximal to the intervertebral foramen. Five embalmed human lumbar spines (T12-S1) were used. Bilaterally, the extraforaminal region was dissected to describe and measure anatomic structures and their relationships. Histology was performed with staining on the sites of attachment and along the ligament. The levels T12-L2 show bilaterally 2 ligaments, a superior extraforaminal ligament and an inferior extraforaminal ligament. The superior extraforaminal ligament emerges from the joint capsule of the facet joints and inserts in both, the intervertebral disc and the ventral crista of the intervertebral foramen, passing the spinal nerve laterally. In one specimen on level L2-L3, the superior extraforaminal ligament is not attached to the spinal nerve. The inferior extraforaminal ligament emerges from the intervertebral disc, passing the nerve medially and attaching the spinal nerve. At the levels L2-L5, the inferior extraforaminal ligaments are only attached to the intervertebral disc, not to the joint capsule. Histologically, the ligaments consisted of mainly collagenous structures. Ligamentous connections exist between lumbar extraforaminal spinal nerves and nearby structures.

  15. Mapping of contributions from collateral ligaments to overall knee joint constraint: an experimental cadaveric study.

    Science.gov (United States)

    Cyr, Adam J; Shalhoub, Sami S; Fitzwater, Fallon G; Ferris, Lauren A; Maletsky, Lorin P

    2015-06-01

    Understanding the contribution of the soft-tissues to total joint constraint (TJC) is important for predicting joint kinematics, developing surgical procedures, and increasing accuracy of computational models. Previous studies on the collateral ligaments have focused on quantifying strain and tension properties under discrete loads or kinematic paths; however, there has been little work to quantify collateral ligament contribution over a broad range of applied loads and range of motion (ROM) in passive constraint. To accomplish this, passive envelopes were collected from nine cadaveric knees instrumented with implantable pressure transducers (IPT) in the collateral ligaments. The contributions from medial and lateral collateral ligaments (LCL) were quantified by the relative contribution of each structure at various flexion angles (0-120 deg) and compound external loads (±10 N m valgus, ±8 N m external, and ±40 N anterior). Average medial collateral ligament (MCL) contributions were highest under external and valgus torques from 60 deg to 120 deg flexion. The MCL showed significant contributions to TJC under external torques throughout the flexion range. Average LCL contributions were highest from 0 deg to 60 deg flexion under external and varus torques, as well as internal torques from 60 deg to 110 deg flexion. Similarly, these regions were found to have statistically significant LCL contributions. Anterior and posterior loads generally reduced collateral contribution to TJC; however, posterior loads further reduced MCL contribution, while anterior loads further reduced LCL contribution. These results provide insight to the functional role of the collaterals over a broad range of passive constraint. Developing a map of collateral ligament contribution to TJC may be used to identify the effects of injury or surgical intervention on soft-tissue, and how collateral ligament contributions to constraint correlate with activities of daily living.

  16. Multiple Ligament Knee Injury: Complications

    OpenAIRE

    Manske, Robert C.; Hosseinzadeh, Pooya; Giangarra, Charles E.

    2008-01-01

    Non-operative and operative complications are common following multiple ligament knee injuries. This article will describe common complications seen by the surgeon and physical therapist following this complex injury. Complications include fractures, infections, vascular and neurologic complications following injury and surgery, compartment syndrome, complex regional pain syndrome, deep venous thrombosis, loss of motion and persistent laxity issues. A brief description of these complications ...

  17. LIGAMENT-CONTROLLED EFFERVESCENT ATOMIZATION

    Science.gov (United States)

    The operating principles and performance of a new type of spray nozzle are presented. This nozzle, termed a "ligament-controlled effervescent atomizer," was developed to allow consumer product manufacturers to replace volatile organic compound (VOC) solvents with water and hydroc...

  18. Malignant Mesothelioma Mimicking Invasive Mammary Carcinoma in a Male Breast

    Directory of Open Access Journals (Sweden)

    Mohamed Mokhtar Desouki

    2015-01-01

    Full Text Available Malignant mesothelioma is an uncommon tumor with strong association with asbestos exposure. Few cases of malignant pleural mesothelioma metastatic to the female breast have been reported. Herein, we presented, for the first time, a case of locally infiltrating malignant pleural mesothelioma forming a mass in the breast of a male as the first pathologically confirmed manifestation of the disease. Breast ultrasound revealed an irregular mass in the right breast which involves the pectoralis muscle. Breast core biopsy revealed a proliferation of neoplastic epithelioid cells mimicking an infiltrating pleomorphic lobular carcinoma. IHC studies showed the cells to be positive for calretinin, CK5/6, WT1, and CK7. The cells were negative for MOC-31, BerEp4, ER, and PR. A final diagnosis of malignant mesothelioma, epithelioid type, was rendered. This case demonstrates the importance of considering a broad differential diagnosis in the setting of atypical presentation with application of a panel of IHC markers.

  19. Textiloma: A Case of Foreign Body Mimicking a Spinal Tumor.

    Science.gov (United States)

    Meshkini, Ali; Salehpour, Firooz; Rezakhah, Amir; Mirzaei, Farhad; Kazemzadeh, Mohammad; Naseri Alavi, Seyed Ahmad

    2017-11-01

    Case report OBJECTIVE.: To report a case of foreign body mimicking spinal tumor. Gossypiboma or more broadly retained foreign object is a surgical complication resulting from foreign materials such as cotton or gauze pads and surgical sponge, accidentally left inside a patient's body. Such foreign materials cause foreign body reaction in the surrounding tissue. A retrospective case report was performed. Informed consent was obtained from patient. We describe a case of textiloma in which the patient presented with low back pain and radiculopathy 12 years after L5\\S1 discectomy. Imaging revealed a round mass lesion in the sacral space. At the end of surgery, the operative site should be flushed with saline and carefully examined for any foreign materials. 4.

  20. Status and headway of the clinical application of artificial ligaments

    Directory of Open Access Journals (Sweden)

    Tianwu Chen

    2015-01-01

    Full Text Available The authors first reviewed the history of clinical application of artificial ligaments. Then, the status of clinical application of artificial ligaments was detailed. Some artificial ligaments possessed comparable efficacy to, and fewer postoperative complications than, allografts and autografts in ligament reconstruction, especially for the anterior cruciate ligament. At the end, the authors focused on the development of two types of artificial ligaments: polyethylene glycol terephthalate artificial ligaments and tissue-engineered ligaments. In conclusion, owing to the advancements in surgical techniques, materials processing, and weaving methods, clinical application of some artificial ligaments so far has demonstrated good outcomes and will become a trend in the future.

  1. approach to and management of acute ankle ligamentous injuries

    African Journals Online (AJOL)

    Enrique

    The anterior talofibular ligament (ATFL), being the first to get injured ... Treatment protocols range from cast immobilisation to functional rehabilitation to acute ... Right foot: lateral view. Posterior talofibular ligament. Calcaneofibular ligament. Anterior talofibular ligament. Components of lateral. (collateral) ligament of ankle.

  2. The Danish Knee Ligament Reconstruction Registry

    Directory of Open Access Journals (Sweden)

    Rahr-Wagner L

    2016-10-01

    Full Text Available Lene Rahr-Wagner, Martin Lind Department of Orthopaedic Surgery, Division of Sports Surgery, Aarhus University Hospital, Aarhus, Denmark Abstract: The Danish Knee Ligament Reconstruction Registry was established in 2005 as a web-based nationwide clinical database with the purpose of improving the monitoring and quality of both primary and revision knee ligament reconstructions in Denmark. All primary and revision anterior and posterior cruciate ligament reconstructions as well as collateral ligament and multiligament reconstructions are recorded. Main variables include sex, age, cause of injury, objective ligament instability, and surgical data, such as affected ligament, graft- and implant choice, operation technique among other things. The operating surgeon prospectively collects the data. Hence, detailed preoperative, intraoperative, and 1-year follow-up data are recorded by the operating surgeon using a standardized form and a secured Internet portal. The number of procedures registered in the database each year is ~2,500 and the first 9 years, in total, 22,775 procedures have been registered. Since the beginning of the database multiple papers have been published in international peer-reviewed journals, improving the knowledge of patients treated with knee ligament reconstruction surgery. This paper reviews the content, organization, and published research from the Danish Knee Ligament Reconstruction Registry. Keywords: ligament reconstruction, anterior cruciate ligament, operation technique, database, graft choice, femoral tunnel drilling, patient-reported outcome measure

  3. Review of common conditions associated with periodontal ligament widening

    Energy Technology Data Exchange (ETDEWEB)

    Mortazavi, Hamed; Baharvand, Maryam [Dept. of Oral Medicine, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran (Iran, Islamic Republic of)

    2016-12-15

    The aim of this article is to review a group of lesions associated with periodontal ligament (PDL) widening. An electronic search was performed using specialized databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus to find relevant studies by using keywords such as “periodontium”, “periodontal ligament”, “periodontal ligament space”, “widened periodontal ligament”, and “periodontal ligament widening”. Out of nearly 200 articles, about 60 were broadly relevant to the topic. Ultimately, 47 articles closely related to the topic of interest were reviewed. When the relevant data were compiled, the following 10 entities were identified: occlusal/orthodontic trauma, periodontal disease/periodontitis, pulpo-periapical lesions, osteosarcoma, chondrosarcoma, non-Hodgkin lymphoma, progressive systemic sclerosis, radiation-induced bone defect, bisphosphonate-related osteonecrosis, and osteomyelitis. Although PDL widening may be encountered by many dentists during their routine daily procedures, the clinician should consider some serious related conditions as well.

  4. Extrinsic wrist ligaments: prevalence of injury by magnetic resonance imaging and association with intrinsic ligament tears.

    Science.gov (United States)

    Taneja, Atul K; Bredella, Miriam A; Chang, Connie Y; Joseph Simeone, F; Kattapuram, Susan V; Torriani, Martin

    2013-01-01

    The objective of this study was to determine the prevalence of extrinsic wrist ligament injury by magnetic resonance imaging and its association with intrinsic ligament tears. We reviewed conventional magnetic resonance images performed over a 5-year period from adult patients in the setting of wrist trauma. Two musculoskeletal radiologists examined the integrity of wrist ligaments and presence of bone abnormalities. In a cohort of 75 subjects, extrinsic ligament injury was present in 75%, with radiolunotriquetral being most frequently affected (45%). Intrinsic ligament injury was present in 60%. Almost half of subjects had combined intrinsic and extrinsic ligament injury. Bone abnormalities were seen in 69%. The rate of extrinsic injury was higher in subjects with bone injury (P = 0.008). There is high prevalence of extrinsic ligament injury in the setting of wrist trauma, especially in the presence of bone abnormalities, with combined injury of intrinsic and extrinsic ligaments in about half of cases.

  5. Characteristics of the three ligaments of human spring ligament complex from a viewpoint of elements.

    Science.gov (United States)

    Tohno, Yoshiyuki; Tohno, Setsuko; Taniguchi, Akira; Azuma, Cho; Minami, Takeshi; Mahakkanukrauh, Pasuk

    2012-06-01

    To elucidate characteristics of the three ligaments constituting the spring ligament complex from a viewpoint of elements, the authors investigated age-related changes of elements, relationships among their elements, relationships among ligaments in the elements, and gender differences in the three ligaments of the spring ligament complex, the superomedial calcaneonavicular (SMCN), inferoplantar longitudinal calcaneonavicular (ICN), and third or medioplantar oblique calcaneonavicular (TCN) ligaments. After ordinary dissection at Nara Medical University was finished, the SMCN, ICN, and TCN ligaments of the spring ligament complex were removed from the subjects. The subjects consisted of 10 men and 12 women, ranging in age from 62 to 99 years (average age = 80.5 ± 9.7 years). After incineration with nitric acid and perchloric acid, the element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that although the Ca and P content hardly changed in the SMCN ligament with aging, the Ca and P content in the ICN ligament increased to about three and five times higher in the 80s in comparison with the 60s, respectively, whereas in the TCN ligament, it increased about 40% and 90% higher in the 80s compared with the 60s, respectively. Regarding the relationships among elements, significant direct correlations were found among the contents of Ca, P, and Mg in all the three ligaments of the spring ligament complex. This finding was in agreement with the previous finding obtained with the three ligaments of the anterior cruciate ligament, posterior longitudinal ligament, and ligamentum capitis femoris. Whether there were significant correlations among the three ligaments of the spring ligament complex with regard to the Ca, P, S, Mg, Zn, and Fe contents was examined using Pearson's correlation. It was found that there were significant direct correlations between the SMCN and TCN ligaments in all the Ca, P, Mg, and Zn contents and

  6. Bioreactor Design for Tendon/Ligament Engineering

    Science.gov (United States)

    Wang, Tao; Gardiner, Bruce S.; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B.; Wang, Allan; Xu, Jiake

    2013-01-01

    Tendon and ligament injury is a worldwide health problem, but the treatment options remain limited. Tendon and ligament engineering might provide an alternative tissue source for the surgical replacement of injured tendon. A bioreactor provides a controllable environment enabling the systematic study of specific biological, biochemical, and biomechanical requirements to design and manufacture engineered tendon/ligament tissue. Furthermore, the tendon/ligament bioreactor system can provide a suitable culture environment, which mimics the dynamics of the in vivo environment for tendon/ligament maturation. For clinical settings, bioreactors also have the advantages of less-contamination risk, high reproducibility of cell propagation by minimizing manual operation, and a consistent end product. In this review, we identify the key components, design preferences, and criteria that are required for the development of an ideal bioreactor for engineering tendons and ligaments. PMID:23072472

  7. variability of the lateral ligamentous complex of the knee

    African Journals Online (AJOL)

    ligaments on the lateral aspect of the knee namely lateral collateral ligament, anterolateral and triradiate collateral ... lateral knee stability and prevention of excessive internal ... anterior cruciate ligaments were repaired. It therefore becomes ...

  8. High-resolution MRI of the ulnar and radial collateral ligaments of the wrist.

    Science.gov (United States)

    Nozaki, Taiki; Wu, Wei Der; Kaneko, Yasuhito; Rafijah, Gregory; Yang, Lily; Hitt, Dave; Yoshioka, Hiroshi

    2017-12-01

    Background Accurate diagnosis of injuries to the collateral ligaments of the wrist is technically challenging on MRI. Purpose To investigate usefulness of high-resolution two-dimensional (2D) and isotropic three-dimensional (3D) magnetic resonance imaging (MRI) for identifying and classifying the morphology of the ulnar and radial collateral ligaments (UCL and RCL) of the wrist. Material and Methods Thirty-seven participants were evaluated using 3T coronal 2D and isotropic 3D images by two radiologists independently. The UCL was classified into four types: 1a, narrow attachment to the tip of the ulnar styloid (Tip); 1b, broad attachment to the Tip; 2a, narrow attachment to the medial base of the ulnar styloid (Base); and 2b, broad attachment to the Base. The RCL was also classified into four types: 1a, separate radioscaphoid and scaphotrapezial ligaments (RS + ST) with narrow scaphoid attachment; 1b, RS + ST with broad scaphoid attachment; 2a, continuous radio-scapho-trapezial ligaments (RST) with narrow scaphoid attachment; and 2b, RST with broad scaphoid attachment. The inter-observer reliability of these classifications was calculated. Results Type 1a was the most common of both collateral ligaments. Of UCL classifications, 31.4% were revised after additional review of multiplanar reconstruction (MPR) images from isotropic data. The inter-observer reliability of UCL classification was substantial (k = 0.62) without MPR, and almost perfect (k = 0.84) with MPR. The inter-observer reliability of RCL classification was almost perfect (k = 0.89). Anatomic delineation between the two sequences was not statistically different. Conclusion The UCL and RCL were each identified on high-resolution 2D and isotropic 3D MRI equally well. MPR allows accurate identification of the UCL attachment to the ulnar styloid.

  9. Imaging of the anterior cruciate ligament

    Science.gov (United States)

    Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

    2011-01-01

    The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

  10. Isolated ovarian tuberculosis mimicking ovarian carcinoma: Case ...

    African Journals Online (AJOL)

    Although genitourinary tuberculosis is common, reports of isolated ovarian tuberculosis are rare. However, its presentation can mimick that of an ovarian tumour, leading to diagnostic difficulties. A woman of 17 years presented with chronic pelvic pain, weight loss, a right ovarian mass on ultrasound, and a significantly ...

  11. unilatefial congenital multicystic dysplastic kidney mimicking cystic ...

    African Journals Online (AJOL)

    70, N0. 4, 2004. African Journal of Urology 289-290. UNILATEFIAL CONGENITAL MULTICYSTIC DYSPLASTIC KIDNEY. MIMICKING CYSTIC FIENAL CELL CARCINOMA IN AN ADULT. NIGERIAN. A.A. 'SALAKO*, V.A. ADETILOYE**, AND 0.8. OJO***. Departments of Surgery*, Radiology“ and Morbid Anatomy***, Obafemi ...

  12. Degenerated Cystic Uterine Myoma Mimicking Postpartum Haemoperitonium

    Directory of Open Access Journals (Sweden)

    Servet Gençdal

    2017-10-01

    Full Text Available Haemoperitoneum due to spontaneous haemorrhage of intraleiomyoma is a very rare complication of uterine myoma. Acute complications of uterine myoma are seldom seen, but it may be fatal. We hereby report case of a female, who presented with abdominal pain and distension, postpratum, found to have degenerated cystic uterine myoma, mimicking postpartum haemoperitonium.

  13. Toward restrictions on boson stars as black hole mimickers

    Energy Technology Data Exchange (ETDEWEB)

    Guzman, F S, E-mail: guzman@ifm.umich.mx [Instituto de Fisica y Matematicas, Universidad Michoacana de San Nicolas de Hidalgo, Edificio C3, Cd. Universitaria, 58040 Morelia, Michoacan (Mexico)

    2011-09-22

    The status of boson stars as black hole mimickers is presented among other mimickers. We focus on the analysis of the emission spectrum of a simple accretion disk model. We describe the free parameters that allow a boson star to become a black hole mimicker and present an example of a particular astrophysical case.

  14. Unusual lesions mimicking impingement syndrome in the shoulder joint - Think medially.

    Science.gov (United States)

    Singh, Rohit; Malhotra, Akshay; Cribb, Gillian; Cool, Paul; Hay, Stuart

    2016-09-01

    Impingement syndrome is usually caused by irritation of the rotator cuff within the sub acromial space and this includes the coraco-acromial arch (Acromion and Coraco-acromial ligament), the acromio-clavicular joint and occasionally the coracoid. Iatrogenic causes such as sutures, pins, plates or wires left from previous surgery can cause similar symptoms. We present a series of four cases mimicking "classical" impingement symptoms/signs in which the causal pathology was identified outside the sub-acromial space. Magnetic Resonance Imaging (MRI) showed lesions that were present in the supra-spinatus fossa but were causing pressure effects on the sub-acromial space, namely - a ganglion cyst in one case, lipomata in two other cases, and a glomus tumour. A ganglion cyst and glomus tumour mimicking impingement syndrome is a rare reported case to our knowledge. These are unusual causes that should be considered when investigating classical impingement syndrome and particularly those who may have failed to respond to decompression surgery. They highlight the potential value of looking beyond the sub-acromial space for causal lesions and in these cases, at a time when limited ultrasound investigation has become increasingly popular; MRI has clearly played an important and was essential in planning surgery as these lesions would not have been identified on USS. Even though the symptoms were classical.

  15. Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction.

    Science.gov (United States)

    Wenny, Raphael; Duscher, Dominik; Meytap, Emmy; Weninger, Patrick; Hirtler, Lena

    2015-06-01

    For operative reconstruction, precise anatomic information on the dimensions of the ankle ligaments is important and can help to optimize these procedures. The purpose of this study was to investigate the length and width dimensions of the ankle ligaments and to contrast the results with the published literature. Seventeen non-paired adult, formalin-fixed ankle specimen were dissected to expose the capsuloligamentous structures. The following ligaments were investigated: tibiofibular syndesmosis (anterior and posterior tibiofibular ligament/ATiFL and PTiFL), lateral ankle ligaments (anterior and posterior talofibular ligament, calcaneofibular ligament/ATFL, PTFL and CFL), medial ankle ligaments (deltoid ligament, anterior and posterior tibiotalar ligament/ATTL and PTTL). After identification of the ligaments, the dimensions were measured with a ruler and a sliding caliper. Additionally, the attachment area and the center of insertion (COI) were evaluated. The dimensions of the ligaments were recorded. Measurements were calculated and discussed according to the existing literature. The tibial COI of the ATiFL was situated 8.35 ± 2.05 mm from the inferior articular surface of the tibia and 5.04 ± 1.32 mm from the fibular notch. Its fibular COI was situated 25.45 ± 5.84 mm from the tip of the lateral malleolus and 3.12 ± 1.01 mm from the malleolar articular surface. The calcaneal COI of the CFL was situated 20.63 ± 3.56 mm anterior and 5.73 ± 1.89 mm plantar to the superior edge of the calcaneal. Its fibular attachment of the CFL was directly at the tip of the lateral malleolus, dorsal to the fibular attachment of the ATFL. Studies of the therapeutic options in severe ankle ligament injuries have shown better results in anatomical reconstructions compared to other operative treatments. To optimize these procedures, exact anatomical information on the dimensions of the ankle ligaments should be beneficial.

  16. The sacroiliac part of the iliolumbar ligament

    NARCIS (Netherlands)

    A.L. Pool-Goudzwaard (Annelies); G.J. Kleinrensink (Gert Jan); C.J. Snijders (Chris); C.A. Entius; R. Stoeckart (Rob)

    2001-01-01

    textabstractThe iliolumbar ligament has been described as the most important ligament for restraining movement at the lumbosacral junction. In addition, it may play an important role in restraining movement in the sacroiliac joints. To help understand its presumed restraining

  17. Instructive materials for tendon and ligament augmentation

    NARCIS (Netherlands)

    Ribeiro Pereira Simões Crispim, João Francisco

    2016-01-01

    Tendons and ligaments (T/L) are the connective tissue that connect muscles to bone and bone to bone, respectively. The main function of tendons is to translate muscle contractions into join motion and consequently generate movement. Ligaments function to stabilize joints and guide them during their

  18. Trends in Materials Science for Ligament Reconstruction.

    Science.gov (United States)

    Sava, Oana Roxana; Sava, Daniel Florin; Radulescu, Marius; Albu, Madalina Georgiana; Ficai, Denisa; Veloz-Castillo, Maria Fernanda; Mendez-Rojas, Miguel Angel; Ficai, Anton

    2017-01-01

    The number of ligament injuries increases every year and concomitantly the need for materials or systems that can reconstruct the ligament. Limitations imposed by autografts and allografts in ligament reconstruction together with the advances in materials science and biology have attracted a lot of interest for developing systems and materials for ligament replacement or reconstruction. This review intends to synthesize the major steps taken in the development of polymer-based materials for anterior cruciate ligament, their advantages and drawbacks and the results of different in vitro and in vivo tests. Until present, there is no successful polymer system for ligament reconstruction implanted in humans. The developing field of synthetic polymers for ligament reconstruction still has a lot of potential. In addition, several nano-structured materials, made of nanofibers or in the form of ceramic/polymeric nanocomposites, are attracting the interest of several groups due to their potential use as engineered scaffolds that mimic the native environment of cells, increasing the chances for tissue regeneration. Here, we review the last 15 years of literature in order to obtain a better understanding on the state-of-the-art that includes the usage of nano- and poly-meric materials for ligament reconstruction, and to draw perspectives on the future development of the field. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  19. Intramuscular Hemangioma Mimicking an Adnexal Malignancy

    Directory of Open Access Journals (Sweden)

    Selen Dogan

    2013-10-01

    Full Text Available Intramuscular hemangiomas were defined as vascular malformations according to the International Society for the Study of Vascular Anomalies (ISSVA classification. Aggressive appearance on radiologic images but nonaggressive course of these lesions results in diagnostic challenge for the clinicians that are unfamiliar with these lesions. Here, we present a 49-year-old woman as a rare case of mixed type intramuscular hemangioma originating from pelvic floor muscles, mimicking a malignant adnexal mass.

  20. Intramuscular Hemangioma Mimicking an Adnexal Malignancy

    OpenAIRE

    Selen Dogan

    2013-01-01

    Intramuscular hemangiomas were defined as vascular malformations according to the International Society for the Study of Vascular Anomalies (ISSVA) classification. Aggressive appearance on radiologic images but nonaggressive course of these lesions results in diagnostic challenge for the clinicians that are unfamiliar with these lesions. Here, we present a 49-year-old woman as a rare case of mixed type intramuscular hemangioma originating from pelvic floor muscles, mimicking a malignant adnex...

  1. Traumatic bone cyst mimicking radicular cyst.

    Science.gov (United States)

    Dincer, Onur; Kose, Taha Emre; Cankaya, Abdulkadir Burak; Aybar, Buket

    2012-12-09

    Traumatic bone cysts were first defined by Lucas and Blum in 1929. It is classified as an intraosseous pseudocyst. They are asymptomatic and are usually seen during routine radiographical examination. According to the 2002 classification of the WHO, traumatic bone cysts are in miscellaneous lesions. This report describes a 16-year-old male patient who had a traumatic bone cyst that mimicked a radicular cyst.

  2. Mammary Analogue Secretory Carcinoma Mimicking Salivary Adenoma

    OpenAIRE

    Williams, Lindsay; Chiosea, Simion I.

    2013-01-01

    Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland tumor characterized by ETV6 translocation. It appears that prior studies have identified MASC by reviewing salivary gland carcinomas, such as acinic cell carcinoma and adenocarcinoma, not otherwise specified. To address the possibility of MASC mimicking benign salivary neoplasms we reviewed 12 salivary gland (cyst)adenomas diagnosed prior to the discovery of MASC. One encapsulated (cyst)adenoma of the parotid g...

  3. Tissue engineered devices for ligament repair, replacement and ...

    African Journals Online (AJOL)

    PRECIOUS

    2009-12-29

    Dec 29, 2009 ... The anterior cruciate ligament (ACL) is one of five ligaments in the knee that are important for stability and kinematics. It is also the most commonly injured ligament of the knee and due to its poor healing potential, severe damage warrants surgical intervention including complete replacement. Ligaments ...

  4. Tissue engineered devices for ligament repair, replacement and ...

    African Journals Online (AJOL)

    The anterior cruciate ligament (ACL) is one of five ligaments in the knee that are important for stability and kinematics. It is also the most commonly injured ligament of the knee and due to its poor healing potential, severe damage warrants surgical intervention including complete replacement. Ligaments are longitudinally ...

  5. Anatomy of the ankle ligaments: a pictorial essay

    NARCIS (Netherlands)

    Golanó, P.; Vega, J.; de Leeuw, P.A.J.; Malagelada, F.; Manzanares, M.C.; Götzens, V.; van Dijk, C.N.

    2010-01-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the

  6. Anatomy of the ankle ligaments: a pictorial essay

    NARCIS (Netherlands)

    Golanó, Pau; Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

    2016-01-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the

  7. Variability of the lateral ligamentous complex of the knee | Ashaolu ...

    African Journals Online (AJOL)

    The current study examined the prevalence and morphometric values of three extracapsular ligaments on the lateral aspect of the knee namely lateral collateral ligament, anterolateral and triradiate collateral ligaments in human cadavers. Twenty knees were used. The lateral collateral ligament, anterolateral and triradiate ...

  8. MEASUREMENTS OF CRUCIATE LIGAMENTS OF KNEE JOINT

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    Sravanthi

    2015-06-01

    Full Text Available AIM OF STU DY: T o measure length and width of Cruciate Ligaments and to observe for any variations in the parameters. PERIOD OF STUDY : 2008 - 2011 . MATERIALS AND METHODS : 100 d isarticulated limbs were collected from department of anatomy , K akatiya M edical C ollege , Warangal. Telangana. Which were preserved in 10% formalin , 50 MRIs of Knee joint were studied and measurements were taken from Vijaya Diagnostic center , Hanamkonda , Wa rangal , Telangana. To expose cruciate ligament a systematic dissection procedure has been adopted . The cruciate ligaments were exposing and their attachments were defined on to the femur and tibia. OBSERVATIONS: Average of parameters for anterior and poste rior cruciate ligaments were calculated for all 100 limbs and 50 knee joint MRI scans. The observations were similar to the previous studies. CONCLUSION: T he parameters which were measure are help full in selection and preparation of the graft and in re co nstruction of ligaments. The aim of re - construction is not just to substitute a torn ligament , but to restore the morphology inherent in the ligament

  9. Oblique popliteal ligament - an anatomical study

    Directory of Open Access Journals (Sweden)

    Lucas Pinto D'Amico Fam

    2013-09-01

    Full Text Available OBJECTIVE: To study the anatomy of the oblique popliteal ligament, as regards its dimensions, expansion and anatomical relationships. METHODS: Eleven cadaver knees were dissected in order to study the anatomy and take mea-surements of anatomical structures and relationships of the oblique popliteal ligament. The dissection was for posterior access to the proper exposure of the oblique popliteal ligament, the semimembranosus muscle and its expansions. For measurement of dimensions, 40 × 12 needles were used for marking the specific points and a caliper. The angles were calculated using the software ImagePro Plus(r . RESULTS: The distance from the origin of the oblique popliteal ligament to the tibial plateau was 7.4 mm, the thickness at its origin was 7.3 mm, length was 33.6 mm and the tibial plateau angle 34.8°. The length of the expansion of the proximal oblique popliteal ligament was 39.2 mm, thickness 7.8 mm and angle of the oblique popliteal ligament with its expansion 32.2°. CONCLUSION: The oblique popliteal ligament is thick, rises in the semimembranosus and protrudes proximally forming an acute angle with the joint interline, crossing the popliteal fossa. In some cases it has a proximal expansion.

  10. Anatomy of the ankle ligaments: a pictorial essay

    Science.gov (United States)

    Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

    2010-01-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail. PMID:20309522

  11. Anatomy of the ankle ligaments: a pictorial essay

    OpenAIRE

    Golanó, Pau; Vega, Jordi; de Leeuw, Peter A. J.; Malagelada, Francesc; Manzanares, M. Cristina; Götzens, Víctor; van Dijk, C. Niek

    2010-01-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

  12. Anatomy of the ankle ligaments: a pictorial essay.

    Science.gov (United States)

    Golanó, Pau; Vega, Jordi; de Leeuw, Peter A J; Malagelada, Francesc; Manzanares, M Cristina; Götzens, Víctor; van Dijk, C Niek

    2016-04-01

    Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

  13. The anatomy and function of Cleland's ligaments.

    Science.gov (United States)

    Zwanenburg, R L; Werker, P M N; McGrouther, D A

    2014-06-01

    The cutaneous ligaments of the digits have been recognized by anatomists for several centuries, but the best known description is that of John Cleland. Subsequent varying descriptions of their morphology have resulted in the surgical community having an imprecise view of their structure and dynamic function. We micro-dissected 24 fresh frozen fingers to analyze the individual components of Cleland's ligamentous system. Arising from the proximal interphalangeal (PIP) joint, proximal, and sometimes middle phalanx, we found strong ligaments that ran proximally (PIP-P) and distally (PIP-D). On each side of each finger there was a PIP-P ligament present, which passed obliquely from the lateral side of the proximal and sometimes middle phalanx towards its insertion into the skin at the level of the proximal phalanx. The distal (PIP-D) ligaments were found to pass obliquely distally on the radial and ulnar aspects of the digit towards cutaneous insertions around the middle phalanx. A similar arrangement exists more distally with fibres originating from the DIP joint and middle phalanx (the DIP-P pass obliquely proximally, and the DIP-D, distally). Each individual PIP ligament consisted of three different layers originating from fibres overlying the flexor tendon sheath, periosteum or joint capsule, and extensor expansion. Ligaments arising at the DIP joint had two layers equivalent to the anterior two layers of the proximal ligaments. Cleland's ligaments act as skin anchors maintaining the skin in a fixed relationship to the underlying skeleton during motion and functional tasks. They also prevent the skin from 'bagging', protect the neurovascular bundle, and create a gliding path for the lateral slips of the extensor tendon. © The Author(s) 2013.

  14. Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy

    Science.gov (United States)

    Esplugas, Mireia; Lluch-Bergada, Alex; Mobargha, Nathalie; Llusa-Perez, Manuel; Hagert, Elisabet; Garcia-Elias, Marc

    2016-01-01

    Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p = 0.004). Conclusion Sectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments. PMID:27777818

  15. Functional tissue engineering of ligament healing

    Directory of Open Access Journals (Sweden)

    Hsu Shan-Ling

    2010-05-01

    Full Text Available Abstract Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL and medial collateral ligament (MCL of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally.

  16. Unilateral aplasia of both cruciate ligaments

    Directory of Open Access Journals (Sweden)

    Liem Dennis

    2010-02-01

    Full Text Available Abstract Aplasia of both cruciate ligaments is a rare congenital disorder. A 28-year-old male presented with pain and the feeling of instability of his right knee after trauma. The provided MRI and previous arthroscopy reports did not indicate any abnormalities except cruciate ligament tears. He was referred to us for reconstruction of both cruciate ligaments. The patient again underwent arthroscopy which revealed a hypoplasia of the medial trochlea and an extremely narrow intercondylar notch. The tibia revealed a missing anterior cruciate ligament (ACL footprint and a single bump with a complete coverage with articular cartilage. There was no room for an ACL graft. A posterior cruciate ligament could not be identified. The procedure was ended since a ligament reconstruction did not appear reasonable. A significant notch plasty if not a partial resection of the condyles would have been necessary to implant a ligament graft. It is most likely that this would not lead to good knee stability. If the surgeon would have retrieved the contralateral hamstrings at the beginning of the planned ligament reconstruction a significant damage would have occurred to the patient. Even in seemingly clear diagnostic findings the arthroscopic surgeon should take this rare abdnormality into consideration and be familiar with the respective radiological findings. We refer the abnormal finding of only one tibial spine to as the "dromedar-sign" as opposed to the two (medial and a lateral tibial spines in a normal knee. This may be used as a hint for aplasia of the cruciate ligaments.

  17. Functional tissue engineering of ligament healing

    Science.gov (United States)

    2010-01-01

    Ligaments and tendons are dense connective tissues that are important in transmitting forces and facilitate joint articulation in the musculoskeletal system. Their injury frequency is high especially for those that are functional important, like the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knee as well as the glenohumeral ligaments and the rotator cuff tendons of the shoulder. Because the healing responses are different in these ligaments and tendons after injury, the consequences and treatments are tissue- and site-specific. In this review, we will elaborate on the injuries of the knee ligaments as well as using functional tissue engineering (FTE) approaches to improve their healing. Specifically, the ACL of knee has limited capability to heal, and results of non-surgical management of its midsubstance rupture have been poor. Consequently, surgical reconstruction of the ACL is regularly performed to gain knee stability. However, the long-term results are not satisfactory besides the numerous complications accompanied with the surgeries. With the rapid development of FTE, there is a renewed interest in revisiting ACL healing. Approaches such as using growth factors, stem cells and scaffolds have been widely investigated. In this article, the biology of normal and healing ligaments is first reviewed, followed by a discussion on the issues related to the treatment of ACL injuries. Afterwards, current promising FTE methods are presented for the treatment of ligament injuries, including the use of growth factors, gene delivery, and cell therapy with a particular emphasis on the use of ECM bioscaffolds. The challenging areas are listed in the future direction that suggests where collection of energy could be placed in order to restore the injured ligaments and tendons structurally and functionally. PMID:20492676

  18. Retroperitoneal Leiomyoma of the Uterus Mimicking Sarcoma in Perimenopausal Woman: Case Report

    Science.gov (United States)

    2014-01-01

    Leiomyomas are very common benign tumors in the uterus and it is rare condition to present the retroperitoneal leiomyoma. The author reported a 48-year-old female patient who presented right pelvic mass with urinary incontinence and lower abdominal discomfort. Based on the preoperative imaging, provisional diagnosis was mesenchymal sarcoma. In the intraoperative findings, huge mass abutting to the uterus was observed in retroperitoneal space beneath the right broad ligament. After the exposure the retroperitoneal space, we encountered the well-demarcated tumor measuring 8 × 6 cm in diameter and this tumor attached the right surface of the uterus with fibrotic tissue. Pathologic findings demonstrated retroperitoneal uterine leiomyoma. PMID:25580425

  19. Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

    Science.gov (United States)

    Dale, Kevin M; Bailey, James R; Moorman, Claude T

    2017-01-01

    The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Histological analysis of the structural composition of ankle ligaments.

    Science.gov (United States)

    Rein, Susanne; Hagert, Elisabet; Schneiders, Wolfgang; Fieguth, Armin; Zwipp, Hans

    2015-02-01

    Various ankle ligaments have different structural composition. The aim of this study was to analyze the morphological structure of ankle ligaments to further understand their function in ankle stability. One hundred forty ligaments from 10 fresh-frozen cadaver ankle joints were dissected: the calcaneofibular, anterior, and posterior talofibular ligaments; the inferior extensor retinaculum, the talocalcaneal oblique ligament, the canalis tarsi ligament; the deltoid ligament; and the anterior tibiofibular ligament. Hematoxylin-eosin and Elastica van Gieson stains were used for determination of tissue morphology. Three different morphological compositions were identified: dense, mixed, and interlaced compositions. Densely packed ligaments, characterized by parallel bundles of collagen, were primarily seen in the lateral region, the canalis tarsi, and the anterior tibiofibular ligaments. Ligaments with mixed tight and loose parallel bundles of collagenous connective tissue were mainly found in the inferior extensor retinaculum and talocalcaneal oblique ligament. Densely packed and fiber-rich interlacing collagen was primarily seen in the areas of ligament insertion into bone of the deltoid ligament. Ligaments of the lateral region, the canalis tarsi, and the anterior tibiofibular ligaments have tightly packed, parallel collagen bundles and thus can resist high tensile forces. The mixed tight and loose, parallel oriented collagenous connective tissue of the inferior extensor retinaculum and the talocalcaneal oblique ligament support the dynamic positioning of the foot on the ground. The interlacing collagen bundles seen at the insertion of the deltoid ligament suggest that these insertion areas are susceptible to tension in a multitude of directions. The morphology and mechanical properties of ankle ligaments may provide an understanding of their response to the loads to which they are subjected. © The Author(s) 2015.

  1. Hypertrophic Nonunion Humerus Mimicking an Enchondroma

    Directory of Open Access Journals (Sweden)

    N. K. Magu

    2014-01-01

    Full Text Available Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face.

  2. Central skeletal sarcoidosis mimicking metastatic disease

    Energy Technology Data Exchange (ETDEWEB)

    Talmi, Danit; Smith, Stacy; Mulligan, Michael E. [University of Maryland School of Medicine, Department of Radiology, Baltimore, MD (United States)

    2008-08-15

    Sarcoidosis is a systemic disease that histologically typically shows non-caseating granulomas. The most common radiologic finding is hilar and mediastinal adenopathy. Patients with widely disseminated disease may show involvement of the peripheral appendicular skeleton in 1-13% of such cases. A primary skeletal presentation without other manifestations typical of the disease is rare. We present a case of sarcoidosis in a middle-aged Caucasian man in whom the disease presented with widespread lytic lesions in the axial skeleton and long bones, mimicking metastatic disease. There was no involvement of the peripheral skeleton, skin or lungs. (orig.)

  3. Benzalkonium Chloride Intoxication Mimicking Herpes Zoster Encephalitis

    Directory of Open Access Journals (Sweden)

    Ekrem Güler

    2011-06-01

    Full Text Available Benzalkonium chloride (BAC is a frequently used disinfectant and its most well-known side effect is contact dermatitis. In this report, two children who had vesicular dermatitis, headache, lethargy, fever and encephalopathy mimicking Herpes zoster encephalitis were presented. Their consciousness level improved on the second day. From the medical history it was understood that the mother had applied 20% BAC solution to the scalps of two children. The aim of the presentation of this report is to draw attention to the fact that BAC application to the scalp for treating pediculosis capitis may resemble the herpes encephalitis clinical picture.

  4. Acute Myelogenous Leukemia Mimicking Fulminant Periorbital Cellulitis

    Directory of Open Access Journals (Sweden)

    Abbas Bagheri

    2013-01-01

    Full Text Available Purpose: To report a patient who was referred for orbital cellulitis but was finally diagnosed with acute leukemia. Case Report: A 17-year-old boy presented with fever, periorbital erythema and swelling mimicking periorbital cellulitis. He underwent empiric antibiotic therapy. Complete blood counts revealed leukocytosis with a predominance of immature blast cells. Bone marrow aspiration confirmed the diagnosis of acute myelogenous leukemia. Chemotherapy was initiated resulting in resolution of signs and symptoms. Conclusion: Acute leukemia may mimic periorbital cellulitis and must be considered in the differential diagnosis.

  5. Littoral cell angioma mimicking hepatic tumor

    Directory of Open Access Journals (Sweden)

    Wenhua Liang

    2012-07-01

    Full Text Available Littoral cell angioma is a rare vascular tumor of the spleen that was described by Falk et al. in 1991. Because of the limited number, untypical imaging manifestations, and lack of knowledge on this tumor type, these tumors are often misdiagnosed. In most cases, the tumor presents with multiple small hypoattenuating nodules in the spleen with delayed enhancement. However, solitary littoral cell angiomas have not been well described. We present the CT features of an unusual littoral cell angioma mimicking hepatic tumor.

  6. Immunoglobulin G4-Related Disease Mimicking Asthma

    Directory of Open Access Journals (Sweden)

    Hiroshi Sekiguchi

    2013-01-01

    Full Text Available Immunoglobulin (Ig G4-related disease (also known as ‘IgG4-related sclerosing disease’, ‘IgG4-related systemic disease’ or ‘hyper-IgG4-disease’ is a recently recognized systemic fibroinflammatory disease associated with IgG4-positive plasma cells in tissue lesions. IgG4-related disease was initially described as autoimmune pancreatitis, but it is now known to affect virtually any organ. The authors describe a patient presenting with multi-organ manifestations, including airway inflammation mimicking asthma, pulmonary parenchymal infiltrates, intrathoracic lymphadenopathy, submandibular gland swelling and a kidney mass.

  7. Revision Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  8. Guideline on anterior cruciate ligament injury

    NARCIS (Netherlands)

    Meuffels, Duncan E; Poldervaart, Michelle T; Diercks, Ronald; Fievez, Alex W F M; Patt, Thomas W; Hart, Cor P van der; Hammacher, Eric R; Meer, Fred van der; Goedhart, Edwin A; Lenssen, Anton F; Muller-Ploeger, Sabrina B; Pols, Margreet A; Saris, Daniel B F

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a

  9. Round Ligament Varicosities During Pregnancy: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Chang Kyu; Oh, Young Taik; Jung, Dae Chul [Yonsei University Health System, Seoul (Korea, Republic of)

    2011-12-15

    There are various causes of a painful palpable mass in the groin during pregnancy. The differential diagnoses of an inguinal mass include hernia, lymphadenopathy, mesothelial cyst, cystic lymphangioma, neoplasms (lipoma, leiomyoma and sarcoma), endometriosis, embryonic remnants and round ligament varicosities. Among them, round ligament varicosities can be easily misdiagnosed as an inguinal hernia in a pregnant woman. These lesions should be managed conservatively because they resolve spontaneously during the postpartum period. Ultrasonography can help make the diagnosis of round ligament varicosities and so prevent unnecessary surgical intervention and the associated morbidity. Herein we report on a case of round ligament varicosities that presented during pregnancy and this condition was readily diagnosed via Doppler sonography

  10. How to treat knee ligament injuries?

    Science.gov (United States)

    Järvinen, M; Kannus, P; Johnson, R J

    1991-01-01

    Indications for conservative treatment of knee ligament injuries can be established for all grade I or II sprains (partial tears), as well as isolated grade III sprains (complete tears) of the posterior cruciate ligament (PCL) and medial collateral ligament (MCL). These injuries should be treated with immediate mobilization. Only in isolated partial anterior cruciate ligament (ACL) tears without a positive pivot shift phenomenon is conservative treatment justified. However, many of these injuries may require operative reconstruction later. In complete ACL tears the surgical treatment consists of primary reconstruction or augmented primary repair. Today, the middle third of the patella tendon with the bone blocks is regarded as the "gold standard" for augmented repairs and late reconstructions. For the present, there is no place for synthetic prostheses in the treatment of an acute ACL rupture. Allograft replacement of the ACL must now be considered an experimental procedure. In the reconstruction of the PCL the above mentioned patella tendon graft is also preferable. Lateral collateral ligament (LCL) tears, especially if they are combined with ruptures of posterolateral ligament complex, should be repaired immediately after the injury. In these injuries late reconstructions are difficult and the results are poor. Conservative treatment of partial tears and postoperative treatment of reconstructed ligaments is twofold: on the one hand, the healing tissue should be protected and on the other hand, atrophy and wasting of uninjured tissue should be avoided. Overload and stretching of the injured ligaments should be eliminated with the aid of a suitable knee brace, but early range of motion exercises of the knee are allowed immediately.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Clinical and Histologic Mimickers of Celiac Disease.

    Science.gov (United States)

    Kamboj, Amrit K; Oxentenko, Amy S

    2017-08-17

    Celiac disease is an autoimmune disorder of the small bowel, classically associated with diarrhea, abdominal pain, and malabsorption. The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet. Histologic findings associated with celiac disease include intraepithelial lymphocytosis, crypt hyperplasia, villous atrophy, and a chronic inflammatory cell infiltrate in the lamina propria. It is important to recognize and diagnose celiac disease, as strict adherence to a gluten-free diet can lead to resolution of clinical and histologic manifestations of the disease. However, many other entities can present with clinical and/or histologic features of celiac disease. In this review article, we highlight key clinical and histologic mimickers of celiac disease. The evaluation of a patient with serologically negative enteropathy necessitates a carefully elicited history and detailed review by a pathologist. Medications can mimic celiac disease and should be considered in all patients with a serologically negative enteropathy. Many mimickers of celiac disease have clues to the underlying diagnosis, and many have a targeted therapy. It is necessary to provide patients with a correct diagnosis rather than subject them to a lifetime of an unnecessary gluten-free diet.

  12. A classic mimicker of systemic vasculitis.

    Science.gov (United States)

    Moreno-Ariño, Marc; Ortiz-Santamaria, Vera; Deudero Infante, Aída; Ayats Delgado, Montserrat; Novell Teixidó, Francesc

    2016-01-01

    Embolic and constitutional manifestations of intracavitary cardiac tumors are included within the classic mimickers of systemic vasculitis, especially in those in which there are no cardiac manifestations. We present a case report of atrial myxoma in which the patient only presented systemic symptoms and in whom an initial diagnostic approach of systemic vasculitis was made. We also performed a literature search of the cases described. A case report of atrial myxoma with atypical presentation manifested as a systemic disease with no concomitant cardiac symptoms is described. The case report is discussed and 11 cases of atrial myxoma pseudovasculitis described in the literature are reviewed, emphasizing their similarities and differences. Constitutional symptoms and cutaneous manifestations were the most common. Most of the cases showed partial response to glucococorticosteroid treatment, reinforcing the theory of the inflammatory role in its pathogenesis. Mean delayed time to diagnosis was 12.27 months. Atrial myxoma is a systemic vasculitis mimicker, this being difficult to diagnose in the absence of cardiac manifestations. This delay in diagnosis entails serious complications. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  13. Ultrasound artifacts mimicking pleural sliding after pneumonectomy.

    Science.gov (United States)

    Cavaliere, Franco; Zamparelli, Roberto; Soave, Maurizio P; Gargaruti, Riccardo; Scapigliati, Andrea; De Paulis, Stefano

    2014-03-01

    To determine the presence of pleural sliding on chest ultrasonography (US) in a series of patients admitted to a surgical intensive care unit (SICU). Prospective, observational study. 16-bed SICU of a University hospital. 8 patients (7 men, 1 woman), aged 64 - 73 years (mean 67.5 yrs). Seven patients underwent pneumonectomy for pulmonary neoplasms; one patient underwent an atypical lung resection after having undergone a pneumonectomy one year before. None. Chest ultrasounds were performed during mechanical ventilation and spontaneous ventilation after endotracheal tube removal. In both examinations, pleural sliding was searched bilaterally in brightness mode (B-mode) and motion mode (M-mode) on the anterior thoracic wall in the least gravitationally dependent areas. During mechanical ventilation, pleural sliding was always absent on the side of the pneumonectomy and present on the other side. During spontaneous ventilation, some artifacts mimicking pleural sliding were noted on the side of the pneumonectomy both in B-mode and M-mode (presence of the seashore sign) in all patients, except for the one patient who had undergone a pneumonectomy one year earlier. Those artifacts became more pronounced during deep breaths. Ultrasound artifacts mimicking pleural sliding may be observed in the absence of the lung and may originate from the activity of intercostal muscles since they become more evident during deep breathing. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Tissue Engineering Strategies in Ligament Regeneration

    Directory of Open Access Journals (Sweden)

    Caglar Yilgor

    2012-01-01

    Full Text Available Ligaments are dense fibrous connective tissues that connect bones to other bones and their injuries are frequently encountered in the clinic. The current clinical approaches in ligament repair and regeneration are limited to autografts, as the gold standard, and allografts. Both of these techniques have their own drawbacks that limit the success in clinical setting; therefore, new strategies are being developed in order to be able to solve the current problems of ligament grafting. Tissue engineering is a novel promising technique that aims to solve these problems, by producing viable artificial ligament substitutes in the laboratory conditions with the potential of transplantation to the patients with a high success rate. Direct cell and/or growth factor injection to the defect site is another current approach aiming to enhance the repair process of the native tissue. This review summarizes the current approaches in ligament tissue engineering strategies including the use of scaffolds, their modification techniques, as well as the use of bioreactors to achieve enhanced regeneration rates, while also discussing the advances in growth factor and cell therapy applications towards obtaining enhanced ligament regeneration.

  15. A mechanistic damage model for ligaments.

    Science.gov (United States)

    Barrett, Jeff M; Callaghan, Jack P

    2017-08-16

    The accuracy of biomechanical models is predicated on the realism by which they represent their biomechanical tissues. Unfortunately, most models use phenomenological ligament models that neglect the behaviour in the failure region. Therefore, the purpose of this investigation was to test whether a mechanistic model of ligamentous tissue portrays behaviour representative of actual ligament failure tests. The model tracks the time-evolution of a population of collagen fibres in a theoretical ligament. Each collagen fibre is treated as an independent linear cables with constant stiffness. Model equations were derived by assuming these fibres act as a continuum and applying a conservation law akin to Huxley's muscle model. A breaking function models the rate of collagen fibre breakage at a given displacement, and was chosen to be a linear function for this preliminary analysis. The model was fitted to experimental average curves for the cervical anterior longitudinal ligament. In addition, the model was cyclically loaded to test whether the tissue model behaves similarly. The model agreed very well with experiment with an RMS error of 14.23 N and an R(2) of 0.995. Cyclic loading exhibited a reduction in force similar to experimental data. The proposed model showcases behaviour reminiscent of actual ligaments being strained to failure and undergoing cyclic load. Future work could incorporate viscous effects, or validate the model further by testing it in various loading conditions. Characterizing the breaking function more accurately would also lead to better results. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. The in situ force in the calcaneofibular ligament and the contribution of this ligament to ankle joint stability.

    Science.gov (United States)

    Kobayashi, Takuma; Yamakawa, Satoshi; Watanabe, Kota; Kimura, Kei; Suzuki, Daisuke; Otsubo, Hidenori; Teramoto, Atsushi; Fujimiya, Mineko; Fujie, Hiromichi; Yamashita, Toshihiko

    2016-12-01

    Numerous biomechanical studies of the lateral ankle ligaments have been reported; however, the isolated function of the calcaneofibular ligament has not been clarified. We hypothesize that the calcaneofibular ligament would stabilize the ankle joint complex under multidirectional loading, and that the in situ force in the calcaneofibular ligament would change in each flexed position. Using seven fresh frozen cadaveric lower extremities, the motions and forces of the intact ankle under multidirectional loading were recorded using a 6-degree-of-freedom robotic system. On repeating these intact ankle joint complex motions after the calcaneofibular ligament transection, the in situ force in the calcaneofibular ligament and the contribution of the calcaneofibular ligament to ankle joint complex stability were calculated. Finally, the motions of the calcaneofibular ligament-transected ankle joint complex were recorded. Under an inversion load, significant increases of inversion angle were observed in all the flexed positions following calcaneofibular ligament transection, and the calcaneofibular ligament accounted for 50%-70% of ankle joint complex stability during inversion. The in situ forces in the calcaneofibular ligament under an anterior force, inversion moment, and external rotation moment were larger in the dorsiflexed position than in the plantarflexed position. The calcaneofibular ligament plays a role in stabilizing the ankle joint complex to multidirectional loads and the role differs with load directions. The in situ force of the calcaneofibular ligament is larger at the dorsiflexed position. This ligament provides the primary restraint to the inversion ankle stability. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament.

    Science.gov (United States)

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Leão, Renata Vidal; Demange, Marco Kawamura; Bordalo-Rodrigues, Marcelo

    2017-04-01

    Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions. Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated. Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury. ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation

  18. Development of Tissue-Engineered Ligaments: Elastin Promotes Regeneration of the Rabbit Medial Collateral Ligament.

    Science.gov (United States)

    Hirukawa, Masaki; Katayama, Shingo; Sato, Tatsuya; Yamada, Masayoshi; Kageyama, Satoshi; Unno, Hironori; Suzuki, Yoshiaki; Miura, Yoshihiro; Shiratsuchi, Eri; Hasegawa, Masahiro; Miyamoto, Keiichi; Horiuchi, Takashi

    2017-12-21

    When ligaments are injured, reconstructive surgery is sometimes required to restore function. Methods of reconstructive surgery include transplantation of an artificial ligament and autotransplantation of a tendon. However, these methods have limitations related to the strength of the bone-ligament insertion and biocompatibility of the transplanted tissue after surgery. Therefore, it is necessary to develop new reconstruction methods and pursue the development of artificial ligaments. Elastin is a major component of elastic fibers and ligaments. However, the role of elastin in ligament regeneration has not been described. Here, we developed a rabbit model of a medial collateral ligament (MCL) rupture and treated animal knees with exogenous elastin [100 µg/(0.5 mL·week)] for 6 or 12 weeks. Elastin treatment increased gene expression and protein content of collagen and elastin (gene expression, 6-fold and 42-fold, respectively; protein content, 1.6-fold and 1.9-fold, respectively), and also increased the elastic modulus of MCL increased with elastin treatment (2-fold) compared with the controls. Our data suggest that elastin is involved in the regeneration of damaged ligaments. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  19. The Broad Superintendents Academy, 2007

    Science.gov (United States)

    Broad Foundation, 2007

    2007-01-01

    The Broad Superintendents Academy is an executive training program that identifies and prepares prominent leaders--executives with experience successfully leading large organizations and a passion for public service--then places them in urban school districts to dramatically improve the quality of education for America's students. This brochure…

  20. Mimicking Seawater For Culturing Marine Bacteria

    DEFF Research Database (Denmark)

    Rygaard, Anita Mac; Sonnenschein, Eva; Gram, Lone

    2015-01-01

    Only about 1% of marine bacteria have been brought into culture using traditional techniques. The purpose of this study was to investigate if mimicking the natural bacterial environment can increase culturability.We used marine substrates containing defined algal polymers or gellan gum...... 100-fold; from 8.5 x 101 CFU/ml to 5.2 x 103 CFU/ml, whereas addition of AHLs did not improve culturability on any of the media.The substitution of agar with gellan gum shows great promise for increasing culturability of marine bacteria, and further studies are ongoing. The AHLs used in this study...... were selected based on a previous study determining the most common AHLs produced by marine strains of the Vibrionaceae family. However, their effect on culturability could not be fully explained, so also here further studies are being carried out....

  1. Orbital Lymphoma Mimicking Lacrimal Gland Pleomorphic Adenoma

    Directory of Open Access Journals (Sweden)

    Diego Strianese

    2013-09-01

    Full Text Available Purpose: To describe the case of a patient affected by orbital lymphoma mimicking pleomorphic adenoma of the lacrimal gland. Methods: This was a retrospective case report. Results: We present the case of a patient with 15-year history of slowly progressive left proptosis and inferomedial bulbar dislocation who had the presumptive diagnosis of lacrimal gland pleomorphic adenoma based on clinical and radiological features. The patient underwent lateral orbitotomy and lacrimal gland excision. Postoperative histological features were consistent with low-grade B-cell non-Hodgkin lymphoma. Conclusion: The accepted clinico-radiological criteria used for the diagnosis of lacrimal gland fossa lesions might have a certain false-positive rate, even in recent years. The initial surgical approach with the appropriate choice between fine-needle aspiration biopsies, intraoperative biopsies and lacrimal gland excisions might be a challenge.

  2. Contiguous spinal metastasis mimicking infectious spondylodiscitis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chul Min; Lee, Seung Hun [Dept. of Radiology, Hanyang University Hospital, Seoul (Korea, Republic of); Bae, Ji Yoon [Dept. of Pathology, National Police Hospital, Seoul (Korea, Republic of)

    2015-12-15

    Differential diagnosis between spinal metastasis and infectious spondylodiscitis is one of the occasional challenges in daily clinical practice. We encountered an unusual case of spinal metastasis in a 75-year-old female breast cancer patient that mimicked infectious spondylodiscitis. Magnetic resonance imaging (MRI) showed diffuse bone marrow infiltrations with paraspinal soft tissue infiltrative changes in 5 contiguous cervical vertebrae without significant compression fracture or cortical destruction. These MRI findings made it difficult to differentiate between spinal metastasis and infectious spondylodiscitis. Infectious spondylodiscitis such as tuberculous spondylodiscitis was regarded as the more appropriate diagnosis due to the continuous involvement of > 5 cervical vertebrae. The patient's clinical presentation also supported the presumptive diagnosis of infectious spondylodiscitis rather than spinal metastasis. Intravenous antibiotics were administered, but clinical symptoms worsened despite treatment. After pathologic confirmation by computed tomography-guided biopsy, we were able to confirm a final diagnosis of spinal metastasis.

  3. Inherited cardiomyopathies mimicking arrhythmogenic right ventricular cardiomyopathy.

    Science.gov (United States)

    Roberts, Jason D; Veinot, John P; Rutberg, Julie; Gollob, Michael H

    2010-01-01

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) represents an inherited cardiomyopathy that manifests clinically with malignant ventricular arrhythmias, sudden cardiac death, and less commonly heart failure. The condition is characterized by replacement of the myocardium, primarily of the right ventricle, with fibrofatty tissue. Extensive fibrofatty replacement of the myocardium has been previously thought to be pathognomonic of ARVC; however, this report details two other forms of inherited cardiomyopathy, namely hypertrophic cardiomyopathy (HCM) and the PRKAG2 cardiac syndrome, that were found to have significant fibrofatty myocardial replacement at pathologic examination. This report represents the first documentation of inherited cardiomyopathies mimicking ARVC and highlights the concept that other cardiac conditions can be associated with fibrofatty replacement of the myocardium. Copyright 2010 Elsevier Inc. All rights reserved.

  4. Acute disseminated encephalomyelitis mimicking acute meningoencephalitis.

    Science.gov (United States)

    Ashrafi, Mahmoud Reza; Amirkashani, Davood; Hirbod-Mobarakeh, Armin; Yaghmaei, Bahareh; Tavassoli, Alireza; Manafi, Farzad; Rezaei, Nima

    2013-12-01

    Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system that usually occurs following an antecedent infection or vaccination. Children and young adults are predominantly affected, but it has low incidence in children younger than 3 years. The disease manifests with a wide range of neurological abnormalities and a variable combination of fever, headache, meningism, convulsion and cranial nerve palsies, and there are no pathognomonic clinical or laboratory findings. So, establishment of definitive diagnosis is challenging in infants. This challenge may result in delayed diagnosis and consequently delayed treatment of acute disseminated encephalomyelitis, which may cause permanent neurological disability. Herein, we report an infant with acute disseminated encephalomyelitis, who mimicked the symptoms of meningoencephalitis and the correct diagnosis and treatment were delayed till the development of a severe phase of the disease.

  5. Tentorium schwannoma mimicking meningioma: an unusual location.

    Science.gov (United States)

    Calişaneller, Tarkan; Ozen, Ozlem; Altinörs, Nur; Caner, Hakan

    2008-07-01

    A 60-year-old female was admitted to our clinic complaining of a long-lasting headache. Cranial magnetic resonance imagining examination of the patient revealed a 22x24 mm extra-axial, well-demarcated, mass lesion based on the left tentorium. The patient underwent a craniotomy and the tumor was totally excised with the adjacent tentorium. The histopathological examination of the tumor complied with the diagnosis of schwannoma. The rest of the clinical course was uneventful and the patient was released from the hospital without any neurological deficit. Intracranial schwannomas can rarely originate from atypical dural locations and radiological techniques are not always helpful in distinguishing tentorial schwannoma from tentorial meningioma. We presented a patient with a tentorium schwannoma mimicking meningioma and discussed the current literature.

  6. Anterior Cruciate Ligament Reconstruction Rehabilitation

    Science.gov (United States)

    Wright, Rick W.; Haas, Amanda K.; Anderson, Joy; Calabrese, Gary; Cavanaugh, John; Hewett, Timothy E.; Lorring, Dawn; McKenzie, Christopher; Preston, Emily; Williams, Glenn; Amendola, Annunziato

    2015-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction rehabilitation has evolved over the past 20 years. This evolution has been driven by a variety of level 1 and level 2 studies. Evidence Acquisition: The MOON Group is a collection of orthopaedic surgeons who have developed a prospective longitudinal cohort of the ACL reconstruction patients. To standardize the management of these patients, we developed, in conjunction with our physical therapy committee, an evidence-based rehabilitation guideline. Study Design: Clinical review. Level of Evidence: Level 2. Results: This review was based on 2 systematic reviews of level 1 and level 2 studies. Recently, the guideline was updated by a new review. Continuous passive motion did not improve ultimate motion. Early weightbearing decreases patellofemoral pain. Postoperative rehabilitative bracing did not improve swelling, pain range of motion, or safety. Open chain quadriceps activity can begin at 6 weeks. Conclusion: High-level evidence exists to determine appropriate ACL rehabilitation guidelines. Utilizing this protocol follows the best available evidence. PMID:26131301

  7. Ligament strain on the iliofemoral, pubofemoral, and ischiofemoral ligaments in cadaver specimens: biomechanical measurement and anatomical observation.

    Science.gov (United States)

    Hidaka, Egi; Aoki, Mitsuhiro; Izumi, Tomoki; Suzuki, Daisuke; Fujimiya, Mineko

    2014-10-01

    The iliofemoral, pubofemoral, and ischiofemoral ligaments are major structures that stabilize the hip joint. We have sought evidence on which to base more effective hip stretching positions. The purpose of this study was to measure strains on these ligaments and to observe them. Eight fresh/frozen translumbar cadaver specimens were used. Clinically available stretching positions for these ligaments were adopted. Strain on each ligament was measured by a displacement sensor during passive torque to the hip joint. Hip motion was measured using an electromagnetic tracking device. The strained ligaments were captured on clear photographs. Significantly, high strains were imposed on the superior iliofemoral ligament by external rotation of the hip (3.48%); on the inferior iliofemoral ligament by maximal extension and 10° or 20° of external rotation with maximal extension (1.86%, 1.46%, 1.25%); on the pubofemoral ligament by maximal abduction and 10°, 20°, or 30° of external rotation with maximal abduction (3.18%, 3.28%, 3.11%, 2.99%); and on the ischiofemoral ligament by 10° or 20° of abduction with maximal internal rotation (7.11%, 7.83%). Fiber direction in each ligament was clearly identified. Significantly, high strains on hip ligaments corresponded with the anatomical direction of the ligament fibers. Positions were identified for each ligament that imposed maximal increase in strain on it. © 2014 Wiley Periodicals, Inc.

  8. A visco-hyperelastic constitutive model for human spine ligaments.

    Science.gov (United States)

    Jiang, Yugang; Wang, Yu; Peng, Xiongqi

    2015-03-01

    Human spine ligaments show a highly non-linear, strain rate dependent biomechanical behavior under tensile tests. A visco-hyperelastic fiber-reinforced constitutive model was accordingly developed for human ligaments, in which the energy density function is decomposed into two parts. The first part represents the elastic strain energy stored in the soft tissue, and the second part denotes the energy dissipated due to its inherent viscous characteristics. The model is applied to various human spinal ligaments including the anterior and posterior longitudinal ligaments, ligamentum flavum, capsular ligament, and interspinous ligament. Material parameters for each type of ligament were obtained by curve-fitting with corresponding experimental data available in the literature. The results indicate that the model presented here can properly characterize the visco-hyperelastic biomechanical behavior of human spine ligaments.

  9. Kinematics of the lateral ligamentous constraints of the elbow joint

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Søjbjerg, Jens Ole; Dalstra, Michel

    1996-01-01

    Thirty osteoligamentous elbow joint specimens were included in a study of the lateral collateral ligament complex (LCLC). The morphologic characteristics of the LCLC were examined, and then three-dimensional kinematic measurements were undertaken after selective ligament dissections were performe...

  10. Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature

    Science.gov (United States)

    Ventura, Alberto; Terzaghi, Clara; Borgo, Enrico; Albisetti, Walter

    2010-01-01

    Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a long rehabilitation period. In the 1980s, artificial ligaments became an attractive alternative to biological grafts. The initial enthusiasm surrounding their introduction stemmed from their lack of donor morbidity, their abundant supply and significant strength, immediate loading and reduced postoperative rehabilitation. Synthetic grafts made of different materials such as carbon fibers, polypropylene, Dacron and polyester have been utilised either as a prosthesis or as an augmentation for a biological ACL graft substitute. Nevertheless, every material presented serious drawbacks: cross-infections, immunological responses, breakage, debris dispersion leading to synovitis, chronic effusions, recurrent instability and knee osteoarthritis. Recently, a resurgence of interest in the use of synthetic prostheses has occurred and studies regarding new artificial grafts have been reported. Although many experimental studies have been made and much effort has been put forth, currently no ideal prosthesis mimicking natural human tissue has been found. PMID:20157811

  11. Advanced imaging of the scapholunate ligamentous complex

    Energy Technology Data Exchange (ETDEWEB)

    Shahabpour, Maryam; Maeseneer, Michel de; Boulet, Cedric; Mey, Johan de [Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Brussels (Belgium); Staelens, Barbara; Scheerlinck, Thierry [Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedics and Traumatology, Brussels (Belgium); Overstraeten, Luc van [Hand and Foot Surgery Unit (HFSU), Tournai (Belgium)

    2015-12-15

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies. (orig.)

  12. Deltoid ligament in acute ankle injury: MR imaging analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Min Sun; Choi, Yun Sun; Kim, Yun Jung; Jung, Yoon Young [Eulji University, Department of Radiology, Eulji Hospital, Seoul (Korea, Republic of); Kim, Jin Su; Young, Ki Won [Eulji University, Department of Orthopedic Surgery, Eulji Hospital, Seoul (Korea, Republic of)

    2014-05-15

    To identify the pattern of deltoid ligament injury after acute ankle injury and the relationship between ankle fracture and deltoid ligament tear by magnetic resonance imaging (MRI). Thirty-six patients (32 male, and 4 female; mean age, 29.8 years) with acute deltoid ligament injury who had undergone MRI participated in this study. The deltoid ligament was classified as having 3 superficial and 2 deep components. An image analysis included the integrity and tear site of the deltoid ligament, and other associated injuries. Association between ankle fracture and deltoid ligament tear was assessed using Fisher's exact test (P < 0.05). Of the 36 patients, 21 (58.3 %) had tears in the superficial and deep deltoid ligaments, 6 (16.7 %) in the superficial ligaments only, and 4 (11.1 %) in the deep ligaments only. The most common tear site of the three components of the superficial deltoid and deep anterior tibiotalar ligaments was their proximal attachments (94 % and 91.7 % respectively), and that of the deep posterior tibiotalar ligament (pTTL) was its distal attachment (82.6 %). The common associated injuries were ankle fracture (63.9 %), syndesmosis tear (55.6 %), and lateral collateral ligament complex tear (44.4 %). All the components of the deltoid ligament were frequently torn in patients with ankle fractures (tibionavicular ligament, P = 0.009). The observed injury pattern of the deltoid ligament was complex and frequently associated with concomitant ankle pathology. The most common tear site of the superficial deltoid ligament was the medial malleolar attachment, whereas that of the deep pTTL was near its medial talar insertion. (orig.)

  13. Ankle Arthroscopic Reconstruction of Lateral Ligaments (Ankle Anti-ROLL)

    OpenAIRE

    Takao, Masato; Glazebrook, Mark; Stone, James; Guillo, Stéphane

    2015-01-01

    Ankle instability is a condition that often requires surgery to stabilize the ankle joint that will improve pain and function if nonoperative treatments fail. Ankle stabilization surgery may be performed as a repair in which the native existing anterior talofibular ligament or calcaneofibular ligament (or both) is imbricated or reattached. Alternatively, when native ankle ligaments are insufficient for repair, a reconstruction of the ligaments may be performed in which an autologous or allogr...

  14. Characteristics of bone tunnel changes after anterior cruciate ligament reconstruction using Ligament Advanced Reinforcement System artificial ligament.

    Science.gov (United States)

    Huang, Jian-ming; Liu, Hao-yuan; Chen, Feng-rong; Jian, Guo-jian; Chen, Qi; Wang, Zi-min; Kang, Yi-fan

    2012-11-01

    There are different materials used for anterior cruciate ligament (ACL) reconstruction. It has been reported that both autologous grafts and allografts used in ACL reconstruction can cause bone tunnel enlargement. This study aimed to observe the characteristics of bone tunnel changes and possible causative factors following ACL reconstruction using Ligament Advanced Reinforcement System (LARS) artificial ligament. Forty-three patients underwent ACL reconstruction using LARS artificial ligament and were followed up for 3 years. X-ray and CT examinations were performed at 1, 3, 6, 12, 24, and 36 months after surgery, to measure the width of tibial and femoral tunnels. Knee function was evaluated according to the Lysholm scoring system. The anterior and posterior stability of the knee was measured using the KT-1000 arthrometer. According to the Peyrache grading method, grade 1 femoral bone tunnel enlargement was observed in three cases six months after surgery. No grade 2 or grade 3 bone tunnel enlargement was found. The bone tunnel enlargement in the three cases was close to the articular surface with an average tunnel enlargement of (2.5 ± 0.3) mm. Forty cases were evaluated as grade 0. The average tibial and femoral tunnel enlargements at the last follow-up were (0.8 ± 0.3) and (1.1 ± 0.3) mm, respectively. There was no statistically significant difference in bone tunnel width changes at different time points (P > 0.05). X-ray and CT measurements were consistent. There was no marked bone tunnel enlargement immediately following ACL reconstruction using LARS artificial ligament. Such enlargement may, however, result from varying grafting factors involving the LARS artificial ligament or from different fixation methods.

  15. Mechanical Analysis of Extra-Articular Knee Ligaments. Part One: Native knee ligaments.

    Science.gov (United States)

    Smeets, Kristof; Slane, Joshua; Scheys, Lennart; Claes, Steven; Bellemans, Johan

    2017-10-01

    The aim of this study was to provide a characterization of the tensile properties of the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterolateral ligament (ALL) and medial patellofemoral ligament (MPFL). Our hypothesis was that extra-articular knee ligaments are heterogeneous in nature and possess distinct material properties. MCL (n=12), LCL (n=11), MPFL (n=12) and ALL (n=19) samples from fresh frozen human cadaveric knees were subjected to uniaxial tensile testing to failure and analyzed for their material properties. The elastic modulus (slope of the linear portion of the stress/strain curve), ultimate stress (stress at failure), ultimate strain (strain at failure) and strain energy density (area under the stress/strain curve) were calculated. The MCL had the highest elastic modulus (441.8±117.2MPa) and was significantly greater than the MPFL (294.6±190.4MPa) and LCL (289.0±159.7MPa) (Pligaments (ALL 7.8±3.1MPa, MCL 7.5±2.9MPa and MPFL 5.0±2.9MPa). Extra-articular knee ligaments are a heterogeneous group with respect to material characteristics. Each ligament has tensile properties that are significantly different from others and treatment strategies should take these findings into account. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kosy, Jonathan D.; Mandalia, Vipul I.; Anaspure, Rahul [Royal Devon and Exeter Hospital, Princess Elizabeth Orthopaedic Centre, Exeter (United Kingdom)

    2015-11-15

    The anterolateral ligament (ALL) may limit tibial internal rotation and pivot-shift following anterior cruciate ligament reconstruction. Previous studies, using magnetic resonance imaging (MRI) to identify this structure, have been inconsistent. We aimed to further characterize the anatomy of this ligament with reference to previous work. Institutional Review Board approval was gained and a retrospective study of 154 consecutive 1.5-T MRI studies was performed by a consultant musculoskeletal radiologist. Cases with a lateral compartment or cruciate injury and patients under 16 years were excluded. A total of 100 MRIs (98 patients; 63 males: 35 females; mean age, 45.3 years, range, 16-85 years) were included in the study. The ALL was visualized partially in 94 (94.0 %) of the cases and fully with distinct femoral and tibial fibers in 57 (57.0 %) of the cases. Although the femoral origin was discreet in only 57 (57.0 %) of cases, the tibial insertion (7.64 ± 1.26 mm below the joint-line) and meniscal attachment were demonstrated in all cases where the ligament was seen. Where the femoral origin was not seen, a broad expansion of the ligament was noted. We identified four types of meniscal attachment (complete, central, bipolar, and inferior-only). The thickness of the ALL, at the level of the joint-line, was 1.75 ± 0.57 mm. The ALL is a consistent structure with meniscal and tibial portions identifiable in the majority of MRI studies of the uninjured knee. There is an attachment to the lateral meniscus with anatomical variation described by our subclassification. (orig.)

  17. Syndesmosis and deltoid ligament injuries in the athlete

    NARCIS (Netherlands)

    McCollum, Graham A.; van den Bekerom, Michel P. J.; Kerkhoffs, Gino M. M. J.; Calder, James D. F.; van Dijk, C. Niek

    2013-01-01

    Injury to the syndesmosis and deltoid ligament is less common than lateral ligament trauma but can lead to significant time away from sport and prolonged rehabilitation. This literature review will discuss both syndesmotic and deltoid ligament injuries without fracture in the professional athlete. A

  18. The fibre bundle anatomy of human cruciate ligaments

    NARCIS (Netherlands)

    Mommersteeg, T. J.; Kooloos, J. G.; Blankevoort, L.; Kauer, J. M.; Huiskes, R.; Roeling, F. Q.

    1995-01-01

    The cruciate ligaments of the knee consist of numerous fascicles, groups of which comprise fibre bundles. The stabilising function of these ligaments is established by changes in the lengths and orientations of the fascicles. Understanding the function of knee ligaments thus requires an

  19. Thoracolumbar spinal ligaments exhibit negative and transverse pre-strain.

    Science.gov (United States)

    Robertson, Daniel J; Von Forell, Gregory A; Alsup, Jeremy; Bowden, Anton E

    2013-07-01

    The present work represents the first reported bi-axial spinal ligament pre-strain data for the thoracic and lumbar spine. Ligament pre-strain (in-situ strain) is known to significantly alter joint biomechanics. However, there is currently a lack of comprehensive data with regards to spinal ligament pre-strain. The current work determined the pre-strain of 71 spinal ligaments (30 anterior longitudinal ligaments, 27 supraspinous ligaments and 14 interspinous ligaments). The interspinous ligament and the anterior longitudinal ligament exhibited bi-axial pre-strain distributions, demonstrating they are not uniaxial structures. The supraspinous ligament frequently exhibited large amounts of negative pre-strain or laxity suggesting it makes no mechanical contribution to spinal stability near the neutral posture. Upon implementing multi-axial pre-strain results into a finite element model of the lumbar spine, large differences in spinal biomechanics were observed. These results demonstrate the necessity of accounting for ligament pre-strain in biomechanical models. In addition, the authors present a unique experimental method for obtaining ligament pre-strain that presents a number of advantages when compared to standard techniques. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. MR imaging of posterior cruciate ligament injuries

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Nobuyuki [Tsukuba Univ., Ibaraki (Japan). Hospital; Niitsu, Mamoru; Itai, Yuji; Sato, Motohiro; Kujiraoka, Yuka; Ikeda, Kotaro; Kanamori, Akihiro

    2001-07-01

    Posterior cruciate ligament (PCL) injuries are less frequent than anterior cruciate ligament (ACL) injuries, but are presumably more common than once thought. Thirty-nine patients with PCL injuries identified on MR images were studied. The criteria for PCL injury were complete tear, partial tear, and avulsion fracture. The approximate site of a partial tear was categorized as proximal, midsubstance, distal, or combination. Fourteen patients (35.9%) had complete tears of the PCL, 21 patients (53.8%) had partial tears, and four patients (10.3%) had avulsion fractures. A total of 12 patients (30.7%) had isolated PCL injuries, while the remaining 27 patients demonstrated evidence of other coexistent knee injuries, such as meniscal tears and ligamentous injuries. Of coexistent knee injuries, meniscal tears (18 patients, 46.2%) were most often seen. (author)

  1. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology.

    Science.gov (United States)

    Ladd, Amy L; Lee, Julia; Hagert, Elisabet

    2012-08-15

    Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p histologic appearance of capsular tissue with low cellularity. The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and

  2. Thumb Ligament Injuries in the Athlete.

    Science.gov (United States)

    Owings, F Patterson; Calandruccio, James H; Mauck, Benjamin M

    2016-10-01

    Hand injuries account for up to 15% of sports injuries and are common in contact sports and in sports with a high risk of falling. Appropriate management requires knowledge of the type of injury, demands of the sport and position, competitive level of the athlete, future athletic demands and expectations, and the role of rehabilitation and protective splints for return to play. Management of the athlete requires aggressive and expedient diagnostic intervention and treatment. This article describes ligamentous injuries to the thumb, including thumb carpometacarpal dislocations, thumb metacarpophalangeal dislocations, collateral ligament injuries and interphalangeal dislocations, their evaluation, treatment and outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Pseudocyclops: two cases of ACL graft partial tears mimicking cyclops lesions on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Simpfendorfer, Claus; Subhas, Naveen; Winalski, Carl S.; Ilaslan, Hakan [Cleveland Clinic, Department of Radiology, Cleveland, OH (United States); Miniaci, Anthony [Cleveland Clinic, Department of Orthopedics, Cleveland, OH (United States)

    2015-08-15

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is a common surgical procedure, particularly in young athletes. Although the procedure has excellent success rates, complications such as mechanical impingement, graft rupture, and arthrofibrosis can occur, often necessitating additional surgery. Magnetic resonance (MR) imaging has become a valuable tool in evaluating complications after ACL reconstruction. We report two cases of ACL reconstruction complicated by arthroscopically proven partial graft tears. In both cases the torn anterior graft fibers were flipped into the intercondylar notch, mimicking anterior arthrofibrosis, i.e., a ''cyclops lesion,'' on MR imaging. Careful review of the direction of graft fibers on MR imaging in the ''pseudocyclops'' lesions can help differentiate these partial tears from the fibrosis of a true cyclops. The ''pseudocyclops'' lesion is a previously undescribed MR imaging sign of partial ACL graft tear. Larger studies are required to determine the sensitivity and specificity of the sign, as well as the clinical importance of these partial graft tears. (orig.)

  4. Immunoglobulin G4 -related kidney disease: A comprehensive pictorial review of the imaging spectrum, Mimickers, and clinicopathological characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Ni Eun; Kim, Jin Hee; Byun, Jae Ho; Lee, Seung Soo; Kim, Hyoung Jung; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2015-10-15

    Immunoglobulin G4 (IgG4)-related kidney disease (IgG4-KD) has recently been demonstrated to be an important part of IgG4-related sclerosing disease (IgG4-SD). However, since IgG4-KD is still relatively unfamiliar to radiologists and physicians as compared to IgG4-SD involving other organs, it could, therefore, be easily missed. In this article, we present a comprehensive pictorial review of IgG4-KD with regards to the imaging spectrum, mimickers, and clinicopathologic characteristics, based on our clinical experience with 48 patients during the past 13 years, as well as a literature review. Awareness of the broad imaging spectrum of IgG4-KD and differential diagnosis from its mimickers will thus facilitate its early diagnosis and treatment.

  5. Injury of the ligaments of the knee: Magnetic resonance evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Joong Mo; Kang, Heung Sik; Kim, Sung Moon; Seong, Sang Cheol [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1992-03-15

    To evaluation the value of MR imaging in the examination of ligament injury of the knee, we retrospectively analysed the MR images of 61 injured knees of 60 patients. The presence of tear was determined by arthroscopy in all caes. Anterio/posterior cruciate ligaments(ACL/PCL) were demonstrated by sagittal images. Medial/lateral collateral ligaments(MCL/ LCL) were evaluated on coronal images. The diagnostic accuracy were 91.8%, 96.7% and 100% for ACL, PCL and MCL, respectively. The specificity for the lateral collateral ligament was 100%. It is concluded that magnetic resonance imaging is an accurate method in detecting injury of the ligaments of the knee.

  6. Lymphocitic infundibuloneurohypophysitis mimicking a pituitary adenoma

    Directory of Open Access Journals (Sweden)

    Hubertus Maximilian Mehdorn

    2011-04-01

    Full Text Available A rare case of infundibulo-neurohypophysitis mimicking a pituitary adenoma is presented. A 69-years-old female patient developed polyuria and polydipsia. Laboratory analysis revealed central diabetes insipidus. No hormonal abnormalities. Cranial-magnetic resonance imaging (MRI showed a left sided mass in the adenohypophysis presuming a pituitary adenoma. The mass had contact to both internal carotids. Admission to our department for neurosurgical treatment followed. Ophthalmo - logic examination and neurological examination yielded normal findings. A second MRI focussing on the sellar-region showed a leftsided (T2-MRI.hyperintense, distended adenohypophysis, without contrast enhancement in T1. The stalk appeared thickened. T1- weighted sequences of the neurohypophysis showed loss of signal intensity. We diagnosed an infundibulo-neurohypophysitis and abstai - ned from surgical removal. The patient was discharged under treatment with corticosteroids and desmopressin. Hypophysitis is rare and shows special clinical characteristics. Despite defined radiological features to differentiate between hypophysitis and adenoma the possibility of misdiagnosis, and unnecessary surgical procedures, should always kept in mind.

  7. [Infestation with Enterobius vermicularis mimicking appendicitis].

    Science.gov (United States)

    Levens, Afra M A; Schurink, Maarten; Koetse, Harma A; van Baren, Robertine

    2014-01-01

    Gastrointestinal infestation with the parasite Enterobius vermicularis is common in humans and is usually harmless. Anal pruritus is the most characteristic symptom, but the parasites can cause severe abdominal pain mimicking appendicitis. Early recognition can prevent an unnecessary appendectomy. A six-year-old girl reported to the accident and emergency department with pain in the lower right abdominal region. She was admitted and treated for suspected perforated appendix, following physical examination supplemented with an abdominal CT scan. After antibiotic treatment the symptoms disappeared as did the abscess, apart from a minor amount of residual infiltrate. She was then readmitted twice with recurrent abdominal pain without radiological evidence of an abdominal focus. We decided to conduct a diagnostic laparoscopy and an elective appendectomy à froid. During this procedure living worms were found in the appendix. Treatment with the anthelminthicum mebendazol was effective. Gastro-intestinal infestation with E. vermicularis is very common, especially in young children. This infestation is usually harmless, but can mimic appendicitis. This infestation is easily treatable with mebendazol.

  8. Microfabricated adhesive mimicking gecko foot-hair.

    Science.gov (United States)

    Geim, A K; Dubonos, S V; Grigorieva, I V; Novoselov, K S; Zhukov, A A; Shapoval, S Yu

    2003-07-01

    The amazing climbing ability of geckos has attracted the interest of philosophers and scientists alike for centuries. However, only in the past few years has progress been made in understanding the mechanism behind this ability, which relies on submicrometre keratin hairs covering the soles of geckos. Each hair produces a miniscule force approximately 10(-7) N (due to van der Waals and/or capillary interactions) but millions of hairs acting together create a formidable adhesion of approximately 10 N x cm(-2): sufficient to keep geckos firmly on their feet, even when upside down on a glass ceiling. It is very tempting to create a new type of adhesive by mimicking the gecko mechanism. Here we report on a prototype of such 'gecko tape' made by microfabrication of dense arrays of flexible plastic pillars, the geometry of which is optimized to ensure their collective adhesion. Our approach shows a way to manufacture self-cleaning, re-attachable dry adhesives, although problems related to their durability and mass production are yet to be resolved.

  9. Microfabricated adhesive mimicking gecko foot-hair

    Science.gov (United States)

    Geim, A. K.; Dubonos, S. V.; Grigorieva, I. V.; Novoselov, K. S.; Zhukov, A. A.; Shapoval, S. Yu.

    2003-07-01

    The amazing climbing ability of geckos has attracted the interest of philosophers and scientists alike for centuries. However, only in the past few years has progress been made in understanding the mechanism behind this ability, which relies on submicrometre keratin hairs covering the soles of geckos. Each hair produces a miniscule force ~10-7 N (due to van der Waals and/or capillary interactions) but millions of hairs acting together create a formidable adhesion of ~10 N cm-2: sufficient to keep geckos firmly on their feet, even when upside down on a glass ceiling. It is very tempting to create a new type of adhesive by mimicking the gecko mechanism. Here we report on a prototype of such 'gecko tape' made by microfabrication of dense arrays of flexible plastic pillars, the geometry of which is optimized to ensure their collective adhesion. Our approach shows a way to manufacture self-cleaning, re-attachable dry adhesives, although problems related to their durability and mass production are yet to be resolved.

  10. Hyperdense dots mimicking microcalcifications : Mammographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Nam Hyeon; Park, Jeong Mi; Goo, Hyun Woo; Bang, Sun Woo [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    1996-12-01

    To differentiate fine hyperdense dots mimicking microcalcifications from true microcalcifications on mammography. Mammograms showing hyperdense dots in ten patients (mean age, 59 years) were evaluated. Two radiologists were asked to differentiate with the naked eye the hyperdense dots seen on ten mammograms and proven microcalcifications seen on ten mammograms. Densitometry was also performed for all lesions and the contrast index was calculated. The shape and distribution of the hyperdense dots were evaluated and enquires were made regarding any history of breast disease and corresponding treatment. Biopsies were performed for two patients with hyperdense dots. Two radiologists made correct diagnoses in 19/20 cases(95%). The contrast index was 0.10-0.88 (mean 0.58) for hyperdense dots and 0.02-0.45 (mean 0.17) for true microcalcifications. The hyperdense dots were finer and homogeneously rounder than the microcalcifications. Distribution of the hyperdense dots was more superficial in subcutaneous fat (seven cases) and subareolar area (six cases). All ten patients with hyperdense dots had history of mastitis and abscesses and had been treated by open drainage (six cases) and/or folk remedy (four cases). In eight patients, herb patches had been attached. Biopsies of hyperdense dots did not show any microcalcification or evidence of malignancy. These hyperdense dots were seen mainly in older patients. Their characteristic density, shape, distribution and clinical history makes differential diagnosis from true microcalcifications easy and could reduce unnecessary diagnostic procedures such as surgical biopsy.

  11. Mammary analogue secretory carcinoma mimicking salivary adenoma.

    Science.gov (United States)

    Williams, Lindsay; Chiosea, Simion I

    2013-12-01

    Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland tumor characterized by ETV6 translocation. It appears that prior studies have identified MASC by reviewing salivary gland carcinomas, such as acinic cell carcinoma and adenocarcinoma, not otherwise specified. To address the possibility of MASC mimicking benign salivary neoplasms we reviewed 12 salivary gland (cyst)adenomas diagnosed prior to the discovery of MASC. One encapsulated (cyst)adenoma of the parotid gland demonstrated features of MASC. The diagnosis was confirmed by fluorescence in situ hybridization with an ETV6 break-apart probe. An unusual complex pattern of ETV6 rearrangement with duplication of the telomeric/distal ETV6 probe was identified. This case illustrates that MASC may mimic salivary (cyst)adenomas. To more accurately assess true clinical and morphologic spectrum of MASC, future studies may have to include review of salivary (cyst)adenomas. The differential diagnosis of MASC may have to be expanded to include cases resembling salivary (cyst)adenomas.

  12. Mesenchymal stem cell isolation and characterization from human spinal ligaments.

    Science.gov (United States)

    Asari, Toru; Furukawa, Ken-Ichi; Tanaka, Sunao; Kudo, Hitoshi; Mizukami, Hiroki; Ono, Atsushi; Numasawa, Takuya; Kumagai, Gentaro; Motomura, Shigeru; Yagihashi, Soroku; Toh, Satoshi

    2012-01-27

    Mesenchymal stem cells (MSCs) have a fibroblast-like morphology, multilineage potential, long-term viability and capacity for self-renewal. While several articles describe isolating MSCs from various human tissues, there are no reports of isolating MSCs from human spinal ligaments, and their localization in situ. If MSCs are found in human spinal ligaments, they could be used to investigate hypertrophy or ossification of spinal ligaments. To isolate and characterize MSCs from human spinal ligaments, spinal ligaments were harvested aseptically from eight patients during surgery for lumbar spinal canal stenosis and ossification of the posterior longitudinal ligament. After collagenase digestion, nucleated cells were seeded at an appropriate density to avoid colony-to-colony contact. Cells were cultured in osteogenic, adipogenic or chondrogenic media to evaluate their multilineage differentiation potential. Immunophenotypic analysis of cell surface markers was performed by flow cytometry. Spinal ligaments were processed for immunostaining using MSC-related antibodies. Cells from human spinal ligaments could be extensively expanded with limited senescence. They were able to differentiate into osteogenic, adipogenic or chondrogenic cells. Flow cytometry revealed that their phenotypic characteristics met the minimum criteria of MSCs. Immunohistochemistry revealed the localization of CD90-positive cells in the collagenous matrix of the ligament, and in adjacent small blood vessels. We isolated and expanded MSCs from human spinal ligaments and demonstrated localization of MSCs in spinal ligaments. These cells may play an indispensable role in elucidating the pathogenesis of numerous spinal diseases. Copyright © 2011 Elsevier Inc. All rights reserved.

  13. [One-stage repair and reconstruction of knee anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament].

    Science.gov (United States)

    Chen, Pingquan; Zhu, Zhenkang; Wang, Sheng

    2012-06-01

    To investigate the effectiveness of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction combined with limited open repair of medial collateral ligament (MCL) in recovering the stability and the function of the knee. Between April 2003 and October 2010, 14 patients (14 knees) with multiple injuries of ACL, PCL, and MCL were treated. There were 10 males and 4 females with an average age of 41 years (range, 21-71 years). Injury was caused by traffic accident in 11 cases and falling in 3 cases. The average time from injury to admission was 2 days (range, 1-4 days). Lysholm score was 17.00 +/- 8.29, and the International Knee Documentation Committee (IKDC) score was 20.93 +/- 8.28. The complicated injuries included dislocation of the knee joint in 9 cases and meniscus injury in 5 cases. Allogeneic tendons (2 cases) and autologous harmstring tendon (12 cases) were used to reconstruct ACL and PCL under arthroscopy, and all cases underwent limited open repair of MCL. All incisions healed by first intention. Numbness of the lower limb occurred in 3 cases and alleviated spontaneously. All patients were followed up 14 months on average (range, 12-18 months). The knee flexion was 120 degrees and extension was 0 degrees at 3 months of follow-up. After 1 year of follow-up, IKDC score and Lysholm score were 89.93 +/- 6.26 and 88.93 +/- 4.82, respectively, showing significant differences when compared with preoperative scores (P injuries of the knee ligaments, an arthroscope with limited open repair and reconstruction of the knee ligament can avoid open joint chamber, reduce postoperative articular adhesion, and encourage the joint function recovery.

  14. Non-harmful insertion of data mimicking computer network attacks

    Energy Technology Data Exchange (ETDEWEB)

    Neil, Joshua Charles; Kent, Alexander; Hash, Jr, Curtis Lee

    2016-06-21

    Non-harmful data mimicking computer network attacks may be inserted in a computer network. Anomalous real network connections may be generated between a plurality of computing systems in the network. Data mimicking an attack may also be generated. The generated data may be transmitted between the plurality of computing systems using the real network connections and measured to determine whether an attack is detected.

  15. Atypical Pyoderma Gangrenosum Mimicking an Infectious Process

    Directory of Open Access Journals (Sweden)

    Derek To

    2014-01-01

    Full Text Available We present a patient with atypical pyoderma gangrenosum (APG, which involved the patient’s arm and hand. Hemorrhagic bullae and progressive ulcerations were initially thought to be secondary to an infectious process, but a biopsy revealed PG. Awareness of APG by infectious disease services may prevent unnecessary use of broad-spectrum antibiotics.

  16. Atypical pyoderma gangrenosum mimicking an infectious process.

    Science.gov (United States)

    To, Derek; Wong, Aaron; Montessori, Valentina

    2014-01-01

    We present a patient with atypical pyoderma gangrenosum (APG), which involved the patient's arm and hand. Hemorrhagic bullae and progressive ulcerations were initially thought to be secondary to an infectious process, but a biopsy revealed PG. Awareness of APG by infectious disease services may prevent unnecessary use of broad-spectrum antibiotics.

  17. Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

    Science.gov (United States)

    Hasenkamp, W; Villard, J; Delaloye, J R; Arami, A; Bertsch, A; Jolles, B M; Aminian, K; Renaud, P

    2014-06-01

    Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL). Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

  18. Trapeziometacarpal joint stability: the evolving importance of the dorsal ligaments.

    Science.gov (United States)

    Lin, James D; Karl, John W; Strauch, Robert J

    2014-04-01

    Trapeziometacarpal (TMC) arthritis of the thumb is a common source of hand pain and disability. TMC ligamentous instability may play a role in TMC degeneration. However, the relative importance of the TMC ligaments in the etiology of degeneration and the use of surgery to treat instability in early-stage arthritis are unclear. In this review, we addressed several questions: (1) What are the primary ligamentous stabilizers of the thumb TMC joint? (2) What is the evidence for ligament reconstruction or ligament imbrication in the treatment of thumb TMC joint osteoarthritis? And (3) what is the evidence for thumb metacarpal osteotomy in the treatment of thumb TMC joint osteoarthritis? We performed a systematic review of the literature using PubMed (MEDLINE(®)) and Scopus(®) (EMBASE(®)) for peer-reviewed articles published until November 2012. Fifty-two studies fit the inclusion criteria. Twenty-four studies were anatomic, biomechanical, or histopathologic studies on TMC joint ligamentous anatomy, 16 studies were clinical studies concerning ligament reconstruction, and 12 studies were clinical studies on thumb metacarpal osteotomy. Over the past two decades, increasing evidence suggests the dorsoradial ligament is the most important stabilizer of the TMC joint. Other ligaments consistently identified are the superficial anterior oblique, deep anterior oblique, intermetacarpal, ulnar collateral, and posterior oblique ligaments. Ligament reconstruction and metacarpal osteotomy relieve pain and improve grip strength based on Level IV studies. The dorsal ligaments are the primary stabilizers of the TMC joint. Ligament reconstruction and metacarpal osteotomy ameliorate ligamentous laxity and relieve pain based on Level IV studies.

  19. Strain rate dependent properties of younger human cervical spine ligaments.

    Science.gov (United States)

    Mattucci, Stephen F E; Moulton, Jeffrey A; Chandrashekar, Naveen; Cronin, Duane S

    2012-06-01

    The cervical spine ligaments play an essential role in limiting the physiological ranges of motion in the neck; however, traumatic loading such as that experienced in automotive crash scenarios can lead to ligament damage and result in neck injury. The development of detailed neck models to evaluate the response and the potential for injury requires accurate ligament mechanical properties at relevant loading rates. The objective of this study was to measure the mechanical properties of the cervical spine ligaments, by performing tensile tests at elongation rates relevant to car crash scenarios, using younger specimens (≤50 years), in simulated in vivo conditions, and to provide a comprehensive investigation of gender and spinal level effects. The five ligaments investigated were the anterior longitudinal ligament, posterior longitudinal ligament, capsular ligament, ligamentum flavum, and interspinous ligament. Ligaments were tested in tension at quasi-static (0.5 s(-1)), medium (20 s(-1)) and high (150-250 s(-1)) strain rates. The high strain rates represented typical car crash scenarios as determined using an existing cervical spine finite element model. In total, 261 ligament tests were performed, with approximately even distribution within elongation rate, spinal level, and gender. The measured force-displacement data followed expected trends compared to previous studies. The younger ligaments investigated in this study demonstrated less scatter, and were both stiffer and stronger than comparable data from older specimens reported in previous studies. Strain rate effects were most significant, while spinal level effects were limited. Gender effects were not significant, but consistent trends were identified, with male ligaments having a higher stiffness and failure force than female ligaments. Copyright © 2012 Elsevier Ltd. All rights reserved.

  20. The anatomy and function of Cleland's ligaments

    NARCIS (Netherlands)

    Zwanenburg, R L; Werker, P M N; McGrouther, D A

    The cutaneous ligaments of the digits have been recognized by anatomists for several centuries, but the best known description is that of John Cleland. Subsequent varying descriptions of their morphology have resulted in the surgical community having an imprecise view of their structure and dynamic

  1. Causes of anterior cruciate ligament injuries.

    Science.gov (United States)

    Ristić, Vladimir; Ninković, Srdan; Harhaji, Vladimir; Milankov, Miroslav

    2010-01-01

    In order to prevent anterior cruciate ligament injuries it is necessary to define risk factors and to analyze the most frequent causes of injuries--that being the aim of this study. The study sample consisted of 451 surgically treated patients, including 400 sportsmen (65% of them being active and 35% recreational sportsmen), 29% female and 71% male; of whom 90% were younger than 35. Sports injuries, as the most frequent cause of anterior cruciate ligament injuries, were recorded in 88% of patients (non-contact ones in 78% and contact ones in 22%), injuries occurring in everyday activities in 11% and in traffic in 1%. Among sportsmen, reconstruction of the anterior cruciate ligament was most frequently performed in football players (48%), then in handball players (22%), basketball players (13%), volleyball players (8%), martial arts fighters (4%). However, the injury incidence was the highest among the active basketball players (1 injured among 91 active players). Type of footwear, warming up before the activity, genetic predisposition and everyday therapy did not have a significant influence on getting injured. Anterior cruciate ligament injuries happened three times more often during matches, in the middle and at the end of a match and training session (79%), at landing after the jump or when changing direction of movement (75%) without a contact with other competitors, on dry surfaces (79%), among not so well prepared sportsmen.

  2. Posterior Cruciate Ligament: Current Concepts Review

    Directory of Open Access Journals (Sweden)

    Santiago Pache

    2018-01-01

    Full Text Available The posterior cruciate ligament (PCL is the largest and strongest ligament in the human knee, and the primary posteriorstabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCLinjuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has becomean important and validated objective measure in surgical decision making and post-operative assessment. Isolatedgrade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occurtogether with other ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic singlebundlePCL reconstruction (SB-PCLR typically restores the larger anterolateral bundle (ALB and represents the mostcommonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR hasled to the development of an anatomic double-bundle (DB PCLR to restore the native PCL footprint and co-dominantbehavior of the anterolateral and posteromedial bundles and re-establish normal knee kinematics. The purpose of thisarticle is to review the pertinent details regarding PCL anatomy, biomechanics, injury diagnosis and treatment options,with a focus on arthroscopically assisted DB-PCLR.

  3. Novel Insights into Anterior Cruciate Ligament Injury

    NARCIS (Netherlands)

    D.E. Meuffels (Duncan)

    2011-01-01

    textabstractAnterior cruciate ligament (ACL) injury is one of the most common sports injuries of the knee. ACL reconstruction has become, standard orthopaedic practice worldwide with an estimated 175,000 reconstructions per year in the United States.6 The ACL remains the most frequently studied

  4. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2015-01-01

    STUDY QUESTION: In young active adults with an acute anterior cruciate ligament (ACL) rupture, do patient reported or radiographic outcomes after five years differ between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  5. Tunnel widening in anterior cruciate ligament reconstruction

    DEFF Research Database (Denmark)

    Clatworthy, M G; Annear, P; Bulow, J U

    1999-01-01

    We report a prospective series evaluating the incidence and degree of tunnel widening in a well-matched series of patients receiving a hamstring or patella tendon graft for anterior cruciate ligament (ACL) deficiency. We correlated tunnel widening with clinical factors, knee scores, KT-1000...

  6. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2013-01-01

    To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  7. Medial ankle pain after lateral ligament rupture

    NARCIS (Netherlands)

    van Dijk, C. N.; Bossuyt, P. M.; Marti, R. K.

    1996-01-01

    After a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the

  8. [Collateral ligament injuries of the metacarpophalangeal joints].

    Science.gov (United States)

    Pillukat, T; Schädel-Höpfner, M; Windolf, J; Prommersberger, K-J

    2012-07-01

    Collateral ligament injuries of the metacarpal joints of the fingers are rare conditions. The injury should be diagnosed by clinical investigation and standard radiographs. Leading symptoms are local tenderness and joint instability. Instability is verified by clinical stress testing of the metacarpophalangeal joint in 90° of flexion. In Grade I injuries stability is preserved due to ligament attenuation or small partial tears. Grade II injuries show laxity with firm endpoint according to incomplete tear. In Grade III injuries instability without endpoint can be found as a result of complete tears. Radiographs may show avulsed bone fragments.In Grade I and II tears or non- displaced avulsion fragments treatment is conservative with buddy taping for 6 weeks. In case of persistent instability or grade III tears suturing or refixation of the ligament are performed. Small avulsion fragments are removed and the ligament is fixed to the bone. Greater avulsion fragments are fixed by suitable small implants. Adequate treatment will lead to reliable good results. Even in chronic tears reconstruction with local material or tendon transplants is usually successful.

  9. Invasive Pulmonary Aspergillosis-mimicking Tuberculosis.

    Science.gov (United States)

    Kim, Sung-Han; Kim, Mi Young; Hong, Sun In; Jung, Jiwon; Lee, Hyun Joo; Yun, Sung-Cheol; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee

    2015-07-01

    Pulmonary tuberculosis is occasionally confused with invasive pulmonary aspergillosis (IPA) in transplant recipients, since clinical suspicion and early diagnosis of pulmonary tuberculosis and IPA rely heavily on imaging modes such as computed tomography (CT). We therefore investigated IPA-mimicking tuberculosis in transplant recipients. All adult transplant recipients who developed tuberculosis or IPA at a tertiary hospital in an intermediate tuberculosis-burden country during a 6-year period were enrolled. First, we tested whether experienced radiologists could differentiate pulmonary tuberculosis from IPA. Second, we determined which radiologic findings could help us differentiate them. During the study period, 28 transplant recipients developed pulmonary tuberculosis after transplantation, and 80 patients developed IPA after transplantation. Two experienced radiologists scored blindly 28 tuberculosis and 50 randomly selected IPA cases. The sensitivities of radiologists A and B for IPA were 78% and 68%, respectively (poor agreement, kappa value = 0.25). The sensitivities of radiologists A and B for tuberculosis were 64% and 61%, respectively (excellent agreement, kappa value = 0.77). We then compared the CT findings of the 28 patients with tuberculosis and 80 patients with IPA. Infarct-shaped consolidations and smooth bronchial wall thickening were more frequent in IPA, and mass-shaped consolidations and centrilobular nodules (tuberculosis. Certain CT findings appear to be helpful in differentiating between IPA and tuberculosis. Nevertheless, the CT findings of about one-third of pulmonary tuberculosis cases in transplant recipients are very close to those of IPA. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  10. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae.

    Science.gov (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Pongpech, Sirintara

    2016-01-01

    The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow.

  11. Superhydrophobic Surfaces Developed by Mimicking Hierarchical Surface Morphology of Lotus Leaf

    Directory of Open Access Journals (Sweden)

    Sanjay S. Latthe

    2014-04-01

    Full Text Available The lotus plant is recognized as a ‘King plant’ among all the natural water repellent plants due to its excellent non-wettability. The superhydrophobic surfaces exhibiting the famous ‘Lotus Effect’, along with extremely high water contact angle (>150° and low sliding angle (<10°, have been broadly investigated and extensively applied on variety of substrates for potential self-cleaning and anti-corrosive applications. Since 1997, especially after the exploration of the surface micro/nanostructure and chemical composition of the lotus leaves by the two German botanists Barthlott and Neinhuis, many kinds of superhydrophobic surfaces mimicking the lotus leaf-like structure have been widely reported in the literature. This review article briefly describes the different wetting properties of the natural superhydrophobic lotus leaves and also provides a comprehensive state-of-the-art discussion on the extensive research carried out in the field of artificial superhydrophobic surfaces which are developed by mimicking the lotus leaf-like dual scale micro/nanostructure. This review article could be beneficial for both novice researchers in this area as well as the scientists who are currently working on non-wettable, superhydrophobic surfaces.

  12. Ligament-induced sacral fractures of the pelvis are possible.

    Science.gov (United States)

    Steinke, Hanno; Hammer, Niels; Lingslebe, Uwe; Höch, Andreas; Klink, Thomas; Böhme, Jörg

    2014-07-01

    Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy. Copyright © 2014 Wiley Periodicals, Inc.

  13. Ligament structures in the tarsal sinus and canal.

    Science.gov (United States)

    Li, Shu-Yuan; Hou, Zhi-Dian; Zhang, Peng; Li, Hong-Liang; Ding, Zi-Hai; Liu, Yu-Jie

    2013-12-01

    The concrete anatomy and functional characteristics of the subtalar ligaments have been a matter of debate that some believe has hampered the progress of clinical ligament reconstruction. In 32 fresh-frozen cadaver feet, the course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured and photographed both from the portal of the tarsal sinus and from a posterior view. The IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint. The results of this study show that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal. The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.

  14. Neck ligament strength is decreased following whiplash trauma

    Directory of Open Access Journals (Sweden)

    Rubin Wolfgang

    2006-12-01

    Full Text Available Abstract Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1 were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95 mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the interspinous and supraspinous ligaments were most flexible. The whiplash

  15. Anterior cruciate ligament reconstruction in a rabbit model using canine small intestinal submucosa and autologous platelet-rich plasma.

    Science.gov (United States)

    Lee, A-Jin; Chung, Wook-Hun; Kim, Dae-Hyun; Lee, Kyung-Pil; Chung, Dai-Jung; Do, Sun Hee; Kim, Hwi-Yool

    2012-11-01

    The bone-ligament interface is the main point of failure after anterior cruciate ligament reconstruction. Synthetic ligament materials have problems such as a greater failure rate of the bone-ligament insertion than autografts. Small intestinal submucosa (SIS) is a biologic scaffold that has been used to repair musculoskeletal tissue and has been shown to promote cell migration and enhance collagen fiber regeneration. Autologous platelet-rich plasma (PRP) has also been investigated as a potential promoter of tendon healing. We investigated SIS and PRP as biomaterials that might strengthen the bone-tunnel interface and improve tendon structure formation. Anterior cruciate ligament grafts were formed of braid-twist canine SIS. These canine SIS ligament grafts were used for anterior cruciate ligament reconstruction in 20 New Zealand white rabbits. The rabbits were divided into 2 treatment groups. In 1 group (SIS group; n = 10), we only implanted the canine SIS grafts. In the second group (PRP group; n = 10), we applied autologous PRP to the surgical area after implantation of canine SIS grafts. We determined the cytokine level of the autologous PRP using a transforming growth factor-β1 enzyme-linked immunosorbent assay kit. At 1 and 4 wk after surgery, magnetic resonance imaging was performed to evaluate the grafts. The femur-graft-tibia complex was assessed histologically and biomechanically at 8 wk after surgery. At 1 wk after surgery, the magnetic resonance imaging scans of the PRP group showed high signal-intensity lesions. In biomechanical tests, the SIS group had a significantly greater maximum load, maximum stress, and ultimate load and strain than the PRP group. The histologic findings of the PRP group revealed a greater cellular response, fibrotic tissue regeneration around the graft, broad chondrocyte cell infiltration, and collagen fibers that were loosely attached to the bone. The PRP group had significantly lower tension load values than the SIS group

  16. Radiologic analysis of the medical collateral ligament rupture

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Chung Che; Lee, Chang Jun; Kim, Kun Sang; Park, Soo Soung [Chung Ang University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    The medical collateral ligament rupture is the most common injury involving the knee joint ligaments. The ruptured medical collateral ligaments of 73 cases with clinical and surgical confirmations were radiologically analyzed. The results were obtained as follows: 1. The most risky age for tearing of the medical collateral ligament was third to fifth decades (50 cases of male and 23 of females). 2. The most common cause of the medical collateral ligament rupture was traffic accident (82.2%). 3. The mean distance of medial knee joint space was 7.9 {+-} 2.0 mm on the normal side and 13.7 {+-} 4.2 mm on the affected side. 4. The mean degree of knee joint space was 10.1 {+-} 2.5 on the normal side and 14.7 {+-} 3.8 on the affected side. 5. The fibula was the bone fractured most frequently in association with the medial collateral ligament rupture (30.6%)

  17. Essentials of anterior cruciate ligament rupture management.

    Science.gov (United States)

    Klinge, Stephen A; Sawyer, Gregory A; Hulstyn, Michael J

    2013-05-01

    Anterior cruciate ligament (ACL) rupture is a common knee injury and an understanding of current medical knowledge regarding its management is essential. Accurate and prompt diagnosis requires an awareness of injury mechanisms and risk factors, common symptoms and physical/radiologic findings. Early mobilization and physical therapy improves outcomes regardless of treatment modality. Many older patients regain sufficient stability and function after non-operative rehabilitation. Early ACL reconstruction is appropriate for younger patients and those who engage in activities requiring frequent pivoting and rapid direction changes. ACL surgery involves reconstruction of the torn ligament tissue with various replacement graft options, each with advantages and disadvantages. The guidance of a knowledgeable and experienced therapist is required throughout an intensive and prolonged rehabilitation course. Generally excellent outcomes and low complication rates are expected, but treatment does not prevent late osteoarthritis.

  18. Anterior cruciate ligament reconstruction and knee osteoarthritis.

    Science.gov (United States)

    Paschos, Nikolaos K

    2017-03-18

    Anterior cruciate ligament (ACL) injury is a traumatic event that can lead to significant functional impairment and inability to participate in high-level sports-related activities. ACL reconstruction is considered the treatment of choice for symptomatic ACL-deficient patients and can assist in full functional recovery. Furthermore, ACL reconstruction restores ligamentous stability to normal, and, therefore, can potentially fully reinstate kinematics of the knee joint. As a consequence, the natural history of ACL injury could be potentially reversed via ACL reconstruction. Evidence from the literature is controversial regarding the effectiveness of ACL reconstruction in preventing the development of knee cartilage degeneration. This editorial aims to present recent high-level evidence in an attempt to answer whether ACL injury inevitably leads to osteoarthritis and whether ACL reconstruction can prevent this development or not.

  19. Macroscopic and Microscopic Analysis of the Thumb Carpometacarpal Ligaments

    Science.gov (United States)

    Ladd, Amy L.; Lee, Julia; Hagert, Elisabet

    2012-01-01

    Background: Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Methods: Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments. Results: Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p thumb carpometacarpal joint provides further evidence regarding the stability and mobility of this joint that is often affected by osteoarthritis. PMID:22992815

  20. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS)

    DEFF Research Database (Denmark)

    Roemer, Frank W; Frobell, Richard; Lohmander, Stefan

    2014-01-01

    OBJECTIVE: To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability. DESIGN...... and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion...

  1. Strength of round and uterosacral ligaments: a biomechanical study.

    Science.gov (United States)

    Martins, Pedro; Silva-Filho, Agnaldo Lopes; Fonseca, Andrea M R M; Santos, Agostinho; Santos, Liliana; Mascarenhas, Teresa; Jorge, Renato M N; Ferreira, António M

    2013-02-01

    To investigate the tensile biomechanical properties of round and uterosacral ligaments. Tissue samples were obtained from 15 female cadavers without pelvic organ prolapse. Uniaxial tensile tests were performed to obtain stiffness and maximum stress of round and uterosacral ligaments. Correlations were calculated using the Pearson correlation coefficient. Statistical differences between groups were tested using Student's paired and unpaired t test. There was a great variability in the measurements of stiffness and maximum stress in pelvic ligaments. The round ligaments demonstrated stiffness of 9.1 ± 1.6 MPa (mean ± SEM) (ranging from 2 to 25.6 MPa) and maximum stress of 4.3 ± 0.7 MPa (ranging from 1.2 to 11.5 MPa). The stiffness of the uterosacral ligaments was 14.1 ± 1.4 MPa (ranging from 5.7 to 26.1 MPa) with maximum stress of 6.3 ± 0.8 MPa (ranging from 2.2 to 11.9 MPa). There was a strong positive correlation between stiffness and maximum stress in female pelvic ligaments (ρ = 0.851; p ligaments demonstrated higher stiffness and maximum stress compared to the round ligaments (p = 0.006 and p = 0.034; respectively). Age, body mass index and menopausal status were not associated with the biomechanical proprieties of round and uterosacral ligaments. Nulliparous women had lower uterosacral stiffness (15.5 ± 1.3 vs. 10 ± 1.8 MPa; p = 0.033) and maximum stress (8.2 ± 0.9 vs. 4.2 ± 1.1 MPa; p = 0.028) compared to parous women. The uterosacral ligaments are significantly more resistant than round ligaments. Parturition seems to enhance the stiffness and maximum stress of the ligaments.

  2. Validation of Cooper's ligament thickness in software breast phantoms

    Science.gov (United States)

    Kuperavage, Adam J.; Imran, Abdullah-Al-Zubaer; Bakic, Predrag R.; Maidment, Andrew; Pokrajac, David D.

    2017-03-01

    Anthropomorphic breast phantoms are important tools for a wide range of tasks including pre-clinical validation of novel imaging techniques. In order to improve the realism in the phantoms, assessment of simulated anatomical structures is crucial. Thickness of simulated Cooper's ligaments influences the percentage of dense tissue, as well as qualitative and quantitative properties of simulated images. We introduce three methods (2-dimensional watershed, 3-dimensional watershed, and facet counting) to assess the thickness of the simulated Cooper's ligaments in the breast phantoms. For the validation of simulated phantoms, the thickness of ligaments has been measured and compared with the input thickness values. These included a total of 64 phantoms with nominal ligament thicknesses of 200, 400, 600, and 800 μm. The 2-dimensional and 3-dimensional watershed transformations were performed to obtain the median skeleton of the ligaments. In the 2-dimensional watershed, the median skeleton was found cross-section by cross-section, while the skeleton was found for the entire 3-dimensional space in the 3-dimensional watershed. The thickness was calculated by taking the ratio of the total volume of ligaments and the volume of median skeleton. In the facet counting method, the ligament thickness was estimated as a ratio between estimated ligaments' volume and average ligaments' surface area. We demonstrated that the 2-dimensional watershed technique overestimates the ligament thickness. Good agreement was found between the facet counting technique and the 3-dimensional watershed for assessing thickness. The proposed techniques are applicable for ligaments' thickness estimation on clinical breast images, provided segmentation of Cooper's ligaments has been performed.

  3. Anterior Cruciate Ligament Strain In Vivo

    Science.gov (United States)

    Luque-Seron, Juan Antonio; Medina-Porqueres, Ivan

    2016-01-01

    Context: Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process. Objective: To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees. Data Sources: A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included anterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy. Study Selection: Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load. Results: A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance. Conclusion: These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials. PMID:27418161

  4. Anterior Cruciate Ligament Injuries in Wakeboarding

    OpenAIRE

    Starr, Harlan M.; Sanders, Brett,

    2012-01-01

    Background: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. Hypothesis: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. Study Design: Descriptive epidemiology study. M...

  5. Ulnar nerve entrapment by anconeus epitrochlearis ligament.

    LENUS (Irish Health Repository)

    Tiong, William H C

    2012-01-01

    Ulnar nerve entrapment at the elbow is the second most common upper limb entrapment neuropathy other than carpal tunnel syndrome. There have been many causes identified ranging from chronic aging joint changes to inflammatory conditions or systemic disorders. Among them, uncommon anatomical variants accounts for a small number of cases. Here, we report our experience in managing ulnar nerve entrapment caused by a rare vestigial structure, anconeus epitrochlearis ligament, and provide a brief review of the literature of its management.

  6. Risk Factors for Anterior Cruciate Ligament Injury

    OpenAIRE

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known an...

  7. Risk Factors for Anterior Cruciate Ligament Injury

    OpenAIRE

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unkn...

  8. Median arcuate ligament syndrome in athletes.

    Science.gov (United States)

    Harr, Jeffrey N; Haskins, Ivy N; Brody, Fred

    2017-01-01

    Exercise-related transient abdominal pain (ETAP) is a common entity in young athletes. Most occurrences are due to a "cramp" or "stitch," but an uncommon, and often overlooked, etiology of ETAP is median arcuate ligament syndrome (MALS). The initial presentation of MALS typically includes postprandial nausea, bloating, abdominal pain, and diarrhea, but in athletes, the initial presentation may be ETAP. We present a case series of three athletes who presented with exercise-related transient abdominal pain and were ultimately diagnosed and treated for MALS. Unlike other patients with median arcuate ligament syndrome, these athletes presented with exercise-induced pain, rather than the common postprandial symptoms. These symptoms persisted despite conservative measures. Work-up of patients with suspected MALS include a computed tomography or magnetic resonance angiography showing compression of the celiac artery with post-stenotic dilation, or a celiac artery ultrasound demonstrating increased velocities (>200 cm/s(2)) with deep exhalation. All patients underwent a laparoscopic median arcuate ligament release. Postoperatively, there were no complications, and all were discharged home on postoperative day #2. All patients have subsequently returned to athletics with resolution of their symptoms. ETAP is common in athletes and often resolves with preventative or conservative strategies. When ETAP persists despite these methods, alternative causes, including MALS, should be considered. A combination of a thorough history and physical exam, as well as radiographic data, is essential to make the appropriate diagnosis and treatment strategy.

  9. Roentgenologic diagnostics of capsular ligament lesions

    Energy Technology Data Exchange (ETDEWEB)

    Wirth, C.J.; Jaeger, M.

    1981-10-01

    The X-ray diagnostic is of obvious importance and relevance in the detection of acute or old capsular ligament lesions of the limb joint. On the one hand it serves as the plain radiograph (roentgenogram without contrast medium) for the assessment of osseous secondary lesions, for the documentation of luxationary positions of the joint partners, and in old capsular ligament lesions for the detection of an already existing arthrosis. On the other hand the X-ray images are of main importance, which are made from the hand-held limb in order to permit a comparison of the two sides, and which beyond the clinical detection of a joint instability indicate the extent and the direction of this instability and which also document it, and which allow in adolescents to recognize a separation of the epiphysis as an alternative to the capsular ligament rupture. Only in particular cases arthrography can provide some additional information, so for example in the case of an isolated syndesmosis rupture, ruptures of the rosette of the rotator muscle or of a damaged triangular disk in the hand. Angiography is only required in cases of traumatic luxations of the knee in order to exclude an intimal lesion of the popliteal artery.

  10. Anterior cruciate ligament ganglion: case report

    Directory of Open Access Journals (Sweden)

    André Pedrinelli

    Full Text Available CONTEXT: A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT: A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later.

  11. Ligament Mediated Fragmentation of Viscoelastic Liquids

    Science.gov (United States)

    Keshavarz, Bavand; Houze, Eric C.; Moore, John R.; Koerner, Michael R.; McKinley, Gareth H.

    2016-10-01

    The breakup and atomization of complex fluids can be markedly different than the analogous processes in a simple Newtonian fluid. Atomization of paint, combustion of fuels containing antimisting agents, as well as physiological processes such as sneezing are common examples in which the atomized liquid contains synthetic or biological macromolecules that result in viscoelastic fluid characteristics. Here, we investigate the ligament-mediated fragmentation dynamics of viscoelastic fluids in three different canonical flows. The size distributions measured in each viscoelastic fragmentation process show a systematic broadening from the Newtonian solvent. In each case, the droplet sizes are well described by Gamma distributions which correspond to a fragmentation-coalescence scenario. We use a prototypical axial step strain experiment together with high-speed video imaging to show that this broadening results from the pronounced change in the corrugated shape of viscoelastic ligaments as they separate from the liquid core. These corrugations saturate in amplitude and the measured distributions for viscoelastic liquids in each process are given by a universal probability density function, corresponding to a Gamma distribution with nmin=4 . The breadth of this size distribution for viscoelastic filaments is shown to be constrained by a geometrical limit which can not be exceeded in ligament-mediated fragmentation phenomena.

  12. Posttraumatic incarceration of medial collateral ligament into knee joint with anterior cruciate ligament injury.

    Science.gov (United States)

    Kini, Sunil-Gurpur; du Pre, Karel; Bruce, Warwick

    2015-01-01

    Medial collateral ligament of the knee is an important coronal stabiliser and often injured in isolation or as combination of injuries. The article reports a case of incarcerated medial collateral ligament (MCL) injury in combination with anterior cruciate ligament (ACL) injury in 20 year old male who presented to us 4 weeks after injury. Clinical examination and MRI was correlated to complete ACL tear with torn distal MCL and incarceration into the joint. Patient was taken up for ACL hamstring graft reconstruction with mini-arthrotomy and repair of the torn MCL. Patient was followed up with dedicated rehabilitation protocol with good functional results. At one year follow-up, patient exhibited full range of motion with negative Lachman, Pivot shift and valgus stress tests. This article highlights the rare pattern of MCL tear and also reviews the literature on this pattern of injury.

  13. Thumb ulnar collateral and radial collateral ligament injuries.

    Science.gov (United States)

    Schroeder, Nicole S; Goldfarb, Charles A

    2015-01-01

    Thumb metacarpophalangeal ulnar and radial collateral ligament injuries occur frequently in the competitive athlete. Collateral ligament integrity is essential to joint stability, pinch strength, and pain-free motion. Acute rupture of the ulnar collateral ligament is due to a sudden radial deviation force on the abducted thumb and is referred to as skier's thumb. An ulnar-directed force causes injury to the radial collateral ligament. The degree of joint instability on clinical examination allows classification of these injuries and guides management. Surgical repair of acute, complete tears results in good outcomes and allows for return to sporting activity. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Ligaments of the rectum: anatomical and surgical considerations.

    Science.gov (United States)

    Charran, Ordessia; Muhleman, Mitchel; Shah, Sameer; Tubbs, R Shane; Loukas, Marios

    2014-03-01

    The ligaments of the rectum have been the subject of controversy for decades. Not only have their contents and components been a source of contention, but also the very existence of these ligaments has been called into question. This article explores the anatomical features of these ligaments with implications for surgical treatment of rectal prolapse, rectal cancer, and resection of the rectum and mesorectum. A theory about the evolution of the lateral rectal ligaments and the mesorectum in humans and higher mammals is also presented.

  15. Loading rate effect on mechanical properties of cervical spine ligaments.

    Science.gov (United States)

    Trajkovski, Ana; Omerovic, Senad; Krasna, Simon; Prebil, Ivan

    2014-01-01

    Mechanical properties of cervical spine ligaments are of great importance for an accurate finite element model when analyzing the injury mechanism. However, there is still little experimental data in literature regarding fresh human cervical spine ligaments under physiological conditions. The focus of the present study is placed on three cervical spine ligaments that stabilize the spine and protect the spinal cord: the anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. The ligaments were tested within 24-48 hours after death, under two different loading rates. An increase trend in failure load, failure stress, stiffness and modulus was observed, but proved not to be significant for all ligament types. The loading rate had the highest impact on failure forces for all three ligaments (a 39.1% average increase was found). The observed increase trend, compared to the existing increase trends reported in literature, indicates the importance of carefully applying the existing experimental data, especially when creating scaling factors. A better understanding of the loading rate effect on ligaments properties would enable better case-specific human modelling.

  16. The Anterolateral Ligament Does Exist: An Anatomic Description.

    Science.gov (United States)

    Zaffagnini, Stefano; Grassi, Alberto; Marcheggiani Muccioli, Giulio Maria; Raggi, Federico; Romagnoli, Matteo; Bondi, Alice; Calderone, Salvatore; Signorelli, Cecilia

    2018-01-01

    The debate around the existence, anatomy, and role of the so-called anterolateral ligament of the knee represents one of the main sources of recent controversy among orthopedic surgeons. In the modern era of sports medicine, several content experts have contributed to the understanding of the anatomy of the anterolateral aspect of the knee. This article analyzes the historical, phylogenetic, anatomic, arthroscopic, and radiological evidence regarding the anterolateral ligament. The existence of the anterolateral ligament as a distinct ligamentous structure and its exact anatomic features are still matters of controversy and ongoing study. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Munchausen syndrome mimicking psychiatric disease with concomitant genuine physical illness.

    Science.gov (United States)

    Almeida, Jaime; da Silva, Joaquim Alves; Xavier, Miguel; Gusmão, Ricardo

    2010-11-29

    Munchausen syndrome is a disorder in which patients intentionally produce symptoms mimicking physical or psychiatric illnesses with the aim to assume the sick role and to gain medical attention. Once a patient receives a Munchausen syndrome diagnosis every complaint made thence tends to be regarded with scepticism by clinical staff. However, it is possible that a bona fide illness, which might be disregarded, may coexist in these patients. We report a case of MS mimicking psychiatric disease with concomitant genuine acute physical illness. Despite the initial doubts about the veracity of the latter, due to its prompt recognition, treatment was successful.

  18. [Acute injuries of lateral ankle joint ligaments].

    Science.gov (United States)

    Lacko, M; Sidor, Z; Stolfa, S; Cellár, R; Vasko, G

    2010-08-01

    Acute injuries of the lateral ankle ligaments are one of the most common form of injury involving the musculoskeletal apparatus. Treatment usually range from cast immobilisation or acute surgical repair to functional rehabilitation. The aim of our study was to evaluate the incidence of different grades of acute injuries of lateral ligaments of the ankle joint in our patients group and to compare the results of non surgical versus surgical treatment of third grade injuries. 3148 patients were treated for acute lateral ankle sprain in a period of 5 years at our department. Each patient had stress X-ray of the ankle for evaluation of instability at the first visit. From the 234 patients with third grade injury, 39 were enrolled in our study with non surgical treatment and 18 with surgical treatment. Each group was divided regarding to the age in two subgroups. Functional outcome was evaluated 12 and 24 months after injury with AOFAS clinical rating scale and Sports Ankle Rating System--Single Assessment Numeric Evaluation. Statistical analysis was done with Pearson's Chi quadrate test with P < 0.05. First grade injury was present in 62%, second grade in 31% and only 7% of the patients had third grade injury of the lateral ankle ligaments. Further only third grade injuries were studied. Statistically significant better results were seen in patients under the age of 25, in the patient group with surgical treatment compared to patients over 25 years of age. Also statistically significant better results were seen in patient with surgical treatment to non surgical treatment in each age group. No significant difference was observed in the non surgical treatment group regarding to age. Although the injuries of the ankle ligaments belong to the most common injuries of the musculoskeletal system, there is no consensus in the treatment of such disorders. Our experiences and the results of our study show, that surgical treatment in indicated cases provides better results in

  19. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.

    Science.gov (United States)

    Dong, Jiangtao; Wang, Xiao Feng; Men, Xiaoqian; Zhu, Junjun; Walker, Garth N; Zheng, Xiao Zuo; Gao, Jin Bao; Chen, Baicheng; Wang, Fei; Zhang, Yingze; Gao, Shi Jun

    2015-06-01

    The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC

  20. Strain rate dependent properties of human craniovertebral ligaments.

    Science.gov (United States)

    Mattucci, Stephen F E; Moulton, Jeffrey A; Chandrashekar, Naveen; Cronin, Duane S

    2013-07-01

    Craniovertebral ligaments were tested to failure under tensile loading. Ligaments tested included: transverse ligament, anterior atlanto occipital membrane, posterior atlanto occipital membrane, capsular ligaments between Skull-C1 and C1-C2, anterior atlantoaxial membrane, posterior atlantoaxial membrane and the tectorial membrane/vertical cruciate/apical/alar ligament complex. The objective of this study was to obtain mechanical properties of craniovertebral ligaments of a younger population, at varying strain rates representative of automotive crash scenarios, and investigate rate and gender effects for use in numerical models of the cervical spine. There have been few studies conducted on the mechanical properties of human craniovertebral ligaments. Only one study has tested all of the ligaments, and previous studies use older age specimens (mean age 67, from most complete study). Further, tests were often not performed at elongation rates representative of car crash scenarios. Previous studies did not perform tests in an environment resembling in vivo conditions, which has been shown to have a significant effect on ligament tensile behaviour. Fifty-four craniovertebral ligaments were isolated from twenty-one spines, and tested to failure in tension under simulated in vivo temperature and hydration levels, at quasi-static (0.5 s(-1)) and high strain rates (150 s(-1)). Values for failure force, failure elongation, stiffness, and toe region elongation were obtained from force-displacement curves. Values were analyzed for strain rate and gender effects. Increased strain rate produced several significant effects including: higher failure forces for the transverse ligament and capsular ligament (Skull-C1), lower failure elongation for the tectorial membrane complex, higher stiffness for the tectorial membrane complex and capsular ligament (Skull-C1), and lower toe region elongation for capsular ligament (Skull-C1). Gender effects were limited. Ligament tests

  1. Calcific Tendinosis: A Potential Mimicker of Malignancy on PET

    OpenAIRE

    Vogel-Claussen, Jens; Morrison, William; Zoga, Adam; Bergin, Diane; Gopez, Angela; Fayad, Laura M.

    2015-01-01

    We report a case of a 53 year old female with breast cancer and elevated glucose activity at the left greater trochanter on PET imaging. Further imaging with CT and MRI showed that this focus of increased FDG activity on PET was calcific tendinosis of the gluteus medius tendon, which mimicked metastatic disease in this patient.

  2. Osteoid osteoma of the radial styloid mimicking de quervain tenosynovitis.

    Science.gov (United States)

    Chloros, George D; Themistocleous, George S; Papagelopoulos, Panayiotis J; Khaldi, Lubna; Efstathopoulos, Dimitrios G; Soucacos, Panayotis N

    2007-10-01

    A very unusual location of osteoid osteoma arising in the radial styloid is presented, which strongly mimicked de Quervain tenosynovitis, thereby resulting in the patient undergoing an additional unnecessary operation and a substantial delay of more than 2 years in diagnosis.

  3. Anterior sacral meningocele mimicking ovarian cyst: a case report.

    Science.gov (United States)

    Polat, Ahmet Veysel; Belet, Umit; Aydin, Ramazan; Katranci, Seckin

    2013-03-01

    Anterior sacral meningocele (ASM) is a rare congenital anomaly, characterized by herniation through a defect in the anterior aspect of the sacrum. We reported a case of ASM associated with neurofibromatosis, which was mimicking a complex ovarian cyst in ultrasonography. ASM can easily be misdiagnosed as an ovarian cyst and needle aspiration can cause intracranial hypotension syndrome or even death.

  4. Endometriosis of the meso-appendix mimicking appendicitis: A case ...

    African Journals Online (AJOL)

    Although appendicitis is largely a clinical diagnosis, on occasions diagnostic modalities may be needed to aid with the diagnosis. Despite the use of adjuncts and exploratory surgery, the diagnosis may not be clear until a histological diagnosis is achieved. Endometriosis of the appendix mimicking appendicitis is one of ...

  5. Mesenteric Panniculitis Mimicking Acute Pancreatitis: A Case Report ...

    African Journals Online (AJOL)

    Mesenteric Panniculitis Mimicking Acute Pancreatitis: A Case Report and Literature review. ... Treatment is empiric and surgical resection is sometimes attempted for definitive therapy. We report a case of a 77 year old man presenting with CT features of mesenteric panniculitis currently in remission. The aim is to highlight ...

  6. Cutaneous Silicone Granuloma Mimicking Breast Cancer after Ruptured Breast Implant

    Directory of Open Access Journals (Sweden)

    Waseem Asim Ghulam El-Charnoubi

    2011-01-01

    Full Text Available Cutaneous manifestations due to migration of silicone from ruptured implants are rare. Migrated silicone with cutaneous involvement has been found in the chest wall, abdominal wall, and lower extremities. We describe a case of cutaneous silicone granuloma in the breast exhibiting unusual growth mimicking breast cancer after a ruptured implant.

  7. Spinal MRI of vincristine neuropathy mimicking Guillain-Barre syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Yun Woo; Yoon, Hye-Kyung; Cho, Jae Min [Department of Radiology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul 135-710 (Korea); Sung, Ki Woong [Department of Paediatrics, Samsung Medical Centre, Seoul 135-710 (Korea)

    2003-11-01

    A 4.3-year-old girl with acute leukaemia, who was being treated with chemotherapy (including vincristine), developed paraplegia. Spinal MRI showed diffusely enhancing nerve roots on contrast-enhanced images. Spinal fluid analysis showed a normal protein level. Vincristine neuropathy mimicking Guillain-Barre syndrome is thought to be the cause of the MRI abnormalities. (orig.)

  8. Endometriosis of the meso-appendix mimicking appendicitis: A case ...

    African Journals Online (AJOL)

    Endometriosis of the appendix mimicking appendicitis is one of these diagnoses described in several case reports. Endometriosis of the meso-appendix has been described in association with intussusception of the appendix in several case reports. However, to our knowledge, endometriosis of the meso-appendix ...

  9. Primary Papillary Mucinous Adenocarcinoma of the Ureter Mimicking Genitourinary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Hanni Gulwani

    2010-01-01

    Full Text Available Primary adenocarcinomas of the renal pelvis and ureter are rare and account for less than 1% of all malignancies at this site. We report a case of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. Early diagnosis is important for the better outcome.

  10. Headache attributed to unruptured saccular aneurysm, mimicking hemicrania continua.

    Science.gov (United States)

    Vikelis, Michail; Xifaras, Michail; Magoufis, Georgios; Gekas, Georgios; Mitsikostas, Dimos Dimitrios

    2005-06-01

    Unruptured cerebral arterial aneurysms most often remain asymptomatic, but they may cause headache or other symptoms or signs. We describe herewith a case of headache attributed to an unruptured internal carotid artery aneurysm, clearly mimicking the phenotype of hemicrania continua. Potential pathophysiological explanations and recommendations for recognition of similar cases are discussed.

  11. A clinical challenging situation of Intra oral fibroma mimicking ...

    African Journals Online (AJOL)

    To differentiate the clinical mimicking situation of intra oral fibroma and pyogenic granuloma, surgical excision was done followed by histopathological examination reporting as intra oral fibroma. Fibroma is of smooth surfaced painless solid mass, occasionally nodular, with collagen and connective tissue histopathologically.

  12. Gastric Schistosomiasis Mimicking Gastric Cancer - A Case Report ...

    African Journals Online (AJOL)

    These parasites cause hepatosplenic and hepatointestinal schistosomiasis associated with significant morbidity and mortality especially in children and young people. We report a case of middle aged northern Nigerian farmer who had gastric schistosomiasis that mimicked an ulcerated gastric tumor at endoscopy with good ...

  13. Bilateral multiple pulmonary tuberculous nodules mimicking metastatic disease

    Energy Technology Data Exchange (ETDEWEB)

    Ariyuerek, Macit O.; Karcaaltincaba, Musturay E-mail: mkarcaal@hacettepe.edu.tr; Demirkazik, Figen B.; Akay, Hadi; Gedikoglu, Gokhan; Emri, Salih

    2002-10-01

    We present CT findings of a young woman who has bilateral pulmonary nodules mimicking metastases. Clinical presentation with active multiple pulmonary macronodules without cavitation responsive to treatment is an atypical manifestation of pulmonary tuberculosis. We reviewed the causes of multiple pulmonary nodules, role of radiological findings in differential diagnosis and parenchymal manifestations of pulmonary tuberculosis in this report.

  14. MRI appearance of surgically proven abnormal accessory anterior-inferior tibiofibular ligament (Bassett's ligament)

    Energy Technology Data Exchange (ETDEWEB)

    Subhas, Naveen [Cleveland Clinic, Department of Radiology, Cleveland, OH (United States); Vinson, Emily N.; Cothran, R.L.; Helms, Clyde A. [Duke University Medical Center, Department of Radiology, P.O. Box 3808, Durham, NC (United States); Santangelo, James R. [Womack Army Medical Center, Orthopedics and Rehabilitation, Fort Bragg, NC (United States); Nunley, James A. [Duke University Medical Center, Division of Orthopedic Surgery, P.O. Box 2923, Durham, NC (United States)

    2008-01-15

    A thickened accessory anterior-inferior tibiofibular ligament (Bassett's ligament) of the ankle can be a cause of ankle impingement. Its imaging appearance is not well described. The purpose of this study was to determine if the ligament could be identified on magnetic resonance imaging (MRI), to determine associated abnormalities, and to determine if MRI could be used to differentiate normal from abnormal. Eighteen patients with a preoperative ankle MRI and an abnormal Bassett's ligament reported at surgery were found retrospectively. A separate cohort of 18 patients was selected as a control population. The presence of Bassett's ligament and its thickness were noted. The integrity and appearance of the lateral ankle ligaments, talar dome cartilage, and anterolateral gutter were also noted. In 34 of the 36 cases (94%), Bassett's ligament was identified on MRI. The ligament was seen in all three imaging planes and most frequently in the axial plane. The mean thickness of the ligament in the surgically abnormal cases was 2.37 mm, compared with 1.87 mm in the control with a p value = 0.015 (t test). Nine of the 18 abnormal cases (50%) had talar dome cartilage lesions as a result of contact with the ligament at surgery, with only 3 cases of high-grade defects seen on MRI. Fourteen of the 18 abnormal cases (78%) had of synovitis or scarring in the lateral gutter at surgery, with only 5 cases with scarring seen on MRI. The anterior-inferior tibiofibular ligament was abnormal or torn in 8 of the 18 abnormal cases (44%) by MRI and confirmed in only 3 cases at surgery. Bassett's ligament can be routinely identified on MRI and was significantly thicker in patients who had it resected at surgery. An abnormal Bassett's ligament is often present in the setting of a normal anterior-inferior tibiofibular ligament. The cartilage abnormalities and synovitis associated with an abnormal Bassett's ligament are poorly detected by conventional MRI

  15. ACL/MCL transection affects knee ligament insertion distance of healing and intact ligaments during gait in the Ovine model.

    Science.gov (United States)

    Tapper, Janet E; Funakoshi, Yusei; Hariu, Mitsuhiro; Marchuk, Linda; Thornton, Gail M; Ronsky, Janet L; Zernicke, Ron; Shrive, Nigel G; Frank, Cyril B

    2009-08-25

    The objective of this study was to assess the impact of combined transection of the anterior cruciate and medial collateral ligaments on the intact and healing ligaments in the ovine stifle joint. In vivo 3D stifle joint kinematics were measured in eight sheep during treadmill walking (accuracy: 0.4+/-0.4mm, 0.4+/-0.4 degrees ). Kinematics were measured with the joint intact and at 2, 4, 8, 12, 16 and 20 weeks after either surgical ligament transection (n=5) or sham surgery without transection (n=3). After sacrifice at 20 weeks, the 3D subject-specific bone and ligament geometry were digitized, and the 3D distances between insertions (DBI) of ligaments during the dynamic in vivo motion were calculated. Anterior cruciate ligament/medial collateral ligament (ACL/MCL) transection resulted in changes in the DBI of not only the transected ACL, but also the intact lateral collateral ligament (LCL) and posterior cruciate ligament (PCL), while the DBI of the transected MCL was not significantly changed. Increases in the maximal ACL DBI (2 week: +4.2mm, 20 week: +5.7mm) caused increases in the range of ACL DBI (2 week: 3.6mm, 20 week: +3.8mm) and the ACL apparent strain (2 week: +18.9%, 20 week: +24.0%). Decreases in the minimal PCL DBI (2 week: -3.2mm, 20 week: -4.3mm) resulted in increases in the range of PCL DBI (2 week: +2.7mm, 20 week: +3.2mm). Decreases in the maximal LCL DBI (2 week: -1.0mm, 20 week: -2.0mm) caused decreased LCL apparent strain (2 week: -3.4%, 20 week: -6.9%). Changes in the mechanical environment of these ligaments may play a significant role in the biological changes observed in these ligaments.

  16. The normal anterior cruciate ligament as a model for tensioning strategies in anterior cruciate ligament grafts

    NARCIS (Netherlands)

    Arnold, MP; Verdonschot, N; van Kampen, A

    Background: There is some confusion about the relationship between the tension placed on the graft and the joint position used in the fixation of anterior cruciate ligament grafts. This is because of deficiency in accurate basic science about this important interaction in the normal and

  17. The normal anterior cruciate ligament as a model for tensioning strategies in anterior cruciate ligament grafts.

    NARCIS (Netherlands)

    Arnold, M.P.; Verdonschot, N.J.J.; Kampen, A. van

    2005-01-01

    BACKGROUND: There is some confusion about the relationship between the tension placed on the graft and the joint position used in the fixation of anterior cruciate ligament grafts. This is because of deficiency in accurate basic science about this important interaction in the normal and

  18. Comparative histology of mouse, rat, and human pelvic ligaments.

    Science.gov (United States)

    Iwanaga, Ritsuko; Orlicky, David J; Arnett, Jameson; Guess, Marsha K; Hurt, K Joseph; Connell, Kathleen A

    2016-11-01

    The uterosacral (USL) and cardinal ligaments (CL) provide support to the uterus and pelvic organs, and the round ligaments (RL) maintain their position in the pelvis. In women with pelvic organ prolapse (POP), the connective tissue, smooth muscle, vasculature, and innervation of the pelvic support structures are altered. Rodents are commonly used animal models for POP research. However, the pelvic ligaments have not been defined in these animals. In this study, we hypothesized that the gross anatomy and histological composition of pelvic ligaments in rodents and humans are similar. We performed an extensive literature search for anatomical and histological descriptions of the pelvic support ligaments in rodents. We also performed anatomical dissections of the pelvis to define anatomical landmarks in relation to the ligaments. In addition, we identified the histological components of the pelvic ligaments and performed quantitative analysis of the smooth muscle bundles and connective tissue of the USL and RL. The anatomy of the USL, CL, and RL and their anatomical landmarks are similar in mice, rats, and humans. All species contain the same cellular components and have similar histological architecture. However, the cervical portion of the mouse USL and RL contain more smooth muscle and less connective tissue compared with rat and human ligaments. The pelvic support structures of rats and mice are anatomically and histologically similar to those of humans. We propose that both mice and rats are appropriate, cost-effective models for directed studies in POP research.

  19. Nonuniform distribution of collagen density in human knee ligaments

    NARCIS (Netherlands)

    Mommersteeg, T. J.; Blankevoort, L.; Kooloos, J. G.; Hendriks, J. C.; Kauer, J. M.; Huiskes, R.

    1994-01-01

    It is generally recognized that the mechanical properties of soft connective tissues are affected by their structural components. We documented collagen density distributions in human knee ligaments to quantify differences in density within and between these ligaments. In order to explain the

  20. Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

    2014-09-15

    Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

  1. Stiffness of the healing medial collateral ligament of the mouse.

    NARCIS (Netherlands)

    Gijssen, Y.; Sierevelt, I.N.; Kooloos, J.G.M.; Blankevoort, L.

    2004-01-01

    The knee joints of mice can serve as a model for studying knee ligament properties. The goal of our study was to measure the structural stiffness of the medial collateral ligament (MCL) of the murine knee. A tensile test was developed for this purpose. First 84 femur-MCL-tibia complexes of

  2. Features extraction in anterior and posterior cruciate ligaments analysis.

    Science.gov (United States)

    Zarychta, P

    2015-12-01

    The main aim of this research is finding the feature vectors of the anterior and posterior cruciate ligaments (ACL and PCL). These feature vectors have to clearly define the ligaments structure and make it easier to diagnose them. Extraction of feature vectors is obtained by analysis of both anterior and posterior cruciate ligaments. This procedure is performed after the extraction process of both ligaments. In the first stage in order to reduce the area of analysis a region of interest including cruciate ligaments (CL) is outlined in order to reduce the area of analysis. In this case, the fuzzy C-means algorithm with median modification helping to reduce blurred edges has been implemented. After finding the region of interest (ROI), the fuzzy connectedness procedure is performed. This procedure permits to extract the anterior and posterior cruciate ligament structures. In the last stage, on the basis of the extracted anterior and posterior cruciate ligament structures, 3-dimensional models of the anterior and posterior cruciate ligament are built and the feature vectors created. This methodology has been implemented in MATLAB and tested on clinical T1-weighted magnetic resonance imaging (MRI) slices of the knee joint. The 3D display is based on the Visualization Toolkit (VTK). Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Reconstruction of the Anterior Cruciate Ligament : Alternative Strategies

    NARCIS (Netherlands)

    van Eijk, F.

    2009-01-01

    This thesis describes the long-term results of reconstruction of the anterior cruciate ligament with an allograft. Due to the poor results found, further studies were performed to investigate alternative strategies for reconstruction of the anterior cruciate ligament in the field of tissue

  4. Anterior Cruciate Ligament Injuries and Outcome of Arthroscopic ...

    African Journals Online (AJOL)

    Objective: To study the results of arterior cruciate ligament (ACL) repairs using arthroscopic assisted reconstructions using harmstrings. A follow-up rehabilitation programme of immediate mobilisation, weight bearing and extension. Subjects: Twenty arthroscopic reconstructions of the anterior cruciate ligament using the ...

  5. Common types and countermeasures of ankle ligament injury ...

    African Journals Online (AJOL)

    Objective: To analyze ankle ligament injury of basketball players caused during movement, summarize injury types, analyze the causes of injury, and put forward corresponding control measures. Methods: The author selected 3100 basketball players with ankle ligament injury during basketball movement and admitted to ...

  6. Plant Growth Absorption Spectrum Mimicking Light Sources

    Directory of Open Access Journals (Sweden)

    Jwo-Huei Jou

    2015-08-01

    Full Text Available Plant factories have attracted increasing attention because they can produce fresh fruits and vegetables free from pesticides in all weather. However, the emission spectra from current light sources significantly mismatch the spectra absorbed by plants. We demonstrate a concept of using multiple broad-band as well as narrow-band solid-state lighting technologies to design plant-growth light sources. Take an organic light-emitting diode (OLED, for example; the resulting light source shows an 84% resemblance with the photosynthetic action spectrum as a twin-peak blue dye and a diffused mono-peak red dye are employed. This OLED can also show a greater than 90% resemblance as an additional deeper red emitter is added. For a typical LED, the resemblance can be improved to 91% if two additional blue and red LEDs are incorporated. The approach may facilitate either an ideal use of the energy applied for plant growth and/or the design of better light sources for growing different plants.

  7. [The broad bean's syndrome in ancient Egypt].

    Science.gov (United States)

    Lippi, D

    1989-01-01

    The problem of broad bean's syndrome and lathyrism in ancient Greece has been deeply studied, with particular referrement to the hypothetic medica and mystical reasons of the Pythagoric order not to eat broad beans. It is impossible to prove Egyptian influence of Phythagora's precept, but we can, however, consider the hypothesis that they had noticed the potential deadly effect of broad beans' use, too, and wonder if their interduction had the same motivations.

  8. Specialisation of extracellular matrix for function in tendons and ligaments

    Science.gov (United States)

    Birch, Helen L.; Thorpe, Chavaunne T.; Rumian, Adam P.

    2013-01-01

    Summary Tendons and ligaments are similar structures in terms of their composition, organisation and mechanical properties. The distinction between them stems from their anatomical location; tendons form a link between muscle and bone while ligaments link bones to bones. A range of overlapping functions can be assigned to tendon and ligaments and each structure has specific mechanical properties which appear to be suited for particular in vivo function. The extracellular matrix in tendon and ligament varies in accordance with function, providing appropriate mechanical properties. The most useful framework in which to consider extracellular matrix differences therefore is that of function rather than anatomical location. In this review we discuss what is known about the relationship between functional requirements, structural properties from molecular to gross level, cellular gene expression and matrix turnover. The relevance of this information is considered by reviewing clinical aspects of tendon and ligament repair and reconstructive procedures. PMID:23885341

  9. Medial patellotibial ligament and medial patellomeniscal ligament: anatomy, imaging, biomechanics, and clinical review.

    Science.gov (United States)

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Kaleka, Camila Cohen; Camanho, Gilberto Luis; Arendt, Elizabeth A

    2017-03-13

    The purpose of this article is to review anatomical, biomechanical, and clinical data of the medial patellotibial ligament (MPTL) and medial patellomeniscal ligament (MPML), as well as studies focusing on the medial patellofemoral ligament (MPFL) but with relevant data about the MPTL and MPML. A literature search of articles specifically addressing the MPTL and/or MPML was included along with studies focusing on the MPFL but with relevant data about the MPTL and MPML. The medial patellar ligaments responsible for maintaining the stability of the patellofemoral (PF) joint include the MPFL, the MPTL, and the MPML. The MPFL is considered the primary restraint to lateral patellar translation, while the latter two are considered secondary restraints. There is robust literature on the anatomical, imaging, and biomechanical characteristics of the MPFL, and also the clinical outcome of its injury and surgical reconstruction; much less is known about the MPTL and MPML. Isolated MPFL reconstruction has good clinical and functional outcomes, with a low failure rate when defined as frank re-dislocation. Complications, including continued episodes of patellar apprehension and subluxation, remain present in most series. In addition, the current literature primarily includes a homogeneous population with few excessive anatomic dysplastic factors. There is lack of knowledge on the role of MPTL and MPML in (potentially) aiding patella stabilization and improving clinical outcomes. Understanding the role of the medial-sided patellar ligaments, in particular the role of the secondary stabilizers, in PF function and injury will aid in this goal. MPTL and MPML have consistent basic science literature, as well as favorable clinical outcomes of surgical patellar stabilization with reconstruction of the MPTL. However, there is much heterogeneity among clinical case series and lack of comparative studies to allow clear indication for the role of isolated or combined surgical reconstruction

  10. Outcomes in Anterior Cruciate Ligament Reconstruction Surgery

    Directory of Open Access Journals (Sweden)

    Roman Mihai

    2016-11-01

    Full Text Available Improving the outcomes in reconstructive surgery of the anterior cruciate ligament (ACL requires a rigorous and permanent assessment of specific parameters. Therefore, we can increase the degree of reproducibility of the procedure and identify particular aspects in order to achieve an adequate and individualized therapeutic approach for each case. In order to accomplish this goal, the use of complex means (scores of quantifying results is required. That includes objective means of verifying the parameters in knee surgery, and a subjective evaluation of the patient in order to compare the results.

  11. [Surgical treatment of multiple ligament injuries of knee joints].

    Science.gov (United States)

    Xu, Hua; Chen, Yi-min; Zhai, Li-feng; Bi, Da-wei

    2016-05-01

    To study operative effects for the treatment of multiple ligament injuries of knee joints. From 2008 to 2013, 26 patients (17 males and 9 females) with multiple ligament injuries of knee joints were treated surgically. The average age was 40.7 years old, ranging from 29 to 55 years old. All the patients were treated with arthroscopic reconstruction of cruiate ligament with autogenous or allogeneic hamstrings and tendon, and at the same time received repair of medial collateral ligament and lateral collateral ligament, as well as the treatment of exterior and interior complex injuries. Nine patients received second stage operation after the initial operation for mistake or missed diagnosis, and other patients were treated at the first stage. The Lysholm scoring system was used to evaluate function and stability of knee joints before and after operation. All the patients were followed up for an average duration of 1.6 years (ranged, 0.8 to 3.2 years). The mean awaiting time for operation was 1.2 months. The Lysholm score was improved from preoperative 42.5 +/- 4.5 (ranged, 33 to 48) to the latest follow-up 78.1 +/- 3.9 (ranged, 57 to 95). The function of knee joint was improved obviously in the arthroscopic reconstruction patients, with joint range of motion exceeding 900 and with Varus & Valgus tests near to normal. All the patients had negative findings in the Lachman test at 70 degrees of flexion. Arthroscopic reconstruction should be the first choice in treating multiple ligament injuries of knee joints. If the anterior and posterior cruciate ligament injuries can't be treated simultaneously, the posterior cruciate ligament injuries should be treated preferentially at the first stage and the anterior cruciate ligament injuries should be treated at the second stage. The diagnosis of posterior cruciate ligament is easy to be missed.

  12. Skeletal ligament healing using the recombinant human amelogenin protein.

    Science.gov (United States)

    Hanhan, Salem; Ejzenberg, Ayala; Goren, Koby; Saba, Faris; Suki, Yarden; Sharon, Shay; Shilo, Dekel; Waxman, Jacob; Spitzer, Elad; Shahar, Ron; Atkins, Ayelet; Liebergall, Meir; Blumenfeld, Anat; Deutsch, Dan; Haze, Amir

    2016-05-01

    Injuries to ligaments are common, painful and debilitating, causing joint instability and impaired protective proprioception sensation around the joint. Healing of torn ligaments usually fails to take place, and surgical replacement or reconstruction is required. Previously, we showed that in vivo application of the recombinant human amelogenin protein (rHAM(+)) resulted in enhanced healing of the tooth-supporting tissues. The aim of this study was to evaluate whether amelogenin might also enhance repair of skeletal ligaments. The rat knee medial collateral ligament (MCL) was chosen to prove the concept. Full thickness tear was created and various concentrations of rHAM(+), dissolved in propylene glycol alginate (PGA) carrier, were applied to the transected MCL. 12 weeks after transection, the mechanical properties, structure and composition of transected ligaments treated with 0.5 μg/μl rHAM(+) were similar to the normal un-transected ligaments, and were much stronger, stiffer and organized than control ligaments, treated with PGA only. Furthermore, the proprioceptive free nerve endings, in the 0.5 μg/μl rHAM(+) treated group, were parallel to the collagen fibres similar to their arrangement in normal ligament, while in the control ligaments the free nerve endings were entrapped in the scar tissue at different directions, not parallel to the axis of the force. Four days after transection, treatment with 0.5 μg/μl rHAM(+) increased the amount of cells expressing mesenchymal stem cell markers at the injured site. In conclusion application of rHAM(+) dose dependently induced mechanical, structural and sensory healing of torn skeletal ligament. Initially the process involved recruitment and proliferation of cells expressing mesenchymal stem cell markers. © 2016 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  13. A New Snowboard Injury Caused by "FLOW" Bindings A Complete Deltoid Ligament and Anterior Talofibular Ankle Ligament Rupture

    NARCIS (Netherlands)

    Haverkamp, Daniel; Hoornenborg, Daniel; Maas, Mario; Kerkhoffs, Gino

    2014-01-01

    We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and

  14. Tissue engineering of ligaments : A comparison of bone marrow stromal cells, anterior cruciate ligament, and skin fibroblasts as cell source

    NARCIS (Netherlands)

    Van Eijk, F; Riesle, J; Willems, WJ; Van Blitterswijk, CA; Verbout, AJ; Dhert, WJA

    Anterior cruciate ligament (ACL) reconstruction surgery still has important problems to overcome, such as "donor site morbidity" and the limited choice of grafts in revision surgery. Tissue engineering of ligaments may provide a solution for these problems. Little is known about the optimal cell

  15. The relationship of the marginal mandibular nerve to the mandibular osseocutaneous ligament and lesser ligaments of the lower face.

    Science.gov (United States)

    Huettner, Franziska; Rueda, Steven; Ozturk, Cemile N; Ozturk, Can; Drake, Richard; Langevin, Claude-Jean; Zins, James E

    2015-02-01

    An in-depth understanding of the nuances of facial anatomy is the best means of preventing complications during facelift surgery. An appreciation of the operative details is complicated not only by the complexity of the anatomy but also by the variability in the nomenclature used. The authors have attempted to clarify these issues by detailing the relationships of the ligaments of the lower face both to each other and to the marginal mandibular nerve. The mandibular ligament, the platysma mandibular ligament, and the marginal mandibular nerve were identified in 22 cadaver halves. The gonial angle, and the lower mandibular border were used as perpendicular reference lines. The mean length, height, and depth of the mandibular ligament and the platysma mandibular ligament were calculated. The mean distance of the mandibular ligament from the gonial angle along the mandibular border was also noted:it was always located superior to the platysma mandibular ligament. The marginal mandibular "danger zone" was identified a quarter of the length of the mandibular body along the lower jaw border. Finally variability in nomenclature of the lower face ligaments was clarified. A topographic map of the structures of surgical importance in the lower face was constructed in the hope that this will prevent surgical errors during facelift surgery. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  16. Ossification of the Ligaments in the Cervical Spine, Including Ossification of the Anterior Longitudinal Ligament, Ossification of the Posterior Longitudinal Ligament, and Ossification of the Ligamentum Flavum.

    Science.gov (United States)

    Ohara, Yukoh

    2018-01-01

    Ossification of the posterior longitudinal ligament (OPLL), ossification of the anterior longitudinal ligament (OALL), and ossification of the ligamentum flavum (OLF) sometimes are seen in the same patients, but the exact coexisting frequencies are not clear especially in the cervical region. The most frequent combination is OPLL and OALL. Cervical OPLL can coexist with thoracic OLF but is rarely associated with cervical OLF. All of these ossifying diseases of the cervical spinal ligaments are influenced by dynamic factors of the spinal column. The most frequent levels in the cervical spine affected by OPLL, OALL, and OLF are different because of anatomic differences inherent to each ligament. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Aseptic tenosynovitis of the digital flexor tendon sheath, fetlock and pastern annular ligament constriction.

    Science.gov (United States)

    Dik, K J; Dyson, S J; Vail, T B

    1995-08-01

    The anatomy of the digital flexor tendon sheath and related tendons and ligaments is described. Diagnosis and management of acute tenosynovitis and long-term tenosynovitis and associated tendon injuries are discussed, as well as the syndrome of stenosis of the fetlock canal (or fetlock annular ligament constriction) and palmar annular ligament constriction. Desmitis of the palmar annular ligament is also described.

  18. The anomalous tides near Broad Sound

    Science.gov (United States)

    Middleton, Jason H.; Buchwald, V. T.; Huthnance, John M.

    Observations of tidal current and height, in conjunction with theoretical mathematical models are used to investigate the propagation of the tide near Broad Sound, a narrowing estuary situated on a wide section of continental shelf toward the southern end of the Great Barrier Reef. The observations indicate that the dense offshore reefs severely inhibit tidal flow, with the result that tides flood toward Broad Sound from the north and from the south, along the main lagoon. There is a local magnification of the semi-diurnal tides within Broad Sound itself. Models of flow across reefs confirm the effectiveness of dense, shallow, and broad reefs in acting as a barrier to the tide. The diffraction of tides through large gaps in the reef is modelled using conformal mapping techniques and with the inclusion of energy leakage, the diffraction model predicts magnification of the semi-diurnal tidal heights by a factor of about 4 and a phase lag of 3 h on the shelf near Broad Sound, these values being consistent with observation. The observed convergence of the tide close to, and within Broad Sound itself is consistent with the proximity of the semi-diurnal tidal period to the natural period for flow in Broad Sound, considered as a narrowing estuary. This results in further amplification, by an additional factor of about 1.5, so that the tides in Broad Sound are increased by a factor of between 5 and 6, altogether, compared with those elsewhere on the east Australian coast.

  19. Broad Prize: Do the Successes Spread?

    Science.gov (United States)

    Samuels, Christina A.

    2011-01-01

    When the Broad Prize for Urban Education was created in 2002, billionaire philanthropist Eli Broad said he hoped the awards, in addition to rewarding high-performing school districts, would foster healthy competition; boost the prestige of urban education, long viewed as dysfunctional; and showcase best practices. Over the 10 years the prize has…

  20. Broad Academy's Growing Reach Draws Scrutiny

    Science.gov (United States)

    Samuels, Christina A.

    2011-01-01

    Billionaire businessman Eli Broad, one of the country's most active philanthropists, founded the "Broad Superintendents Academy" in 2002 with an extraordinarily optimistic goal: Find leaders from both inside and outside education, train them, and have them occupying the superintendencies in a third of the 75 largest school districts--all in just…

  1. Anterior cruciate ligament reconstruction: principles of treatment

    Science.gov (United States)

    Paschos, Nikolaos K.; Howell, Stephen M.

    2016-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures in sports medicine. Several areas of controversy exist in ACL tear management which have engaged surgeons and researchers in debates towards identifying an ideal approach for these patients. This instructional review discusses the principles of ACL reconstruction in an attempt to provide guidelines and initiate a critical thinking approach on the most common areas of controversy regarding ACL reconstruction. Using high-level evidence from the literature, as presented in randomised controlled trials, systematic reviews, and meta-analyses, operative versus conservative treatment, timing of surgery, and rehabilitation are discussed. Also, the advantages and disadvantages of the most common types of autografts, such as patellar tendon and hamstrings as well as allografts are presented. Key considerations for the anatomical, histological, biomechanical and clinical data (‘IDEAL’) graft positioning are reviewed. Cite this article: Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev 2016;398-408. DOI: 10.1302/2058-5241.1.160032. PMID:28461919

  2. Dynamic Mechanical and Nanofibrous Topological Combinatory Cues Designed for Periodontal Ligament Engineering.

    Science.gov (United States)

    Kim, Joong-Hyun; Kang, Min Sil; Eltohamy, Mohamed; Kim, Tae-Hyun; Kim, Hae-Won

    2016-01-01

    Complete reconstruction of damaged periodontal pockets, particularly regeneration of periodontal ligament (PDL) has been a significant challenge in dentistry. Tissue engineering approach utilizing PDL stem cells and scaffolding matrices offers great opportunity to this, and applying physical and mechanical cues mimicking native tissue conditions are of special importance. Here we approach to regenerate periodontal tissues by engineering PDL cells supported on a nanofibrous scaffold under a mechanical-stressed condition. PDL stem cells isolated from rats were seeded on an electrospun polycaprolactone/gelatin directionally-oriented nanofiber membrane and dynamic mechanical stress was applied to the cell/nanofiber construct, providing nanotopological and mechanical combined cues. Cells recognized the nanofiber orientation, aligning in parallel, and the mechanical stress increased the cell alignment. Importantly, the cells cultured on the oriented nanofiber combined with the mechanical stress produced significantly stimulated PDL specific markers, including periostin and tenascin with simultaneous down-regulation of osteogenesis, demonstrating the roles of topological and mechanical cues in altering phenotypic change in PDL cells. Tissue compatibility of the tissue-engineered constructs was confirmed in rat subcutaneous sites. Furthermore, in vivo regeneration of PDL and alveolar bone tissues was examined under the rat premaxillary periodontal defect models. The cell/nanofiber constructs engineered under mechanical stress showed sound integration into tissue defects and the regenerated bone volume and area were significantly improved. This study provides an effective tissue engineering approach for periodontal regeneration-culturing PDL stem cells with combinatory cues of oriented nanotopology and dynamic mechanical stretch.

  3. MR imaging of normal extrinsic wrist ligaments using thin slices with clinical and surgical correlation.

    Science.gov (United States)

    Shahabpour, M; De Maeseneer, M; Pouders, C; Van Overstraeten, L; Ceuterick, P; Fierens, Y; Goubau, J; De Mey, J

    2011-02-01

    Eighty-nine MR examinations of the wrist were retrospectively analyzed. MRI results were compared with clinical findings and/or arthroscopy. Thin proton density and T2 weighted sequences and 3D DESS weighted sequences were applied on a 1.5T scanner. On the palmar side three radiocarpal ligaments are recognized including the radioscaphocapitate, radiolunotriquetral, radioscapholunate, and midcarpal triquetroscaphoidal ligaments. Ulnocarpal ligaments include the ulnolunate ligament and the ulnotriquetral ligament. On the dorsal side three ligaments are recognized: the dorsal radiolunotriquetral, and the midcarpal triquetroscaphoidal and triquetro-trapezoido-trapezial. The collateral ligaments include the radial and ulnar collateral ligament. MR is a valuable technique in the assessment of the extrinsic and midcarpal ligaments. Depiction of the extrinsic ligaments can best be accomplished with coronal 3D DESS sequences and sagittal and transverse proton density and T2 weighted sequences with thin slices. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  4. Anterior cruciate ligament repair with LARS (ligament advanced reinforcement system: a systematic review

    Directory of Open Access Journals (Sweden)

    Machotka Zuzana

    2010-12-01

    Full Text Available Abstract Background Injury to the anterior cruciate ligament (ACL of the knee is common. Following complete rupture of the ACL, insufficient re-vascularization of the ligament prevents it from healing completely, creating a need for reconstruction. A variety of grafts are available for use in ACL reconstruction surgery, including synthetic grafts. Over the last two decades new types of synthetic ligaments have been developed. One of these synthetic ligaments, the Ligament Advanced Reinforcement System (LARS, has recently gained popularity. The aim of this systematic review was to assess the current best available evidence for the effectiveness of the LARS as a surgical option for symptomatic, anterior cruciate ligament rupture in terms of graft stability, rehabilitation time and return to pre-injury function. Method This systematic review included studies using subjects with symptomatic, ACL ruptures undergoing LARS reconstruction. A range of electronic databases were searched in May 2010. The methodological quality of studies was appraised with a modified version of the Law critical appraisal tool. Data relating to study characteristics, surgical times, complication rates, outcomes related to knee stability, quality of life, function, and return to sport as well as details of rehabilitation programs and timeframes were collected. Results This review identified four studies of various designs, of a moderate methodological quality. Only one case of knee synovitis was reported. Patient satisfaction with LARS was high. Graft stability outcomes were found to be inconsistent both at post operative and at follow up periods. The time frames of rehabilitation periods were poorly reported and at times omitted. Return to pre-injury function and activity was often discussed but not reported in results. Conclusions There is an emerging body of evidence for LARS with comparable complication rates to traditional surgical techniques, and high patient

  5. Periodontal tissue regeneration using the cytokine cocktail mimicking secretomes in the conditioned media from human mesenchymal stem cells.

    Science.gov (United States)

    Sakaguchi, Kohei; Katagiri, Wataru; Osugi, Masashi; Kawai, Takamasa; Sugimura-Wakayama, Yukiko; Hibi, Hideharu

    2017-02-26

    Secretomes in the conditioned media from human mesenchymal stem cells (MSC-CM) were previously demonstrated to promote periodontal tissue regeneration. By mixing insulin-like growth factor-1, vascular endothelial growth factor-A, and transforming growth factor-β1 which were included in MSC-CM, we made the cytokine cocktail (CC) mimicking MSC-CM, and then evaluated its efficacy on periodontal tissue regeneration. In vitro, CC promoted the migration of dog bone marrow-derived stem cells and periodontal ligament cells, and the tube formation of human umbilical vein endothelial cells. In vivo, class II furcation defects were surgically created at premolars in dogs. After 4 weeks of vinylpolysiloxane-induced inflammation, defects were filled with or without CC mixed in hydroxypropyl cellulose, or enamel matrix derivative (EMD). After 8 weeks, periodontal tissues were evaluated histologically and immunohistochemically. CC showed promotional effects on angiogenesis and formation of new bone and cementum. Osteogenesis by CC was greater than that by EMD and cementogenesis by CC was as well as that by EMD. CC may be promising for periodontal tissue regeneration. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Microvasculature of the suspensory ligament of the forelimb of horses.

    Science.gov (United States)

    Williams, Megan R; Arnoczky, Steven P; Pease, Anthony P; Stick, John A

    2013-12-01

    To determine the microvascular anatomy of the suspensory ligament of the forelimb of horses. 17 cadaveric forelimbs from 9 adult horses with no known history of forelimb lameness. The median artery of the forelimb was cannulated proximal to the antebrachiocarpal joint and injected with contrast medium for CT evaluation of the gross vasculature (n = 2) or India ink to evaluate the microvasculature (12). Routine histologic evaluation was performed on an additional 3 forelimbs to confirm the microvascular anatomy. The vascular supply of the suspensory ligament of the forelimb originated from branches of the medial and lateral palmar and palmar metacarpal vessels as well as the proximal and distal deep palmar arches. An abundant, longitudinally oriented microvascular supply was evident throughout the length of the suspensory ligament without distinct variation among the proximal, midbody, and distal regions. The intraligamentous blood supply originated from a periligamentous vascular plexus that surrounded the suspensory ligament throughout its length. Histologic findings indicated the presence of a periligamentous connective tissue plexus, which contained vessels that penetrated and anastomosed with an extensive network of intraligamentous vessels throughout the length of the suspensory ligament. The suspensory ligament of the equine forelimb had an abundant intraligamentous microvascular supply throughout its entire length. The absence of an obvious hypovascular area suggested that regional variations in healing rates of the suspensory ligament are not associated with the microvascular anatomy.

  7. Human cervical spine ligaments exhibit fully nonlinear viscoelastic behavior.

    Science.gov (United States)

    Troyer, Kevin L; Puttlitz, Christian M

    2011-02-01

    Spinal ligaments provide stability and contribute to spinal motion patterns. These hydrated tissues exhibit time-dependent behavior during both static and dynamic loading regimes. Therefore, accurate viscoelastic characterization of these ligaments is requisite for development of computational analogues that model and predict time-dependent spine behavior. The development of accurate viscoelastic models must be preceded by rigorous, empirical evidence of linear viscoelastic, quasi-linear viscoelastic (QLV) or fully nonlinear viscoelastic behavior. This study utilized multiple physiological loading rates (frequencies) and strain amplitudes via cyclic loading and stress relaxation experiments in order to determine the viscoelastic behavior of the human lower cervical spine anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum. The results indicated that the cyclic material properties of these ligaments were dependent on both strain amplitude and frequency. This strain amplitude-dependent behavior cannot be described using a linear viscoelastic formulation. Stress relaxation experiments at multiple strain magnitudes indicated that the shape of the relaxation curve was strongly dependent on strain magnitude, suggesting that a QLV formulation cannot adequately describe the comprehensive viscoelastic response of these ligaments. Therefore, a fully nonlinear viscoelastic formulation is requisite to model these lower cervical spine ligaments during activities of daily living. Copyright © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  8. Morphological study of mechanoreceptors in collateral ligaments of the ankle joint

    OpenAIRE

    Wu, Xiaochuan; Song, Weidong; Zheng, Cuihuan; Zhou, Shixiong; Bai, Shengbin

    2015-01-01

    Background The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle collateral ligaments using histological techniques, in order to observe the morphology and distribution of mechanoreceptors in the collateral ligaments of cadaver ankle joint, and to provide the morphological evidence for the role of the ligament in joint sensory function. Methods Twelve lateral collateral ligaments including anterior talofibular ligament (ATFL; n?=?6), posterior talofibula...

  9. A comparison of spinal ligaments--differences between bipeds and quadrupeds.

    OpenAIRE

    Jiang, H.; Moreau, M.; Raso, V. J.; Russell, G.; Bagnall, K

    1995-01-01

    Following dissection, the spinal ligaments were observed in a selection of bipedal, pseudobipedal and quadrupedal animals during a search for an appropriate animal model for investigating the innervation of these ligaments. Midline spinal ligaments were found in all animals while lateral spinal ligaments could only be observed in bipedal (human) and pseudobipedal (avian) species. The presence of lateral spinal ligaments in these animals and their absence in quadrupeds suggests that the develo...

  10. A pulmonary paragonimiasis case mimicking metastatic pulmonary tumor.

    Science.gov (United States)

    Kim, Ki Uk; Lee, Kwangha; Park, Hye-Kyung; Jeong, Yeon Joo; Yu, Hak Sun; Lee, Min Ki

    2011-03-01

    Pulmonary paragonimiasis is a relatively rare cause of lung disease revealing a wide variety of radiologic findings, such as air-space consolidation, nodules, and cysts. We describe here a case of pulmonary paragonimiasis in a 27-year-old woman who presented with a 2-month history of cough and sputum. Based on chest computed tomography (CT) scans and fluorodeoxyglucose positron emission tomography (FDG-PET) findings, the patient was suspected to have a metastatic lung tumor. However, she was diagnosed as having Paragonimus westermani infection by an immunoserological examination using ELISA. Follow-up chest X-ray and CT scans after chemotherapy with praziquantel showed an obvious improvement. There have been several reported cases of pulmonary paragonimiasis mimicking lung tumors on FDG-PET. However, all of them were suspected as primary lung tumors. To our knowledge, this patient represents the first case of paragonimiasis mimicking metastatic lung disease on FDG-PET CT imaging.

  11. A case of ovarian paragonimiasis mimicking ovarian carcinoma.

    Science.gov (United States)

    Tantipalakorn, Charuwan; Khunamornpong, Surapan; Tongsong, Theera

    2014-01-01

    The purpose of this report is to describe ovarian paragonimiasis, a rare form of lung fluke infestation, mimicking ovarian cancer. A 47-year-old Thai woman presented with a pelvic mass. Imaging suggested ovarian cancer with pulmonary and hepatic metastases. She was scheduled for complete surgical staging. However, a frozen section revealed Paragonimus eggs in the enlarged ovarian mass. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed instead of complete staging. All other lesions were also proven later to be Paragonimus infestation. Postoperative treatment with antiparasitic drugs resulted in dramatic improvement, with nearly complete resolution of all lesions at 4 months of follow-up. This is an unusual case of ovarian paragonimiasis mimicking ovarian cancer, which is instructive and informative for differential diagnoses of pelvic masses. © 2014 S. Karger AG, Basel.

  12. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee.

    Science.gov (United States)

    Smith, James O; Yasen, Sam K; Lord, Breck; Wilson, Adrian J

    2015-11-01

    Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence V.

  13. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?

    Science.gov (United States)

    Victor, Jan; Wong, Pius; Witvrouw, Eric; Sloten, Jos Vander; Bellemans, Johan

    2009-10-01

    Ligament isometry is a cornerstone in the description of normal knee function and thorough knowledge is mandatory for successful repair of torn ligaments. This study was undertaken to validate a novel experimental model for the study of ligament strains and to determine the length changes in the superficial medial collateral, lateral collateral, and medial patellofemoral ligaments. Descriptive laboratory study. Passive motions and loaded squats of 12 cadaveric specimens were performed while controlling ankle load and optically tracking the motion of the bones. Preexperiment and postexperiment computed axial tomography scans allow the transformation of rigid body motion to relative motion of relevant anatomic landmarks on the femur, tibia, and patella. The superficial medial collateral ligament is a near-isometric ligament with a strain of less than 2%. The ligament is a little more slack in midflexion (30 degrees to 50 degrees ) and in deep flexion, but length changes are not significant (P > .05). The lateral collateral ligament behaves near isometric (tension from the collateral ligaments (P superficial medial collateral ligament is a near-isometric ligament with no significant length changes. The medial patellofemoral ligament behaves differently in its cranial and caudal parts. In knees with chronic medial collateral ligament insufficiency, isometric repair of the superficial medial collateral ligament can be attempted. A medial patellofemoral ligament reconstruction with a double fixation on the medial patellar border is supported. The cranial bundle should be tightened at full extension and the caudal bundle at 30 degrees of knee flexion.

  14. Mimicking Biological Design and Computing Principles in Artificial Olfaction

    Science.gov (United States)

    2011-01-01

    Biology has inspired solutions to many engineering problems, including those encountered in chemical sensing. Modern approaches to chemical sensing have been based on the biological principle of combining cross-selective chemical sensors with a pattern recognition engine to identify odors. Here, we review some recent advances made in mimicking biological design and computing principles to develop an electronic nose. The resulting technology will have important applications in fundamental biological research, as well as in industrial, security, and medical domains. PMID:22081790

  15. Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour

    OpenAIRE

    Xiao, Shuo-meng; Xu, Rui; Tang, Xiao-li; Ding, Zhi; Li, Ji-man; Zhou, Xiang

    2017-01-01

    Background Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. Case presentation We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Com...

  16. Cartilage Delamination Flap Mimicking a Torn Medial Meniscus.

    Science.gov (United States)

    Jonathan, Gan Zhi-Wei; Bin Abd Razak, Hamid Rahmatullah; Amit Kanta, Mitra

    2016-01-01

    We report a case of a chondral delamination lesion due to medial parapatellar plica friction syndrome involving the medial femoral condyle. This mimicked a torn medial meniscus in clinical and radiological presentation. Arthroscopy revealed a chondral delamination flap, which was debrided. Diagnosis of chondral lesions in the knee can be challenging. Clinical examination and MRI have good accuracy for diagnosis and should be used in tandem. Early diagnosis and treatment of chondral lesions are important to prevent progression to early osteoarthritis.

  17. An abdominal tuberculosis case mimicking an abdominal mass

    African Journals Online (AJOL)

    An abdominal tuberculosis case mimicking an abdominal mass. Derya Erdog˘ an a. , Yasemin Ta ¸scı Yıldız b. , Esin Cengiz Bodurog˘lu c and Naciye Go¨nu¨l Tanır d. Abdominal tuberculosis is rare in childhood. It may be difficult to diagnose as it mimics various disorders. We present a 12-year-old child with an unusual ...

  18. Degenerated uterine leiomyomas mimicking malignant bilateral ovarian surface epithelial tumors

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Yi Boem Ha; Lee, Hae Kyung; Lee, Min Hee; Choi, Seo Youn; Chung, Soo Ho [Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

    2017-07-15

    Uterine leiomyomas are the most common benign uterine neoplasms. Undegenerated uterine leiomyomas are easily recognizable by the typical imaging findings on radiologic studies. However, degenerated fibroids can have unusual and variable appearances. The atypical appearances due to degenerative changes may cause confusion in diagnosis of leiomyomas. In this article, we report a case of a patient with extensive cystic and myxoid degeneration of uterine leiomyoma, mimicking malignant bilateral ovarian surface epithelial tumors.

  19. Mimicking Nonequilibrium Steady States with Time-Periodic Driving

    Science.gov (United States)

    2016-08-29

    biochemical reactions , can be effectively mimicked by a constrained periodic driving. DOI: 10.1103/PhysRevX.6.021022 Subject Areas: Statistical...error rates in biochemical reactions such as protein synthesis. The system in kinetic proofreading is described by a discrete-state continuous-time... concentrations are constantly maintained out of equilibrium. Such a coupling modifies the Arrhenius rates : Denoting the rate matrix now by R (as it is not

  20. Amiodarone-induced pulmonary toxicity mimicking metastatic lung disease.

    Science.gov (United States)

    Patel, P; Honeybourne, D; Watson, R D

    1987-05-01

    A 65 year old man developed atrial arrhythmias secondary to a congestive cardiomyopathy which were resistant to quinidine and disopyramide. Amiodarone controlled the paroxysmal atrial tachycardia but 4 months after starting the drug he developed increasing dyspnoea and radiological changes highly suggestive of metastatic lung disease. Lung biopsy showed change of drug-induced pneumonitis and 4 months after stopping amiodarone his symptoms resolved and the chest X-ray had cleared. Amiodarone may cause pulmonary toxicity mimicking metastatic lung disease.

  1. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Nirmal Raj Gopinathan

    2016-01-01

    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  2. Juvenile Myelomonocytic Leukemia in a Premature Neonate Mimicking Neonatal Sepsis

    Directory of Open Access Journals (Sweden)

    Ming-Luen Lee

    2016-04-01

    Full Text Available Juvenile myelomonocytic leukemia (JMML is a rare hematologic malignancy in children. Its presentations include anemia, thrombocytopenia, monocytosis, skin rash, marked hepatomegaly, and/or splenomegaly. Fever and respiratory involvement are common. Here, we report a case of a premature neonate with initial symptoms of respiratory distress. She gradually developed clinical manifestations of JMML that mimicked neonatal sepsis. Three weeks after birth, JMML was diagnosed. This is the first reported case of JMML presenting in a premature infant in Taiwan.

  3. Primary Ovarian and Pararectal Hydatid Cysts Mimicking Pelvic Endometriosis

    Directory of Open Access Journals (Sweden)

    Mehmet Karaman

    2012-12-01

    Full Text Available We report a case of 48-year-old woman with multiple hydatid cysts in pararectal region and right paraovarian localization with an unusual sonographic and computed tomographic presentation mimicking a pelvic endometriosis. During laparotomy, multiple pararectal and right ovarian cysts resembling endometriosis were resected. Pathologic examination gives the diagnosis of hydatid cysts. Retrospectively, we investigate the primary infection but the patient had no history of hepatic and liver involvement, it is a case of primary infection

  4. Desmitis of the fetlock annular ligament in the horse.

    Science.gov (United States)

    Verschooten, F; Picavet, T M

    1986-03-01

    Desmitis of the fetlock annular ligament was diagnosed in 30 horses during a period of eight years. Most of the horses had been lame for a prolonged period and had chronically distended digital flexor tendon sheaths. Air tendograms demonstrated thickened palmar or plantar annular ligaments. In 25 horses the ligament was cut longitudinally; of these, 16 horses returned to full work without any difficulty and one became sound after a second operation. Follow up time varied from three months to seven-and-a-half years. None of the five untreated horses returned to work.

  5. Absence of sensory function in the reconstructed anterior cruciate ligament

    DEFF Research Database (Denmark)

    Krogsgaard, Michael R; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

    2011-01-01

    Cruciate ligaments provide sensory information that cause excitatory as well as inhibitory effects to the activity of the muscles around the knee. The aim of the study was to determine whether these muscular reflexes are reestablished after anterior cruciate ligament (ACL) re-construction. Wire...... electrodes were inserted during arthroscopy into the normal posterior cruciate ligament (PCL) and the reconstructed ACL in 11 patients who had a successful ACL re-construction 8 months to 12 years earlier. After the anesthesia had subsided, the PCL was stimulated electrically through the electrodes...

  6. Segmentation of Bony Structures with Ligament Attachment Sites

    Science.gov (United States)

    Seim, Heiko; Lamecker, Hans; Heller, Markus; Zachow, Stefan

    This work presents an approach towards reconstructing ligament and tendon attachment sites from 3D medical image data. We apply statistical shape models with an additional free form step to reconstruct the anatomical shape of the distal femur from CT data. After the shape fitting process the locations of ligament attachment sites, which are incorporated in the geometric model, are extracted and their positions optimized via an image based approach. To show the potential of our method we manually extracted the surface of 11 distal femora and their corresponding ligament attachment sites in clinical CT data and compared them to the results of our method.

  7. Mechanical behavior of nanoporous Au with fine ligaments

    Science.gov (United States)

    Pia, Giorgio; Delogu, Francesco

    2015-08-01

    A theoretical model relating the overall mechanical behavior of NP metals to the bending response of thick ligaments is developed based on an idealized regular lattice of massive cubic nodes and thick ligaments with square cross section. The model predictions are compared with the Young's modulus and yield strength of nanoporous Au with ligaments a few nanometers in size obtained by numerical simulation and available in literature. It is shown that the model provides a quantitative description of the elastic and plastic deformation of nanoporous Au, reproducing to a considerable extent the numerically estimated Young's modulus and yield strength values.

  8. Anterior cruciate ligament remnant and its values for preservation

    Directory of Open Access Journals (Sweden)

    Takeshi Muneta

    2017-01-01

    Full Text Available Controversy surrounds the remnant-preserving anterior cruciate ligament surgery. Advantages of remnant preservation have been reported in regard to better healing and knee function, although no consensus has been reached. This review article discussed the value and meaning of anterior cruciate ligament remnant preservation in several sections such as effects on healing, remnant classification, biomechanical evaluation, relation to proprioception, animal studies, and clinical studies. We hope that this review will facilitate further discussion and investigation for better treatment of anterior cruciate ligament injuries. So far, the current reviews have not provided sufficient scientific evidence to support the value of preserving the remnant.

  9. The fibular collateral ligament of the knee: a detailed review.

    Science.gov (United States)

    Song, Young-Bin; Watanabe, Koichi; Hogan, Elizabeth; D'Antoni, Anthony V; Dilandro, Anthony C; Apaydin, Nihal; Loukas, Marios; Shoja, Mohammadali M; Tubbs, R Shane

    2014-07-01

    The fibular collateral ligament (FCL) is one of the larger ligaments of the knee. The FCL, along with the popliteus tendon, arcuate popliteal ligament, and joint capsule, make up the posterolateral corner of the knee. Recently, there has there been an increased awareness and research on the structures of the posterolateral corner of the knee, particularly the FCL. Studying the detailed structure of the FCL may provide a better understanding that can lead to better diagnosis and treatments following injury. Therefore, this article reviews the FCL, which appears to be the primary restraint to varus rotation but is poorly oriented to resist external rotation of the knee. © 2013 Wiley Periodicals, Inc.

  10. Dengue fever mimicking acute appendicitis: A case report.

    Science.gov (United States)

    McFarlane, M E C; Plummer, J M; Leake, P A; Powell, L; Chand, V; Chung, S; Tulloch, K

    2013-01-01

    Dengue fever is an acute viral disease, which usually presents as a mild febrile illness. Patients with severe disease present with dengue haemorrhagic fever or dengue toxic shock syndrome. Rarely, it presents with abdominal symptoms mimicking acute appendicitis. We present a case of a male patient presenting with right iliac fossa pain and suspected acute appendicitis that was later diagnosed with dengue fever following a negative appendicectomy. A 13-year old male patient presented with fever, localized right-sided abdominal pain and vomiting. Abdominal ultrasound was not helpful and appendicectomy was performed due to worsening abdominal signs and an elevated temperature. A normal appendix with enlarged mesenteric nodes was found at surgery. Complete blood count showed thrombocytopenia with leucopenia. Dengue fever was now suspected and confirmed by IgM enzyme-linked immunosorbent assay against dengue virus. This unusual presentation of dengue fever mimicking acute appendicitis should be suspected during viral outbreaks and in patients with atypical symptoms and cytopenias on blood evaluation in order to prevent unnecessary surgery. This case highlights the occurrence of abdominal symptoms and complications that may accompany dengue fever. Early recognition of dengue fever mimicking acute appendicitis will avoid non-therapeutic operation and the diagnosis may be aided by blood investigations indicating a leucopenia, which is uncommon in patients with suppurative acute appendicitis. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Lateral Patellofemoral Ligament: An Anatomic Study.

    Science.gov (United States)

    Shah, Kalpit N; DeFroda, Steven F; Ware, James Kristopher; Koruprolu, Sarath C; Owens, Brett D

    2017-12-01

    Medial instability of the patellofemoral joint is a rare but known phenomenon that may result from an incompetent lateral patellofemoral ligament (LPFL). Surgical reconstruction of the LPFL has been described. However, anatomic details of the ligament have not been the subject of scrutiny. To describe the anatomic origin and insertion of the LPFL. Descriptive laboratory study. Ten fresh-frozen, unpaired human cadaveric knees (mean age, 57 years) were dissected to identify the LPFL. The dissection was carried out by elevating the iliotibial band to expose the deep capsular layer of the knee joint, followed by a medial parapatellar approach to the knee. Then the quadriceps and patellar tendons were sectioned, and the LPFL was isolated by visualization and palpation. The LPFL was dissected to reveal its origin and insertion; these were measured with respect to the lateral epicondyle and the superior-inferior axis of the lateral patella, respectively. On average, the LPFL had a variable point of origin in location as well as width about the lateral epicondyle. The LPFL originated, on average, 2.6 mm distal (range, 13.1 mm proximal to 11.4 mm distal) and 10.8 mm anterior (range, 7.3 mm posterior to 14.9 mm anterior) to the lateral epicondyle. The LPFL insertion on the patella was more reliably found to be about 45% (range, 23.7%-58.4%) of its lateral articular surface. The insertion on the patella was found to be in the middle third of the lateral patella. The LPFL has an origin that is variable but, on average, was found to be distal and anterior to the lateral epicondyle. The patella insertion was more reliably found to be in the middle third of the lateral patella. These anatomic relationships can help the surgeon reconstruct the LPFL in a more anatomic fashion. Surgeons who are tasked with reconstruction of the LPFL of a patient with idiopathic medial instability or a previous aggressive lateral release of the knee may reference this article to perform an anatomic

  12. The name cranial ovarian suspensory ligaments in mammalian anatomy should be used only to indicate the structures derived from the foetal cranial mesonephric and gonadal ligaments

    NARCIS (Netherlands)

    P. van der Schoot (P.)

    1993-01-01

    textabstractThe term ovarian suspensory ligament appears ambiguous when human adult anatomy textbooks are compared with human embryology or with general mammalian anatomy textbooks. The term ovarian suspensory ligament in laboratory rodents and domestic animals indicates homologous structures during

  13. The phenomenon of "ligamentization": anterior cruciate ligament reconstruction with autogenous patellar tendon.

    Science.gov (United States)

    Amiel, D; Kleiner, J B; Roux, R D; Harwood, F L; Akeson, W H

    1986-01-01

    Reconstruction of the anterior cruciate ligament (ACL) with patellar tendon (PT) is a common procedure for the symptomatic ACL-deficient knee. Questions regarding graft incorporation, viability, and nutrition of the transplanted tissue are of concern. This relates to the graft's response to its new intrasynovial milieu and new physical forces. These factors were studied in a rabbit model of ACL reconstruction using PT and were evaluated with histological and biochemical parameters with respect to time. A histological and biochemical metamorphosis of the grafted PT occurred in this study. Autografts demonstrated a gradual assumption of the microscopic properties of normal ACL; by 30 weeks postoperatively, cell morphology was ligamentous in appearance. Normally, type III collagen is not observed in PT, however, a gradual increase in its concentration was seen in the grafts; by 30 weeks its concentration (10%) was the same as in normal ACL. Similarly, glycosaminoglycans content increased from its normally low level in PT to that found in native ACL. Collagen-reducible crosslink analysis demonstrated that grafted tissue changed from the normal PT pattern of low dihydroxylysinonorleucine (DHLNL) and high histidinohydroxymerodesmosine (HHMD) to the pattern seen in normal ACL (high DHLNL and low HHMD) by 30 weeks. These data suggest that when PT is placed in the anatomic and environmental milieu of the ACL, a "ligamentization" of the grafted tissue results; also the autograft initially depends on synovial fluid nutrition, as revascularization occurs after 6 weeks.

  14. Does the tibial remnant of the anterior cruciate ligament promote ligamentization?

    Science.gov (United States)

    Lee, Byung Ill; Kim, Byoung Min; Kho, Duk Hwan; Kwon, Sai Won; Kim, Hyeung June; Hwang, Hyun Ryong

    2016-12-01

    The purpose of this study was to clarify the difference in ligamentization between the remnant-preserving (RP) and remnant-sacrificing (RS) techniques in anterior cruciate ligament (ACL) reconstruction using magnetic resonance imaging (MRI). A retrospective comparative study was carried out on 98 patients undergoing ACL reconstruction using either an RP (n=56) or RS (n=42) technique. MRI was performed at one of four time points postoperatively, and the signal intensity of the ACL graft was analyzed using the signal to noise quotient (SNQ) ratio and inter-bundle high signal intensity, along with an analysis of the survival rate of remnant tissue. The mean SNQ ratio of grafted tendons in the RP group was significantly higher than that seen in the RS group in the proximal and middle regions two to four months after surgery (Pligamentization of grafts in the RP group proceeded more quickly. Preserving the remnant in ACL reconstruction appears to have a positive effect on ligamentization. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Proprioception in anterior cruciate ligament deficient knees and its relevance in anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Mandeep S Dhillon

    2011-01-01

    Full Text Available Injury to the anterior cruciate ligament (ACL not only causes mechanical instability but also leads to a functional deficit in the form of diminished proprioception of the knee joint. "Functional" recovery is often incomplete even after "anatomic" arthroscopic ACL reconstruction, as some patients with a clinically satisfactory repair and good ligament tension continue to complain of a feeling of instability and giving way, although the knee does not sublux on clinical testing. Factors that may play a role could be proprioceptive elements, as the intact ACL has been shown to have significant receptors. Significant data have come to light demonstrating proprioceptive differences between normal and injured knees, and often between injured and reconstructed knees. ACL remnants have been shown to have proprioceptive fibers that could enhance functional recovery if they adhere to or grow into the reconstructed ligament. Conventionally the torn remnants are shaved off from the knee before graft insertion; modern surgical techniques, with remnant sparing methods have shown better outcomes and functional recovery, and this could be an avenue for future research and development. This article analyzes and reviews our understanding of the sensory element of ACL deficiency, with specific reference to proprioception as an important component of functional knee stability. The types of mechanoreceptors, their distribution and presence in ACL remnants is reviewed, and suggestions are made to minimize soft tissue shaving during ACL reconstruction to ensure a better functional outcome in the reconstructed knee.

  16. Measuring Prevention More Broadly, An Empirical...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Measuring Prevention More Broadly, An Empirical Assessment of CHIPRA Core Measures Differences in CHIP design and structure, across states and over time, may limit...

  17. Prospects for broadly protective influenza vaccines.

    Science.gov (United States)

    Treanor, John Jay

    2015-11-27

    The development of vaccines that could provide broad protection against antigenically variant influenza viruses has long been the ultimate prize in influenza research. Recent developments have pushed us closer to this goal, and such vaccines may now be within reach. This brief review outlines the current approaches to broadly protective vaccines, and the probable hurdles and roadblocks to achieving this goal. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Ltd.. All rights reserved.

  18. Mechanical Analysis of Extra-Articular Knee Ligaments. Part two: Tendon grafts used for knee ligament reconstruction.

    Science.gov (United States)

    Smeets, Kristof; Bellemans, Johan; Scheys, Lennart; Eijnde, Bert O; Slane, Joshua; Claes, Steven

    2017-10-01

    The aim of this study was to provide information about the mechanical properties of grafts used for knee ligament reconstructions and to compare those results with the mechanical properties of native knee ligaments. Eleven cadaveric knees were dissected for the semitendinosus, gracilis, iliotibial band (ITB), quadriceps and patellar tendon. Uniaxial testing to failure was performed using a standardized method and mechanical properties (elastic modulus, ultimate stress, ultimate strain, strain energy density) were determined. The elastic modulus of the gracilis tendon (1458±476MPa) (Pligament reconstructions often differ significantly from the original knee ligament which the graft is supposed to emulate. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Anterior cruciate ligament injuries: etiology and prevention.

    Science.gov (United States)

    Brophy, Robert H; Silvers, Holly J; Mandelbaum, Bert R

    2010-03-01

    The relatively high risk of noncontact anterior cruciate ligament (ACL) rupture among female athletes has been a major impetus for investigation into the etiology of this injury. A number of risk factors have been identified, both internal and external to the athlete, including neuromuscular, anatomical, hormonal, shoe-surface interaction, and environmental, such as weather. The anatomic and neuromuscular risk factors, often gender related, are the focus of most ACL injury prevention programs. Although studies have shown that biomechanic- centered prevention programs can reduce the risk of ACL injury, many questions remain unanswered. More research is needed to increase our understanding of the risk factors for ACL injury; how injury prevention programs work and can the clinical application of such programs be optimized.

  20. J. Leonard Goldner Award 2010. Ligament balancing for total ankle arthroplasty: an in vitro evaluation of the elongation of the hind- and midfoot ligaments.

    Science.gov (United States)

    Merian, Marc; Glisson, Richard R; Nunley, James A

    2011-05-01

    The changes in length of the hindfoot ligaments in response to alterations in ankle and subtalar joint orientation under physiologic load in eight fresh-frozen cadaver limbs were documented. In eversion, the tibiocalcaneal (11% ± 4%, mean ± SD], calcaneofibular (6% ± 4%), posterior talofibular (7% ± 4%), posterolateral talocalcaneal (21% ± 9%), posteromedial talocalcaneal (33% ± 45%) and calcaneonavicular (bifurcate) (8% ± 7%) ligaments were elongated relative to their lengths in inversion. In inversion, the anterior capsular (talocalcaneal) (5% ± 3%) and the plantar cuboidnavicular (5% ± 6%) ligaments were elongated relative to their everted lengths. In dorsiflexion, the superficial (26% ± 8%) and deep posterior tibiotalar (30% ± 13%), calcaneofibular (8% ± 4%), tibiocalcaneal (4% ± 2%) and lateral talocalcaneal (cervical) (2% ± 1%) ligaments were elongated. In plantarflexion, the tibionavicular (26% ± 5%) and the anterior talofibular (7% ± 4%) ligaments were lengthened. No statistically significant elongation was documented in any ankle position for the anterior tibiotalar, talocalcaneal interosseous, plantar calcaneocuboid, calcaneocuboid (bifurcate), all components of the spring ligament, and the dorsal cuboidnavicular ligaments. Components of the deltoid ligament complex elongated largest at the ankle joint with any hindfoot movement but inversion. Therefore, selective release of components of the deltoid ligament complex may provide a means for achieving optimal ligament balancing in total ankle arthroplasty. Specifically, release of the superficial and deep posterior tibiotalar ligament may improve range of motion in total ankle arthroplasties, whereas the release of the tibiocalcaneal ligament may correct a varus talar tilt.

  1. Knee-ligament injuries associated with leg fractures. Prospective study.

    Science.gov (United States)

    Matić, A; Kasić, M; Hudolin, I

    1992-09-01

    It has been proved in 25-35% of the cases that knee-ligament injuries are associated with fracture of the femoral diaphysis. No such association has been confirmed between leg fractures and knee ligaments. In order to find out if this is a coincidence, a prospective study was conducted on 229 patients who had undergone operations for leg fractures at various locations and of variable intensity. It was established in 41 cases (17.34%) that the leg fracture was associated with knee-ligament injuries, resulting in joint instability. A significantly higher percentage of associated ligament lesions was found in open fractures as opposed to closed leg fractures. The examination was carried out with the patient under general or block anesthesia. On the basis of what was established it is recommended that the knee be examined clinically in all leg osteosynthesis cases.

  2. Telomere length of anterior crucial ligament after rupture

    DEFF Research Database (Denmark)

    Ponsot, Elodie; Langberg, Henning; Krogsgaard, Michael R

    2011-01-01

    of human anterior cruciate ligament (ACL) obtained during ACL reconstruction: the macroscopically injured proximal part and macroscopically noninjured mid- and distal portions in eight subjects (age 28 ± 8 years). The mean telomere length in ACL was within normal range of values usually reported for other......The regeneration of ligaments following injury is a slow process compared to the healing of many other tissues and the underlying mechanisms remain unknown. The purpose of the study was to evaluate the proliferative potential of ligaments by assessing telomere length within three distinct parts...... tissues indicating that the endogenous machinery responsible for the proliferative potential of ligament is not implicated in its poor healing capacity. The three ACL parts showed similar mean TRF lengths (distal part: 11.5 ± 0.8 kbp, mid-portion: 11.8 ± 1.2 kbp, proximal part: 11.9 ± 1.6 kbp...

  3. Tendon and ligament adaptation to exercise, immobilization, and remobilization.

    Science.gov (United States)

    Wren, T A; Beaupré, G S; Carter, D R

    2000-01-01

    This study provides a theoretical and computational basis for understanding and predicting how tendons and ligaments adapt to exercise, immobilization, and remobilization. In a previous study, we introduced a model that described the growth and development of tendons and ligaments. In this study, we use the same model to predict changes in the cross-sectional area, modulus, and strength of tendons and ligaments due to increased or decreased loading. The model predictions are consistent with the results of experimental exercise and immobilization studies performed by other investigators. These results suggest that the same fundamental principles guide both development and adaptation. A basic understanding of these principles can contribute both to prevention of tendon and ligament injuries and to more effective rehabilitation when injury does occur.

  4. Ligament tissue engineering: an evolutionary materials science approach.

    Science.gov (United States)

    Laurencin, Cato T; Freeman, Joseph W

    2005-12-01

    The anterior cruciate ligament (ACL) is important for knee stabilization. Unfortunately, it is also the most commonly injured intra-articular ligament. Due to poor vascularization, the ACL has inferior healing capability and is usually replaced after significant damage has occurred. Currently available replacements have a host of limitations, this has prompted the search for tissue-engineered solutions for ACL repair. Presently investigated scaffolds range from twisted fiber architectures composed of silk fibers to complex three-dimensional braided structures composed of poly (L-lactic acid) fibers. The purpose of these tissue-engineered constructs is to apply approaches such as the use of porous scaffolds, use of cells, and the application of growth factors to promote ligament tissue regeneration while providing mechanical properties similar to natural ligament.

  5. Creep behaviour and creep mechanisms of normal and healing ligaments

    Science.gov (United States)

    Thornton, Gail Marilyn

    Patients with knee ligament injuries often undergo ligament reconstructions to restore joint stability and, potentially, abate osteoarthritis. Careful literature review suggests that in 10% to 40% of these patients the graft tissue "stretches out". Some graft elongation is likely due to creep (increased elongation of tissue under repeated or sustained load). Quantifying creep behaviour and identifying creep mechanisms in both normal and healing ligaments is important for finding clinically relevant means to prevent creep. Ligament creep was accurately predicted using a novel yet simple structural model that incorporated both collagen fibre recruitment and fibre creep. Using the inverse stress relaxation function to model fibre creep in conjunction with fibre recruitment produced a superior prediction of ligament creep than that obtained from the inverse stress relaxation function alone. This implied mechanistic role of fibre recruitment during creep was supported using a new approach to quantify crimp patterns at stresses in the toe region (increasing stiffness) and linear region (constant stiffness) of the stress-strain curve. Ligament creep was relatively insensitive to increases in stress in the toe region; however, creep strain increased significantly when tested at the linear region stress. Concomitantly, fibre recruitment was evident at the toe region stresses; however, recruitment was limited at the linear region stress. Elevating the water content of normal ligament using phosphate buffered saline increased the creep response. Therefore, both water content and fibre recruitment are important mechanistic factors involved in creep of normal ligaments. Ligament scars had inferior creep behaviour compared to normal ligaments even after 14 weeks. In addition to inferior collagen properties affecting fibre recruitment and increased water content, increased glycosaminoglycan content and flaws in scar tissue were implicated as potential mechanisms of scar creep

  6. Complications following anterior cruciate ligament reconstruction in the English NHS.

    OpenAIRE

    Jameson, Simon S.; Dowen, Daniel; James, Philip; Serrano Pedraza, Ignacio; Reed, Mike R; Deehan, David

    2012-01-01

    Unlike the English National Joint Registry (NJR) for arthroplasty, no surgeon driven national database currently exists for ligament surgery in England. Therefore information on outcome and adverse events following anterior cruciate ligament (ACL) surgery is limited to case series. This restricts the ability to make formal recommendations upon surgical care. Prospectively collected data, which is routinely collected on every NHS patient admitted to hospital in England, was analysed to determi...

  7. Lymphatic Stomata in the Adult Human Pulmonary Ligament.

    Science.gov (United States)

    Oshiro, Hisashi; Miura, Masahiro; Iobe, Hiroaki; Kudo, Tomoo; Shimazu, Yoshihito; Aoba, Takaaki; Okudela, Koji; Nagahama, Kiyotaka; Sakamaki, Kentaro; Yoshida, Maki; Nagao, Toshitaka; Nakaya, Takeo; Kurata, Atsushi; Ohtani, Osamu

    2015-06-01

    Lymphatic stomata are small lymphatic openings in the serosal membrane that communicate with the serosal cavity. Although these stomata have primarily been studied in experimental mammals, little is known concerning the presence and properties of lymphatic stomata in the adult human pleura. Thus, adult human pleurae were examined for the presence or absence of lymphatic stomata. A total of 26 pulmonary ligaments (13 left and 13 right) were obtained from 15 adult human autopsy cases and examined using electron and light microscopy. The microscopic studies revealed the presence of apertures fringed with D2-40-positive, CD31-positive, and cytokeratin-negative endothelial cells directly communicating with submesothelial lymphatics in all of the pulmonary ligaments. The apertures' sizes and densities varied from case to case according to the serial tissue section. The medians of these aperture sizes ranged from 2.25 to 8.75 μm in the left pulmonary ligaments and from 2.50 to 12.50 μm in the right pulmonary ligaments. The densities of the apertures ranged from 2 to 9 per mm(2) in the left pulmonary ligaments and from 2 to 18 per mm(2) in the right pulmonary ligaments. However, no significant differences were found regarding the aperture size (p=0.359) and density (p=0.438) between the left and the right pulmonary ligaments. Our study revealed that apertures exhibit structural adequacy as lymphatic stomata on the surface of the pulmonary ligament, thereby providing evidence that lymphatic stomata are present in the adult human pleura.

  8. Spring Ligament Complex and Posterior Tibial Tendon: MR Anatomy and Findings in Acquired Adult Flatfoot Deformity.

    Science.gov (United States)

    Mengiardi, Bernard; Pinto, Clinton; Zanetti, Marco

    2016-02-01

    The spring ligament complex is an important stabilizer of the medial ankle, together with the posterior tibial tendon (PTT) and the deltoid ligament complex. Lesions in these stabilizers result in acquired adult flatfoot deformity. The spring ligament complex includes three ligaments: the superomedial calcaneonavicular ligament, the medioplantar oblique calcaneonavicular ligament, and the inferoplantar longitudinal calcaneonavicular ligament. Normal MR imaging anatomy of the spring ligament complex and the PTT are described and illustrated in detail. Isolated lesions of the spring ligament complex are rare. In most cases, spring ligament complex lesions are secondary to PTT dysfunction. The best criteria for an injury of the clinically relevant superomedial calcaneonavicular ligament are increased signal on proton-density or T2-weighted sequences with thickening (> 5 mm), thinning (lesion seen by the orthopedic foot surgeon at the junction between the tibiospring ligament and the superomedial portion of the calcaneonavicular ligament is commonly classified as a spring ligament injury. In addition, an overview of MR imaging findings in different stages of the acquired adult flatfoot deformity is provided. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Cervical ligamentous instability in a canine in vivo model.

    Science.gov (United States)

    Whitehill, R; Moran, D J; Fechner, R E; Ruch, W W; Drucker, S; Hooper, W E; McCoig, J A

    1987-12-01

    A canine in vivo model of midcervical ligamentous instability was developed by dividing the anterior longitudinal ligament, anulus fibrosus, and all posterior ligamentous structures including the ligamentum flavum. The natural history of healing in the model, the effect on its healing by an adjacent one-level arthrodesis, and the effect of a one-level arthrodesis on normal adjacent ligamentous structures were studied radiographically, mechanically, and histologically. The authors determined that healing takes place primarily by anterior scar formation in their instability model but not to a degree sufficient to recreate normal mechanical stability. After three months, healing in the model was not affected by an adjacent arthrodesis; however, acutely, instability apparently was increased as three animals became quadriplegic between the second and fourth postoperative days. Arthrodesis did not affect adjacent normal ligamentous structures, during this period. Incomplete healing in the authors' model supports those who advocate arthrodesis as the treatment of choice for destabilizing cervical ligamentous injury. The authors previously reported the case of a patient who sustained bilateral facet dislocations adjacent to an arthrodesed segment and questioned whether this resulted from a stress-concentrating effect. This study indicates that this could well have been the case acutely. Thus, inadvertent exclusion of an unstable segment from an arthrodesis has potentially catastrophic results. Finally, the authors also have previously questioned whether arthrodesis of a midcervical segment could lead to instability of adjacent normal segments. This project does not support such a concern, at least for the three postoperative months of study.

  10. Relationship between stress ankle radiographs and injured ligaments on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyoung Min; Chung, Chin Youb; Chung, Myung Ki; Won, Sung Hun; Lee, Seung Yeol; Park, Moon Seok [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Kyungki (Korea, Republic of); Kwon, Soon-Sun [Seoul National University Bundang Hospital, Biomedical Research Institute, Kyungki (Korea, Republic of)

    2013-11-15

    This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p < 0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability. (orig.)

  11. Relationship between stress ankle radiographs and injured ligaments on MRI.

    Science.gov (United States)

    Lee, Kyoung Min; Chung, Chin Youb; Kwon, Soon-Sun; Chung, Myung Ki; Won, Sung Hun; Lee, Seung Yeol; Park, Moon Seok

    2013-11-01

    This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability.

  12. [VARIANT ANATOMY OF SPLENIC LIGAMENTS AND ARTERIES PASSING THROUGH THEM].

    Science.gov (United States)

    Gaivoronskiy, I V; Kotiv, B N; Alekseyev, V S; Nichiporuk, G I

    2015-01-01

    The research was performed on 15 non embalmed bodies and 32 abdominal complexes of adult individuals. The comparative study of variant anatomy of splenic ligaments and architectonics of arteries passing through them was carried out to substantiate the mobilization of splenopancreatic complex. Anatomical and angiographic restudied were carried out using preparation, morphometry, injection of gastric, pancreatic and splenic vascular bed with red lead suspension. It was established that the form and sizes of splenic ligaments and their interrelation with the branches of the splenic artery were variable. The minimal and maximal sizes of gastrolienal, phrenicosplenic and splenocolic ligaments differed 2-3 times. In most cases, spleen was fixed in abdominal cavity by many short ligaments. It was shown that architectonics and topography of main branches of spleen artery were determined by morphometric characteristics of the spleen proper and its ligaments. The knowledge of splenic ligament variant anatomy allows a new perspective to approach to substantiate different methods of the mobilization of spleno-pancreatic complex during surgical operations on organs of the upper part of the peritoneal cavity and organ-preserving surgery of the spleen.

  13. Chronic multiple knee ligament injuries: epidemiological analysis of more than one hundred cases

    Directory of Open Access Journals (Sweden)

    Rosalvo Zosimo Bispo Júnior

    2008-01-01

    Full Text Available INTRODUCTION: Diagnosis and treatment of multiple ligament injuries of the knee remain a real challenge for most surgeons. OBJECTIVE: To find out the epidemiological profile of patients surgically treated at a Reference Service with more than one chronic ligament injury in the knee joint. MATERIALS AND METHODS: Of a total of 978 operated patients, 109 presented at least two associated ligament injuries in the same knee. Demographic and clinical variables were evaluated. RESULTS: The anterior cruciate ligament group presented a larger number of cases of ligament injuries related with sports practice and falls, while the posterior cruciate ligament and anterior cruciate ligament + posterior cruciate ligament groups presented more cases related to traffic accidents and trauma with object (weight on the knee (p<0.001. The varus group presented significantly higher values of time since injury (p<0.01. In the group with new anterior cruciate ligament injury (neoligament associated with other ligament injuries the disruption times were higher, showing statistical significance (p<0.001. CONCLUSIONS: Anterior cruciate ligament injury associated with other ligament injuries other than posterior cruciate ligament injury are related to sports practice and falls. Posterior cruciate ligament injury associated to other ligament injuries, including or not anterior cruciate ligament injury, are related to traffic accidents and direct trauma caused by an object on the knee. Significant delay between primary ligament injuries and their reconstructions generates varus deformity of the affected knee. In spite of the large delay in seeking medical treatment, few patients with neoligament anterior cruciate ligament injury and other combined disruptions will develop varus deformity.

  14. Various Tumor-Mimicking Lesions in the Musculoskeletal System: Causes and Diagnostic Approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sue Yon; Park, Ji Seon; Ryu, Kyung Nam; Jin, Wook [Kyung Hee University Medical Center, Seoul (Korea, Republic of); Park, So Young [East-West Neo Medical Center, Kyung Hee University, Seoul (Korea, Republic of)

    2011-04-15

    Tumor-mimicking lesions in the musculoskeletal system can be defined as lesions mistaken as tumors due to the presence of palpation upon physical examination or a tumor-like appearance upon radiological examination. Moreover, tumor mimicking lesions show diverse etiologies and anatomic locations. We illustrated the various tumor-mimicking lesions involving bone and soft tissue. In this review, the tumor-mimicking lesions were classified into those based on clinical examination and those based on radiological examination in musculoskeletal radiology. Awareness of the various causes of tumor-mimicking lesions, correctly obtaining clinical information, and the proper selection of imaging modality are important for the differentiation of tumor-mimicking lesions from true neoplasms

  15. An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 2: Anterolateral Ligament Reconstruction Combined With Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Nitri, Marco; Rasmussen, Matthew T; Williams, Brady T; Moulton, Samuel G; Cruz, Raphael Serra; Dornan, Grant J; Goldsmith, Mary T; LaPrade, Robert F

    2016-03-01

    Recent biomechanical studies have demonstrated that an extra-articular lateral knee structure, most recently referred to as the anterolateral ligament (ALL), contributes to overall rotational stability of the knee. However, the effect of anatomic ALL reconstruction (ALLR) in the setting of anterior cruciate ligament (ACL) reconstruction (ACLR) has not been biomechanically investigated or validated. The purpose of this study was to investigate the biomechanical function of anatomic ALLR in the setting of a combined ACL and ALL injury. More specifically, this investigation focused on the effect of ALLR on resultant rotatory stability when performed in combination with concomitant ACLR. It was hypothesized that ALLR would significantly reduce internal rotation and axial plane translation laxity during a simulated pivot-shift test compared with isolated ACLR. Controlled laboratory study. Ten fresh-frozen cadaveric knees were evaluated with a 6 degrees of freedom robotic system. Knee kinematics were evaluated with simulated clinical examinations including a simulated pivot-shift test consisting of coupled 10-N·m valgus and 5-N·m internal rotation torques, a 5-N·m internal rotation torque, and an 88-N anterior tibial load. Kinematic differences between ACLR with an intact ALL, ACLR with ALLR, and ACLR with a deficient ALL were compared with the intact state. Single-bundle ACLR tunnels and ALLR tunnels were placed anatomically according to previous quantitative anatomic attachment descriptions. Combined anatomic ALLR and ACLR significantly improved the rotatory stability of the knee compared with isolated ACLR in the face of a concurrent ALL deficiency. During a simulated pivot-shift test, ALLR significantly reduced internal rotation and axial plane tibial translation when compared with ACLR with an ALL deficiency. Isolated ACLR for the treatment of a combined ACL and ALL injury was not able to restore stability of the knee, resulting in a significant increase in

  16. Primary Anterolateral Ligament Rupture in Patients Requiring Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Magnetic Resonance Imaging Review

    OpenAIRE

    Carr, James Bradley; Yildirim, Baris; Richter, Dustin L.; Etier, Brian Edward; Diduch, David R.; Anderson, Mark W.; Pierce, Jennifer

    2017-01-01

    Objectives: After anterior cruciate ligament reconstruction (ACLR), only 60% of patients are able to return to their pre-injury level of sports with nearly 15% experiencing persistent rotatory instability. Young patients returning to pivoting sports experience high rates of graft tear and subsequent need for revision ACLR. Recently, the anterolateral ligament (ALL) has gained attention as an important rotatory stabilizer about the knee in prevention of the pivot shift phenomenon. It is theori...

  17. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var)

    Science.gov (United States)

    2013-01-01

    Background Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Results Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. Conclusions The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage. PMID:23557095

  18. Morphology of the transverse ligament of the atlas and the alar ligaments in the silver fox (Vulpes vulpes var).

    Science.gov (United States)

    Kupczynska, Marta; Barszcz, Karolina; Janczyk, Pawel; Wasowicz, Michal; Czubaj, Norbert

    2013-04-04

    Recent new anatomical and histological features of craniocervical junction in dogs and cats were described providing evidence of differences between the carnivore species. No information on these structures in foxes exists. Two parts of the alar ligaments were found. A longer one aroused from dens of axis to the internal (medial) surface of the occipital condyles and was called apical part. A shorter part originated from the entire length of the lateral edge of the dens of axis and terminated on the internal wall of the vertebral foramen of atlas and thus was called the lateral part. The transverse ligament of the atlas was widened in the mid region, above the dens of axis, and thickened at enthesis. Periosteal fibrocartilage was detected in the transverse ligament of the atlas at the enthesis, and sesamoid fibrocartilage was present on periphery in the middle of the ligament. The craniocervical junction in foxes differs in part from other carnivores such as dogs and cats but resembles that of mesaticephalic dogs. The sesamoid and periosteal fibrocartilage supports the transverse ligament of the atlas whereas the alar ligaments have no cartilage.

  19. Characterization of transverse isotropy in compressed tissue-mimicking phantoms.

    Science.gov (United States)

    Urban, Matthew W; Lopera, Manuela; Aristizabal, Sara; Amador, Carolina; Nenadic, Ivan; Kinnick, Randall R; Weston, Alexander D; Qiang, Bo; Zhang, Xiaoming; Greenleaf, James F

    2015-06-01

    Tissues such as skeletal muscle and kidneys have well-defined structure that affects the measurements of mechanical properties. As an approach to characterize the material properties of these tissues, different groups have assumed that they are transversely isotropic (TI) and measure the shear wave velocity as it varies with angle with respect to the structural architecture of the organ. To refine measurements in these organs, it is desirable to have tissue-mimicking phantoms that exhibit similar anisotropic characteristics. Some approaches involve embedding fibers into a material matrix. However, if a homogeneous solid is under compression due to a static stress, an acoustoelastic effect can manifest that makes the measured wave velocities change with the compression stress. We propose to exploit this characteristic to demonstrate that stressed tissue mimicking phantoms can be characterized as a TI material. We tested six phantoms made with different concentrations of gelatin and agar. Stress was applied by the weight of a water container centered on top of a plate on top of the phantom. A linear array transducer and a V-1 Verasonics system were used to induce and measure shear waves in the phantoms. The shear wave motion was measured using a compound plane wave imaging technique. Autocorrelation was applied to the received in-phase/quadrature data. The shear wave velocity, c, was estimated using a Radon transform method. The transducer was mounted on a rotating stage so measurements were made every 10° over a range of 0° to 360°, where the stress is applied along 0° to 180° direction. The shear moduli were estimated. A TI model was fit to the data and the fractional anisotropy was evaluated. This approach can be used to explore many configurations of transverse isotropy with the same phantom, simply by applying stress to the tissue-mimicking phantom.

  20. Characterization of Transverse Isotropy in Compressed Tissue Mimicking Phantoms

    Science.gov (United States)

    Urban, Matthew W.; Lopera, Manuela; Aristizabal, Sara; Amador, Carolina; Nenadic, Ivan; Kinnick, Randall R.; Weston, Alexander D.; Qiang, Bo; Zhang, Xiaoming; Greenleaf, James F.

    2015-01-01

    Tissues such as skeletal muscle and kidneys have well-defined structure that affects the measurements of mechanical properties. As an approach to characterize the material properties of these tissues, different groups have assumed that they are transversely isotropic (TI) and measure the shear wave velocity as it varies with angle with respect to the structural architecture of the organ. To refine measurements in these organs, it is desirable to have tissue mimicking phantoms that exhibit similar anisotropic characteristics. Some approaches involve embedding fibers into a material matrix. However, if a homogeneous solid is under compression due to a static stress, an acoustoelastic effect can manifest which makes the measured wave velocities change with the compression stress. We propose to exploit this characteristic to demonstrate that stressed tissue mimicking phantoms can be characterized as a TI material. We tested six phantoms made with different concentrations of gelatin and agar. Stress was applied by the weight of a water container centered on top of a plate on top of the phantom. A linear array transducer and a V-1 Verasonics system were used to induce and measure shear waves in the phantoms. The shear wave motion was measured using a compound plane wave imaging technique. Autocorrelation was applied to the received in-phase/quadrature data. The shear wave velocity, c, was estimated using a Radon transform method. The transducer was mounted on a rotating stage so measurements were made every 10° over a range of 0–360°, where the stress is applied along 0–180° direction. The shear moduli were estimated. A TI model was fit to the data and the fractional anisotropy was evaluated. This approach can be used to explore many configurations of transverse isotropy with the same phantom, simply by applying stress to the tissue mimicking phantom. PMID:26067038

  1. Evaluation of tomosynthesis elastography in a breast-mimicking phantom

    Energy Technology Data Exchange (ETDEWEB)

    Engelken, Florian Jan, E-mail: florian.engelken@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany); Sack, Ingolf, E-mail: ingolf.sack@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany); Klatt, Dieter, E-mail: dieter.klatt@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany); Fischer, Thomas, E-mail: thom.fischer@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany); Fallenberg, Eva Maria, E-mail: eva.fallenberg@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany); Bick, Ulrich, E-mail: ulrich.bick@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany); Diekmann, Felix, E-mail: felix.diekmann@charite.de [Department of Radiology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin (Germany)

    2012-09-15

    Objective: To evaluate whether measurement of strain under static compression in tomosynthesis of a breast-mimicking phantom can be used to distinguish tumor-simulating lesions of different elasticities and to compare the results to values predicted by rheometric analysis as well as results of ultrasound elastography. Materials and methods: We prepared three soft breast-mimicking phantoms containing simulated tumors of different elasticities. The phantoms were imaged using a wide angle tomosynthesis system with increasing compression settings ranging from 0 N to 105 N in steps of 15 N. Strain of the inclusions was measured in two planes using a commercially available mammography workstation. The elasticity of the phantom matrix and inclusion material was determined by rheometric analysis. Ultrasound elastography of the inclusions was performed using two different ultrasound elastography algorithms. Results: Strain at maximal compression was 24.4%/24.5% in plane 1/plane 2, respectively, for the soft inclusion, 19.6%/16.9% for the intermediate inclusion, and 6.0%/10.2% for the firm inclusion. The strain ratios predicted by rheometrical testing were 0.41, 0.83 and 1.26 for the soft, intermediate, and firm inclusions, respectively. The strain ratios obtained for the soft, intermediate, and firm inclusions were 0.72 ± 0.13, 1.02 ± 0.21 and 2.67 ± 1.70, respectively for tomosynthesis elastography, 0.91, 1.64 and 2.07, respectively, for ultrasound tissue strain imaging, and 0.97, 2.06 and 2.37, respectively, for ultrasound real-time elastography. Conclusions: Differentiation of tumor-simulating inclusions by elasticity in a breast mimicking phantom may be possible by measuring strain in tomosynthesis. This method may be useful for assessing elasticity of breast lesions tomosynthesis of the breast.

  2. Endometriosis mimicking the perianal fistula tract: Case report

    Directory of Open Access Journals (Sweden)

    Gül Türkcü

    2014-09-01

    Full Text Available Endometriosis is the presence of endometrial glands and stroma outside the uterine cavity. Nowadays, in many cases, although routine use of episiotomy perineal endo metriosis is extremely rare. A 36 year old female patient was referred to our hospital with complaints of pain in the perianal region for five months. On physical examination, stiffness was palpated and then magnetic resonance im aging (MRI was performed. MRI is compatible with fistula tract. The lesion was excised and the histopathological appearance correspond to endometriosis. Perianal endo metriosis is rare in the perianal region and in the clinic mimicking perianal fistulas and malignancy should be kept in mind in the differential diagnosis

  3. Mental foramen mimicking as periapical pathology - A case report

    Directory of Open Access Journals (Sweden)

    Anusha Rangare Lakshman

    2014-09-01

    Full Text Available The radiographic recognition of any disease requires a thorough knowledge of the radiographic appearance of normal structure. Intelligent diagnosis mandates an appreciation of the wide range of variation in the appearance of normal anatomical structures. The mental foramen is usually the anterior limit of the inferior dental canal that is apparent on radiographs. It opens on the facial aspect of the mandible in the region of the premolars. It can pose diagnostic dilemma radiographically because of its anatomical variation which can mimic as a periapical pathosis. Hereby we are reporting a rare case of superimposed mental foramen over the apex of right mandibular second premolar mimicking as periapical pathology.

  4. Splenosis with lower gastrointestinal bleeding mimicking colonical gastrointestinal stromal tumour.

    Science.gov (United States)

    Xiao, Shuo-Meng; Xu, Rui; Tang, Xiao-Li; Ding, Zhi; Li, Ji-Man; Zhou, Xiang

    2017-04-11

    Splenosis refers to the heterotopic transplantation of splenic tissue following splenic trauma or splenectomy. Splenosis is typically asymptomatic and is often identified incidentally. We report a case of splenosis with colon and stomach invasion presenting as lower gastrointestinal bleeding and mimicking colonic gastrointestinal stromal tumour (GIST). The importance of suspicion for splenosis in patients with a history of splenic injury should be highlighted. Computed tomography (CT)-guided biopsy, nuclear scintigraphy and ferumoxide-enhanced magnetic resonance imaging (MRI) can support an accurate diagnosis. An accurate diagnosis of splenosis is important to avoid unnecessary operations, especially in patients with previous histories of splenic trauma or splenectomy.

  5. Abdominal Splenosis Mimicking Hepatic Tumor: A Case Report

    Directory of Open Access Journals (Sweden)

    Ming-Lun Yeh

    2008-11-01

    Full Text Available Diagnosis of abdominal splenosis is often undiagnosed until treatment for splenic rupture or splenectomy. This report describes a patient with splenosis mimicking hepatic tumor. The patient had a history of splenic trauma with splenectomy and chronic hepatitis C. After routine abdominal ultrasound revealed a liver nodule, further imaging studies, including magnetic resonance imaging, computed tomography and angiography, were performed. After the patient eventually underwent surgery, pathology revealed splenic tissue. Despite its distinguishable clinical features, splenosis is difficult to identify by modern imaging modalities. Therefore, accurate and timely diagnosis of this disease requires constant vigilance.

  6. Abdominal splenosis mimicking hepatic tumor: a case report.

    Science.gov (United States)

    Yeh, Ming-Lun; Wang, Liang-Yen; Huang, Ching-I; Hsieh, Ming-Yen; Lin, Zu-Yau; Chuang, Wan-Long; Chang, Wen-Tsan; Wu, Chun-Chieh; Chen, Chiao-Yun

    2008-11-01

    Diagnosis of abdominal splenosis is often undiagnosed until treatment for splenic rupture or splenectomy. This report describes a patient with splenosis mimicking hepatic tumor. The patient had a history of splenic trauma with splenectomy and chronic hepatitis C. After routine abdominal ultrasound revealed a liver nodule, further imaging studies, including magnetic resonance imaging, computed tomography and angiography, were performed. After the patient eventually underwent surgery, pathology revealed splenic tissue. Despite its distinguishable clinical features, splenosis is difficult to identify by modern imaging modalities. Therefore, accurate and timely diagnosis of this disease requires constant vigilance.

  7. Aneurysm of the common iliac vein mimicking a pelvic mass

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Eun Joo; Kim, Dong Hun [Dept. of Radiology, Chosun University College of Medicine, Gwangju (Korea, Republic of); Suk, Eun Ha [Dept. of Anesthesiology and Pain Medicine, Seonam University College of Medicine, Namwon (Korea, Republic of)

    2013-07-15

    Venous aneurysm, especially of primary origin, is rare. The authors report a case of a 63-year-old female who was admitted for back pain and an aneurysm of the common iliac which was detected incidentally. CT, magnetic resonance (MR), Doppler ultrasonography, and conventional venography showed an aneurysm of the left common iliac vein measuring 4.5 , 00D7, 3, 00D7, 4 cm. Because there were no complications of the aneurysm, no further treatment was administered. Herein, we describe findings of a venous aneurysm of the common iliac vein mimicking a pelvic mass on CT and MR scans and with a review of the literature.

  8. Report of ischemic stroke mimicking isolated ulnar nerve paralysis

    Directory of Open Access Journals (Sweden)

    Çetin Kürşad Akpınar

    2016-12-01

    Full Text Available The cortical motor hand area is the precentral gyrus. Small cortical infarcts of this area can caused isolated hand weakness. Weakness can consist of either all fingers or ulnar-sided fingers. A 71-year-old man admitted to the emergency department with sudden weakness of the right fourth and fifth fingers Diffusion-weighted brain imaging of a magnetic resonance imaging scan revealed acute infarction of right precentral gyrus. Cardioembolus is the determined ischemic stroke subtype. This report presented a case of ischemic stroke mimicking isolated ulnar nerve paralysis.

  9. Simple bone cyst of mandible mimicking periapical cyst.

    Science.gov (United States)

    Hs, Charan Babu; Rai, Bhagawan Das; Nair, Manju A; Astekar, Madhusudan S

    2012-05-29

    Simple bone cysts (SBC) are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient.

  10. Simple bone cyst of mandible mimicking periapical cyst

    Directory of Open Access Journals (Sweden)

    Charan Babu HS

    2012-05-01

    Full Text Available Simple bone cysts (SBC are pseudocysts occurring less commonly in the maxillofacial region. The uncertain and unclear etiopathogenesis led to numerous synonyms to refer this particular cyst. These cysts are devoid of an epithelial lining and are usually empty or contain blood or straw-colored fluid. In jaws initially it mimics a periapical cyst and later can lead to cortical bone expansion warranting for radical approach, which is seldom required. SBC is predominantly diagnosed in first two decades of life. Here we report a case of solitary bone cyst mimicking a periapical cyst of a mandibular molar in a 37-year-old patient.

  11. Tinea capitis caused by Trichophyton rubrum mimicking favus.

    Science.gov (United States)

    Boyd, Alan S

    2016-12-01

    Favus is an uncommon form of tinea capitis (TC) currently seen in geographic areas with poor sanitation and limited access to health care such as emerging nations. Several variants of this condition have been described including one exhibiting a plaque composed of parchmentlike material. The makeup of this plaque has not been described. Tinea capitis is rare in adults, particularly when the infectious agent is Trichophyton rubrum, and affected patients often exhibit comorbidities associated with diminished immune surveillance. This case report describes an elderly woman with TC due to T rubrum mimicking a rare form of favus.

  12. Nephrogenic rests mimicking Wilms' tumor on CT

    Energy Technology Data Exchange (ETDEWEB)

    Subhas, Naveen; Siegelman, Stanley S. [Russell H. Morgan Department of Radiology, The Johns Hopkins Hospital and School of Medicine, 600 N. Wolfe St., 21287, Baltimore, MD (United States); Argani, Pedram [Department of Pathology, Johns Hopkins Hospital and School of Medicine, 21287, Baltimore, MD (United States); Gearhart, John P. [Department of Pediatric Urology, Brady Urologic Institute, The Johns Hopkins Hospital and School of Medicine, 21287, Baltimore, MD (United States)

    2004-02-01

    Nephrogenic rests (NR) are persistent benign remnants of embryonic renal tissue. A small percentage of these may develop into Wilms' tumor (WT). Radiologic imaging is relied upon to differentiate between these entities, with the hallmark of malignant transformation being growth on serial imaging studies. There is, however, considerable overlap in their imaging characteristics. The authors present a case of two biopsy-proven NR in a 2-year-old girl with sporadic aniridia that were indistinguishable from WT on initial radiologic studies. One of the NR grew on serial imaging studies mimicking a WT, but after resection was confirmed to be a benign hyperplastic NR on pathologic examination. (orig.)

  13. Hızma Induced Papul of Nose Mimicking Pyogenic Granuloma

    Directory of Open Access Journals (Sweden)

    Mualla Polat

    2014-09-01

    Full Text Available The application of body piercing is popular among young people, who consider it as a sign of marginality, beauty, or group identity. Piercing procedure is observed to cause a large number of complications such as infections, pain, inflammatory reactions, bleeding, dental fractures or fissures, and gingival damage, etc., mostly in young individuals. Hizma is a traditional body ornament worn by Anatolian women via a piercing procedure. Herein, we describe a papule of nose mimicking pyogenic granuloma as an uncommon complication of Hızma.

  14. Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis.

    Science.gov (United States)

    Misra, Durga Prasanna; Parida, Jyoti Ranjan; Chowdhury, Abhra Chandra; Pani, Krushna Chandra; Kumari, Niraj; Krishnani, Narendra; Agarwal, Vikas

    2014-01-01

    Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis.

  15. Dual anaplastic large cell lymphoma mimicking meningioma: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Keun Ho; Kim, Ki Hwan; Lee, Ghi Jai; Lee, Hye Kyung; Shim, Jae Chan; Lee, Kyoung Eun; Suh, Jung Ho [Seoul Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Lee, Chae Heuck [Dept. of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang (Korea, Republic of)

    2014-01-01

    Anaplastic large cell lymphoma (ALCL) is a rare T cell lymphoma composed of CD30-positive lymphoid cells. Most ALCLs present as nodal disease, with skin, bone, soft tissue, lung, and liver as common extranodal sites. ALCL rarely occurs in the central nervous system and is even more infrequent in the dura of the brain. We report a case of dural-based ALCL secondary to systemic disease in a 17-year-old male that mimicked meningioma on magnetic resonance imaging and angiography.

  16. Embolized prostatic brachytherapy seeds mimicking acute chest pain syndromes

    Directory of Open Access Journals (Sweden)

    Nirmal Guragai

    2017-01-01

    Full Text Available A 59-year-old male with a history of nonobstructive coronary artery disease, diabetes mellitus, hypertension, and prostate cancer presented to the hospital with 1-day history of pleuritic chest pain. Initial workup for acute coronary event was unremarkable. Chest X-ray revealed multiple small radial densities which were linear and hyperdense, consistent with embolization of metallic seeds to the pulmonary circulation. The patient was noted to have had radioactive metallic seeds implanted for prostate cancer 6 months ago. Diagnosis of pulmonary embolization of prostatic seeds is challenging as they frequently present with chest pain mimicking acute coronary syndromes.

  17. Intracortical bone metastasis mimicking intracortical osteoid osteoma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Yu Ri; Kim, Jee Young [St. Vincent' s Hospital, The Catholic University of Korea, Suwon (Korea, Republic of)

    2007-08-15

    Cortical metastasis usually occurs in the diaphysis of the long bones with the appearance of a cookie-bite pattern; this is associated with cortical destruction extending into the soft tissue as well as into the medullary cavity, or there can be a periosteal reaction. We report here on a 66-year-old woman who was diagnosed with intracortical metastasis in the proximal metaphysis of the right femur as an initial metastatic focus from primary lung cancer. CT detected an intracortical osteolytic lesion without cortical destruction or thickening. The MR images showed extensive peritumoral edema in the surrounding soft tissue and adjacent bone marrow edema, and this all mimicked osteoid osteoma.

  18. Lepra Reaction with Lucio Phenomenon Mimicking Cutaneous Vasculitis

    Directory of Open Access Journals (Sweden)

    Durga Prasanna Misra

    2014-01-01

    Full Text Available Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis.

  19. Parosteal osteosarcoma mimicking osteochondroma: A radio-histologic approach on two cases

    Directory of Open Access Journals (Sweden)

    Papathanassiou Zafiria G

    2011-07-01

    Full Text Available Abstract Objective Parosteal osteosarcoma is a well-differentiated variant of osteosarcoma that affects the surface of the bone. The imaging pattern is very typical. We report two cases mimicking an osteochondroma, radiologically and histologically and propose an explanation. Material The review of 86 parosteal osteosarcomas of bone revealed this atypical pattern only once. A consultation case was received in the same time, and added to ours. Patients were 28 years old and 56 years old females. Imaging studies included two radiographs, two CTscans, one MRI examination and one bone scan and the results were compared to histology. Results On imaging, both lesions presented as ossified lobulated masses attached with a broad base to the underlying cortex. No radiolucent cleft separated the masses and the host bone and cortex continuity between the mass and the femur was seen, with medullary communication. The marrow of the mass had a different density and intensity compared to normal marrow. So, there were features of an osteochondroma (cortex and medullary continuity and of a parosteal osteosarcoma (ossified marrow. Pathological assessment on the final specimen confirmed the presence of low-grade parosteal osteosarcomas, after an erroneous diagnosis of osteochondroma on the initial biopsy. Conclusions Parosteal osteosarcoma can be rarely confused with osteochondroma. A radiologic-pathologic correlation is essential. Cortex continuity is the most misleading imaging feature that may occur in parosteal osteosarcomas. A knowledge of this misleading pattern will help diagnose the lesion from the beginning.

  20. Anatomical transverse magnetic resonance imaging study of ligaments in palmar surface of metacarpus in Miniature donkey: identification of a new ligament.

    Science.gov (United States)

    Nazem, M N; Sajjadian, S M

    2017-01-01

    Palmar region of metacarpus in the horses and donkeys is an important region because of its tendons and ligaments which contribute to stay apparatus. This study was done on forelimbs of 6 healthy Miniature donkeys to detect the tendons, ligaments and their accessories on the palmar surface of metacarpus in this animal. Based on that magnetic resonance imaging (MRI) is a good technique to evaluate the soft tissues such as tendons and ligaments, palmar aspects of metacarpus in 6 euthanatised Miniature donkeys were prepared for anatomical and trans-sectional MRI studies to determine the tendons and ligaments in this region. Suspensory ligament, deep digital flexor tendon and its inferior check ligament were similar to them in the horse. Superficial digital flexor tendon (SDFT) in this animal had superior check ligament that was present before the carpal joint. On the other hand in the Miniature donkey there was a second accessory ligament for the SDFT that originated from the proximal of palmar surface of the large metacarpal bone which we named it second accessory ligament of SDFT. This ligament was determined in the MRI images too. It seems that this ligament helps the Miniature donkey to stay apparatus, supporting more weight and load for a longer period of time and distance which is a specific morphological feature in this animal.

  1. Gross, Arthroscopic, and Radiographic Anatomies of the Anterior Cruciate Ligament: Foundations for Anterior Cruciate Ligament Surgery.

    Science.gov (United States)

    Irarrázaval, Sebastián; Albers, Marcio; Chao, Tom; Fu, Freddie H

    2017-01-01

    The anterior cruciate ligament (ACL) is one of the more studied structures in the knee joint. It is not a tubular structure, but is much narrower in its midsubstance and broader at its ends, producing an hourglass shape. The ACL is composed of 2 functional bundles, the anteromedial and posterolateral bundles, that are named for their location of insertion on the anterior surface of the tibial plateau. Although the relative contribution in terms of total cross-sectional area of the ACL has been noted to be equal in regards to each bundle, dynamically these bundles demonstrate different properties for knee function. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. In-vivo glenohumeral translation and ligament elongation during abduction and abduction with internal and external rotation

    National Research Council Canada - National Science Library

    Massimini, Daniel F; Boyer, Patrick J; Papannagari, Ramprasad; Gill, Thomas J; Warner, Jon P; Li, Guoan

    2012-01-01

    ...) compare the inferred glenohumeral ligament functions with previous literature and 3) create a baseline data of healthy adult shoulder glenohumeral ligament lengths as controls for future studies...

  3. Quantitative morphology of the lateral ligaments of the spine. Assessment of their importance in maintaining lateral stability.

    Science.gov (United States)

    Jiang, H; Raso, J V; Moreau, M J; Russell, G; Hill, D L; Bagnall, K M

    1994-12-01

    This study used human cadaveric material to examine the three-dimensional morphology and biomechanics of the superior and lateral costotransverse ligaments and the intertransverse ligament of the spine. To provide descriptive and quantitative data on the morphology of the lateral ligaments of the spine and to assess their importance in maintaining lateral stability, especially regarding the pathogenesis of idiopathic scoliosis. Ligaments have been reported as being able to stabilize the spine by mechanical constraint and by neurologic feed-back. Midline spinal ligaments have been well studied but do not appear to be effective in maintaining lateral stability because of their sites of attachment. Lateral ligaments of the spine have not been adequately documented in the literature. The morphology, sites of attachment, and dimensions of the superior costotransverse ligament, lateral costotransverse ligament, and intertransverse ligament from thoracic level 7 to thoracic level 10 were determined on 32 human cadavers. The intertransverse ligament was found not to be a true ligament. The lateral costotransverse ligament was a true ligament but did not have the characteristics appropriate for involvement in lateral stability. The superior costotransverse ligament also was a true ligament and had all of the characteristics appropriate for involvement in the active lateral balancing of the spine. In contrast to the midline ligaments of the spine, the superior costotransverse ligament perhaps is the most important ligament for active lateral balancing of the spine and warrants further study, particularly regarding the development of idiopathic scoliosis.

  4. Prevalence and progression of pectinate ligament dysplasia in the Welsh springer spaniel.

    Science.gov (United States)

    Oliver, J A C; Ekiri, A; Mellersh, C S

    2016-08-01

    To determine the prevalence of pectinate ligament dysplasia in a large group of Welsh springer spaniels; to investigate associations between pectinate ligament dysplasia and age, sex and intraocular pressure and between intraocular pressure and age and sex; and to investigate progression of pectinate ligament dysplasia in individual dogs. In a prospective study, gonioscopy was performed in both eyes of 227 Welsh springer spaniels and intraocular pressure measured by rebound tonometry. Eyes were classified as "unaffected" if 0% of the iridocorneal angle was affected with pectinate ligament dysplasia (grade 0), "mildly affected" if 90% was affected (grade 3). In a retrospective study, progression of pectinate ligament dysplasia over time was investigated for 65 dogs. One hundred and thirty-nine of 227 dogs (61·2%) were affected by pectinate ligament dysplasia (grades 1 to 3) and 82/227 (36·2%) were moderately or severely affected. There was a significant association between pectinate ligament dysplasia and age. There were no associations between pectinate ligament dysplasia and intraocular pressure or pectinate ligament dysplasia and sex. Thirty-five of 65 dogs (53·8%) demonstrated progression of pectinate ligament dysplasia. Prevalence of pectinate ligament dysplasia was high despite widespread screening and selection against the condition. Our data indicate that gonioscopic features of pectinate ligament dysplasia can progress in the Welsh springer spaniel. Dogs deemed unaffected at an early age may subsequently be diagnosed with pectinate ligament dysplasia. © 2016 British Small Animal Veterinary Association.

  5. Teaching the Broad, Interdisciplinary Impact of Evolution

    Science.gov (United States)

    Benson, David; Atlas, Pierre; Haberski, Raymond; Higgs, Jamie; Kiley, Patrick; Maxwell, Michael, Jr.; Mirola, William; Norton, Jamey

    2009-01-01

    As perhaps the most encompassing idea in biology, evolution has impacted not only science, but other academic disciplines as well. The broad, interdisciplinary impact of evolution was the theme of a course taught at Marian College, Indianapolis, Indiana in 2002, 2004, and 2006. Using a strategy that could be readily adopted at other institutions,…

  6. Giant Broad Line Regions in Dwarf Seyferts

    Indian Academy of Sciences (India)

    High angular resolution spectroscopy obtained with the Hubble Space Telescope (HST) has revealed a remarkable population of galaxies hosting dwarf Seyfert nuclei with an unusually large broad-line region (BLR). These objects are remarkable for two reasons. Firstly, the size of the BLR can, in some cases, rival those ...

  7. Pitfalls of magnetic resonance imaging of alar ligament

    Energy Technology Data Exchange (ETDEWEB)

    Roy, Sumit; Hol, Per Kristian; Tillung, Terje [Interventional Centre, Rikshospitalet University Hospital, Oslo (Norway); Laerum, L. Thea [Anglo-European College of Chiropractic, Bournemouth (United Kingdom)

    2004-05-01

    An observational study of variations in the appearance of the alar ligament on magnetic resonance imaging (MRI) and the normal range of lateral flexion and rotation of the atlas was performed to validate some of the premises underlying the use of MRI for the detection of injuries to the alar ligament. Fifteen healthy volunteers were included. Three sets of coronal proton-density images, and axial T2-weighted images of the craniovertebral junction, were obtained at 0.5 T with the neck in neutral position and laterally flexed (coronal proton density) or rotated (axial T2). Five of the subjects also underwent imaging at 1.5 T. The scans were independently examined twice by two radiologists. The presence of alar ligaments was recorded and a three-point scale used to grade the extent of hyperintensity exhibited by the structures: the ligament were graded as 2 and 3 if, respectively, less or more of its cross-section was hyperintense, whereas grade 1 represented a hypointense ligament. The effect of lateral flexion on image quality was assessed. Concordance analysis of the data were performed before and after dichotomising the data on grading. The atlanto-axial angle and rotation of the atlas were measured. The magnitude of movement to right was normalised to that to the left to give, respectively, the flexion index and the rotation index. The alar ligaments were most reliably seen on coronal proton-density scans, with a Maxwell's RE of 0.96 as compared with 0.46 for sagittal images. Flexion of the neck improved definition of the ligaments in only rare instances. (orig.)

  8. Biomechanical evaluation of a novel dynamic posterior cruciate ligament brace.

    Science.gov (United States)

    Heinrichs, Christian H; Schmoelz, Werner; Mayr, Raul; Keiler, Alexander; Schöttle, Philip B; Attal, René

    2016-03-01

    Use of a rigid brace or cast immobilization is recommended in conservative treatment or postoperative rehabilitation after a posterior cruciate ligament injury. To prevent the loss of knee joint function and muscle activity often associated with this, a flexible knee brace has been developed that allows an adjustable anteriorly directed force to be applied to the calf in order to prevent posterior tibial translation. The purpose of this biomechanical study was to evaluate the impact of this novel dynamic brace on posterior tibial translation after posterior cruciate ligament injury and reconstruction. A Telos stress device was used to provoke posterior tibial translation in seven human lower limb specimens, and stress radiographs were taken at 90° of knee flexion. Posterior tibial translation was measured in the native knees with an intact posterior cruciate ligament; after arthroscopic posterior cruciate ligament dissection with and without a brace; and after posterior cruciate ligament reconstruction with and without a brace. The force applied with the brace was measured using a pressure sensor. Posterior tibial translation was significantly reduced (P=0.032) after application of the brace with an anteriorly directed force of 50N to the knees with the dissected posterior cruciate ligament. The brace also significantly reduced posterior tibial translation after posterior cruciate ligament reconstruction in comparison with reconstructed knees without a brace (P=0.005). Posterior tibial translation was reduced to physiological values using this dynamic brace system that allows an anteriorly directed force to be applied to the calf. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. [Diagnostic value of Blumensaat angle for anterior cruciate ligament injury].

    Science.gov (United States)

    Cheng, Xiang-Yun; Feng, Jiang-Feng; Lu, Yan-Hui; Zhao, Yong-Liang; Yang, Zi-Quan

    2017-08-25

    The receiver operator characteristic(ROC) curve was used to determine the best Blumensaat angle for the diagnosis of anterior cruciate ligament injury, so as to objectively evaluate the diagnostic value of Blumensaat angle for anterior cruciate ligament injury. Total 167 patients who had knee arthroscopic treatment in a hospital from January 2015 to January 2016 were retrospectively studied, and the patients' age, gender, left and right limb condition were recorded. The patients were divided into two groups according to Blumensaat angle measured on the MRI: group A(Blumensaat angle0°). The ROC curve was drawn from the statistical data of the group B to get the best critical value of the anterior cruciate ligament injury when the Blumensaat angle was more than 0°. According to the best critical value obtained by ROC curve, the coincidence rate of the total sample was obtained. There were no significant differences in patients' age, gender, and affected limbs. There were 51 patients in group A, in which 49 patients were diagnosed as anterior cruciate injury under arthroscopy(gold standard for diagnosis of anterior cruciate ligament injury), and 2 patients were diagnosed as no anterior cruciate injury under arthroscopy. When the Blumensaat angle was=15°, the probability of anterior cruciate ligament injury was greater. When the Blumensaat angle was 0° to 15°, the anterior cruciate ligament was more likely to be not injured. The Blumensaat angle=15° were used to diagnose the injury of anterior cruciate ligament. Compared with the results of arthroscopy, the coincidence rate of the total sample was 92.8%. Blumensaat angle is helpful to diagnose the ACL injuries. When the Blumensaat angle was =15°, the probability of ACL injury is greater.

  10. Ulnar collateral ligament reconstruction in major league baseball pitchers.

    Science.gov (United States)

    Gibson, Brett W; Webner, David; Huffman, G Russell; Sennett, Brian J

    2007-04-01

    Ulnar collateral ligament reconstruction is commonly performed in major league pitchers, but little is known about pitching performance after a return to major league play. Pitching performance after ulnar collateral ligament reconstruction returns to baseline by the second season after surgery. Cohort study (prognosis); Level of evidence, 2. Data were reviewed for 68 major league pitchers who pitched in at least 1 major league game before undergoing ulnar collateral ligament reconstruction between 1998 and 2003. Mean innings pitched per season, earned run average, and walks and hits per inning pitched were compared for each major league pitcher before and after surgery. All demographic and performance variables were analyzed for an association with ulnar collateral ligament insufficiency and a successful return to major league play. Fifty-six (82%) pitchers returned to major league play at a mean of 18.5 months after surgery with no significant change in mean earned run average or walks and hits per inning pitched. The mean innings pitched per season was not statistically different from controls by the second season after surgery. Starting pitchers demonstrated a higher risk of ulnar collateral ligament injury requiring reconstruction. More experienced pitchers and those with a higher earned run average were less likely to require ulnar collateral ligament reconstruction. No factors predictive of a successful return to play were identified. Most major league pitchers return from ulnar collateral ligament reconstruction by the second season after surgery with no statistical change in mean innings pitched, earned run average, or walks and hits per inning pitched from preinjury levels.

  11. Mastication and the Postorbital Ligament: Dynamic Strain in Soft Tissues

    Science.gov (United States)

    Herring, Susan W.; Rafferty, Katherine L.; Liu, Zi Jun; Lemme, Michael

    2011-01-01

    Although the FEED database focuses on muscle activity patterns, it is equally suitable for other physiological recording and especially for synthesizing different types of information. The present contribution addresses the interaction between muscle activity and ligamentary stretch during mastication. The postorbital ligament is the thickened edge of a septum dividing the orbital contents from the temporal fossa and is continuous with the temporal fascia. As a tensile element, this fascial complex could support the zygomatic arch against the pull of the masseter muscle. An ossified postorbital bar has evolved repeatedly in mammals, enabling resistance to compression and shear in addition to tension. Although such ossification clearly reinforces the skull against muscle pull, the most accepted explanation is that it helps isolate the orbital contents from contractions of the temporalis muscle. However, it has never been demonstrated that the contraction of jaw muscles deforms the unossified ligament. We examined linear deformation of the postorbital ligament in minipigs, Sus scrofa, along with electromyography of the jaw muscles and an assessment of changes in pressure and shape in the temporalis. During chewing, the ligament elongated (average 0.9%, maximum 2.8%) in synchrony with the contraction of the elevator muscles of the jaw. Although the temporalis bulged outward and created substantial pressure against the braincase, the superficial fibers usually retracted caudally, away from the postorbital ligament. In anesthetized animals, stimulating either the temporalis or the masseter muscle in isolation usually elongated the ligament (average 0.4–0.7%). These results confirm that contraction of the masticatory muscles can potentially distort the orbital contents and further suggest that the postorbital ligament does function as a tension member resisting the pull of the masseter on the zygomatic arch. PMID:21593142

  12. Concomitant ligamentous and meniscal injuries in floating knee.

    Science.gov (United States)

    Liu, Ya; Zhang, Jun; Zhang, Shu; Li, Rui; Yue, Xianhu

    2015-01-01

    To identify and characterize the concomitant ligamentous and meniscal injuries in floating knee. A total of 37 cases of floating knee were enrolled. Arthroscopic or open surgical examination of the knee, Lachman test, posterior drawer's test, and varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury. Through arthroscopic and open surgical examinations, a medial meniscal tear was detected in 14 (37.8%) cases and a lateral meniscal tear in 11 (29.7%). Twenty-one (56.8%) patients had anterior cruciate ligament (ACL) injury including complete injury in 6 and incomplete injury in 15 cases. Three (8.1%) patients had posterior cruciate ligament (PCL) tear, including complete injury in 1 and incomplete injury in 2. Varus and valgus stress tests revealed that 10 (27.0%) and 7 (18.9%) patients had medial and lateral collateral ligament (MCL and LCL) laxity, respectively. Lachman test showed positive in 8 (21.6%) cases. Posterior drawer test showed positive in 3 (8.1%) cases. Twenty-six (70.3%) patients had knee ligamentous injuries. ACL injury was the most common ligamentous injury. ACL injury in 15 (71.4%) cases was associated with meniscal injury, including medial meniscal injury in 9 (42.9%) and lateral meniscal injury in 6 (28.6%). Physicians should pay attention to the concomitant ligamentous and meniscal injuries in floating knee. Careful clinical examination with aid of arthroscopic examination is helpful for the early diagnosis and treatment of these injuries.

  13. Knee Bracing After Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Rodríguez-Merchán, E Carlos

    2016-07-01

    Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.]. Copyright 2016, SLACK Incorporated.

  14. Current trends in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Duquin, Thomas R; Wind, William M; Fineberg, Marc S; Smolinski, Robert J; Buyea, Cathy M

    2009-01-01

    In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean=55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction. Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking.

  15. Failure of Anterior Cruciate Ligament Reconstruction

    Science.gov (United States)

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  16. Guideline on anterior cruciate ligament injury

    Science.gov (United States)

    2012-01-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

  17. Failure of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Gonzalo Samitier

    2015-10-01

    Full Text Available The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient.

  18. Failure of Anterior Cruciate Ligament Reconstruction

    Directory of Open Access Journals (Sweden)

    Gonzalo Samitier

    2015-09-01

    Full Text Available The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient.

  19. Biomechanics and anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Vercillo Fabio

    2006-09-01

    Full Text Available Abstract For years, bioengineers and orthopaedic surgeons have applied the principles of mechanics to gain valuable information about the complex function of the anterior cruciate ligament (ACL. The results of these investigations have provided scientific data for surgeons to improve methods of ACL reconstruction and postoperative rehabilitation. This review paper will present specific examples of how the field of biomechanics has impacted the evolution of ACL research. The anatomy and biomechanics of the ACL as well as the discovery of new tools in ACL-related biomechanical study are first introduced. Some important factors affecting the surgical outcome of ACL reconstruction, including graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing, are then discussed. The scientific basis for the new surgical procedure, i.e., anatomic double bundle ACL reconstruction, designed to regain rotatory stability of the knee, is presented. To conclude, the future role of biomechanics in gaining valuable in-vivo data that can further advance the understanding of the ACL and ACL graft function in order to improve the patient outcome following ACL reconstruction is suggested.

  20. Morphological Analysis of the Transverse Carpal Ligament

    Science.gov (United States)

    Pacek, Corey A.; Chakan, Matthew; Goitz, Robert J.; Kaufmann, Robert A.

    2009-01-01

    Transection of the transverse carpal ligament (TCL) for carpal tunnel syndrome is commonly performed, yet actual knowledge of TCL morphology is rudimentary and the anatomical terminology is inconsistently used. The purpose of this study was to perform a morphological analysis of the TCL, to redefine the anatomical terminology concerning the TCL and surrounding structures, and to evaluate any correlation between external, measurable hand dimensions, and TCL dimensions. A silicone casting technique and digitization were employed to measure the morphology of the TCL in cadaveric specimens and to construct a three-dimensional TCL model. The TCL was the thickest distally at the midline and ulnar segments and the thickest proximally at the radial segment. External hand dimensions did not significantly correlate with TCL dimensions. The TCL thickness distribution is variable along the radioulnar axis. The thickness of the TCL was 2.1 ± 0.8 mm, ranging from 1.3 to 3.0 mm. PMID:19701670

  1. Tissue-mimicking phantoms for photoacoustic and ultrasonic imaging

    Science.gov (United States)

    Cook, Jason R.; Bouchard, Richard R.; Emelianov, Stanislav Y.

    2011-01-01

    In both photoacoustic (PA) and ultrasonic (US) imaging, overall image quality is influenced by the optical and acoustical properties of the medium. Consequently, with the increased use of combined PA and US (PAUS) imaging in preclinical and clinical applications, the ability to provide phantoms that are capable of mimicking desired properties of soft tissues is critical. To this end, gelatin-based phantoms were constructed with various additives to provide realistic acoustic and optical properties. Forty-micron, spherical silica particles were used to induce acoustic scattering, Intralipid® 20% IV fat emulsion was employed to enhance optical scattering and ultrasonic attenuation, while India Ink, Direct Red 81, and Evans blue dyes were utilized to achieve optical absorption typical of soft tissues. The following parameters were then measured in each phantom formulation: speed of sound, acoustic attenuation (from 6 to 22 MHz), acoustic backscatter coefficient (from 6 to 22 MHz), optical absorption (from 400 nm to 1300 nm), and optical scattering (from 400 nm to 1300 nm). Results from these measurements were then compared to similar measurements, which are offered by the literature, for various soft tissue types. Based on these comparisons, it was shown that a reasonably accurate tissue-mimicking phantom could be constructed using a gelatin base with the aforementioned additives. Thus, it is possible to construct a phantom that mimics specific tissue acoustical and/or optical properties for the purpose of PAUS imaging studies. PMID:22076278

  2. Spontaneous motor entrainment to music in multiple vocal mimicking species.

    Science.gov (United States)

    Schachner, Adena; Brady, Timothy F; Pepperberg, Irene M; Hauser, Marc D

    2009-05-26

    The human capacity for music consists of certain core phenomena, including the tendency to entrain, or align movement, to an external auditory pulse [1-3]. This ability, fundamental both for music production and for coordinated dance, has been repeatedly highlighted as uniquely human [4-11]. However, it has recently been hypothesized that entrainment evolved as a by-product of vocal mimicry, generating the strong prediction that only vocal mimicking animals may be able to entrain [12, 13]. Here we provide comparative data demonstrating the existence of two proficient vocal mimicking nonhuman animals (parrots) that entrain to music, spontaneously producing synchronized movements resembling human dance. We also provide an extensive comparative data set from a global video database systematically analyzed for evidence of entrainment in hundreds of species both capable and incapable of vocal mimicry. Despite the higher representation of vocal nonmimics in the database and comparable exposure of mimics and nonmimics to humans and music, only vocal mimics showed evidence of entrainment. We conclude that entrainment is not unique to humans and that the distribution of entrainment across species supports the hypothesis that entrainment evolved as a by-product of selection for vocal mimicry.

  3. Demodex folliculitis mimicking acute graft-vs-host disease.

    Science.gov (United States)

    Cotliar, Jonathan; Frankfurt, Olga

    2013-12-01

    Acute graft-vs-host disease (GVHD) typically requires high-dose systemic steroids as first-line treatment. Like drug eruptions, viral exanthema, and toxic erythema of chemotherapy, Demodex folliculitis is a clinical mimicker of acute GVHD and requires nonimmunosuppressive therapy. This case of Demodex folliculitis mimicking acute GVHD highlights the need for skin biopsy in patients who have undergone a stem cell transplant with eruptions on the head and neck. A 46-year-old white woman with a history of Fms-like tyrosine kinase 3 acute myeloid leukemia presented to the dermatology clinic with a 5-day history of a nonpruritic eruption on her face and neck 28 days after undergoing a double umbilical cord blood hematopoietic stem cell transplant (HSCT). Findings from the skin biopsy demonstrated a deep dermal lymphocytic infiltrate adjacent to follicular units along with an abundance of Demodex mites noted within the hair follicles consistent with Demodex folliculitis. Oral ivermectin, 12 mg, was given, and the eruption cleared within 24 hours. To our knowledge, this is only the fifth reported case of Demodex folliculitis following HSCT, but the first ever reported to be successfully treated with oral ivermectin. Demodex folliculitis should be added to the differential diagnosis of skin eruptions that arise after HSCT.

  4. Early mobilization of rabbit medial collateral ligament repairs: biomechanic and histologic study.

    Science.gov (United States)

    Goldstein, W M; Barmada, R

    1984-05-01

    The postoperative management of repaired medial collateral ligaments is controversial. There are proponents for either early mobilization or immobilization. To contribute to an understanding of the issues, 24 adult Dutch rabbits were divided into four groups and a comparative study was made of their incised medial collateral ligaments, contrasting early immobilization with mobilization at three and six weeks. The ligaments were studied histologically and biomechanically. At three weeks, the immobilized ligaments were twice as strong as mobilized ligaments. Histologically, the immobilized ligaments demonstrated more fibroblastic reaction while the mobilized ligaments showed more mature tissue development at the repair site. There were no statistically significant differences between knees mobilized for six weeks and knees immobilized for three weeks and then subsequently mobilized for three weeks. In view of these results, the authors conclude that the deleterious effects of immobilization should be considered when planning postoperative or postinjury treatment of torn medial collateral ligaments.

  5. Anterior cruciate ligament reconstruction with double bundle versus single bundle: experimental study

    National Research Council Canada - National Science Library

    Roberto F. Mota e Albuquerque; Sandra Umeda Sasaki; Marco Martins Amatuzzi; Fabio Janson Angelini

    2007-01-01

    OBJECTIVE: To test an intra-articular reconstruction of the anterior cruciate ligament of the knee in 10 human cadavers by replacing 2 anterior cruciate ligament bundles, with the purpose of producing...

  6. Craniocervical junction in dogs revisited--new ligaments and confirmed presence of enthesis fibrocartilage.

    Science.gov (United States)

    Kupczynska, M; Wieladek, A; Janczyk, P

    2012-06-01

    The study was performed to investigate and to describe features of gross and microscopic morphology of craniocervical junction (CCJ) in dogs. Seventy mature dogs (38 females, 32 males) of different body weight, representing small, medium and large breeds of dolicho-, mesati-, and brachycephalic morphotype were dissected. Morphological details were localised using an operating microscope with integrated video channel. Occurrence and distribution of fibrocartilage in the ligaments from 10 dogs was analysed histologically. Three new pairs of ligaments were described and named: dorsal ligaments of atlas, cranial internal collateral ligaments of atlas, and caudal internal collateral ligaments of atlas. Several new findings in the course of the known ligaments were found relating to breed and body weight. For the first time enthesis fibrocartilage was identified in ligaments of CCJ in dogs. Sesamoidal fibrocartilage was identified in the transversal ligament of atlas in large dogs. The findings are discussed for clinical importance. Copyright © 2011 Elsevier Ltd. All rights reserved.

  7. Influence of a mono-centric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament--an in vitro study.

    Science.gov (United States)

    Hinterwimmer, S; Graichen, H; Baumgart, R; Plitz, W

    2004-08-01

    To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency. The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model. Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the knee joint. Therefore knee braces should reduce that tension increase. However, that effect has never been proven quantitatively. After anterior cruciate ligament-transection, the forces of the medial (anterior/posterior part) and lateral collateral ligament were measured in ten fresh human cadaver knees at 0 degrees, 20 degrees, 40 degrees, 60 degrees, 80 degrees and 100 degrees of flexion, with and without application of a mono-centric knee brace. To quantify the ligament forces, strain gauges were fixed at the bony origins of the ligaments. Bracing led to a significant decrease of ligament forces (20-100 degrees: P anterior part of the medial collateral ligament in all joint positions. In the posterior aspect, this effect was observed only at 40 degrees (P ligament, bracing caused a strain reduction from 60 degrees to 100 degrees of flexion (P knee bracing on the strain was seen in the posterior aspect of the medial and in the lateral collateral ligament in anterior cruciate ligament deficient knee joints. Application of a mono-centric knee brace leads to a significant position dependent reduction of collateral ligament tension after anterior cruciate ligament-rupture.

  8. Ex Vivo Growth of Bioengineered Ligaments and Other Tissues

    Science.gov (United States)

    Altman, Gregory; Kaplan, David L.; Martin, Ivan; Vunjak-Novakovic, Gordana

    2005-01-01

    A method of growing bioengineered tissues for use in surgical replacement of damaged anterior cruciate ligaments has been invented. An anterior cruciate ligament is one of two ligaments (the other being the posterior cruciate ligament) that cross in the middle of a knee joint and act to prevent the bones in the knee from sliding forward and backward relative to each other. Anterior cruciate ligaments are frequently torn in sports injuries and traffic accidents, resulting in pain and severe limitations on mobility. By making it possible to grow replacement anterior cruciate ligaments that structurally and functionally resemble natural ones more closely than do totally synthetic replacements, the method could create new opportunities for full or nearly full restoration of functionality in injured knees. The method is also adaptable to the growth of bioengineered replacements for other ligaments (e.g., other knee ligaments as well as those in the hands, wrists, and elbows) and to the production of tissues other than ligaments, including cartilage, bones, muscles, and blood vessels. The method is based on the finding that the histomorphological properties of a bioengineered tissue grown in vitro from pluripotent cells within a matrix are affected by the direct application of mechanical force to the matrix during growth generation. This finding provides important new insights into the relationships among mechanical stress, biochemical and cell-immobilization methods, and cell differentiation, and is applicable to the production of the variety of tissues mentioned above. Moreover, this finding can be generalized to nonmechanical (e.g., chemical and electromagnetic) stimuli that are experienced in vivo by tissues of interest and, hence, the method can be modified to incorporate such stimuli in the ex vivo growth of replacements for the various tissues mentioned above. In this method, a three-dimensional matrix made of a suitable material is seeded with pluripotent stem

  9. Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens.

    Science.gov (United States)

    Shea, Kevin G; Milewski, Matthew D; Cannamela, Peter C; Ganley, Theodore J; Fabricant, Peter D; Terhune, Elizabeth B; Styhl, Alexandra C; Anderson, Allen F; Polousky, John D

    2017-06-01

    Anterior cruciate ligament (ACL) reconstruction failure rates are highest in youth athletes. The role of the anterolateral ligament in rotational knee stability is of increasing interest, and several centers are exploring combined ACL and anterolateral ligament reconstruction for these young patients. Literature on the anterolateral ligament of the knee is sparse in regard to the pediatric population. A single study on specimens younger than age 5 years demonstrated the presence of the anterolateral ligament in only one of eight specimens; therefore, much about the prevalence and anatomy of the anterolateral ligament in pediatric specimens remains unknown. We sought to (1) investigate the presence or absence of the anterolateral ligament in prepubescent anatomic specimens; (2) describe the anatomic relationship of the anterolateral ligament to the lateral collateral ligament; and (3) describe the anatomic relationship between the anterolateral ligament and the physis. Fourteen skeletally immature knee specimens (median age, 8 years; range, 7-11 years) were dissected (12 male, two female specimens). The posterolateral structures were identified in all specimens, including the lateral collateral ligament and popliteus tendon. The presence or absence of the anterolateral ligament was documented in each specimen, along with origin, insertion, and dimensions, when applicable. The relationship of the anterolateral ligament origin to the lateral collateral ligament origin was recorded. The anterolateral ligament was identified in nine of 14 specimens. The tibial attachment point was consistently located in the same region on the proximal tibia, between the fibular head and Gerdy's tubercle; however, the femoral origin of the anterolateral ligament showed considerable variation with respect to the lateral collateral ligament origin. The median femoral origin of the anterolateral ligament was 10 mm (first interquartile 6 mm, third interquartile 13) distal to the distal

  10. Sonoanatomy and injection technique of the iliolumbar ligament.

    LENUS (Irish Health Repository)

    Harmon, Dominic

    2012-01-31

    BACKGROUND: The iliolumbar ligament plays an important biomechanic role in anchoring the spine to the pelvic ring and stabilizing the sacroiliac joint. Iliolumbar syndrome is a back pain condition caused by pathology of the iliolumbar ligament. History and physical examination are important in the assessment of back pain, but they lack sufficient specificity. Injection of small volumes of local anesthetic into the structure considered to be the source of the pain (i.e. the iliolumbar ligament) increases the specificity of the diagnostic workup. OBJECTIVE: To describe an ultrasound - guided technique for injecting the iliolumbar ligament. STUDY DESIGN: Case report based on knowledge of topographic anatomy and sonoanatomy. SETTING: Outpatient clinic. METHODS: A patient with a clinical picture suggestive of iliolumbar syndrome was selected. An ultrasound-guided injection of the iliolumbar ligament with local anesthetic was performed. We recorded the patient\\'s subjective assessment of pain and the change in range of movement and pain scores during provocative tests. RESULTS: Following the injection, the patient\\'s pain score decreased, provocation tests became negative, and the range of movement increased. LIMITATIONS: Case report. Target specificity and dispersion of local anesthetic spread not confirmed with an independent technique (i.e. magnetic resonance imaging). CONCLUSIONS: Ultrasound guidance allows the selective deposition of small volumes of local anesthetic into structures believed to cause soft tissue back pain and thus to confirm or exclude the working diagnosis. Further studies are needed to confirm our conclusions and to prove the clinical feasibility of this technique.

  11. Bone tunnel enlargement on anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Leonardi, Adriano Barros de Aguiar; Duarte Junior, Aires; Severino, Nilson Roberto

    2014-01-01

    To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study.

  12. STUDY OF ANTERIOR CRUCIATE LIGAMENT INJURY AND ITS MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Tummala Venkata

    2016-03-01

    Full Text Available BACKGROUND The anterior cruciate ligament is the weaker of the two cruciate ligaments stabilizing the knee joint, and therefore gets torn easier than the posterior cruciate ligament. OBJECTIVE To determine pattern of anterior cruciate ligament injury and its management in a tertiary care center. MATERIALS AND METHODS A prospective study was carried out for two years, 28 patients with ACL injury were included. A detailed history regarding the pattern of injury was noted and ACL reconstruction was done using BT Bautograft with mini-arthrotomy and arthroscopic assisted ACL reconstruction. RESULTS The mean age of the study subjects was 30.6±7.3 years & majority were males. Majority of the ACL injury was sports related & was on the right knee. 64% underwent arthroscopic assisted ACL reconstruction & majority of them had normal range of motion of the knee. CONCLUSION Our present study concludes that most common age group involved was 20-30 years & ACL injury was more common among males. Patients with an early ACL reconstruction were more satisfied with the end result. Also, ACL reconstruction techniques using BTB auto graft leads to good ligamentous stability and function of the knee.

  13. Reduction of artifacts in computer simulation of breast Cooper's ligaments

    Science.gov (United States)

    Pokrajac, David D.; Kuperavage, Adam; Maidment, Andrew D. A.; Bakic, Predrag R.

    2016-03-01

    Anthropomorphic software breast phantoms have been introduced as a tool for quantitative validation of breast imaging systems. Efficacy of the validation results depends on the realism of phantom images. The recursive partitioning algorithm based upon the octree simulation has been demonstrated as versatile and capable of efficiently generating large number of phantoms to support virtual clinical trials of breast imaging. Previously, we have observed specific artifacts, (here labeled "dents") on the boundaries of simulated Cooper's ligaments. In this work, we have demonstrated that these "dents" result from the approximate determination of the closest simulated ligament to an examined subvolume (i.e., octree node) of the phantom. We propose a modification of the algorithm that determines the closest ligament by considering a pre-specified number of neighboring ligaments selected based upon the functions that govern the shape of ligaments simulated in the subvolume. We have qualitatively and quantitatively demonstrated that the modified algorithm can lead to elimination or reduction of dent artifacts in software phantoms. In a proof-of concept example, we simulated a 450 ml phantom with 333 compartments at 100 micrometer resolution. After the proposed modification, we corrected 148,105 dents, with an average size of 5.27 voxels (5.27nl). We have also qualitatively analyzed the corresponding improvement in the appearance of simulated mammographic images. The proposed algorithm leads to reduction of linear and star-like artifacts in simulated phantom projections, which can be attributed to dents. Analysis of a larger number of phantoms is ongoing.

  14. Biaxial mechanical properties of swine uterosacral and cardinal ligaments.

    Science.gov (United States)

    Becker, Winston R; De Vita, Raffaella

    2015-06-01

    Mechanical alterations to pelvic floor ligaments may contribute to the development and progression of pelvic floor disorders. In this study, the first biaxial elastic and viscoelastic properties were determined for uterosacral ligament (USL) and cardinal ligament (CL) complexes harvested from adult female swine. Biaxial stress-stretch data revealed that the ligaments undergo large strains. They are orthotropic, being typically stiffer along their main physiological loading direction (i.e., normal to the upper vaginal wall). Biaxial stress relaxation data showed that the ligaments relax equally in both loading directions and more when they are less stretched. In order to describe the experimental findings, a three-dimensional constitutive law based on the Pipkin-Rogers integral series was formulated. The model accounts for incompressibility, large deformations, nonlinear elasticity, orthotropy, and stretch-dependent stress relaxation. This combined theoretical and experimental study provides new knowledge about the mechanical properties of USLs and CLs that could lead to the development of new preventive and treatment methods for pelvic floor disorders.

  15. Combined chronic anterior cruciate ligament and posterior cruciate ligament reconstruction: functional and clinical results.

    Science.gov (United States)

    Denti, Matteo; Tornese, Davide; Melegati, Gianluca; Schonhuber, Herbert; Quaglia, Alessandro; Volpi, Piero

    2015-10-01

    Multiligamentous injury to the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) is an uncommon but debilitating event. Patients with combined ligament injuries typically complain of painful, debilitating knee instability that restricts their sports and daily activities. The purpose of this retrospective study was to evaluate functional and clinical outcomes of patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot. Medical records of 20 consecutive patients with chronic ACL and PCL deficiency who underwent simultaneous single-stage arthroscopic reconstruction of the central pivot were retrospectively reviewed. All patients had received either an allograft (group A) or a semitendinosus-gracilis graft for ACL repair and a bone-patellar tibial-bone graft for PCL repair (group B). Functional outcomes, after the initial follow-up period at 24-month FU, were assessed with concentric isokinetic knee extensor-flexor testing at 60 and 180°/s. The secondary aim was to compare long-term clinical recovery by the administration of the IKDC (International Knee Document Committee) Knee Ligament Evaluation Form, the Lysholm Knee Scoring Scale and the Cincinnati Knee Rating Scale. The mean per cent quadriceps strength deficit in the operated as compared to the healthy knee was 13.5 % in group A and 15 % in group B (angular velocity 60°/s) and 13.5 % in group A and 9.4 % in group B (angular velocity 180°/s). The mean per cent flexor strength deficit in the operated as compared to the healthy knee was 10.4 % in group A and 12.3 % in group B (angular velocity 60°/s) and 12.2 % in group A and 9 % in group B (angular velocity of 180°/s). The flexor-quadriceps ratio was 49.4 % in group A and 48.8 % in group B in the healthy knee and 53.2 % in group A and 53.8 % in group B in the operated knee (angular velocity 60°/s) and 63.9 % in group A and 60.7 % in group B in

  16. An osteogenesis/angiogenesis-stimulation artificial ligament for anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Li, Hong; Li, Jinyan; Jiang, Jia; Lv, Fang; Chang, Jiang; Chen, Shiyi; Wu, Chengtie

    2017-05-01

    To solve the poor healing of polyethylene terephthalate (PET) artificial ligament in bone tunnel, copper-containing bioactive glass (Cu-BG) nanocoatings on PET artificial ligaments were successfully prepared by pulsed laser deposition (PLD). It was hypothesized that Cu-BG coated PET (Cu-BG/PET) grafts could enhance the in vitro osteogenic and angiogenic differentiation of rat bone marrow mesenchymal stem cells (rBMSCs) and in vivo graft-bone healing after anterior cruciate ligament (ACL) reconstruction in a goat model. Scanning electron microscope and EDS mapping analysis revealed that the prepared nanocoatings had uniform element distribution (Cu, Ca, Si and P) and nanostructure. The surface hydrophilicity of PET grafts was significantly improved after depositing Cu-BG nanocoatings. The in vitro study displayed that the Cu-BG/PET grafts supported the attachment and proliferation of rBMSCs, and significantly promoted the expression of HIF-1α gene, which up-regulated the osteogenesis-related genes (S100A10, BMP2, OCN) and angiogenesis-related genes (VEGF) in comparison with PET or BG coated PET (BG/PET) grafts which do not contain Cu element. Meanwhile, Cu-BG/PET grafts promoted the bone regeneration at the graft-host bone interface and decreased graft-bone interface width, thus enhancing the bonding strength as well as angiogenesis (as indicated by CD31 expression) in the goat model as compared with BG/PET and pure PET grafts. The study demonstrates that the Cu-containing biomaterials significantly promote osteogenesis and angiogenesis in the repair of bone defects of large animals and thus offering a promising method for ACL reconstruction by using Cu-containing nanobioglass modified PET grafts. It remains a significant challenge to develop an artificial graft with distinct osteogenetic/angiogenetic activity to enhance graft-bone healing for ligament reconstruction. To solve these problems, copper-containing bioactive glass (Cu-BG) nanocoatings on PET artificial

  17. A study of isokinetic strength and laxity with and without anterior cruciate ligament injury

    OpenAIRE

    Kim, Kewwan; Jeon, Kyoungkyu; Mullineaux, David R.; Cho, Eunok

    2016-01-01

    [Purpose] The purpose of this study was to provide useful information for future treatments and to organize rehabilitation programs for anterior cruciate ligament injury by assessing isokinetic muscle strength and laxity of knee joints in athletes with anterior cruciate ligament injuries. [Subjects and Methods] Thirty-one high school athletes with anterior cruciate ligament injuries participated in this study. Isokinetic muscle strength at 60?/sec and anterior cruciate ligament laxity for non...

  18. Immunohistochemical analysis of sensory nerve endings in ankle ligaments: a cadaver study.

    OpenAIRE

    Rein, Susanne; Hagert, Elisabet; Hanisch, Uwe; Lwowski, Sophie; Fieguth, Armin; Zwipp, Hans

    2013-01-01

    BACKGROUND: The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle ligaments using immunohistochemical techniques, in order to gain more insight into functional ankle stability. METHODS: One hundred forty ligaments from 10 cadaver feet were included: the calcaneofibular and anterior/posterior talofibular ligaments from the lateral complex; inferior extensor retinaculum complex, talocalcaneal oblique and canalis tarsi ligaments from the sinus tarsi; d...

  19. [The value of MRI in diagnosis of ligament injuries of knee joint].

    Science.gov (United States)

    Teng, Chen-Di; Qiu, Qian-De

    2010-10-01

    To study the performance of MRI and its diagnostic value for ligament injuries of knee joint. Form June 2008 to February 2010, the MRI of 74 patients with ligament injuries of knee joint were retrospectively analyzed. There were 47 males and 27 females in the group, which course was from 2 h to 10 d, with an average age of 37.3 years (ranged from 12 to 76). The clinical symptom included knee swelling, pain, joint instability, extension-flexion movement disorder. The physical examination showed valgus test or drawer test positive, and tenderness of medial knee positive. There were ligament injuies in 74 cases, among them, 19 cases were anterior cruciate ligament (25.7%),18 were posterior cruciate ligament (24.3%), 13 were lateral collateral ligament (17.6%), 24 were medial collateral (32.4%), the ligament of 12 cases were completely broken (included 8 cases cruciate ligament and 4 cases collateral ligament presented as discontinued signals of the ligament, and swelling and thickening of the ligament with medium signal in PDWI and high signal intensity in T2WI and in SPIR). The MRI of 62 patients with partial longitudinal tearing ligaments showed continuity, swelling and thickening of the ligaments with medium signal in PDWI and high signal intensity in T2WI and in SPIR. Forty-four cases were examined with surgery and arthroscopy, 41 ligaments were accorded with MRI, diagnosis rate of MRI was 95%. MRI can accurately diagnose the ligament injuries of knee joint,which is an ideal technique in the diagnosis of ligament injuries of knee joint, and should be used as a routine examining method.

  20. Mimicry in social interaction: Benefits for mimickers, mimickees, and their interaction

    NARCIS (Netherlands)

    Stel, M.; Vonk, R.

    2010-01-01

    Mimicry has benefits for people in social interactions. However, evidence regarding the consequences of mimicry is incomplete. First, research on mimicry has particularly focused on effects of being mimicked. Secondly, on the side of the mimicker evidence is correlational or lacks real interaction

  1. Tax mimicking and yardstick competition among local governments in the Netherlands

    NARCIS (Netherlands)

    Allers, MA; Elhorst, JP

    This paper provides a spatial-econometric analysis of the setting of property tax rates by Dutch municipalities. We find evidence of tax mimicking: a ten percent higher property tax rate in neighboring municipalities leads to a 3.5 percent higher tax rate. Mimicking is less pronounced in

  2. Parallel evaluation of broad virus detection methods.

    Science.gov (United States)

    Modrof, Jens; Berting, Andreas; Kreil, Thomas R

    2014-01-01

    The testing for adventitious viruses is of critical importance during development and production of biological products. The recent emergence and ongoing development of broad virus detection methods calls for an evaluation of whether these methods can appropriately be implemented into current adventitious agent testing procedures. To assess the suitability of several broad virus detection methods, a comparative experimental study was conducted: four virus preparations, which were spiked at two different concentrations each into two different cell culture media, were sent to four investigators in a blinded fashion for analysis with broad virus detection methods such as polymerase chain reaction-electrospray ionization mass spectrometry (PCR-ESI/MS), microarray, and two approaches utilizing massively parallel sequencing. The results that were reported by the investigators revealed that all methods were able to identify the majority of samples correctly (mean 83%), with a surprisingly narrow range among the methods, that is, between 72% (PCR-ESI/MS) and 95% (microarray). In addition to the correct results, a variety of unexpected assignments were reported for a minority of samples, again with little variation regarding the methods used (range 20-45%), while false negatives were reported for 0-25% of the samples. Regarding assay sensitivity, the viruses were detected by all methods included in this study at concentrations of about 4-5 log10 quantitative PCR copies/mL, and probably with higher sensitivity in some cases. In summary, the broad virus detection methods investigated were shown to be suitable even for detection of relatively low virus concentrations. However, there is also some potential for the production of false-positive as well as false-negative assignments, which indicates the requirement for further improvements before these methods can be considered for routine use. © PDA, Inc. 2014.

  3. Atomization of broad specification aircraft fuels

    Science.gov (United States)

    Skifstad, J. G.; Lefebvre, A. H.

    1980-01-01

    The atomization properties of liquid fuels for the potential use in aircraft gas turbine engines are discussed. The significance of these properties are addressed with respect to the ignition and subsequent combustion behavior of the fuel spray/air mixture. It is shown that the fuel properties which affect the atomization behavior (viscosity, surface tension, and density) are less favorable for the broad specification fuels as compared to with those for conventional fuels.

  4. MRI of knee joint without surgery and knee joint after alloplastic cruciate ligament prothesis (polyethylene terephthalate)

    Energy Technology Data Exchange (ETDEWEB)

    Baum, H.; Kuehnert, A.; Sundermeyer, R.

    1987-09-01

    When using the spin-echo technique natural, ligament and menisci have practically nearly no signal. Degenerative lesions, lesions of cartilage, and osteochondrosis dissecans are visible. After ligament plastic the borecanal for the alloplastic ligament is visible. The advantages of MRI are pointed out.

  5. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty.

    Science.gov (United States)

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty.

  6. Ligament-bone interaction in a three-dimensional model of the knee

    NARCIS (Netherlands)

    Blankevoort, L.; Huiskes, R.

    1991-01-01

    In mathematical knee-joint models, the ligaments are usually represented by straight-line elements, connecting the insertions of the femur and tibia. Such a model may not be valid if a ligament is bent in its course over bony-surfaces, particularly not if the resulting redirection of the ligament

  7. Caffeine may enhance orthodontic tooth movement through increasing osteoclastogenesis induced by periodontal ligament cells under compression.

    Science.gov (United States)

    Yi, Jianru; Yan, Boxi; Li, Meile; Wang, Yu; Zheng, Wei; Li, Yu; Zhao, Zhihe

    2016-04-01

    Caffeine is the kernel component of coffee and has multiple effects on bone metabolism. Here we aimed to investigate the effects of caffeine intake on orthodontic tooth movement (OTM). (1) In the in vivo study, two groups comprising 15 randomly assigned rats each underwent orthodontic treatment. One group ingested caffeine at 25mg/kg body weight per day and the other, plain water. After 3 weeks, the degree of tooth movement and effect on the periodontium were assessed. (2) In the in vitro study, we established a model mimicking the essential bioprocess of OTM, which contained a periodontal ligament tissue model (PDLtm), and a co-culture system of osteoblasts (OBs) and osteoclast precursors (pre-OCs). After being subjected to static compressive force with or without caffeine administration, the conditioned media from the PDLtm were used for the OB/pre-OC co-cultures to induce osteoclastogenesis. (1) In vivo, the caffeine group displayed a significantly greater rate of tooth movement than the control. The alveolar bone mineral density and bone volume fraction were similar between the two groups; however, immunohistochemical staining showed that the caffeine group had significantly more TRAP(+) osteoclasts and higher RANKL expression in the compressed periodontium. (2) In vitro, caffeine at 0.01mM significantly enhanced the compression-induced expression of RANKL and COX-2, as well as prostaglandin E2 production in the PDLtm. Furthermore, the "caffeine+compression"-conditioned media induced significantly more TRAP(+) OC formation when compared with compression alone. Daily intake of caffeine, at least at some specific dosage, may enhance OTM through increasing osteoclastogenesis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The intricate anatomy of the periodontal ligament and its development: Lessons for periodontal regeneration.

    Science.gov (United States)

    de Jong, T; Bakker, A D; Everts, V; Smit, T H

    2017-12-01

    The periodontal ligament (PDL) connects the tooth root and alveolar bone. It is an aligned fibrous network that is interposed between, and anchored to, both mineralized surfaces. Periodontal disease is common and reduces the ability of the PDL to act as a shock absorber, a barrier for pathogens and a sensor of mastication. Although disease progression can be stopped, current therapies do not primarily focus on tissue regeneration. Functional regeneration of PDL may be achieved using innovative techniques, such as tissue engineering. However, the complex fibrillar architecture of the PDL, essential to withstand high forces, makes PDL tissue engineering very challenging. This challenge may be met by studying PDL anatomy and development. Understanding PDL anatomy, development and maintenance provides clues regarding the specific events that need to be mimicked for the formation of this intricate tissue. Owing to the specific composition of the PDL, which develops by self-organization, a different approach than the typical combination of biomaterials, growth factors and regenerative cells is necessary for functional PDL engineering. Most specifically, the architecture of the new PDL to be formed does not need to be dictated by textured biomaterials but can emerge from the local mechanical loading conditions. Elastic hydrogels are optimal to fill the space properly between tooth and bone, may house cells and growth factors to enhance regeneration and allow self-optimization by the alignment to local stresses. We suggest that cells and materials should be placed in a proper mechanical environment to initiate a process of self-organization resulting in a functional architecture of the PDL. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  10. Absence of sensory function in the reconstructed anterior cruciate ligament

    DEFF Research Database (Denmark)

    Krogsgaard, Michael R; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

    2011-01-01

    Cruciate ligaments provide sensory information that cause excitatory as well as inhibitory effects to the activity of the muscles around the knee. The aim of the study was to determine whether these muscular reflexes are reestablished after anterior cruciate ligament (ACL) re-construction. Wire...... electrodes were inserted during arthroscopy into the normal posterior cruciate ligament (PCL) and the reconstructed ACL in 11 patients who had a successful ACL re-construction 8 months to 12 years earlier. After the anesthesia had subsided, the PCL was stimulated electrically through the electrodes...... and the sensory threshold was determined. Stimulus amplitudes were increased to 1.5-2.0 times the sensory threshold, and inhibitory reflexes could be elicited from PCL in the quadriceps during active extension and in the hamstrings muscles during active flexion in all patients. Subsequently the ACL re-constructions...

  11. Medial collateral ligament recession for chronic medial knee laxity.

    Science.gov (United States)

    Backes, Jeffrey R; Wiltfong, Roger E; Steensen, Robert N

    2013-06-01

    The medial collateral ligament (MCL) is the primary restraint to valgus stress of the knee. Although the MCL has demonstrated an ability to reliably heal with conservative management, chronic medial instability has been well described following an isolated MCL injury or in combination with an anterior cruciate ligament (ACL) tear. When the MCL heals with persistent medial laxity surgical treatment may be necessary to prevent chronic medial instability and valgus overload of a reconstructed cruciate ligament. We present a simple technique for MCL recession that can be used for isolated MCL laxity as well as in chronic ACL/MCL knee injuries. This technique allows for secure fixation with bone-to-bone healing, avoids donor-site morbidity, maintains relative MCL isometry, and can be performed through a modest incision. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  12. The Collateral Ligaments and Posterolateral Corner: What Radiologists Should Know.

    Science.gov (United States)

    Vasilevska Nikodinovska, Violeta; Gimber, Lana H; Hardy, Jolene C; Taljanovic, Mihra S

    2016-02-01

    Ligamentous and tendinous structures of the posterolateral corner of the knee provide important static and dynamic stability to the knee joint and act in conjunction with anterior and posterior cruciate ligaments. Injuries of these structures are not uncommon. Failure to treat posterolateral corner injuries leads to posterolateral instability of the knee and subsequently poor outcome of cruciate ligament reconstructions. Currently, MRI is the diagnostic modality of choice in the evaluation of posterolateral corner injuries of the knee. We review normal MR imaging anatomy of the complex anatomical structures of the posterolateral corner of the knee, their biomechanical function, injuries, and current treatment options. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Distal radio-ulnar ligament motion during supination and pronation.

    Science.gov (United States)

    Acosta, R; Hnat, W; Scheker, L R

    1993-08-01

    The dorsal and palmar distal radio-ulnar ligaments (DRUL) play an important role in the stability of the distal radio-ulnar joint (DRUJ). Various authorities, however, hold opposite opinions regarding DRUL motion during DRUJ pronation and supination, thus implying opposite techniques for reconstruction of the unstable DRUJ. With the hypothesis that relative displacement would increase in the dorsal DRUL during pronation and would increase in the palmar DRUL during supination, measurements were made of the relative DRUL displacement with a Hall-effect displacement transducer during DRUJ pronation and supination in six fresh cadaver wrists. The hypothesis was confirmed that the dorsal radio-ulnar ligament undergoes relative displacement during pronation, while the palmar radio-ulnar ligament undergoes relative displacement during supination.

  14. Incidence rate of anterior cruciate ligament reconstructions.

    Science.gov (United States)

    Csintalan, Rick P; Inacio, Maria C S; Funahashi, Tadashi T

    2008-01-01

    Anterior cruciate ligament (ACL) reconstructions are among the most common sports medicine procedures performed in the US each year. Differences have been reported in the incidence rates (IRs) of ACL tears among male and female national elite athletes. However, there is little information in the published literature that assesses IRs for ACL reconstructions done in the Health Maintenance Organization (HMO) setting specifically. Different populations may show variation in ACL reconstruction IRs. This study reports on the IR of ACL reconstructions in a predefined population and compares the differences in age and sex over time. A retrospective analysis of 4485 ACL reconstructions performed within Kaiser Permanente Southern California between 2001 and 2005 was completed by a query of an administrative database. Trends in IRs per 100,000 members were calculated and compared across age, sex, and the five-year study period. Linear regression was used to test trends in IR. Sex distribution was compared using the χ(2) test. Analysis of variance was used to compare the mean age from year to year in males and females. The independent sample t-test was used to compare mean age between males and females for each independent year. The IR of ACL reconstructions in females rose significantly (p = 0.010) from 14.4 in 2001 (95% confidence interval [CI], 12.6-16.3) to 19.3 in 2005 (95% CI, 17.2-21.5). Within specific age groups, IR increased significantly for females age 14 to 17 (p = 0.013), 18 to 21 (p = 0.017), and 45 to 49 years (p = 0.014). The most dramatic change was seen in the female age category of 14 to 17 years, which increased at a rate of 8.14 cases/100,000 members per year. Identifying the sex and age groups with most rapidly increasing rates of ACL reconstructions is important in implementing ACL injury-prevention programs.

  15. Familial predisposition to anterior cruciate ligament injury

    Directory of Open Access Journals (Sweden)

    Kenichi Goshima

    2014-04-01

    Full Text Available Although several risk factors for anterior cruciate ligament (ACL injury have been evaluated in the literature, there are few reports on familial predisposition. This study investigated the familial predisposition to ACL injury. The study included 350 patients who underwent ACL reconstruction between January 2005 and September 2008. All patients were surveyed by telephone or a written questionnaire about family history (FH of ACL injury, sports played by family members, and mechanisms of injury. We also compared age, sex, height, weight, body mass index, Tegner activity score, general joint laxity, and tibial slope between an FH group (with FH and a control group (without FH. In addition, we compared the incidence of ACL graft rupture and contralateral ACL rupture 2 years after primary surgery. Complete information was obtained from 316 patients, 38 (12.0% of whom had FH of ACL injury. Two families had three members with ACL injuries. Of the 40 family members with ACL injuries, 38 (95% had noncontact injuries and 34 (85% shared a similar mechanism of injury with the related patient. No significant differences were identified between the two groups, except that tibial slope was significantly greater in the FH group than in the control group. Although the incidence of repeat ACL injury was greater in the FH group (23.7% than in the control group (16.4%, there was no significant difference. Our results indicated a high probability of familial predisposition to many of the identified risk factors for ACL injury. In addition, patients with FH of ACL injury might be at high risk for initial and repeat ACL injuries. Therefore, prevention programs should be implemented for patients with FH of ACL injury in order to decrease the risk of these injuries.

  16. Mechanoreceptors of the ligaments and tendons around the knee.

    Science.gov (United States)

    Çabuk, Haluk; Kuşku Çabuk, Fatmagül

    2016-09-01

    Proprioceptive inputs from the joints and limbs arise from mechanoreceptors in the muscles, ligaments and tendons. The knee joint has a wide range of movements, and proper neuroanatomical organization is critical for knee stability. Four ligaments (the anterior (ACL) and posterior (PCL) cruciate ligaments and the medial (MCL) and lateral (LCL) collateral ligaments) and four tendons (the semitendinosus (STT), gracilis (GT), popliteal (PoT), and patellar (PaT) tendons) from eight fresh frozen cadavers were harvested. Each harvested tissue was divided into its bone insertion side and its tendinous part for immunohistochemical examination using S100 staining. Freeman-Wyke's classification was used to identify the mechanoreceptors. The mechanoreceptors were usually located close to the bone insertion. Free nerve endings followed by Ruffini endings were the most common mechanoreceptors overall. No Pacini corpuscles were observed; free nerve endings and Golgi-like endings were most frequent in the PCL (PCL-PaT: P = 0.0.1, PCL-STT: P = 0.00), and Ruffini endings in the popliteal tendon (PoT-PaT: P = 0.00, Pot-STT: P = 0.00, PoT-LCL: P = 0.00, PoT-GT: P = 0.00, PoT-ACL: P = 0.09). The cruciate ligaments had more mechanoreceptors than the medial structures (MS) or the patellar tendon (CR-Pat: P = 0.000, CR-MS: P = 0.01). The differences in mechanoreceptor distributions between the ligaments and tendons could reflect the different roles of these structures in the dynamic coordination of knee motion. Clin. Anat. 29:789-795, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Reducing time to surgery after anterior cruciate ligament injury.

    Science.gov (United States)

    Sapsford, H; Sutherland, A G

    2016-05-01

    Recent work suggests that reconstruction of the ruptured anterior cruciate ligament within 12 months of injury results in better outcomes. We present a complete audit cycle examining the effect of establishment of an Acute Knee Clinic on time to surgery. Records of 20 anterior cruciate ligament reconstructions undertaken by the senior author between June 2003 and May 2004 were examined to identify the time to surgery. The Acute Knee Clinic was established in December 2004. Prospectively collected data on patients attending the Acute Knee Clinic between May 2005 and July 2007 and patients undergoing anterior cruciate ligament reconstruction from September 2006 to 2007 were reviewed with respect to referral route, time from injury to specialist review and time to surgery. Mean time from injury to surgery of the initial cohort was 14 months (range 3-56). After establishment of the Acute Knee Clinic, 90% of referrals from Accident and Emergency (A&E) were seen by a specialist within four weeks. Between September 2006 and September 2007, 49 patients underwent anterior cruciate ligament reconstruction: 21 came via the Acute Knee Clinic, with a mean time from injury to surgery of 6 months; 28 patients from the elective clinic had a mean time to surgery of 25 months. 95% of Acute Knee Clinic patients and 53 % of elective clinic patients had surgery within 12 months of injury. The Acute Knee Clinic has been shown to reduce the time from injury to anterior cruciate ligament reconstruction. The Acute Knee Clinic only accounts for the referral of 40% of anterior cruciate ligament reconstructions in this series: Further education work is required with A&E staff and GPs regarding the referral of knee injuries. Access to the Acute Knee Clinic could be extended to GPs, although this could create service overload. © The Author(s) 2016.

  18. Cemento-ossifying fibroma of mandible mimicking complex composite odontome.

    Science.gov (United States)

    Dewan, Hitesh Sudarshan; Dewan, Sudarshan Kumar; Bahl, Sumit; Tushar Parekh, Parth

    2016-10-19

    Cemento-ossifying fibroma (COF) is a fibro-osseous lesion or non-odontogenic tumour that affects craniofacial bones. These lesions are included in the spectrum of fibro-osseous lesions arising from periodontal ligament cells, which can deposit combination of cementum and bone surrounded by fibrous tissue. It clinically, macroscopically and radiologically resembles complex composite odontome and can be differentiated only on the basis of histopathology. They usually occur solitarily as a painless and expansile spherical or ovoid jawbone mass that may displace the roots of adjacent teeth. They predominantly occur in females in third and fourth decades of life. We present a case report of a 20-year-old man, with a mildly painful swelling in the mandible which was successfully treated with enucleation and diagnosed as COF. Its resemblance to complex composite odontome and unique surgical approach are highlighted in this paper. 2016 BMJ Publishing Group Ltd.

  19. Cysto-duodeno-colic ligament and its clinical relevance

    Directory of Open Access Journals (Sweden)

    Vishwajit Ravindra Deshmukh

    2016-12-01

    Full Text Available During a routine dissection class for the undergraduate students at All India Institute of Medical Sciences, New Delhi, a rare uncommon variation of the peritoneal ligament was found. Information regarding variation in such type of accessory peritoneal reflections is necessary for anatomists, surgeons, and radiologists. Normally there was no peritoneal reflection between gallbladder, duodenum and transverse colon, but in the present case report, it was present and termed as cysto-duodeno-colic ligament. Knowledge of such variation is necessary during gallbladder surgeries and liver transplantation surgeries.

  20. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome

    Directory of Open Access Journals (Sweden)

    John Williams

    2015-01-01

    Full Text Available This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS. The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS. There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario.

  1. Miscellaneous conditions of tendons, tendon sheaths, and ligaments.

    Science.gov (United States)

    Dyson, S J; Dik, K J

    1995-08-01

    The use of diagnostic ultrasonography has greatly enhances our ability to diagnose injuries of tendons and tendon sheaths that were previously either unrecognized or poorly understood. For may of these injuries, there is currently only a small amount of follow-up data. This article considers injuries of the deep digital flexor tendon and its accessory ligament, the carpal tunnel syndrome soft tissue swellings on the dorsal aspect of the carpus, intertubercular (bicipital) bursitis and bicipital tendinitis, injuries of the gastrocnemius tendon, common calcaneal tendinitis, rupture of peroneus (fibularis tertius) and ligaments injuries of the back.

  2. [Integration of the musculoskeletal components by tendons and ligaments.

    Science.gov (United States)

    Shukunami, Chisa

    Tendons transmit the mechanical force of skeletal muscle contraction to the bones, whereas ligaments connect the two bones together to stabilize the joint. During embryonic development, each component in the musculoskeletal system, initially develops as an individual primordium of tendon, ligament, skeletal muscle, and cartilage. Later, mutual interaction between these tissues plays an important role for the integration of the musculoskeletal components. Accumulating evidence suggests that myotendinous and osteotendinous/osteoligamentous junctions are important structures to maintain homeostasis of the integrated musculoskeletal components. In this review, we will focus on the establishment and maintenance of these junctions.

  3. Ligament balancing in total knee arthroplasty—Medial stabilizing technique

    Directory of Open Access Journals (Sweden)

    Shuichi Matsuda

    2015-10-01

    Full Text Available Ligament balancing is one of the most important surgical techniques for successful total knee arthroplasty. It has traditionally been recommended that medial and lateral as well as flexion and extension gaps are equal. This article reviews the relevant literature and discusses the clinical importance of the aforementioned gaps. Current evidence indicates that achieving medial stability throughout the range of motion should be a high priority in ligament balancing in total knee arthroplasty. Finally, the medial stabilising surgical technique, which aims to achieve good medial stability in posterior cruciate-retaining total knee arthroplasty, is introduced.

  4. The Role of Bioreactors in Ligament and Tendon Tissue Engineering.

    Science.gov (United States)

    Mace, James; Wheelton, Andy; Khan, Wasim S; Anand, Sanj

    2016-01-01

    Bioreactors are pivotal to the emerging field of tissue engineering. The formation of neotissue from pluripotent cell lineages potentially offers a source of tissue for clinical use without the significant donor site morbidity associated with many contemporary surgical reconstructive procedures. Modern bioreactor design is becoming increasingly complex to provide a both an expandable source of readily available pluripotent cells and to facilitate their controlled differentiation into a clinically applicable ligament or tendon like neotissue. This review presents the need for such a method, challenges in the processes to engineer neotissue and the current designs and results of modern bioreactors in the pursuit of engineered tendon and ligament.

  5. Anatomic study and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater.

    Science.gov (United States)

    Chen, Rongzi; Shi, Benchao; Zheng, Xuefeng; Zhou, Zhilai; Jin, Anmin; Ding, Zihai; Lv, Hai; Zhang, Hui

    2015-05-15

    A dissection-based study of 18 embalmed thoracic specimens. To investigate the properties and clinical significance of the dorsal meningovertebral ligaments of the thoracic dura mater. Previously, we performed a comprehensive anatomic study on the dorsal meningovertebral ligaments in the lumbosacral and cervical regions, whereby we concluded that the ligaments were an anatomic factor leading to dural laceration and hemorrhage during flavectomy and laminectomy. Unfortunately, thus far, no systematic anatomic study has been undertaken to examine the dorsal meningovertebral ligaments of the thoracic dura mater. Eighteen adult embalmed cadavers were studied, and the morphology, orientation, attachment site, and distribution traits of the dorsal meningovertebal ligaments were observed. In addition, the length, width, or diameter and thickness of the ligaments were measured using a Vernier caliper. Two meningovertebal ligaments were removed for histological examination. In the thoracic region, the dorsal meningovertebral ligaments anchored the dura mater to the lamina or ligamentum flavum. The meningovertebral ligaments displayed a relatively even distribution along the upper thoracic region (T1-T7) and a gradual increase in frequency in the lower thoracic region from T7 to T12. The meningovertebral ligaments protrude into the dura and correspondingly become an integral part of the dura. Some ligaments are accompanied by or are attached to blood vessels. Histological examination of the meningovertebral ligaments revealed fibrous connective tissue. The dorsal meningovertebral ligaments exist between the dural sac and ligamentum flavum or lamina in the thoracic spine. Based on their anatomic features, meningovertebral ligaments may be one potential cause for dural laceration and epidural hemorrhage. We propose that, during thoracic flavectomy and laminectomy, the meningovertebral ligaments should first be identified and properly handled, thereby minimizing the occurrence

  6. [A Case of Intracranial Localized Castleman's Disease Mimicking Convexity Meningioma].

    Science.gov (United States)

    Ozono, Keisuke; Fujimoto, Takashi; Hirose, Makoto; Kawahara, Ichiro; Uchihashi, Kazuyoshi

    2017-01-01

    A 68-year-old man presented with abnormal behavior and Todd's paralysis on the right side after having taken a bath. Computed tomography and magnetic resonance imaging revealed a tumor mimicking convexity meningioma that had a perifocal edema, although its mass was not very large. The patient underwent surgery, and full recovery was achieved following a total removal of the lesion. Pathohistological examination demonstrated an intermediate type of Castleman's disease. The final diagnosis was intracranial localized Castleman's disease because the results of the full physical examination and laboratory analyses were normal. Castleman's disease is a rare lymphoproliferative disorder of unknown etiology. Moreover, intracranial involvement is very rare. In cases of intracranial meningeal tumors with perifocal edema, we should take this disease into consideration in the differential diagnosis.

  7. Dental technician pneumoconiosis mimicking pulmonary tuberculosis: a case report.

    Science.gov (United States)

    Tan, Han Loong; Faisal, Mohamed; Soo, Chun Ian; Ban, Andrea Y L; Manap, Roslina Abdul; Hassan, Tidi M

    2016-09-07

    Dental laboratory technicians are at risk of developing occupational respiratory diseases due to exposure to various potentially toxic substances in their working environment. Since 1939, few cases of silicosis among dental technician have been reported. We illustrate a 38 year-old female, who worked in a dental laboratory for 20 years, initially treated as pulmonary tuberculosis and chronic necrotising aspergillosis without much improvement. Computed tomography guided lung biopsy and bronchoscopic transbronchial lung biopsy were performed. Lung tissue biopsies showed presence of refractile dental materials within the areas of histiocyte proliferation. The diagnosis of dental technician pneumoconiosis was obtained and our patient underwent pulmonary rehabilitation. This case highlights the importance of obtaining a detailed occupational history in tuberculosis endemic area, as pulmonary tuberculosis is a great mimicker of other respiratory diseases.

  8. A syndrome of the dentate nucleus mimicking psychogenic ataxia.

    Science.gov (United States)

    Salih, Farid; Breuer, Eva; Harnack, Daniel; Hoffmann, Karl-Titus; Ploner, Christoph J

    2010-03-15

    To date, cerebellar involvement in control of non-motor functions like cognition and emotion is increasingly well established. Current models suggest that motor and non-motor networks connecting the cerebellum with cortical areas operate independently in closed and segregated loops. Here, we report a 59-year-old female patient with a small cerebellar lesion that shows that cognitive activation can significantly influence cerebellar motor control. Surprisingly, this led to a clinical picture mimicking a psychogenic disorder. Similar to non-human primates, this case suggests that the human dentate nucleus consists of distinct cognitive and motor domains with additional somatotopical arrangement of the latter. Extending current models of cerebro-cerebellar interaction, this case further illustrates that there can be significant functional cross-talk between motor and cognitive cerebellar networks.

  9. Pituitary adenoma with extensive calcaficcations mimicking crainopharyngioma: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jin, Sung Chan; Lee, Seoung Ro; Kwon, Bae Ju; Moon, Won Jin; Jeon, Eui Yong [Hanyang Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-01-01

    A 27-year-old man presented with complaints of headache and visual disturbance, first noted six months earlier. Simple radiographs of skull sellar widening and calcification. Brian CT revealed a 3 x 3 x 4 cm-sized sellar suprasellar mass with heavy calcification. T1-weighted MR images showed that the signal intencity of the mass was slightly lower than that of the gray matter, while T2-weighted images showed heterogeneous high signal intensity with centrl low-signal-intensity foci, suggesting calcification After contrast infusion, enancement was irregular. Surgery revealed a 4 x 5 cm sized, well-demarcated, lobulated mass adhering to the meninges. Papillary-type pituitary adenoma was histologically confirmed. We report the CT and MR findings of atypical pituitary adenoma with extensive internal calcification mimicking craniopharyngioma.

  10. Mimicking biological stress–strain behaviour with synthetic elastomers

    Science.gov (United States)

    Vatankhah-Varnosfaderani, Mohammad; Daniel, William F. M.; Everhart, Matthew H.; Pandya, Ashish A.; Liang, Heyi; Matyjaszewski, Krzysztof; Dobrynin, Andrey V.; Sheiko, Sergei S.

    2017-09-01

    Despite the versatility of synthetic chemistry, certain combinations of mechanical softness, strength, and toughness can be difficult to achieve in a single material. These combinations are, however, commonplace in biological tissues, and are therefore needed for applications such as medical implants, tissue engineering, soft robotics, and wearable electronics. Present materials synthesis strategies are predominantly Edisonian, involving the empirical mixing of assorted monomers, crosslinking schemes, and occluded swelling agents, but this approach yields limited property control. Here we present a general strategy for mimicking the mechanical behaviour of biological materials by precisely encoding their stress–strain curves in solvent-free brush- and comb-like polymer networks (elastomers). The code consists of three independent architectural parameters—network strand length, side-chain length and grafting density. Using prototypical poly(dimethylsiloxane) elastomers, we illustrate how this parametric triplet enables the replication of the strain-stiffening characteristics of jellyfish, lung, and arterial tissues.

  11. Postpolypectomy Electrocoagulation Syndrome: A Mimicker of Colonic Perforation

    Directory of Open Access Journals (Sweden)

    Brian C. Benson

    2013-01-01

    Full Text Available Postpolypectomy electrocoagulation syndrome is a rare complication of polypectomy with electrocautery and is characterized by a transmural burn of the colon wall. Patients typically present within 12 hours after the procedure with symptoms mimicking colonic perforation. Presented is the case of a 56-year-old man who developed abdominal pain six hours after colonoscopy during which polypectomy was performed using snare cautery. CT imaging of the abdomen revealed circumferential thickening of the wall of the transverse colon without evidence of free air. The patient was treated conservatively as an outpatient and had resolution of his pain over the following four days. Recognition of the diagnosis and understanding of the treatment are important to avoid unnecessary exploratory laparotomy or hospitalization.

  12. A rare case of ascending colon actinomycosis mimicking cancer

    Directory of Open Access Journals (Sweden)

    Zizi Diamanto

    2005-01-01

    Full Text Available Abstract Background Actinomycosis is a rare inflammatory disease caused by an anaerobic bacterium that can rarely affect the large intestine. Case presentation We present a rare case of a cecum and ascending colon actinomycosis in a 72 years old woman, mimicking clinically a malignant inflammatory tumor of the right colon. The patient complained of right lower quadrant pain. Although our first thought was a peri-appendiceal abscess, CT scan suggested a right colon tumor. The patient underwent a right colectomy and the histological examination of the specimen revealed colon actinomycosis. Conclusions Preoperative diagnosis in colon actinomycosis is difficult to achieve. Treatment of choice is antibiotics administration. A review of the possible pathogenesis and therapeutic modalities is also presented.

  13. An Adolescent Patient with Scabies Mimicking Gottron Papules

    Directory of Open Access Journals (Sweden)

    Eiji Yoshinaga

    2009-01-01

    Full Text Available Atypical features of scabies occur in infants and children and patients with prolonged use of corticosteroids or immunosuppression. We report a non-immunosuppressed 15-year-old female case of scabies showing scaly reddish papules over the proximal interphalangeal joints mimicking Gottron papules in classic dermatomyositis. Periungal erythema was also seen. Four months’ topical corticosteroids from previous clinics had been used. Dermoscopic findings were consistent with typical pictures of scabies. Scraping of hand crusts demonstrated scabies mites and ova. Skin lesions of the patient were cured with oral ivermectin and topical 10% crotamiton. This case suggests that a lesion resembling Gottron papules may be added to the panel of unusual presentations of scabies.

  14. Myelodysplastic changes mimicking MDS following treatment for osteosarcoma

    DEFF Research Database (Denmark)

    Løhmann, Ditte

    Myelodysplastic changes mimicking MDS following treatment for osteosarcoma Ditte Juel Adolfsen Løhmann, Department of Pediatrics, Aarhus University Hospital, Skejby, Denmark Authors: Ditte Juel Adolfsen Løhmann and Henrik Hasle. Therapy-related myelodysplastic syndrome/acute myeloid leukaemia (t-MDS....../AML) is a feared long-term complication of paediatric cancer including osteosarcoma. Few develop t-MDS/AML, but it is not known how many have significant haematological changes after finishing treatment for osteosarcoma. In this study we reviewed biochemistry from a consecutive series of children for up to two...... MDS (refractory anaemia with excess blasts) with monosomy 7 was found and a hematopoietic stem cell transplant was performed. In the other case MDS without excess of blasts was found and a spontaneous normalization of the biochemistry occurred. In conclusion in our study most patients treated...

  15. Concurrent periosteal chondroma and enchondroma of the fibula mimicking chondrosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Yasuhiro; Washimi, Osuke; Yamada, Harumoto; Washimi, Yuki; Itoh, Masato [Fujita Health University, Department of Orthopedic Surgery, Toyoake City, Aichi (Japan); Kuroda, Makoto [Fujita Health University, Department of Pathology, Toyoake City, Aichi (Japan)

    2006-05-15

    We present a rare concurrence of enchondroma and periosteal chondroma in the right distal fibula that mimicked chondrosarcoma in a 13-year-old boy. Radiographs and CT scans showed a periosteal lesion producing saucerization without periosteal reaction and calcification in the distal metaphysis of the right fibula. MRI showed an intramedullary lesion adjacent to the periosteal lesion, although it was invisible at CT. There was no cortical breach on imaging and gross examination. Because both lesions represented benign cartilaginous tumors on histology, concurrent periosteal chondroma and enchondroma of the fibula was diagnosed. This combination in the same bone in a patient without enchondromatosis is exceedingly rare. Such imaging features may be confused with those of chondrosarcoma. (orig.)

  16. Enzyme-Mimicking properties of silicates and other minerals

    Science.gov (United States)

    Siegel, B. Z.; Siegel, S. M.

    The adsorptive and/or catalytic properties of clays, silicates in general, and other minerals are well known. More recently, their probable role in prebiotic syntheses of bio-organic compounds has become a matter of record. We demonstrate that, in addition to their role in de novo formation of important biomolecules, clays, micas, fibrous silicates and other minerals mimick the activities of contemporary enzymes including oxidases, esterases, phosphatases and glucosidases. The existence of such capabilities in substances likely to be represented on the surfaces of Earth-like planets may offer a challenge to the technology and design of remote life detection systems which must then distinguish between bona fide biological chemistry and mineral-base pseudometabolism. It also raises questions about the importance of mineral surfaces in post-mortem transformations of organic metabolites in our own biosphere.

  17. Giant cystic sacral schwannoma mimicking tarlov cyst: a case report.

    Science.gov (United States)

    Attiah, Mark A; Syre, Peter P; Pierce, John; Belyaeva, Elizaveta; Welch, William C

    2016-05-01

    To present a rare case of a giant schwannoma of the sacrum mimicking a Tarlov cyst. A 58-year-old woman had a 1-year history of low back pain. MRI revealed a large cystic mass in the sacral canal with bony erosion. Radiological diagnosis of Tarlov cyst was made. The patient underwent surgical treatment for the lesion, which revealed a solid mass. Histopathological examination of the tumor confirmed the diagnosis of schwannoma. The postoperative course was uneventful and the patient has had significant improvement in her pain 1 month postoperatively. Giant cystic schwannoma of the sacrum is a very rare diagnosis overlooked by practitioners for more common cystic etiologies, but its treatment is significantly different. Care should be taken to include this diagnosis in a differential for a cystic sacral mass.

  18. Impedance of tissue-mimicking phantom material under compression

    Directory of Open Access Journals (Sweden)

    Barry Belmont

    2013-02-01

    Full Text Available The bioimpedance of tissues under compression is a field in need of study. While biological tissues can become compressed in a myriad of ways, very few experiments have been conducted to describe the relationship between the passive electrical properties of a material (impedance/admittance during mechanical deformation. Of the investigations that have been conducted, the exodus of fluid from samples under compression has been thought to be the cause of changes in impedance, though until now was not measured directly. Using a soft tissue-mimicking phantom material (tofu whose passive electrical properties are a function of the conducting fluid held within its porous structure, we have shown that the mechanical behavior of a sample under compression can be measured through bioimpedance techniques.

  19. A Case of Myopericarditis Mimicking Acute Myocardial Infarction in Childhood

    Directory of Open Access Journals (Sweden)

    Rahmi Özdemir

    2015-11-01

    Full Text Available Myopericarditis is an inflammatory disease of the both myocardial and pericardial tissues, and resulting from different etiologies. Viral agents such as coxsackie virus type B, adenovirus, and echovirus are the most common leading cause of this disease and it usually occurs following viral upper respiratory tract infections. Although there are different clinical features according to ages groups, some common findings such as tachycardia incompatible with fever, deeply heared heart sounds, and heart failure can be seen. Clinical findings often mimics a myocardial infarction. Diagnosis of this disease is made by the evaluation of the clinical condition, electrocardiography, echocardiography and elevation of the cardiac enzymes. Because it is mortality, discrimination of myopericarditis from myocardial infarction is very important. Herein, we report a 13 year-old-girl with the diagnosis of myopericarditis presenting with chest pain, electrocardiographic changes mimicking myocardial infarction and elevated cardiac enzymes and also aimed to emphasize the importance of accurate diagnosis of this disease.

  20. Postpartum Unilateral Sacral Stress Fracture Mimicking Lumbar Radiculopathy: Case Report

    Directory of Open Access Journals (Sweden)

    Sinan Bağçacı

    2018-01-01

    Full Text Available Postpartum sacral stress fracture is a very rare clinical entity. Because of the ambiguous clinical and radiological findings, it is often diagnosed late. A case of a postpartal 25-year-old female patient presented with acute onset of low back pain radiating to the right extremity, mimicking lumbar radiculopathy. Magnetic resonance imaging of sacrum revealed a non-displaced stress fracture of the right sacral ala. The 25-hydroxy vitamine D level of the patient was very low; dual energy X-ray absorptiometry measurements were in the normal range. The patient is completely cured as a result of conservative treatment. As a result, sacrum stress fracture should be kept in mind in the presence of back pain during pregnancy and postpartum period.

  1. Adenoid Cystic Carcinoma Mimicking an Oroantral Fistula: A Case Report

    Directory of Open Access Journals (Sweden)

    Monteiro, Bárbara Vanessa de Brito

    2014-01-01

    Full Text Available Introduction Adenoid cystic carcinoma (ACC is one of the most frequent malignant salivary gland tumors, which commonly affects the minor salivary glands of the mouth and is rare in the nose and paranasal sinuses. In the maxillary sinus, ACC can mimic inflammatory diseases and has a poor prognosis. Objective To report a case of a 50-year-old man with ACC of the maxillary sinus whose clinical findings in the alveolar ridge mimicked an oroantral fistula. Case Report An excisional biopsy was performed and histopathologic analysis revealed ACC. Lung metastases and residual tumor in the maxillary sinus were detected by imaging methods. In view of the poor general health of the patient, no new surgical intervention was performed and he was only treated by radiotherapy and follow-up. Conclusion Although rare in the maxillary sinus, ACC should be included in the differential diagnosis of lesions affecting this site.

  2. [Disseminated histoplamosis in adolescent mimicking granulomatosis with polyangiitis].

    Science.gov (United States)

    van Weelden, Marlon; Viola, Gabriela R; Kozu, Katia T; Aikawa, Nadia E; Ivo, Claudia M; Silva, Clovis A

    2015-03-04

    Systemic histoplasmosis is an invasive fungal infection that may mimic primary vasculitis, particularly granulomatosis with polyangiitis (GPA), and was rarely described in adult patients. We reported an immunocompetent patient with disseminated histoplasmosis mimicking GPA who fulfilled European League Against Rheumatism (EULAR)/Pediatric Rheumatology International Trials Organisation (PRINTO)/Pediatric Rheumatology European Society (PRES) validated classification criteria. A 6-year old boy presented acute migratory polyarthritis with spontaneous improvement, sinus inflammation, fever, headache and abdominal pain. Serologic test for hepatitis, cytomegalovirus, human immunodeficiency virus, Epstein-Barr virus, toxoplasmosis, dengue virus and antistreptolysin O were all negative. Magnetic resonance imaging (MRI) showed moderate ascites in pelvis and pansinusitis. Antineutrophil cytoplasmic antibodies (c-ANCA) were positive. He had spontaneous remission of the symptoms including fever. At the age of 11 years and 11 months, he had sinusitis, pneumonia and epididymitis. A month later, he was hospitalized and MRI showed left eye proptosis. Cerebrospinal fluid was normal and indirect tests of fungi were negative. Two months later, he had lumbar pain and computer tomography showed a mass in the right kidney and pulmonary nodule in the right lung. He fulfilled EULAR/PRINTO/PRES criteria for GPA, however the renal biopsy showed a focal granulomatous interstitial nephritis with yeast fungal cells compatible with Histoplasma sp. He was treated with liposomal amphotericin B and itraconazole with improvement of signs and symptoms. We reported a progressive disseminated histoplasmosis case mimicking GPA. Histoplasmosis infection should be considered in immunocompetent subjects with uncommon clinical manifestations, such as arthritis, nephritis and epididymitis. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  3. Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression.

    Science.gov (United States)

    Deep, Nicholas L; Graffeo, Christopher S; Copeland, William R; Link, Michael J; Atkinson, John L; Neff, Brian A; Raghunathan, Aditya; Carlson, Matthew L

    2017-03-01

    To report two patients with a history of microvascular decompression (MVD) for hemifacial spasm who presented with Teflon granulomas (TG) mimicking cerebellopontine angle (CPA) tumors and to perform a systematic review of the English-language literature. Case series at a single tertiary academic referral center and systematic review. Retrospective chart review with analysis of clinical, radiological, and histopathological findings. Systematic review using PubMed, Embase, MEDLINE, and Web of Science databases. Two patients with large skull base TGs mimicking CPA tumors clinically and radiographically were managed at the authors' institution. The first presented 4 years after MVD with asymmetrical sensorineural hearing loss, multiple progressive cranial neuropathies, and brainstem edema due to a growing TG. Reoperation with resection of the granuloma confirmed a foreign-body reaction consisting of multinucleated giant cells containing intracytoplasmic Teflon particles. The second patient presented 11 years after MVD with asymmetrical sensorineural hearing loss and recurrent hemifacial spasm. No growth was noted over 2 years, and the patient has been managed expectantly. Only one prior case of TG after MVD for hemifacial spasm has been reported in the English literature. TG is a rare complication of MVD for hemifacial spasm. The diagnosis should be suspected in patients presenting with a new-onset enhancing mass of the CPA after MVD, even when performed decades earlier. A thorough clinical and surgical history is critical toward establishing an accurate diagnosis to guide management and prevent unnecessary morbidity. Surgical intervention is not required unless progressive neurologic complications ensue. 4 Laryngoscope, 127:715-719, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  4. Acoustical characterization of polysaccharide polymers tissue-mimicking materials.

    Science.gov (United States)

    Cuccaro, Rugiada; Musacchio, Chiara; Giuliano Albo, P Alberto; Troia, Adriano; Lago, Simona

    2015-02-01

    Tissue-mimicking phantoms play a crucial role in medical ultrasound research because they can simulate biological soft tissues. In last years, many types of polymeric tissues have been proposed and characterized from an acoustical and a thermal point of view, but, rarely, a deep discussion about the quality of the measurements, in terms of the uncertainty evaluation, has been reported. In this work, considering the necessity to develop laboratory standards for the measurement of ultrasonic exposure and dose quantities, a detailed description of the experimental apparatuses for the sound speed and the attenuation coefficient measurements is given, focusing the attention on the uncertainty evaluation both of the results and analysis algorithms. In particular, this algorithm reveals a novel empirical relation, fixing a limit to the energy content (therefore limits the number of cycles) of the three parts in which the authors have proposed to divide the acoustical signal. Furthermore, the realisation of multi-components phantoms, Agar and Phytagel based tissue-mimicking gels along with others long chain molecules (dextrane or polyvinyl alcohol) and scattering materials (silicon carbide and kieselguhr) are investigated. This paper reports accurate speed of sound and attenuation coefficient measurements. Speed of sound is measured by a pulse-echo technique in far-field condition, using an optical glass buffer rod; while attenuation coefficient is determined by an insertion technique, using demineralized water as reference material. The experimental sound speed results are subjected to an overall estimated relative uncertainty of about 1.5% and the attenuation coefficient uncertainty is less than 2.5%. For the development of laboratory standards, a detailed analysis of the measurement uncertainty is fundamental to make sample properties comparable. The authors believe this study could represent the right direction to make phantoms characterizations referable and traceable

  5. Broad-band semiconductor optical amplifiers

    Energy Technology Data Exchange (ETDEWEB)

    Ding Ying [Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083 (China)]. E-mail: yingding@red.semi.ac.cn; Kan Qiang [Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083 (China); Wang Junling [Institute of Optoelectronic Technology, Beijing Jiaotong University, Beijing 100044 (China); Pan Jiaoqing [Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083 (China); Zhou Fan [Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083 (China); Chen Weixi [School of Physics, Peking University, Beijing 100871 (China); Wang Wei [Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083 (China)

    2007-01-15

    Broad-band semiconductor optical amplifiers (SOAs) with different thicknesses and thin bulk tensile-strained active layers were fabricated and studied. Amplified spontaneous emission (ASE) spectra and gain spectra of SOAs were measured and analyzed at different CW biases. A maximal 3 dB ASE bandwidth of 136 nm ranging from 1480 to 1616 nm, and a 3 dB optical amplifier gain bandwidth of about 90 nm ranging from 1510 to 1600 nm, were obtained for the very thin bulk active SOA. Other SOAs characteristics such as saturation output power and polarization sensitivity were measured and compared.

  6. Broad spectrum antibiotic compounds and use thereof

    Energy Technology Data Exchange (ETDEWEB)

    Koglin, Alexander; Strieker, Matthias

    2016-07-05

    The discovery of a non-ribosomal peptide synthetase (NRPS) gene cluster in the genome of Clostridium thermocellum that produces a secondary metabolite that is assembled outside of the host membrane is described. Also described is the identification of homologous NRPS gene clusters from several additional microorganisms. The secondary metabolites produced by the NRPS gene clusters exhibit broad spectrum antibiotic activity. Thus, antibiotic compounds produced by the NRPS gene clusters, and analogs thereof, their use for inhibiting bacterial growth, and methods of making the antibiotic compounds are described.

  7. Crx broadly modulates the pineal transcriptome

    DEFF Research Database (Denmark)

    Rovsing, Louise; Clokie, Samuel; Bustos, Diego M

    2011-01-01

    Cone-rod homeobox (Crx) encodes Crx, a transcription factor expressed selectively in retinal photoreceptors and pinealocytes, the major cell type of the pineal gland. In this study, the influence of Crx on the mammalian pineal gland was studied by light and electron microscopy and by use...... of microarray and qRTPCR technology, thereby extending previous studies on selected genes (Furukawa et al. 1999). Deletion of Crx was not found to alter pineal morphology, but was found to broadly modulate the mouse pineal transcriptome, characterized by a > 2-fold down-regulation of 543 genes and a > 2-fold up......-regulation of 745 genes (p pineal glands of wild...

  8. Surgical technique: medial collateral ligament reconstruction using Achilles allograft for combined knee ligament injury.

    Science.gov (United States)

    Marx, Robert G; Hetsroni, Iftach

    2012-03-01

    Previous approaches for medial collateral ligament (MCL) reconstruction have been associated with extensive exposure, risk of donor site morbidity with autografts, loss of motion, nonanatomic graft placement, and technical complexity with double-bundle constructs. Therefore, we implemented a technique that uses Achilles allograft, small incisions, and anatomic insertions to reconstruct the MCL. The MCL femoral insertion was identified, and a socket reamed over a guide pin. The Achilles bone plug was fixed in the socket and the tendon passed distally under the skin and fixed on the tibia, creating isometric reconstruction. We evaluated 14 patients who had this MCL reconstruction. We determined range of knee motion, knee ligament laxity, functional outcome scores (International Knee Documentation Committee [IKDC]-subjective, Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS]), and activity level scores (Tegner, Marx). Followup range was 24 to 61 months. Knee motion was maintained in 12 cases. Grade 0-1 + valgus stability was obtained in all 14 cases. In cases of MCL with primary ACL reconstruction, IKDC-subjective, Lysholm, and KOOS-sports scores were 91 ± 6, 92 ± 6, and 93 ± 12, respectively, and return to preinjury activity levels was achieved. In cases of MCL with revision ACL reconstruction, function was inferior, and patients did not return to their preinjury activity levels. This technique uses allograft that provides bone-to-bone healing on the femur, requires small incisions, and creates isometric reconstruction. When performed with a cruciate reconstruction, knee stability can be restored at 2 to 5 years followup. In patients with MCL with primary ACL reconstruction, return to preinjury activity level in recreational athletes can be achieved.

  9. Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Zappia, Marcello [University of Molise, Department of Medicine and Health Sciences, Campobasso (Italy); Varelli Institute, Naples (Italy); Castagna, Alessandro [Humanitas Research Hospital, Rozzano, Milan (Italy); Barile, Antonio [University of L' Aquila, Applied Clinical Science and Biotechnology, L' Aquila (Italy); Chianca, Vito [University ' ' Federico II' ' , Department of Advanced Biomedical Sciences, Naples (Italy); Brunese, Luca [University of Molise, Department of Medicine and Health Sciences, Campobasso (Italy); Pouliart, Nicole [Vrije Universiteit Brussel (VUB), Basic Biomedical Sciences - Human Anatomy, Brussels (Belgium); Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedics and Traumatology - Shoulder and Elbow Unit, Brussels (Belgium)

    2017-08-15

    The coracoglenoid ligament (CGL) forms part of the anterosuperior capsuloligamentous complex of the shoulder. Although it has received attention in the anatomical literature, it has not been investigated on imaging. The purpose of this study is to determine the percentage value and the interobserver agreement of identification and classification of the CGL on MR and MR arthrography (MRA) imaging. Retrospectively, 280 MR and 150 MRA examinations were evaluated for detection of the CGL by two musculoskeletal radiologists. On the MRA examinations the CGL configuration in relation to the superior glenohumeral (SGHL) and coracohumeral ligament (CHL) was classified into five types. Additionally, the percentage of intra-articular appearance of the CGL and its mean thickness value were calculated. Finally, a possible correlation between pathological condition and anatomical type was evaluated on MRA. The CGL could be identified in 56%/54% of MRI and in 76%/77% of MRA examinations. On MRA, the CGL was detected as distinct structures in 37%/35% of cases and it appeared fused (partially or totally) with the SGHL and/or CHL in 39%/42%; it was absent in 12%/12% and it appears undistinguishable in the remaining cases. The interobserver agreement was excellent (κ = 0.98 for detection on MRI; p = 0.927 for classification of anterosuperior anatomy on MRA; κ = 0.873 and 0.978 for identification on sagittal and axial external rotation MRA respectively; κ = 0.943 for classification as intra- or extra-articular on MRA). The CGL can be reliably identified on MRI and MRA. (orig.)

  10. Sex Differences in Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: Data From the Swedish Knee Ligament Register

    DEFF Research Database (Denmark)

    Ageberg, Eva; Forssblad, Magnus; Herbertsson, Pär

    2010-01-01

    BACKGROUND: Female gender is a risk factor for sustaining anterior cruciate ligament (ACL) injury. However, little is known about possible sex differences in patients with ACL injury/reconstruction. PURPOSE: To study sex differences in patient-reported outcomes before and at 1 and 2 years after ACL...... reconstruction and to present reference values. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Between 2005 and 2008, 10 164 patients (mean age, 27 years; SD, 9.8; 42% females) with primary ACL reconstruction were registered in the Swedish national knee ligament register. There were 4438 (44...

  11. New insights into mutable collagenous tissue: correlations between the microstructure and mechanical state of a sea-urchin ligament.

    Directory of Open Access Journals (Sweden)

    Ana R Ribeiro

    Full Text Available The mutable collagenous tissue (MCT of echinoderms has the ability to undergo rapid and reversible changes in passive mechanical properties that are initiated and modulated by the nervous system. Since the mechanism of MCT mutability is poorly understood, the aim of this work was to provide a detailed morphological analysis of a typical mutable collagenous structure in its different mechanical states. The model studied was the compass depressor ligament (CDL of a sea urchin (Paracentrotus lividus, which was characterized in different functional states mimicking MCT mutability. Transmission electron microscopy, histochemistry, cryo-scanning electron microscopy, focused ion beam/scanning electron microscopy, and field emission gun-environmental scanning electron microscopy were used to visualize CDLs at the micro- and nano-scales. This investigation has revealed previously unreported differences in both extracellular and cellular constituents, expanding the current knowledge of the relationship between the organization of the CDL and its mechanical state. Scanning electron microscopies in particular provided a three-dimensional overview of CDL architecture at the micro- and nano-scales, and clarified the micro-organization of the ECM components that are involved in mutability. Further evidence that the juxtaligamental cells are the effectors of these changes in mechanical properties was provided by a correlation between their cytology and the tensile state of the CDLs.

  12. Acute fatigue impairs neuromuscular activity of anterior cruciate ligament-agonist muscles in female team handball players.

    Science.gov (United States)

    Zebis, M K; Bencke, J; Andersen, L L; Alkjaer, T; Suetta, C; Mortensen, P; Kjaer, M; Aagaard, P

    2011-12-01

    In sports, like team handball, fatigue has been associated with an increased risk of anterior cruciate ligament (ACL) injury. While effects of fatigue on muscle function are commonly assessed during maximal isometric voluntary contraction (MVC), such measurements may not relate to the muscle function during match play. The purpose of this study was to investigate the effect of muscle fatigue induced by a simulated handball match on neuromuscular strategy during a functional sidecutting movement, associated with the incidence of ACL injury. Fourteen female team handball players were tested for neuromuscular activity [electromyography (EMG)] during a sidecutting maneuver on a force plate, pre and post a simulated handball match. MVC was obtained during maximal isometric quadriceps and hamstring contraction. The simulated handball match consisted of exercises mimicking handball match activity. Whereas the simulated handball match induced a decrease in MVC strength for both the quadriceps and hamstring muscles (Phandball match play. Thus, screening procedures should involve functional movements to reveal specific fatigue-induced deficits in ACL-agonist muscle activation during high-risk phases of match play. © 2010 John Wiley & Sons A/S.

  13. Biomechanics of the meniscus-meniscal ligament construct of the knee.

    Science.gov (United States)

    Masouros, S D; McDermott, I D; Amis, A A; Bull, A M J

    2008-12-01

    The menisci of the knee act primarily to redistribute contact force across the tibio-femoral articulation. This meniscal function is achieved through a combination of the material, geometry and attachments of the menisci. The main ligaments that attach the menisci to the tibia (insertional ligaments, deep medial collateral ligament), the femur (meniscofemoral ligaments, deep medial collateral ligament) and each other (the anterior intermeniscal ligament) are the means by which the contact force between tibia and femur is distributed into hoop stresses in the menisci to reduce contact pressure at the joint. This means that the functional biomechanics of the menisci cannot be considered in isolation and should be considered as the functional biomechanics of the meniscus-meniscal ligament construct. This article presents the current knowledge on the anatomy and functional biomechanics of the meniscus and its associated ligaments. Much is known about the function of the meniscus-meniscal ligament construct; however, there still remain significant gaps in the literature in terms of the properties of the anterior intermeniscal ligament and its function, the properties of the insertional ligaments, and the most appropriate ways to reconstruct meniscal function surgically.

  14. An anatomical study of the lumbar external foraminal ligaments: appearance at MR imaging.

    Science.gov (United States)

    Marić, Dušica L; Krstonošić, Bojana; Erić, Mirela; Marić, Dušan M; Stanković, Milan; Milošević, Nebojša T

    2015-01-01

    The purpose of this study was to examine the MRI appearance of the ligaments within the external space of the lumbar intervertebral foramen by correlating MR images with the corresponding anatomic dissection of the cadaver lumbar spine. This was a two part study. Part I of the anatomic study consisted of the dissection of lumbar specimens from one embalmed adult male cadaver. At each lumbar level the external ligamentous structures were identified and their origin, insertion and position were determined. Part II of the study consisted of the anatomical analysis of the external transforaminal ligaments in the 180 lumbar intervertebral foramina on the MR images (1.5 T) in the sagittal plane. The diagnostic procedure was performed on 18 individuals from 18 to 25 years of age. The external transforaminal ligaments were observed at all levels and from both sides in the lumbar intervertebral foramen. The presence of the superior corporotransverse ligament was found in 45.56% intervertebral foramina, while the inferior corporotransverse ligament was found in 61.67% intervertebral foramina in the MRI. Our results confirm that external transforaminal ligaments are common structures in the intervertebral foramen. The results of this study show that the external transforaminal ligaments can be clearly visualized in MR images. It is crucial to have previous knowledge of the cadaveric specimens to recognize the transforaminal ligaments in MR images. The presence of these ligaments is clinically important because the ligaments could be the cause of nerve root compression or the low back pain syndrome.

  15. The role of the antebrachiocarpal ligaments in the prevention of hyperextension of the antebrachiocarpal joint.

    Science.gov (United States)

    Milgram, Joshua; Milshtein, Tomer; Meiner, Yaron

    2012-02-01

    To evaluate the role of the medial collateral ligament, lateral collateral ligament, and the palmar carpal ligaments in the prevention of hyperextension of the antebrachiocarpal (AC) joint. In vitro experiment. Cadaveric canine thoracic limbs (n = 12 pair). Thoracic limbs from 12 healthy mixed breed dogs, free of carpal joint pathology, were assigned to 1 of 6 groups, defined by the order in which the ligaments stabilizing the AC joint were cut. The antebrachium, carpus, and proximal metacarpal (MC) bones were stripped of all muscle tissue, preserving the carpal joint capsule. After specimens were prepared for biomechanical testing, the manus was loaded using a system of weights and pulleys to extend the carpus. Extension was measured using a single motion tracking sensor fixed to the MC bones. All specimens were tested with all ligaments intact and after cutting each of the ligaments. Cutting each of the ligaments resulted in a significant change in the angle of extension of the carpus when compared with carpal extension with the ligaments intact. Cutting the palmar AC ligaments resulted in a significantly larger change in extension angle than occurred after cutting the medial and lateral collateral ligaments. Each of the ligaments tested contribute to the prevention of hyperextension of the AC joint. © Copyright 2011 by The American College of Veterinary Surgeons.

  16. Crx broadly modulates the pineal transcriptome

    Science.gov (United States)

    Rovsing, Louise; Clokie, Samuel; Bustos, Diego M.; Rohde, Kristian; Coon, Steven L.; Litman, Thomas; Rath, Martin F.; Møller, Morten; Klein, David C.

    2011-01-01

    Cone-rod homeobox (Crx) encodes Crx, a transcription factor expressed selectively in retinal photoreceptors and pinealocytes, the major cell type of the pineal gland. Here, the influence of Crx on the mammalian pineal gland was studied by light and electron microscopy and by use of microarray and qRTPCR technology, thereby extending previous studies on selected genes (Furukawa et al. 1999). Deletion of Crx was not found to alter pineal morphology, but was found to broadly modulate the mouse pineal transcriptome, characterized by a >2-fold downregulation of 543 genes and a >2-fold upregulation of 745 genes (p pineal glands of wild-type animals; only eight of these were also day/night expressed in the Crx−/− pineal gland. However, in the Crx−/− pineal gland 41 genes exhibit differential night/day expression that is not seen in wild-type animals. These findings indicate that Crx broadly modulates the pineal transcriptome and also influences differential night/day gene expression in this tissue. Some effects of Crx deletion on the pineal transcriptome might be mediated by Hoxc4 upregulation. PMID:21797868

  17. The response of periodontal ligament collagen fibres and the thickness of inserting periodontal ligament fibre bundles at cementum pressure sites of fixed orthodontic appliances

    Directory of Open Access Journals (Sweden)

    Noengki Prameswari

    2007-06-01

    Full Text Available Previous research has indicated that there were several reactions in cellular activity and periodontal ligament collagen fibre as a response after orthodontic force application. Cementum has function to give attachment to collagen fibres of the periodontal ligament, maintaining the integrity of the root, helping to maintain the tooth in its functional position in the mouth, and being involved in tooth repair and regeneration so in the orthodontic tooth movement can induce changes in the cementum. The aim of this research is to investigate that fixed orthodontic appliance can change the amount of periodontal ligament collagen fibre and the thickness of inserting periodontal ligament fibre bundles at pressure site of cementum. This experimental study was held in laboratory with post test only control group design. Twenty two (22 premolar sample from 11 patient were divided into 2 groups. K group as control group (without treatment and P group as treatment group (with using fixed orthodontic appliance. The amount of periodontal ligament collagen fibre and thickness of inserting periodontal ligament fibre bundles was examined by light microscopy and measured by image tool program. In the summary, there are increasing amount of periodontal ligament collagen fibre and the thickness of inserting periodontal ligament fibre bundles at cementum pressure sites as a normal response to remodeling and regenerating to orthodontic appliance and have function for strengthen adhering tooth cementum to the periodontal ligament.

  18. Emerging Trends in Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Budny, Jacob; Fox, Joseph; Rauh, Michael; Fineberg, Marc

    2017-01-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed and researched orthopedic procedures. As technology and comparative research have advanced, surgical practices have changed to achieve a superior outcome. Our group performed a survey of orthopedic surgeons to evaluate current practice trends and techniques as a follow-up to similar surveys performed in 1999 and 2006. In a survey between 2013 and 2014 consisting of 35 questions regarding the surgical technique, graft choice, fixation method, and perioperative care in ACL reconstruction was sent electronically to the members of the American Orthopaedic Society of Sports Medicine and the Arthroscopy Association of North America. Responses were recorded and compared with previous results. Survey responses were received from 824 active surgeons. Of the respondents, 89.4% are subspecialty trained, 98% of which in sports medicine. Preoperatively, full-knee extension was the only "very significant" factor in surgical timing. Approach preference via an arthroscopic-assisted single-incision approach predominated (89%)-similar to earlier results. Bone-patellar-tendon-bone use decreased relative to hamstring allograft at 45 and 41%, respectively. Tibial tunnel placement shifted anteriorly and femoral tunnel placement shifted posterosuperiorly as compared with the results obtained 5 years ago. Femoral drilling through a low medial portal was preferred in 47% of responses, increased from 15%. Preferred fixation on both the tibial and femoral sides was either metal or bioabsorbable interference screws. The use of transfixation pins and other devices decreased. Postoperative rehab protocols did not significantly change, 68.7% preferred full-weight bearing, 55% using a range of motion knee brace locked in extension, 66.4% starting physical therapy 1 week postoperatively, with unrestricted activity at 6 to 9 months. Overall, an increasing trend toward using hamstring autograft and drilling the

  19. Morphological study of mechanoreceptors in collateral ligaments of the ankle joint.

    Science.gov (United States)

    Wu, Xiaochuan; Song, Weidong; Zheng, Cuihuan; Zhou, Shixiong; Bai, Shengbin

    2015-06-12

    The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle collateral ligaments using histological techniques, in order to observe the morphology and distribution of mechanoreceptors in the collateral ligaments of cadaver ankle joint, and to provide the morphological evidence for the role of the ligament in joint sensory function. Twelve lateral collateral ligaments including anterior talofibular ligament (ATFL; n = 6), posterior talofibular ligament (PTFL; n = 6), and calcaneofibular ligament (CFL; n = 6) were harvested from six fresh frozen cadavers. The ligaments were embedded in paraffin, sectioned at 4 μm, and then stained using a modified gold-chloride staining methods. The collateral ligament was divided into three segments: proximal, middle, and distal segments. Fifty-four ATFL slides, 90 PTFL slides, and 108 CFL slides were analyzed. Mechanoreceptors were classified based on Freemen and Wyke's classification. Mechanoreceptor distribution was analyzed statistically. One-way ANOVA (postHoc LSD) was used for statistical analysis. All the four typical types of nerve endings (the Ruffini corpuscles, Pacinian corpuscles, Golgi tendon organs, and free nerve endings) were identified in these ligaments. Pacinian corpuscles were the predominant in all four complexes. More mechanoreceptors were found in synovial membrane near both ends of the ligaments attached to the bone. No statistical differences were found in the amount of mechanoreceptors among distal, middle, and proximal parts of the ligaments. The four typical types of mechanoreceptors were all identified in the collateral ligaments of the human ankle. Pacinian corpuscles were the predominant in all four complexes. This indicates that the main function of ankle collateral ligaments is to sense joint speeds in motions.

  20. Anterior Cruciate Reconstruction Using Bone-patellar Ligament ...

    African Journals Online (AJOL)

    Methods: Thirty five patients with anterior cruciate ligament tear in one knee and a normal contralateral knee were evaluated and followed up for six years. Clinical history, physical evaluation, X-ray and athroscopies were done to rule out concomitant meniscal lesions and facilitate their treatment accurately. Follow up ...

  1. Palmar annular ligament desmotomy in horses with the Arthrex ...

    African Journals Online (AJOL)

    Ibrahim Eldaghayes

    2018-01-25

    Jan 25, 2018 ... Published: 07/02/2018. Palmar annular ligament desmotomy in horses with the Arthrex-Centerline™ ... Ten horse distal front limbs from horses free of PAL disease were prepared for tenoscopy of the digital flexor tendon sheath .... operative field, a better diagnosis and a reduction in both the surgical wound.

  2. Anterior cruciate ligament reconstruction complicated by pyoderma gangrenosum

    OpenAIRE

    Bagouri, E; Smith, Jon; Geutjens, G

    2012-01-01

    We report a case of pyoderma gangrenosum as a complication of an anterior cruciate ligament reconstruction in a patient with inflammatory bowel disease, which was misdiagnosed initially as a post-operative wound infection. An early dermatology opinion and skin biopsy should be considered in cases of suspected infection where thorough surgical debridement and antimicrobial therapy has failed to improve the clinical picture.

  3. Patient-Reported Outcome Following Ulnotriquetral Ligament Split Tear Repair.

    Science.gov (United States)

    Tang, Camelia Qian Ying; Lai, Sean Wei Hong; Leow, Geraldine; Tay, Shian Chao

    2017-12-01

    While the clinical presentation and mechanism of injury of ulnotriquetral (UT) ligament split tear had been well described, there has been no other studies that has reported on the outcome of a UT ligament repair. This study aims to look at the patient-reported outcomes following UT ligament split tear repair. 18 wrists (13 right and 5 left) in 17 patients (12 males and 5 females, mean age 25.0 ± 8.4 years, range 16-50 years) who had UT ligament split tear and undergone surgical repair between November 2007 and December 2013 were retrospectively analysed. Patient-reported outcome of resolution of pain, and objective measurements such as improvement in grip strength and range of movement of the wrist were recorded. Patients were followed up until the pain was completely resolved or the last documented consultation. The mean follow-up duration was 16.2 months. 94% reported improvements post-surgery, of which 63% reported complete resolution of pain. 6% reported no improvement in pain post-operatively. No patient reported worsening of pain after the surgery. There was significant improvement in grip strength from a mean of 23.5 kg to 27.1 kg. There was no significant change in range of motion of the wrist. The majority of patients reported resolution or improvement of pain after surgical repair. In addition, there was statistically significant improvement in grip strength recorded.

  4. Ultrasonographic evaluation of fetlock annular ligament constriction in the horse.

    Science.gov (United States)

    Dik, K J; van den Belt, A J; Keg, P R

    1991-07-01

    The diagnosis of restriction of free movement of the flexor tendons through the fetlock canal usually rests on the characteristic clinical appearance of this condition, or airtendography. In a series of seven normal Warmblood horses and 16 diseased horses of various breeds, the efficacy of ultrasonography in the diagnosis of this condition was determined. In normal limbs, the annular ligament is a very thin structure usually not visible on sonograms. In diseased limbs, ultrasonography outlined flexor tendon injury, distension and thickening of the digital sheath, peritendovaginal tissue proliferation and thickening of the annular ligament. Four different types of constriction syndrome were noticed. The first type (nine cases), was characterised by thickening of the annular ligament and distension of the digital sheath; the second type (three cases) was dominated by distension of the digital sheath; the third type (three cases) was characterised by superficial digital flexor tendon injury and thickening of the annular ligament and in the fourth type (one case), the constriction resulted from distension of the digital sheath and extensive peritendovaginal tissue proliferation.

  5. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair

    OpenAIRE

    Yong, Elaine X. L.; Cheong, Elaine Y.L.; Boutlis, Craig S.; Chen, Darren B.; Liu, Eunice Y.-T.; McKew, Genevieve L.

    2015-01-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis.

  6. Mucoid degeneration of the anterior cruciate Ligament: a case report ...

    African Journals Online (AJOL)

    We report a case of mucoid degeneration of the anterior cruciate ligament (ACL). Mucoid degeneration of the ACL is a very rare cause of knee pain. There have been only some reported cases of mucoid degeneration of the ACL in the English literature. We reviewed previous reports and summarized clinical features and ...

  7. Return to work in miners following anterior cruciate ligament ...

    African Journals Online (AJOL)

    Introduction: The aim of the study is retrospectively investigated durations for returning to work following anatomic ACL reconstruction by hamstring autograft in miners and the reasons in patients who were delayed to return to work. Methods: Miners with symptomatic anterior cruciate ligament rupture underwent arthroscopic ...

  8. The effect of anterior cruciate ligament injury on bone curvature

    DEFF Research Database (Denmark)

    Hunter, D J; Lohmander, Stefan; Makovey, J

    2014-01-01

    OBJECTIVE: Investigate the 5-year longitudinal changes in bone curvature after acute anterior cruciate ligament (ACL) injury, and identify predictors of such changes. METHODS: In the KANON-trial (ISRCTN 84752559), 111/121 young active adults with an acute ACL tear to a previously un-injured knee...

  9. Healing Potential of the Anterior Cruciate Ligament Remnant Stump.

    Science.gov (United States)

    Trocan, Ilie; Ceausu, Raluca A; Jitariu, Andreea A; Haragus, Horia; Damian, Gratian; Raica, Marius

    2016-01-01

    The aim of this study was to analyze the microstructural architecture and cellular differentiation of the anterior cruciate ligament (ACL) stumps in different stages after injury, as this could augment graft biointegration. The histological appearance and immunoreaction for cluster of differentiation 34 antigen (CD34) of 54 biopsies from 27 remnants were compared to 10 biopsies from 5 normal cruciate ligaments. CD34 reaction in endothelial cells, fibroblasts and fibrocytes was consistently positive in small synovial vessels. Remnants also exhibited CD34(+) cells among collagen fibers. Blood vessel density varied between specimens. The mean vascular microdensity was 43 per ×200 field in remnants compared to 15.2 in controls. A total of 94.44% of remnant ACL samples had significant hyperplasia of stellate and fusiform stromal cells, CD34(+); 22.4% had developed capillary vessels inside the ligament; 33% exhibited ongoing angiogenesis. Significant differences exist between torn and intact ACL regarding microvascularization. The remnants contain stellate stromal cells and CD34(+) fibrocytes, and display angiogenesis both at synovia as well as in the ligament itself. These findings underline the potential contribution to neoligament healing when remnants are preserved. Copyright © 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  10. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    NARCIS (Netherlands)

    Hofbauer, Marcus; Muller, Bart; Wolf, Megan; Forsythe, Brian; Fu, Freddie H.

    2013-01-01

    Over the past decade, intense research of the function of the 2 distinct bundles, the anteromedial and posterolateral, of the anterior cruciate ligament (ACL) has led to pronounced changes in the technical concepts of ACL reconstruction. Recently, the renewed focus of ACL reconstruction has been to

  11. Results of the surgical reconstruction of the anterior cruciate ligament.

    Science.gov (United States)

    Zelić, Zoran; Jovanović, Savo; Wertheimer, Vjekoslav; Sarić, Gordan; Biuk, Egon; Gulan, Gordan

    2012-03-01

    Results of the surgical reconstruction of the anterior cruciate ligament (ACL), using as a graft fourfold hamstring tendons (gracilis and semitendinosus) and middle third of the patellar ligament, were compared. In all patients that were participating in this study clinical examination and magnetic resonance showed ACL rupture, and apart from the choice of the graft, surgical technique was identical. We evaluated 112 patients with implemented patellar ligament graft and fourfold hamstring tendons graft six months after the procedure. Both groups were similar according to age, sex, activity level, knee instability level and rehabilitation program. The results showed that there was no significant difference between groups regarding Lysholm Knee score, IKDC 2000 score, activity level, musculature hypotrophy, and knee joint stability 6 months after the surgery. Anterior knee pain incidence is significantly higher in the group with patellar ligament graft (44% vs. 21%). Both groups had a significant musculature hypotrophy of the upper leg of the knee joint that was surgically treated, six months after the procedure. Both grafts showed good subjective and objective results.

  12. Anterior cruciate ligament reconstruction in patients with generalized joint laxity.

    Science.gov (United States)

    Kim, Sung-Jae; Kumar, Praveen; Kim, Sung-Hwan

    2010-09-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation.

  13. ACL graft can replicate the normal ligament's tension curve.

    NARCIS (Netherlands)

    Arnold, M.P.; Verdonschot, N.J.J.; Kampen, A. van

    2005-01-01

    The anatomical femoral insertion of the normal anterior cruciate ligament (ACL) lies on the deep portion of the lateral wall of the intercondylar fossa. Following the deep bone-cartilage border, it stretches from 11 o'clock high in the notch all the way down to its lowest border at 8 o'clock. The

  14. ACL graft can replicate the normal ligament's tension curve

    NARCIS (Netherlands)

    Arnold, MP; Verdonschot, N; van Kampen, A

    2005-01-01

    The anatomical femoral insertion of the normal anterior cruciate ligament (ACL) lies on the deep portion of the lateral wall of the intercondylar fossa. Following the deep bone-cartilage border, it stretches from 11 o'clock high in the notch all the way down to its lowest border at 8 o'clock. The

  15. Comparative ultrasound study of acute lateral ankle ligament ...

    African Journals Online (AJOL)

    The purpose of this study was to establish the difference in rehabilitation outcomes between the Jump Stretch Flex Band (JSFB) programme and conventional ankle rehabilitation programmes of acute lateral ankle ligament injuries. This study compares the process of healing under the guidance of ultrasound in both groups.

  16. The concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction

    NARCIS (Netherlands)

    Hofbauer, M.; Muller, B. [=Bart; Murawski, C. D.; van Eck, C. F.; Fu, F. H.

    2014-01-01

    To describe the concept of individualized anatomic anterior cruciate ligament (ACL) reconstruction. The PubMed/Medline database was searched using keywords pertaining to ACL reconstruction. Relevant articles were reviewed in order to summarize important concepts of individualized surgery in ACL

  17. Anatomy and histology of the transverse humeral ligament.

    Science.gov (United States)

    Snow, Brian J; Narvy, Steven J; Omid, Reza; Atkinson, Roscoe D; Vangsness, C Thomas

    2013-10-01

    The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament. Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors. This study's findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator. Copyright 2013, SLACK Incorporated.

  18. Humeral avulsion of the glenohumeral ligament: The J sign ...

    African Journals Online (AJOL)

    The lesion resulting from humeral avulsion of the glenohumeral ligament (HAGL) is an important cause of anterior glenohumeral instability and can be seen in isolation or combination with an antero-inferior labral complex lesion. A conclusive magnetic resonance imaging diagnosis is aided when either a joint effusion is ...

  19. Extraforaminal ligaments of the cervical spinal nerves in humans

    NARCIS (Netherlands)

    Kraan, Gerald A.; Smit, Theo H.; Hoogland, Piet V. J. M.

    2011-01-01

    During the last 120 years, several mechanisms to protect the spinal nerve against traction have been described. All the described structures were located inside the spinal canal proximal to the intervertebral foramen. Ligaments with a comparable function just outside the intervertebral foramen are

  20. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair.

    Science.gov (United States)

    Yong, Elaine X L; Cheong, Elaine Y L; Boutlis, Craig S; Chen, Darren B; Liu, Eunice Y-T; McKew, Genevieve L

    2015-08-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  1. Degenerative Suspensory Ligament Desmitis – A New Reality

    Directory of Open Access Journals (Sweden)

    Jaroslava Halper*, Ahrar Khan1 and P. O. Eric Mueller2

    2011-01-01

    Full Text Available Degenerative suspensory ligament desmitis (DSLD is a chronic, debilitating disease occurring primarily in Peruvian Pasos and Peruvian Paso crosses. However, many other breeds are afflicted as well. DSLD is characterized by a slowly progressing bilateral or quadrilateral lameness. Typically, the owner does not recall any trauma or performance related injury. Fetlock effusion, static and dynamic hyperextension and degenerative joint disease are hallmarks on physical examination. Ultrasonography of affected ligaments reveals diffuse loss of echogenicity, and an irregular fiber pattern. Though until recently DSLD was considered a collagen disorder strictly limited to suspensory ligaments (SLs, our data show that it is a systemic disease involving tissues with high content of collagen. We have identified abnormal accumulations of proteoglycans not only in the SLs, but also in the superficial and deep digital flexor tendons, patellar and nuchal ligaments, aorta, coronary arteries and sclerae of DSLD-affected horses. Our most recent data point to the presence of an abnormal form of decorin in these proteoglycan deposits. This decorin also exhibited altered biological activity. Treatment for DSLD-affected horses is empirical and directed at minimizing musculoskeletal pain and providing support for the suspensory apparatus. Restricted exercise, supportive bandages and nonsteroidal anti-inflammatory drugs provide some, but usually only temporary relief. Unfortunately, unrelenting pain, severe lameness and suffering require all too often humane euthanasia.

  2. Benign Multicystic Mesothelioma in the Left Round Ligament: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Bae, So Young; Yi, Boem Ha; Lee, Hae Kyung; Park, Seong Jin; Cho, Gyu Seok; Kwak, Jeong Ja [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2010-02-15

    Benign multicystic mesothelioma is a rare mesothelial lesion that forms multicystic masses in the upper abdomen, pelvis, and retroperitoneum. Most cases have a benign course. We present the ultrasound and MR findings of benign multicystic mesothelioma in the left round ligament, which caused a left inguinal hernia in a 46-year-old woman.

  3. SPECT bone scintigraphy of medial collateral ligament/meniscus injury

    Energy Technology Data Exchange (ETDEWEB)

    Micallef, L.; Larcos, G. [Westmead Medical Imaging, Westmead, NSW (Australia)

    1998-06-01

    Full text: Acute or chronic knee pain is common amongst athletic persons. MRI is generally regarded as the best test, but is not widely available and may lack specificity in meniscal tears and cruciate injury. Bone scan with SPECT is an appealing alternative since it is relatively cheap and easily obtained. Further, a number of investigators have published data indicating sensitivity and specificity exceeding 85%. The purpose of the study is to determine typical scintigraphic findings in medial collateral ligament or medial meniscus injury. We present a small group of patients with acute knee trauma in whom arthroscopy and/or clinical follow-up indicated medial collateral ligament injury. Bone scans were undertaken after 900-1000 MBq of {sup 99m}Tc-MDP with immediate blood pool, delayed planar images and SPECT acquired on a Picker Prism 2000. SPECT was obtained with high resolution collimators and 20 sec/stop for 180 deg each. SPECT images showed focal radiopharmaceutical accumulation in the medial proximal tibial shaft and medial femoral condyle, corresponding to the superficial layer of the medial collateral ligament (best seen on coronal images). Disruption of the deep layer and/or medial meniscus can be suspected with abnormal uptake in part or all of the meniscus (best seen on transverse images). We conclude that acute/chronic medial collateral ligament injury can be detected on bone scintigraphy with abnormal uptake at the predicted anatomic site of attachment

  4. The Influence of Interleukin-4 on Ligament Healing

    Science.gov (United States)

    Chamberlain, Connie S; Leiferman, Ellen M; Frisch, Kayt E; Wang, Sijian; Yang, Xipei; Brickson, Stacey L; Vanderby, Ray

    2011-01-01

    Despite a complex cascade of cellular events to reconstruct the damaged extracellular matrix, ligament healing results in a mechanically inferior scarred ligament. During normal healing, granulation tissue expands into any residual normal ligamentous tissue (creeping substitution), resulting in a larger region of healing, greater mechanical compromise, and an inefficient repair process. To control creeping substitution and possibly enhance the repair process, the anti-inflammatory cytokine, interleukin-4 (IL-4) was administered to rats prior to and after rupture of their medial collateral ligaments. In vitro experiments demonstrated a time-dependent effect on fibroblast proliferation after interleukin-4 treatment. In vivo treatments with interleukin-4 (100 ng/ml i.v.) for 5 days resulted in decreased wound size and type III collagen and increased type I procollagen, indicating a more regenerative early healing in response to the interleukin-4 treatment. However, continued treatment of interleukin-4 to day 11 antagonized this early benefit and slowed healing. Together, these results suggest that interleukin-4 influences the macrophages and T-lymphocytes but also stimulates fibroblasts associated with the proliferative phase of healing in a dose-, cell-, and time-dependent manner. Although treatment significantly influenced healing in the first week after injury, interleukin-4 alone was unable to maintain this early regenerative response. PMID:21518087

  5. Morphology and History of Spinal Ligaments from Three Primates.

    Science.gov (United States)

    1981-07-01

    anatomical geometry of the vertebrae has been described in the literature by Swindler and Wood (1973), Kapandji (1974), Hamilton (1976), Gray (1977...131, 1978. 6. Heyling, D.J.A., "The supraspinous and Intraspinous Ligaments in the Dog, Cat and Baboon," J. Anati, 130(2):223-228, 1980. -. Kapandji

  6. Broad ion beam serial section tomography

    Energy Technology Data Exchange (ETDEWEB)

    Winiarski, B., E-mail: b.winiarski@manchester.ac.uk [School of Materials, University of Manchester, Manchester M13 9PL (United Kingdom); Materials Division, National Physical Laboratory, Teddington TW11 0LW (United Kingdom); Gholinia, A. [School of Materials, University of Manchester, Manchester M13 9PL (United Kingdom); Mingard, K.; Gee, M. [Materials Division, National Physical Laboratory, Teddington TW11 0LW (United Kingdom); Thompson, G.E.; Withers, P.J. [School of Materials, University of Manchester, Manchester M13 9PL (United Kingdom)

    2017-01-15

    Here we examine the potential of serial Broad Ion Beam (BIB) Ar{sup +} ion polishing as an advanced serial section tomography (SST) technique for destructive 3D material characterisation for collecting data from volumes with lateral dimensions significantly greater than 100 µm and potentially over millimetre sized areas. Further, the associated low level of damage introduced makes BIB milling very well suited to 3D EBSD acquisition with very high indexing rates. Block face serial sectioning data registration schemes usually assume that the data comprises a series of parallel, planar slices. We quantify the variations in slice thickness and parallelity which can arise when using BIB systems comparing Gatan PECS and Ilion BIB systems for large volume serial sectioning and 3D-EBSD data acquisition. As a test case we obtain 3D morphologies and grain orientations for both phases of a WC-11%wt. Co hardmetal. In our case we have carried out the data acquisition through the manual transfer of the sample between SEM and BIB which is a very slow process (1–2 slice per day), however forthcoming automated procedures will markedly speed up the process. We show that irrespective of the sectioning method raw large area 2D-EBSD maps are affected by distortions and artefacts which affect 3D-EBSD such that quantitative analyses and visualisation can give misleading and erroneous results. Addressing and correcting these issues will offer real benefits when large area (millimetre sized) automated serial section BIBS is developed. - Highlights: • In this work we examine how microstructures can be reconstructed in three-dimensions (3D) by serial argon broad ion beam (BIB) milling, enabling much larger volumes (>250×250×100µm{sup 3}) to be acquired than by serial section focused ion beam-scanning electron microscopy (FIB-SEM). • The associated low level of damage introduced makes BIB milling very well suited to 3D-EBSD acquisition with very high indexing rates. • We explore

  7. Against a Broad Definition of "Empathy"

    Directory of Open Access Journals (Sweden)

    Sarah Songhorian

    2015-04-01

    Full Text Available In this paper I will try to provide some arguments against a broad definition of “empathy”. Firstly, I will deal with attempts to define empathy as an umbrella concept. Then, I will try to point out the four main elements which contribute to the confusion that researchers in both the social and political as well as the scientific and philosophical domains face when dealing with empathy. In order to resolve this confusion, I suggest applying David Marr’s distinction to the field of empathy. Instead of providing an umbrella definition for empathy, which tries to account for all the data coming from different disciplines, I believe understanding that there are different levels of explanations and that different disciplines can contribute to each of them will provide a more detailed and less confused definition of empathy.

  8. Stress changes of lateral collateral ligament at different

    Directory of Open Access Journals (Sweden)

    ZHONG Yan-lin

    2011-04-01

    Full Text Available 【Abstract】 Objective: To create a 3-dimensional finite element model of knee ligaments and to analyse the stress changes of lateral collateral ligament (LCL with or without displaced movements at different knee flexion conditions. Methods: A four-major-ligament contained knee specimen from an adult died of skull injury was prepared for CT scanning with the detectable ligament insertion footprints, locations and orientations precisely marked in advance. The CT scanning images were converted to a 3-dimensional model of the knee with the 3-dimensional reconstruction technique and transformed into finite element model by the software of ANSYS. The model was validated using experimental and numerical results obtained by other scientists. The natural stress changes of LCL at five different knee flexion angles (0°, 30°, 60°, 90°, 120° and under various motions of anterior-posterior tibial translation, tibial varus rotation and internal-external tibial rotation were measured. Results: The maximum stress reached to 87%-113% versus natural stress in varus motion at early 30° of knee flexions. The stress values were smaller than the peak value of natural stress at 0° (knee full extension when knee bending was over 60° of flexion in anterior-posterior tibial translation and internal-external rotation. Conclusion: LCL is vulnerable to varus motion in almost all knee bending positions and susceptible to anterior- posterior tibial translation or internal-external rotation at early 30° of knee flexions. Key words: Knee joint; Collateral ligaments; Finite element analysis

  9. Arthroscopic dorsal capsulo-ligamentous repair in the treatment of chronic scapho-lunate ligament tears.

    Science.gov (United States)

    Wahegaonkar, Abhijeet L; Mathoulin, Christophe L

    2013-05-01

    Introduction Scapholunate ligament injuries usually result due to a fall on the outstretched hand leading to scapholunate instability. The natural history of untreated scapholunate instability remains controversial and usually results in late arthritic changes- the so-called "SLAC" wrist. The advent of wrist arthroscopy helps in early diagnosis and treatment of these serious injuries. In selected cases with reducible scapholunate instability (Garcia-Elias stages 2, 3 and 4) we propose a new "all arthroscopic dorsal capsulo- ligamentous repair" with the added advantage of early rehabilitation and prevention of post-operative stiffness. Material and Methods We report the results of our series of 57 consecutive patients suffering from chronic wrist pain refractory to conservative measures. All patients underwent a thorough clinical examination in addition to a standard set of radiographs and MRI exam; and they were treated by an all-arthroscopic dorsal capsulo-ligamentous repair under loco-regional anesthesia on an ambulatory basis. All patients were available for follow-up at regular intervals during the post-operative period. At follow-up, the wrist ROM in all directions, the grip strength, DASH questionnaire and pain relief based on the VAS were recorded for both- the operated and contra-lateral sides. Results There were 34 males & 23 females with a mean age of 38.72 ± 11.33 years (range 17-63 years). The dominant side was involved in 52 cases. The mean time since injury was 9.42 ± 6.33 months (range 3-24 months) and the mean follow-up was 30.74 ± 7.05 months (range 18-43 months). The mean range of motion improved in all directions. The mean difference between the post- and pre-operative extension was 14.03° (SEM = 1.27°; p < 0.001); while the mean difference between the post-and pre-operative flexion was 11.14° (SEM = 1.3°; p < 0.0001) with flexion and radial deviation reaching 84.3% and 95.72% respectively of the

  10. A Rare Case of Arteriovenous Hemangioma Clinically Mimicking Pigmented Nevus

    Directory of Open Access Journals (Sweden)

    Sri Lestari

    2015-05-01

    Full Text Available Abstrak   Arteriovenous hemangioma (AH adalah lesi jinak pembuluh darah kulit yang jarang, biasanya muncul pada kulit wajah berupa lesi tunggal, meninggi, papul merah, atau keunguan; kadang-kadang papul coklat. Dilaporkan satu kasus AH dengan gambaran klinis menyerupai nevus pada pasien perempuan yang berusia 19 tahun. Ini adalahkasus pertama di Bagian Ilmu Kesehatan Kulit dan Kelamin RS. Dr. M. Djamil Padang. Pasien datang dengan keluhan bintik hitam di lengan kanan bawah sejak satu bulan lalu. Pada pemeriksaan fisik, terdapat papul hitam soliter, dengan ukuran 0,3 x 0, 4 mm, bentuk bulat, skuama halus,  berbatas tegas, pinggir reguler dengan permukaan tidak rata.Berdasarkan pemeriksaan histopatologi, lesi terdiri dari pembuluh darah yang berdinding tebal dan berdinding tipis yang sangat melebar, penuh dengan eritrosit dan dilapisi oleh selapis endotel yang sesuai untuk AH. Arteriovenous hemangioma adalah tumor yang dijumpai pada usia pertengahan hingga dewasa lanjut dengan puncak insiden pada dekade keempat dan kelima kehidupan. Pada kasus ini, umur pasien tergolong dewasa muda dengan gambaran klinis lesi menyerupai nevus pigmentosus. Kata kunci: arteriovenous hemangioma, kasus jarang, nevus pigmentosus Abstract Arteriovenous hemangioma (AH is a rare benign vascular skin lesion, which typically appears in the skin of the face and extremities and  most commonly occurring on the head and neck region with appearances as single, raised, red, or violaceous papules; sometime tan papule. A case of AH clinically mimicking pigmented nevus in 19year-old womanwas reported. This is the first case in Dermatology Department of Dr.M. Djamil Padang Hospital. She complained about a black pimple on the right lower arm since one month. Physical examination: there is a solitare black papule, with 0,3x0,4 mm, round shape, fine scales, well defined, regular border with irreguler surface.Histopathology findings: the lesions consist of thicked-walled and very

  11. Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study.

    Science.gov (United States)

    Lee, Kyung-Tai; Lee, Jung Il; Sung, Ki Sun; Kim, J-Young; Kim, Eung Soo; Lee, Sang-Heon; Wang, Joon Ho

    2008-08-01

    The modified Brostrom procedure is commonly recommended for reconstruction of the anterior talofibular ligament (ATF) and calcaneofibular ligament (CF) with an advancement of the inferior retinaculum. However, some surgeons perform the modified Bostrom procedure with an semi-single ATF ligament reconstruction and advancement of the inferior retinaculum for simplicity. This study evaluated the initial stability of the modified Brostrom procedure and compared a two ligaments (ATF + CF) reconstruction group with a semi-single ligament (ATF) reconstruction group. Sixteen paired fresh frozen cadaveric ankle joints were used in this study. The ankle joint laxity was measured on the plane radiographs with 150 N anterior drawer force and 150 N varus stress force. The anterior displacement distances and varus tilt angles were measured before and after cutting the ATF and CF ligaments. A two ligaments (ATF + CF) reconstruction with an advancement of the inferior retinaculum was performed on eight left cadaveric ankles, and an semi-single ligament (ATF) reconstruction with an advancement of the inferior retinaculum was performed on eight right cadaveric ankles. The ankle instability was rechecked after surgery. The decreases in instability of the ankle after surgery were measured and the difference in the decrease was compared using a Mann-Whitney U test. The mean decreases in anterior displacement were 3.4 and 4.0 mm in the two ligaments reconstruction and semi-single ligament reconstruction groups, respectively. There was no significant difference between the two groups (P = 0.489). The mean decreases in the varus tilt angle in the two ligaments reconstruction and semi-single ligament reconstruction groups were 12.6 degrees and 12.2 degrees , respectively. There was no significant difference between the two groups (P = 0.399). In this cadaveric study, a substantial level of initial stability can be obtained using an anatomical reconstruction of the anterior talofibular

  12. Meniscus and ligament injuries; Meniskus- und Bandlaesionen

    Energy Technology Data Exchange (ETDEWEB)

    Glaser, C.; Trumm, C. [Klinikum Grosshadern der Ludwig-Maximilians-Universitaet Muenchen, Institut fuer Klinische Radiologie (Germany); Scheidler, J.; Heuck, A. [Radiologisches Zentrum Muenchen, Pasing (Germany)

    2006-01-01

    The knee is one of the major weight-bearing joints and is relatively exposed to trauma. Capsuloligamentous structures are essential to provide joint stability and - in turn - persistent instability bears a risk for osteoarthritis that needs timely and comprehensive diagnosis. Using MRI it may be beneficial to routinely apply (T)SE sequences in all three major planes as a basic protocol and to add additional sequences according to the clinical information available and imaging findings in the basic protocol. Especially fat-suppressed sequences (STIR, T2w/PDw FS TSE) are very useful because they sensitively depict bone marrow edema pattern (BMEP)-like changes. This finding often alerts the reader to - sometimes only discrete - underlying pathologies and may - if found in typical locations - give information about the mechanism of injury and thus lead the radiologist to look for specific concomitant capsuloligamentous, cartilage, and/or meniscal injury. BMEP is quite prominent in contusion injury, whereas often it is but discrete in avulsion lesions. There is extensive literature about the signs, possible pitfalls, and the accuracy of MRI for the diagnosis of specific pathologies such as meniscal tears or cruciate or collateral ligament ruptures. However, combined injuries of more than one structure are frequent and affect the therapeutic approach. Thus, the primary goal of the radiologist is to go beyond the description of any isolated lesion and to give a comprehensive description of (or to reliably exclude) any injury to other structures. A necessary prerequisite to accomplish this is a thorough knowledge of the - in some locations - complex anatomic relationships, pitfalls, and locations where lesions typically occur and where they may be overlooked. (orig.) [German] Das Knie ist vergleichsweise exponiert gegenueber Traumata. Sein Kapsel-Band-Apparat ist ein wesentlicher Faktor fuer die Gelenkstabilitaet. Umgekehrt erhoeht persistierende Instabilitaet das Risiko

  13. [MRI of the thumb collateral ligament at the metacarpophalangeal joint: anatomy and injuries].

    Science.gov (United States)

    Ye, Wei; Zhan, Huili; Bai, Rongjie; Qian, Zhanhua; Li, Yaxiong; Wu, Bodong

    2015-05-05

    To explore the anatomy and injuries features of the thumb collateral ligamentat the metacarpophalangeal (MCP) joints. The study was reviewed and approved by an institutional review board of hospital. Clinical imaging data of 7 healthy volunteers who without injuries and 20 patients with thumb collateral ligament injuries were retrospectively analyzed. All subjects underwent magnetic resonance examination, then comparative analysis of the normal anatomy and the thumb collateral ligament injury at MCP joints of MRI features in healthy volunteers and patients with injury. Imaging findings were compared with the surgical results and confirmed by followed up in patients. Seven volunteers without ligament injures showed homogeneous low-signal-intensity on T1-weighted and proton fat saturation sequence (PD-FS) images. The average thickness of the ulnarcollateral ligament is about 2.0 to 2.3 mm, however, the normal radial collateral ligament is thinner, the average thickness is about 1.4-1.5 mm. There were 20 patients with thumb collateral ligament injuresat MCP joints, including 12 cases of ulnar collateral ligament injury and 8 cases of radial collateral ligament injury, which demonstrated poor definition, discontinuity and heterogeneously increased signal intensity in proton fat saturation sequence (PD-FS) of the involved collateral ligament. There was edema in the soft tissues surrounding the injured sites. MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the thumb collateral ligamentsat MCP joints, and it is a useful tool for early diagnosis and treatment of the thumb collateral ligaments injuries.

  14. A real-time computational model for estimating kinematics of ankle ligaments.

    Science.gov (United States)

    Zhang, Mingming; Davies, T Claire; Zhang, Yanxin; Xie, Sheng Quan

    2016-01-01

    An accurate assessment of ankle ligament kinematics is crucial in understanding the injury mechanisms and can help to improve the treatment of an injured ankle, especially when used in conjunction with robot-assisted therapy. A number of computational models have been developed and validated for assessing the kinematics of ankle ligaments. However, few of them can do real-time assessment to allow for an input into robotic rehabilitation programs. An ankle computational model was proposed and validated to quantify the kinematics of ankle ligaments as the foot moves in real-time. This model consists of three bone segments with three rotational degrees of freedom (DOFs) and 12 ankle ligaments. This model uses inputs for three position variables that can be measured from sensors in many ankle robotic devices that detect postures within the foot-ankle environment and outputs the kinematics of ankle ligaments. Validation of this model in terms of ligament length and strain was conducted by comparing it with published data on cadaver anatomy and magnetic resonance imaging. The model based on ligament lengths and strains is in concurrence with those from the published studies but is sensitive to ligament attachment positions. This ankle computational model has the potential to be used in robot-assisted therapy for real-time assessment of ligament kinematics. The results provide information regarding the quantification of kinematics associated with ankle ligaments related to the disability level and can be used for optimizing the robotic training trajectory.

  15. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction.

    Science.gov (United States)

    Zhang, Xiangkai; Aoyama, Tomoki; Takaishi, Ryota; Higuchi, Shinya; Yamada, Shigehito; Kuroki, Hiroshi; Takakuwa, Tetsuya

    2015-01-01

    This study aimed to analyze the spatial developmental changes of rat cruciate ligaments by three-dimensional (3D) reconstruction using episcopic fluorescence image capture (EFIC). Cruciate ligaments of Wister rat embryos between embryonic day (E) 16 and E20 were analyzed. Samples were sectioned and visualized using EFIC. 3D reconstructions were generated using Amira software. The length of the cruciate ligaments, distances between attachment points to femur and tibia, angles of the cruciate ligaments and the cross angle of the cruciate ligaments were measured. The shape of cruciate ligaments was clearly visible at E17. The lengths of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) increased gradually from E17 to E19 and drastically at E20. Distances between attachment points to the femur and tibia gradually increased. The ACL angle and PCL angle gradually decreased. The cross angle of the cruciate ligaments changed in three planes. The primordium of the 3D structure of rat cruciate ligaments was constructed from the early stage, with the completion of the development of the structures occurring just before birth.

  16. Healing ligaments have shorter lifetime and greater strain rate during fatigue than creep at functional stresses.

    Science.gov (United States)

    Thornton, Gail M; Bailey, Soraya J

    2013-09-01

    Healing ligaments have compromised strength, which makes them susceptible to damage during daily activities at normal functional stresses. Daily activities expose ligaments to cyclic (fatigue) and static (creep) loading. A gap injury was created in the midsubstance of both hindlimb medial collateral ligaments of 40 female 1-year-old New Zealand White rabbits. After a 14-week healing interval, medial collateral ligament gap scars were exposed to long-term fatigue and creep loading over a range of functional force/stress levels. Lifetime and strain behavior were compared during fatigue and creep. The contribution of time-dependent mechanisms to fatigue lifetime was modeled using creep data. Fatigue-loaded healing ligaments had shorter lifetime, greater steady-state strain rate and greater increase in strain at 0.8 h than creep-loaded healing ligaments. The actual fatigue lifetime was less than the predicted fatigue lifetime which was derived from time-dependent damage alone, indicating an important role for cycle-dependent damage mechanisms in healing ligaments during fatigue loading. Cyclic loading decreased lifetime and increased strain rate and strain prior to rupture compared to static loading in healing ligaments. These findings suggest that, after a ligament injury, more care should be taken when exercises result in cyclic loading rather than static loading of the healing ligament even at functional stresses.

  17. Aetiology and pathogenesis of cranial cruciate ligament rupture in cats by histological examination.

    Science.gov (United States)

    Wessely, Marlis; Reese, Sven; Schnabl-Feichter, Eva

    2017-06-01

    Objectives The aim of this study was to examine histologically intact and ruptured cranial cruciate ligaments in cats, in order to evaluate whether degeneration is a prerequisite for rupture. Methods We performed a histological examination of 50 intact and 19 ruptured cranial cruciate ligaments in cadaver or client-owned cats, respectively, using light microscopy. Cats with stifle pathology were further divided into five age groups in order to investigate the relationship of changes in the ligament with lifespan. Cats with ruptured cranial cruciate ligaments were divided into two groups according to medical history (with presumed history of trauma or without any known history of trauma) in order to investigate the relationship of ligament rupture with a traumatic event. Data from 200 healthy cats were selected randomly and reviewed to make a statistical comparison of cats with and without cranial cruciate ligament rupture (reference group). Results On histological examination, the intact cranial cruciate ligaments showed basic parallel arrangement of the collagen fibres, with no relation to age. While cats of a more advanced age showed fibrocartilage in the middle of the cranial cruciate ligament - a likely physiological reaction to compression forces over the lifespan - degenerative changes within the fibrocartilage were absent in all cases, regardless of age or rupture status. Cats suffering from cranial cruciate ligament rupture without history of trauma were significantly older than cats in the reference group. Conclusions and relevance This study showed that differentiation of fibrocartilage in the middle of the cranial cruciate ligament is likely a physiological reaction to compressive forces and not a degenerative change associated with greater risk of rupture in advanced age. This finding in cats is distinct from the known decrease in differentiation of fibrocartilage in dogs with cranial cruciate ligament rupture. Furthermore, the histological examination

  18. Radio sterilized human ligaments and their clinical application;Ligamentos humanos radioesterilizados y su aplicacion clinica

    Energy Technology Data Exchange (ETDEWEB)

    Luna Z, D.; Reyes F, M. L. [ININ, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico); Diaz M, I.; Hernandez R, G., E-mail: daniel.luna@inin.gob.m [Centro Estatal de Trasplantes del Estado de Mexico, Pablo Sidar No. 602, Col. Universidad, 50130 Toluca, Estado de Mexico (Mexico)

    2009-10-15

    The ligaments are human tissues that are used in the transplantation area. A ligament is an anatomical structure in band form, composed by resistant fibers that connect the tissues that unite the bones with the articulations. In an articulation, the ligaments allow and facilitate the movement inside the natural anatomical directions, while it restricts those movements that are anatomically abnormal, impeding lesions that could arise of this type of movements. The kneecap ligament is a very important tissue in the knee mobility and of walking in the human beings. This ligament can injure it because of automobile accidents, for sport lesions or illnesses, and in many cases the only form of recovering the knee movement is carried out a transplant with the purpose of replacing the damage ligament by allo gen kneecap ligament processed in specialized Tissue Banks where the tissue is sterilized with gamma radiation of {sup 60}Co at very low temperatures, obtaining high quality ligaments for clinical application in injured patients. The kneecap ligaments are processed in the Tissue Banks with a segment of kneecap bone, a segment of tibial bone, the contained ligament between both bones and in some cases a fraction of the quadriceps tendon. In this work is given a description of the selection method of the tissue that includes the donor's serologic control, the kneecap ligament processing in the Radio Sterilized Tissues Bank, its sterilization with gamma radiation of {sup 60}Co, also it is indicated like the clinical application of the allo gen ligament was realized in a hasty patient and whose previous crossed ligament was injured. Finally the results are presented from the tissue obtaining until the clinical application of it is, and in this case is observed a favorable initial evolution of the transplantation patient. (Author)

  19. Tensile Engagement of the Peri-Ankle Ligaments in Stance Phase

    Science.gov (United States)

    Tochigi, Yuki; Rudert, M. James; Amendola, Annunziato; Brown, Thomas D.; Saltzman, Charles L.

    2008-01-01

    Background The efficacy of reconstructive surgical procedures that attempt to restore normal ankle kinematics theoretically requires a full biomechanical understanding of the natural human ankle during gait. The contribution of the peri-ankle ligaments versus the articular surfaces to ankle motion control is not yet well understood. Knowledge of the tensile engagement of the peri-ankle ligaments during stance phase is necessary in order to achieve physiologic motion patterns. Methods Eleven fresh-frozen cadaver ankles were subjected to a dynamic loading sequence simulating the stance phase of normal level gait. Simultaneously, ligament strain was continuously monitored in the anterior talofibular, calcaneofibular, and posterior talofibular ligaments, as well as in the anterior, middle, and posterior superficial deltoid ligaments. Eight of these specimens underwent further quasi-static range of motion testing, where ligament tension recruitment was assessed at 30° plantar flexion and 30° dorsiflexion. Results In the dynamic loading tests, none of the ligaments monitored showed a reproducible strain pattern consistent with playing a role in ankle stabilization. However, in the extended range of motion tests, most ligaments were often taut in plantar flexion or dorsiflexion. Conclusions A consistent combination of individual ligament strain patterns that principally control ankle motion was not manifest; rather, none of the ligaments under study were reproducibly recruited to be a primary stabilizing structure. The peri-ankle ligaments are likely to be secondary restraining structures that serve to resist motion, to avoid extreme positions. Stance phase ankle motion appears to be primarily controlled by articular congruity, not by peri-ankle ligament tension. Clinical Relevance Reconstructive ankle surgeries which aim to restore normal kinematics should focus on optimizing motion control by means of the articulating surface topography, rather than relying

  20. Enzyme-mimicking polymer brush-functionalized surface for combating biomaterial-associated infections

    Science.gov (United States)

    Jiang, Rujian; Xin, Zhirong; Xu, Shiai; Shi, Hengchong; Yang, Huawei; Song, Lingjie; Yan, Shunjie; Luan, Shifang; Yin, Jinghua; Khan, Ather Farooq; Li, Yonggang

    2017-11-01

    Biomaterial-associated infections critically compromise the functionality and performance of the medical devices, and pose a serious threat to human healthcare. Recently, natural DNase enzyme has been recognized as a potent material to prevent bacterial adhesion and biofilm formation. However, the vulnerability of DNase dramatically limits its long-term performance in antibacterial applications. In this work, DNase-mimicking polymer brushes were constructed to mimic the DNA-cleavage activity as well as the macromolecular scaffold of the natural DNase. The bacteria repellent efficacy of DNase-mimicking polymer brush-functionalized surface was comparable to that of the DNase-functionalized surface. More importantly, due to their inherent stability, DNase-mimicking polymer brushes presented the much better performance in inhibiting bacterial biofilm development for prolonged periods of time, as compared to the natural DNase. The as-developed DNase-mimicking polymer brush-functionalized surface presents a promising approach to combat biomaterial-associated infections.

  1. Multifocal Skeletal Tuberculosis Mimicking Metastasis Involving the Sternum, Lumbar Vertebra, and Sacrum

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun Ho; Cho, Soon Gu; Kim, Kwang Ho; Kim, Yeo Ju; Hyun, In Young; Lee, Kyung Hee [Inha University Hospital, Incheon (Korea, Republic of)

    2010-02-15

    The incidence of multifocal skeletal tuberculosis is very rare and its diagnosis, very difficult because of vague somatic symptoms and non-specific physical and radiologic findings. We report a case of multifocal skeletal tuberculosis mimicking metastasis

  2. Acute Fulminant Uremic Neuropathy Following Coronary Angiography Mimicking Guillain?Barre Syndrome

    OpenAIRE

    Priti, Kumari; Ranwa, Bhanwar

    2017-01-01

    A 55-year-old diabetic woman suffered a posterior wall ST-elevation myocardial infarction. She developed contrast-induced nephropathy following coronary angiography. Acute fulminant uremic neuropathy was precipitated which initially mimicked Guillan?Barre Syndrome, hence reported.

  3. Acute Fulminant Uremic Neuropathy Following Coronary Angiography Mimicking Guillain-Barre Syndrome.

    Science.gov (United States)

    Priti, Kumari; Ranwa, Bhanwar

    2017-01-01

    A 55-year-old diabetic woman suffered a posterior wall ST-elevation myocardial infarction. She developed contrast-induced nephropathy following coronary angiography. Acute fulminant uremic neuropathy was precipitated which initially mimicked Guillan-Barre Syndrome, hence reported.

  4. Cell-bound and extracellular matrix-associated alkaline phosphatase activity in rat periodontal ligament. Experimental Oral Biology Group.

    Science.gov (United States)

    Groeneveld, M C; Van den Bos, T; Everts, V; Beertsen, W

    1996-01-01

    In previous studies it was noted that alkaline phosphatase (ALP) activity in periodontal ligament does not only seem to be related to cells but may also be associated with the extracellular matrix. In an attempt to clarify this we studied the distribution of the enzyme at the electron microscopic level. In addition, ALP-activity was assessed biochemically following extraction of the ligament with (i) agents dissolving the membrane or splitting the phosphatidylinositol anchor (Triton X-100 or phosphatidylinositol-phospholipase C, respectively), and (ii) a matrix-degrading enzyme cocktail (collagenase, hyaluronidase and elastase). Histochemical observations revealed (a) a heterogeneous distribution of ALP-activity, with highest activity adjacent to the alveolar bone and (b) two pools of activity; one bound to cells and one associated with the collagenous extracellular matrix. In line with this were the biochemical data indicating that approximately 10% of the enzyme activity was firmly bound to the extracellular matrix and 90% to plasma membranes. Isoelectric focusing did not reveal differences between the two fractions, both samples yielding a single broad band corresponding with an isoelectric point of about 4.4.

  5. Orbital compressed air and petroleum injury mimicking necrotizing fasciitis.

    Science.gov (United States)

    Mellington, Faye E; Bacon, Annette S; Abu-Bakra, Mohammed A J; Martinez-Devesa, Pablo; Norris, Jonathan H

    2014-09-01

    Orbital injury secondary to petroleum-based products is rare. We report the first case, to our knowledge, of a combined compressed air and chemical orbital injury, which mimicked necrotizing fasciitis. A 58-year-old man was repairing his motorcycle engine when a piston inadvertently fired, discharging compressed air and petroleum-based carburetor cleaner into his left eye. He developed surgical emphysema, skin necrosis, and a chemical cellulitis, causing an orbital compartment syndrome. He was treated initially with antibiotics and subsequently with intravenous steroid and orbital decompression surgery. There was almost complete recovery by 4 weeks postsurgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Petroleum-based products can cause severe skin irritation and necrosis. Compressed air injury can cause surgical emphysema. When these two mechanisms of injury are combined, the resulting orbitopathy and skin necrosis can mimic necrotizing fasciitis and cause diagnostic confusion. A favorable outcome is achievable with aggressive timely management. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Visual Loss from Choroidal Melanoma Mimicking Neurological Syndromes

    Directory of Open Access Journals (Sweden)

    Karim Hammamji

    2017-03-01

    Full Text Available Melanoma of the eye is rare, but can mimic a range of disorders. This report highlights 2 cases of choroidal melanoma with vision loss mimicking neurological diagnoses. The first patient is a 41-year-old white male with a known history of multiple sclerosis and a previous episode of optic neuritis in the right eye, who presented with a 6-month history of decreased vision in the same eye, and occasional photopsiae. He was treated with 2 courses of oral steroids for presumed recurrent optic neuritis. After a temporary improvement in his symptoms, his vision worsened, following which he had a head MRI, which revealed a solid intraocular mass. He was subsequently diagnosed with a choroidal melanoma for which he was treated successfully with ruthenium-106 plaque brachytherapy. The second patient is a 57-year-old female, who presented with a progressive cerebellar syndrome under investigation by the neurology service, as well as decreased vision in the right eye. Her visual acuity gradually deteriorated and her neurological assessment, which included a PET-CT, revealed uptake in the right eye. The diagnosis of a choroidal melanoma was made, and following conservative treatment with proton beam radiotherapy, she had an enucleation of the eye. Intraocular tumours can masquerade as many different entities. Unexplained unilateral visual loss, especially if it is atypical for a neurological syndrome, should prompt dilated fundoscopy and referral to an ophthalmologist.

  7. Hepatic glycogenosis in type 1 diabetes mellitus mimicking Mauriac syndrome.

    Science.gov (United States)

    Jung, In Ah; Cho, Won Kyoung; Jeon, Yeon Jin; Kim, Shin Hee; Cho, Kyoung Soon; Park, So Hyun; Jung, Min Ho; Suh, Byung-Kyu

    2015-06-01

    Hepatic glycogenosis in type 1 diabetes mellitus (DM) can be caused by poor glycemic control due to insulin deficiency, excessive insulin treatment for diabetic ketoacidosis, or excessive glucose administration to control hypoglycemia. Mauriac syndrome, which is characterized by hepatomegaly due to hepatic glycogenosis, growth retardation, delayed puberty, and Cushingoid features, is a rare diabetic complication. We report a case of hepatic glycogenosis mimicking Mauriac syndrome. A 14-year-old girl with poorly controlled type 1 DM was admitted to The Catholic University of Korea, Seoul St. Mary's Hospital for abdominal pain and distension. Physical examination revealed hepatomegaly and a Cushingoid face. The growth rate of the patient had decreased, and she had not yet experienced menarche. Laboratory findings revealed elevated liver enzyme levels. A liver biopsy confirmed hepatic glycogenosis. Continuous glucose monitoring showed hyperglycemia after meals and frequent hypoglycemia before meals. To control hyperglycemia, we increased insulin dosage by using an insulin pump. In addition, we prescribed uncooked cornstarch to prevent hypoglycemia. After strict blood glucose control, the patient's liver functions and size normalized. The patient subsequently underwent menarche. Hepatic glycogenosis is a complication of type 1 DM that is reversible with appropriate glycemic control.

  8. Duodenal White Spots Mimicking Intestinal Candidiasis: Report of Case

    Directory of Open Access Journals (Sweden)

    Ozgur Turk

    2015-12-01

    Full Text Available Duodenal white spots are mentioned in these nonspecific lesions until recently. Although there is not enough studies about duedonal white spots yet; these lesions described in a separate syndrome. Here now we reported a case that we diagnosed multiple Duodenal white spots mimicking intestinal candidiasis. Clinical manifestation and endoscopic appearance of lesions gave rise to thought intestinal candidiasis histopathological examination revealed us several duodenitis. There was no evidence of fungal infection in PAS staining. Early after endoscopy patient took treatment of Lansoprozole at the 30 mg dose and bismuth salicylate. Patients compliant declined and control endoscopy exposed white duodenal spots cleared away three months later. Duodenal white spots are becoming to be designated as a separate disease even a syndrome. Etiology of duodenal white spots must be determined carefully during endoscopy. Sometimes it is difficult to make the correct diagnosis by appearance of lesion; in such cases histopathological examination can be useful both differential diagnosis of disease and determination of etiological factor. [J Contemp Med 2015; 5(4.000: 249-252

  9. Follicular thyroid carcinoma mimicking meningioma: A case report

    Directory of Open Access Journals (Sweden)

    Krishnalatha Buandasan

    2012-02-01

    Full Text Available Follicular thyroid carcinoma (FTC is a well-differentiated tumor which resembles the normal microscopic pattern of the thyroid. Although intracranial metastasis to the brain is frequent in adults, metastasis from FTC is very rare. Dural metastases mimicking meningioma have been documented in the literature now and then. However, cases arising from a FTC are again very rare. We report the case of a middle-aged lady who presented with progressive, painless left eye proptosis. She was noted to have a non-axial proptosis with dystopia, compressive optic neuropathy and exposure keratitis. She also had a painless swelling over the occipital region. She was initially misdiagnosed to have multiple foci of meningioma based on magnetic resonance imaging findings. Subsequent histopathological examination revealed presence of FTC. She was euthyroid but was found to have multiple small thyroid nodules by ultrasonography. Hence, the definite diagnosis of all dural masses must be histological wherever possible and thyroid carcinoma should be considered as a potential primary tumour in such presentations.

  10. A case of relapsing polychondritis mimicking Ludwig’s angina

    Directory of Open Access Journals (Sweden)

    Adnan Agha

    2009-09-01

    Full Text Available Relapsing polychondritis (RP is a severe progressive inflammatory condition involving cartilaginous structures and caused by an autoimmune process, for which there is no confirmatory serological biomarker and which still is diagnosed on a mainly clinical basis. RP has been associated with many diseases like Sweet’s syndrome, Behcet’s disease, rheumatoid arthritis, and other autoimmune disorders. We attempt to describe here a unique case of a 38-year-old female with a high-grade fever, sore throat, difficulty in swallowing, hoarseness of the voice, and found to have signs of tongue swelling and inflammation of the oral cavity that mimicked Ludwig’s angina, necessitating antibiotic use. On careful re-evaluation the patient was diagnosed to have relapsing polychondritis based on auricular and respiratory tract chondritis and response to steroids. The purpose of this report is to emphasize the fact that careful clinical assessment is needed to diagnose RP, which may be misdiagnosed as Ludwig’s angina.

  11. Idiopathic Transverse Myelitis Mimicking an Intramedullary Spinal Cord Tumor

    Directory of Open Access Journals (Sweden)

    Andrew A. Fanous

    2016-01-01

    Full Text Available The differential diagnoses for spinal cord lesions include spinal tumors and inflammatory processes. The distinction between these pathologies can be difficult if solely based on imaging. We report for the first time to our knowledge a case of idiopathic transverse myelitis (ITM mimicking a discrete cervical spinal lesion in a 66-year-old man who presented with gait instability and neck pain. The patient’s symptoms failed to resolve after an initial course of steroid therapy. Surgical biopsy confirmed the diagnosis of ITM. Subsequent treatment with dexamethasone resulted in complete resolution of the symptoms as well as the intramedullary enhancement. ITM is most common in the cervical and thoracic spine, spanning 3-4 spinal segments. It usually occupies more than 50% of the cross-sectional area of the spinal cord and tends to be central, uniform, and symmetric. It exhibits patchy and peripheral contrast enhancement. These criteria are useful guidelines that help distinguish ITM from neoplastic spinal lesions. A decision to perform biopsy must take into consideration the patient’s clinical symptoms, the rate of progression of neurological deficits, and the imaging characteristics of the lesion. Surgical biopsy for questionable lesions should be reserved for patients with progressive neurological deficits refractory to empirical medical therapy.

  12. Strongyloides Colitis as a Harmful Mimicker of Inflammatory Bowel Disease

    Directory of Open Access Journals (Sweden)

    Julio Poveda

    2017-01-01

    Full Text Available Autoinfection caused by Strongyloides stercoralis frequently becomes a life-long disease unless it is effectively treated. There is overlapping histomorphology between Strongyloides colitis and inflammatory bowel disease; a low index of suspicion can lead to misdiagnosis and fatal consequences. We present a case of Strongyloides colitis mimicking the clinical and pathologic features of inflammatory bowel disease. A 64-year-old female presented to the emergency department with a four-day history of abdominal pain, diarrhea, and hematochezia. Colonoscopy revealed diffuse inflammation suggestive of inflammatory bowel disease, which led to initiation of 5-aminosalicylic acid and intravenous methylprednisolone. Biopsies of the colon revealed increased lymphoplasmacytic infiltrate of the lamina propria with eosinophilic microabscesses and presence of larvae, consistent with Strongyloides stercoralis. Immunosuppressive medication was halted. The patient ultimately died a few days later. This case emphasizes the importance of identifying the overlapping clinical and pathologic features of Strongyloides colitis and inflammatory bowel disease. A high index of suspicion and recognition of particular histological findings, including eosinophilic microabscesses, aid in the correct diagnosis. Definitive diagnosis is crucial as each disease carries distinct therapeutic implications and outcome.

  13. Cholangiocarcinoma and its mimickers in primary sclerosing cholangitis.

    Science.gov (United States)

    Lee, Jonghun John; Schindera, Sebastian T; Jang, Hyun-Jung; Fung, Scott; Kim, Tae Kyoung

    2017-12-01

    Cholangiocarcinoma (CCA) is the most common malignancy in primary sclerosing cholangitis (PSC). Approximately half of CCA are diagnosed within two years of initial diagnosis and often have a poor prognosis because of advanced tumor stage at the time of diagnosis. Thus, rigorous initial imaging evaluation for detecting CCA is important. CCA in PSC usually manifests as intrahepatic mass-forming or perihilar periductal-infiltrating type. Imaging diagnosis is often challenging due to pre-existing biliary strictures and heterogeneous liver. Multimodality imaging approach and careful comparison with prior images are often helpful in detecting small CCA. Ultrasound is widely used as an initial test, but has a limited ability to detect small tumors in the heterogeneous liver with PSC. MRI combined with MRCP is excellent to demonstrate focal biliary abnormalities as well as subtle liver masses. Contrast-enhanced ultrasound is useful to demonstrate CCA by demonstrating rapid and marked washout. In addition, there are other disease entities that mimic CCA including hepatocellular carcinoma, confluent hepatic fibrosis, IgG4-related sclerosing cholangitis, inflammatory mass, and focal fat deposition. In this pictorial essay, imaging findings of CCA in PSC is described and discuss the challenges in imaging surveillance for CCA in the patients with PSC. Imaging findings of the mimickers of CCA in PSC and their differentiating features are also discussed.

  14. Tophaceous gout of the lumbar spine mimicking a spinal meningioma.

    Science.gov (United States)

    Ribeiro da Cunha, Pedro; Peliz, António Judice; Barbosa, Marcos

    2016-11-05

    Although gout is a common metabolic disorder, it usually affects distal joints of the appendicular skeleton. Axial spine involvement is rare, with only 131 cases reported in the literature. The authors report a rare case of lumbar spinal gout mimicking a spinal meningioma. A 77-year-old man with a history of gout presented with chronic low back pain and progressive paraparesis. Imaging revealed a lumbar spine compressive mass lesion with a dural tail signal. The differential diagnosis was thought to be straightforward favoring a spinal meningioma. Tophaceous gout was never considered. The presence of a dural tail associated with the lesion is an interesting detail of this case, that strongly misguided it and to the best of our knowledge it is the first one reported in the literature. The patient underwent surgery and intra-operative findings were surprisingly different from those expected, revealing a chalky white mass lesion firmly adherent and compressing the dural sac. It was completely excised, leaving the dura intact. Histopathology confirmed the diagnosis of tophaceous gout. The patient was sent to physical therapy and had a complete remission of pain and neurological deficit, regaining his walking capacity. Although spinal gout is rare, it should be considered in the differential diagnosis for patients presenting with symptoms of spinal stenosis, a suspicion of neoplastic lesion of the spine, and a previous history of gout. Early diagnosis can ensure proper and timely medical management, perhaps avoiding neurological compromise and the need for surgery.

  15. Extramedullary Plasmacytoma Mimicking Pancreatic Cancer: An Unusual Presentation.

    Science.gov (United States)

    Sciancalepore, Daniela; Musci, Sergio; Fracella, Maria Rosaria; D'Alesio, Grazia; Sportelli, Azzurra; Ingravallo, Giuseppe; Vacca, Angelo; Ria, Roberto

    2016-01-01

    Multiple myeloma is a plasma cell tumor that homes to and expands in the bone marrow and that, despite the new available drugs, remains incurable. Extramedullary plasmacytoma is a not frequent manifestation during the natural history of multiple myeloma and is frequently associated with plasma cell bone marrow infiltration. The most common locations for an EMP include the gastrointestinal tract, pleura, testis, skin, peritoneum, liver, endocrine glands, and lymph nodes. Primary involvement of the gallbladder fossa is exceedingly rare. In this report, we describe a patient with multiple myeloma who achieved a clinical and serological remission after autologous transplant but progressed rapidly at extramedullary site mimicking a second cancer (i.e., pancreatic or biliary cancer). In this case, the extramedullary localization was refractory to standard therapy, differently from bone marrow localization, but responded to lymphoma-like therapy. In this patient (i) the particular site of developing plasmacytoma is the gallbladder fossa, (ii) the timing of onset of this neoplasm is immediately after autologous transplant, and (iii) its disjunction from primary myeloma is that it appears in clinical and serological remission phase which may be confounding during the diagnostic approach simulating a different tumor (solid tumor).

  16. Germinoma Mimicking Tumefactive Demyelinating Disease in Pediatric Patients.

    Science.gov (United States)

    Akiyama, Yukinori; Suzuki, Hime; Mikuni, Nobuhiro

    2016-01-01

    Cases of intracranial germinoma with granulomatous reaction are rare, so a pathological diagnosis of this disease is difficult. In this report, we describe the case of a 13-year-old boy with a bilateral thalamic germinoma which initially mimicked tumefactive demyelinating disease with inflammation, based on the clinical symptoms, imaging results and histology of a biopsy specimen obtained endoscopically. Upon examination of the cerebrospinal fluid, oligoclonal bands were detected. Although his symptoms and radiological findings improved following steroid pulse treatment, they worsened dramatically almost 1 year after the first surgery and even after an additional steroid pulse treatment. Prompted by the clinical course, a second biopsy was performed, and a pathological examination of the specimen showed a two-cell pattern. The diagnosis was changed to intracranial germinoma. After chemotherapeutic treatment with etoposide and cisplatin, the patient's symptoms and radiological findings dramatically improved. We conclude that it is very challenging to distinguish germinomas with a granulomatous reaction due to other inflammatory diseases, especially when only small specimens can be obtained. Stereotactic or endoscopic biopsies should be performed using samples from several different points even if the lesions are associated with eloquent brain regions. © 2016 S. Karger AG, Basel.

  17. Bartonella henselae Infection: An Uncommon Mimicker of Autoimmune Disease

    Science.gov (United States)

    Maritsi, Despoina N.; Zarganis, Diagoras; Metaxa, Zoi; Papaioannou, Georgia; Vartzelis, George

    2013-01-01

    We present a case of a seven-year-old immunocompetent female patient who developed systemic symptoms mimicking an autoimmune rather than an infectious disease. The patient presented with rash, biquotidian fever, night sweats, and arthralgias. There was no antecedent history of cat contact. Investigations showed increased inflammatory markers, leukocytosis, thrombocytosis, hypercalcemia, and raised angiotensin-converting enzyme. Interferon-gamma releasing assay for tuberculosis infection was negative. Abdominal imaging demonstrated multifocal lesions of the liver and spleen (later proved to be granulomata), chest X-ray showed enlarged hilar lymph nodes, and ophthalmology review revealed uveitis. Clinical, laboratory, and imaging features pointed towards sarcoidosis. Subsequently, raised titers (IgM 1 : 32, IgG 1 : 256) against Bartonella confirmed the diagnosis of B. henselae infection. She was treated with gentamycin followed by ciprofloxacin; repeat investigations showed complete resolution of findings. The presence of hepatic and splenic lesions in children with bartonellosis is well documented. Our case, however, exhibited certain unusual findings such as the coexistence of acute ocular and systemic involvement in an immunocompetent host. Serological testing is an inexpensive and effective way to diagnose bartonellosis in immunocompetent patients; we suggest that bartonella serology is included in the baseline tests performed on children with prolonged fever even in the absence of contact with cats in countries where bartonellosis is prevalent. PMID:23424700

  18. Retinal pigmentary changes in chronic uveitis mimicking retinitis pigmentosa.

    Science.gov (United States)

    Sevgi, D Damla; Davoudi, Samaneh; Comander, Jason; Sobrin, Lucia

    2017-05-18

    To present retinal pigmentary changes mimicking retinitis pigmentosa (RP) as a finding of advanced uveitis. We retrospectively reviewed charts of patients without a family history of inherited retinal degenerations who presented with retinal pigment changes and signs of past or present intraocular inflammation. Comprehensive eye examination including best-corrected visual acuity, slit-lamp examination and dilated fundus examination was performed on all patients in addition to color fundus photography, optical coherence tomography, fluorescein angiography (FA), and full-field electroretinogram testing. We identified five patients with ages ranging from 33 to 66 years, who presented with RP-like retinal pigmentary changes which were eventually attributed to longstanding uveitis. The changes were bilateral in three cases and unilateral in two cases. Four of five cases presented with active inflammation, and the remaining case showed evidence of active intraocular inflammation during follow-up. This study highlights the overlapping features of advanced uveitis and RP including the extensive pigmentary changes. Careful review of possible past uveitis history, detailed examination of signs of past or present inflammation and ancillary testing, with FA often being most helpful, are required for the correct diagnosis. This is important, because intervention can prevent further damage if the cause of the pigmentary changes is destructive inflammation.

  19. Toxicology Analysis of Tissue-Mimicking Phantom Made From Gelatin

    Science.gov (United States)

    Dolbashid, A. S.; Hamzah, N.; Zaman, W. S. W. K.; Mokhtar, M. S.

    2017-06-01

    Skin phantom mimics the biological skin tissues as it have the ability to respond to changes in its environment. The development of tissue-mimicking phantom could contributes towards the reduce usage of animal in cosmetics and pharmacokinetics. In this study, the skin phantoms made from gelatin were tested with four different commonly available cosmetic products to determine the toxicity of each substance. The four substances used were; mercury-based whitening face cream, carcinogenic liquid make-up foundation, paraben-based acne cleanser, and organic lip balm. Toxicity test were performed on all of the phantoms. For toxicity testing, topographical and electrophysiological changes of the phantoms were evaluated. The ability of each respective phantom to react with mild toxic substances and its electrical resistance were analysed in to determine the toxicity of all the phantom models. Four-electrode method along with custom made electrical impedance analyser was used to differentiate electrical resistance between intoxicated phantom and non-intoxicated phantom in this study. Electrical resistance values obtained from the phantom models were significantly higher than the control group. The result obtained suggests the phantom as a promising candidate to be used as alternative for toxicology testing in the future.

  20. A series of parapharyngeal glial heterotopia mimicking lymphatic malformation.

    Science.gov (United States)

    Haloob, Nora; Pepper, Christopher; Hartley, Benjamin

    2015-12-01

    Otolaryngologists will most frequently encounter extra-cranial glial tissue within the nasal cavity, where it is known as a 'nasal glioma', and may communicate with the dura. However, glial tissue can also present extra-nasally in the form of a neck mass with no intracranial connection. In these rare cases, they can present soon after birth as an enlarging neck mass, causing compressive symptoms with airway obstruction and feeding difficulties. In this way, it is often initially misdiagnosed as a more common lesion such as a lymphatic malformation, teratoma, branchial anomaly or vascular malformation. As with many congenital head and neck masses, offering the most the appropriate management relies heavily on radiological imaging and, where possible, histopathology from a diagnostic biopsy. Once the diagnosis of extra-nasal glial heterotopia has been confirmed, the gold standard management is complete surgical excision. We review three cases of extra-nasal glial heterotopia presenting to our institution over an eleven year period as a large neck mass, which mimicked other congenital neck lumps, and discuss them in the context of those in the literature. We highlight how their clinical and radiological features can easily be confused with lymphatic malformations, and the potential implications of misdiagnosis. Raising awareness of this diagnostic confusion will highlight the need for management of these cases within an appropriate paediatric multidisciplinary setting. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.