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Sample records for broad ligament

  1. Multiple and bilateral benign cystic teratomas of ovary with broad ligament leiomyoma: a case report

    OpenAIRE

    Choukimath S.M; Ramalingappa C.A

    2012-01-01

    Background: Benign cystic teratoma is the most common tumor of ovary. Though bilateralism is seen in 10-15% of the cases, bilateral and multiple benign cystic teratomas are rare and very few cases have been reported in the literature. Aim: We present a case of bilateral and multiple benign cystic teratomas with a broad ligament leiomyoma. Case findings: A 38 –year- old female presented with lower abdominal pain of 5 months duration. Ultrasonography of abdomen showed bilateral multiple adnexal...

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

    Directory of Open Access Journals (Sweden)

    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

  3. Hernia of the bladder through the broad ligament with renal agenesis and ipsilateral ureter blind ending.

    Science.gov (United States)

    El Madi, Aziz; Khattala, Khalid; Rami, Mohammed; Bouabdallah, Youssef

    2014-01-01

    Hernia through a defect of the broad ligament is extremely rare in children. These defects can result from a developmental defect or a spontaneous rupture of cystic formations remnants of mesonephric ducts or Müller. Genital anomalies associated with unilateral renal agenesis are more common in females. We report the case of a 13 months girl allowed for assessment of recurrent urinary tract infection; abdominal examination did not objectified palpable mass, the external genitalia were without abnormalities. Abdominal ultrasound revealed a left renal space is empty with a retrovesical cyst. Cystography was requested that objectified a large pelvic cystic mass retrovesical communicating with the bladder, there was also a left vesicoureteral reflux. Uro- MRI showed a cystic formation retrovesical communicating with the bladder, the right pelvic kidney; uterus is normal size for age. DMSA scintigraphy confirmed the absence of the left kidney with the right kidney that ensures 100% of total renal function. To surgical exploration we found a hernia of the bladder through the left broad ligament, the uterus was dislocated on the right side; left ovary was hypoplasic; the ipsilateral ureter was blind with renal agenesis, we performed by reduction of the bladder then closing the hernial orifice, dissection of the ureter with its ligation and section at the vesical stoma. The postoperative course was uneventful. Evolution is favorable. This observation illustrates a hernia of the bladder through the broad ligament associated with ovarian hypoplasia, renal agenesis and ipsilateral ureter blind ending; this association was not described to our knowledge in the literature. PMID:25422693

  4. Multiple and bilateral benign cystic teratomas of ovary with broad ligament leiomyoma: a case report

    Directory of Open Access Journals (Sweden)

    Choukimath S.M

    2012-01-01

    Full Text Available Background: Benign cystic teratoma is the most common tumor of ovary. Though bilateralism is seen in 10-15% of the cases, bilateral and multiple benign cystic teratomas are rare and very few cases have been reported in the literature. Aim: We present a case of bilateral and multiple benign cystic teratomas with a broad ligament leiomyoma. Case findings: A 38 –year- old female presented with lower abdominal pain of 5 months duration. Ultrasonography of abdomen showed bilateral multiple adnexal cystic masses with multiple hyper-echoic solid components. Laparoscopy was done. There were bilateral tumors, two on right side and three on left side. Posterior surface of the uterus showed a fibroid. Ovarian cystectomy and myomectomy was done under general anesthesia with preservation of both ovaries. Report of bilateral and multiple benign cystic teratomas with broad ligament fibroid was given. Conclusion: When teratomas are multiple and bilateral, recurrence in the form of a dermoid cyst (3% or immature teratoma (2-2.6% in the residual ipsilateral ovary is most frequent. Because of the rarity and increased recurrence rate, we are presenting this case.

  5. Genotyping diagnosis of nongestational choriocarcinoma involving fallopian tube and broad ligament: a case study.

    Science.gov (United States)

    Buza, Natalia; Rutherford, Thomas; Hui, Pei

    2014-01-01

    A 22 year-old G1P1 woman presented to the emergency room with clinical impression of "ruptured right adnexal mass" and underwent a right salpingo-oophorectomy to rule out ectopic pregnancy. Instead, gross and microscopic examination revealed a pure choriocarcinoma involving the right fallopian tube and broad ligament. On the basis of the patient's age, recent history of delivery, last menstrual period for 10 weeks, large tumor mass, and possible pelvic lymph node metastasis, the patient promptly started to receive 8 cycles of multiagent chemotherapy regimen with a working diagnosis of high-risk gestational choriocarcinoma. Subsequent DNA genotyping analysis showed that the tumor cells had an identical genetic profile to that of the normal tissue of the patient, therefore establishing a final diagnosis of nongestational choriocarcinoma. Six months after the initial presentation, a second surgery was performed to remove a persistent right para-adnexal mass, which showed only necrotic tissue upon microscopic examination. The patient received 1 additional cycle of multiagent chemotherapy. She was alive without evidence of recurrence 26 months after the initial diagnosis. PMID:24300537

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

    OpenAIRE

    Ross Claire; Sharma Sunita; Louca Onsy; Scurr Michelle; Hayes Andrew; Judson Ian

    2011-01-01

    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 presen...

  7. Bowel Obstruction and Peritoneal Dialysis: A Case Report of a Patient with Complications from a Broad Ligament Hernia

    Science.gov (United States)

    Otani-Takei, Naoko; Akimoto, Tetsu; Sadatomo, Ai; Saito, Osamu; Muto, Shigeaki; Kusano, Eiji; Nagata, Daisuke

    2016-01-01

    Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery. The concerns about the perioperative dialytic management as well as the diagnostic problems regarding the disease that arose in our experience with the present patient are also discussed.

  8. Mechanisms of anterior cruciate ligament injury

    International Nuclear Information System (INIS)

    The anterior cruciate ligament (ACL) may be injured by various mechanisms. Each mechanism is know to produce specific combinations of ligamentous and meniscal abnormalities. This paper reports that this project was undertaken to evaluate the ability of MR imaging to characterize fully these different patterns of ACL injury. Two hundred fifty knee MR examinations in patients with suspected ACL injury were reviewed retrospectively. The presence of ACL injury and associated ligamentous, capsular, meniscal, and bone marrow abnormalities were correlated with the clinical history and mechanism of injury. Surgical or arthroscopic follow-up was available in all patients. As expected, ACL injuries were found to have a broad spectrum of associated abnormalities identified by MR imaging. Several mechanism-specific patterns of ligamentous and meniscal injury were observed; however, patterns of bone marrow edema and injury proved to be the most useful in predicting the mechanism of injury

  9. Ultrasonography of ankle ligaments

    International Nuclear Information System (INIS)

    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)

  10. Anterior Cruciate Ligament (ACL) Injuries

    Science.gov (United States)

    ... Help a Friend Who Cuts? Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  11. Rupture of the meniscofibular ligament

    OpenAIRE

    Poyanli Oguz; Esenkaya Irfan; Ozkan Korhan; Unay Koray; Akan Kaya

    2010-01-01

    Abstract The meniscofibular ligament is an anatomically defined ligament of the knee in humans. However, there are no data regarding the prognosis following injury to this ligament. Our case was a 42-year-old man who presented at our clinic with pain of the lateral side of his left knee. MRI of his left knee revealed the rupture of the meniscofibular ligament. The mechanism of injury was consistent with anatomical and mechanical studies of the meniscofibular ligament. The patient was treated ...

  12. Endoscopic Intermetatarsal Ligament Decompression.

    Science.gov (United States)

    Lui, Tun Hing

    2015-12-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic decompression of the intermetatarsal nerve. The ligament is released by a retrograde knife through the toe-web portal under arthroscopic guidance through the plantar portal. PMID:27284515

  13. Endoscopic Intermetatarsal Ligament Decompression

    OpenAIRE

    Lui, Tun Hing

    2015-01-01

    Morton neuroma is an entrapment of the intermetatarsal nerve by the deep intermetatarsal ligament. It is usually treated conservatively. Surgery is considered if there is recalcitrant pain that is resistant to conservative treatment. The surgical options include resection of the neuroma or decompression of the involved nerve. Decompression of the nerve by release of the intermetatarsal ligament can be performed by either an open or minimally invasive approach. We describe 2-portal endoscopic ...

  14. Meniscotibial (coronary) ligament tears

    International Nuclear Information System (INIS)

    Preservation of the meniscus whenever possible is essential in maintaining knee stability and preventing premature osteoarthritis. Peripheral meniscal tears are the most amenable to surgical repair. This study evaluates the peripheral attachments of the medial meniscus and focuses on a specific tear limited to the meniscotibial ligament (coronary ligament). The diagnosis is made arthrographically when the medial meniscus floats above the tibial plateau without separating completely from the capsule. The lateral meniscus is rarely involved in this type of injury. (orig.)

  15. Anterior cruciate ligament (ACL) injury

    Science.gov (United States)

    Cruciate ligament injury - anterior; ACL injury; Knee injury - anterior cruciate ligament (ACL) ... confirm the diagnosis. It may also show other knee injuries. First aid for an ACL injury may include: ...

  16. Ankle ligament injuries

    Directory of Open Access Journals (Sweden)

    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. Cruciate ligament reflexes

    DEFF Research Database (Denmark)

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

    2002-01-01

    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 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...... isokinetic muscle work, and also during dynamic activity (gait). This inhibitory reflex subjectively resembledgiving way. The latency of the reflex was short in animals (about 3 ms) and long in humans (60-120 ms), probably caused by differences in the experimental setup and between species. The long latency...

  18. MR imaging of cruciate ligaments.

    Science.gov (United States)

    Naraghi, Ali; White, Lawrence M

    2014-11-01

    Cruciate ligament injuries, and in particular injuries of the anterior cruciate ligament (ACL), are the most commonly reconstructed ligamentous injuries of the knee. As such, accurate preoperative diagnosis is essential in optimal management of patients with cruciate ligament injuries. This article reviews the anatomy and biomechanics of the ACL and posterior cruciate ligament (PCL) and describes the magnetic resonance (MR) imaging appearances of complete and partial tears. Normal postoperative appearances of ACL and PCL reconstructions as well as MR imaging features of postoperative complications will also be reviewed. PMID:25442023

  19. Anterior Cruciate Ligament Injury

    OpenAIRE

    Vilaseca, Tomas; Chahla, Jorge; Rodriguez, Gustavo Gomez; Arroquy, Damián; Herrera, Gonzalo Perez; Orlowski, Belen; Carboni, Martín

    2015-01-01

    Objectives: The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterior cruciate ligament (ACL) than in a control group of volunteers without knee pathology. Methods: We included prospectively recreational athletes between 18 and 40 years with an acute ACL injury between January 2011 and January 2013. They were compared with a control group of volunteers recreational...

  20. Hindlimb unloading alters ligament healing

    Science.gov (United States)

    Provenzano, Paolo P.; Martinez, Daniel A.; Grindeland, Richard E.; Dwyer, Kelley W.; Turner, Joanne; Vailas, Arthur C.; Vanderby, Ray Jr

    2003-01-01

    We investigated the hypothesis that hindlimb unloading inhibits healing in fibrous connective tissue such as ligament. Male rats were assigned to 3- and 7-wk treatment groups with three subgroups each: sham control, ambulatory healing, and hindlimb-suspended healing. Ambulatory and suspended animals underwent surgical rupture of their medial collateral ligaments, whereas sham surgeries were performed on control animals. After 3 or 7 wk, mechanical and/or morphological properties were measured in ligament, muscle, and bone. During mechanical testing, most suspended ligaments failed in the scar region, indicating the greatest impairment was to ligament and not to bone-ligament insertion. Ligament testing revealed significant reductions in maximum force, ultimate stress, elastic modulus, and low-load properties in suspended animals. In addition, femoral mineral density, femoral strength, gastrocnemius mass, and tibialis anterior mass were significantly reduced. Microscopy revealed abnormal scar formation and cell distribution in suspended ligaments with extracellular matrix discontinuities and voids between misaligned, but well-formed, collagen fiber bundles. Hence, stress levels from ambulation appear unnecessary for formation of fiber bundles yet required for collagen to form structurally competent continuous fibers. Results support our hypothesis that hindlimb unloading impairs healing of fibrous connective tissue. In addition, this study provides compelling morphological evidence explaining the altered structure-function relationship in load-deprived healing connective tissue.

  1. Carpal Ligament Anatomy and Biomechanics.

    Science.gov (United States)

    Pulos, Nicholas; Bozentka, David J

    2015-08-01

    A fundamental understanding of the ligamentous anatomy of the wrist is critical for any physician attempting to treat carpal instability. The anatomy of the wrist is complex, not only because of the number of named structures and their geometry but also because of the inconsistencies in describing these ligaments. The complex anatomy of the wrist is described through a review of the carpal ligaments and their effect on normal carpal motion. Mastery of this topic facilitates the physician's understanding of the patterns of instability that are seen clinically. PMID:26205699

  2. Anterior cruciate ligament reconstruction

    International Nuclear Information System (INIS)

    This paper determines the efficacy of MR imaging in evaluation of the anterior cruciate ligament (ACL) following reconstructive surgery. Forty-three MR examinations were performed in 33 patients who had undergone previous arthroscopic ACL reconstruction with patellar bone-tendon- bone autografts (postoperative period, 1-24 months; mean, 5.2 months). Of the 40 studies performed in clinically stable knees (30 patients), MR demonstrated a well-defined, signal void ACL graft in 36. Of the three studies performed in three patients with clinical ACL laxity or suspected tear, the neoligament was of intermediate definition in one and nondiscernible in the other two. As in the native knee, buckling of the PCL was suggestive of ACL insufficiency. Bone tunnel placement, patellar tendon changes, and joint effusions were also evaluated

  3. [Treitz and his ligament].

    Science.gov (United States)

    van Gijn, Jan; Gijselhart, Joost P

    2011-01-01

    Václav (Wenzel) Treitz (1819-1872) grew up in the Czech community that was part of the Habsburg Empire. He studied medicine at the German Karl Ferdinand University in Prague where he specialised in pathological anatomy. He continued this specialisation in Vienna, under Rokitansky. In 1855, after a stint in Krakow (now Poland; then also under Austrian rule), he was appointed Professor of Pathological Anatomy in Prague during which time he discovered a small muscle that connected the duodenojejunal flexure with the coeliac axis. It was called the 'ligament of Treitz' for a long time, but is known today as the musculus suspensorius duodeni (suspensory muscle of duodenum). In addition to this, he focused on internal intestinal herniation alongside a peritoneal duplicature at the duodenojejunal junction ('arch of Treitz'). Treitz taught in Czech and became increasingly involved in patriotic agitations which estranged him from most of his colleagues. Eventually, his mental as well as physical health deteriorated. PMID:21557825

  4. Elbow medial collateral ligament injuries

    OpenAIRE

    Rahman, Ra’Kerry K.; Levine, William N.; Ahmad, Christopher S.

    2008-01-01

    Elbow medial collateral ligament sprain occurs when the elbow is subjected to a valgus force exceeding the tensile properties of the medial collateral ligament (MCL). This is an injury seen more often in throwing athletes. Understanding the differential diagnosis of medial elbow pain is paramount to diagnose MCL injury as well as addressing other medial elbow pathology. A natural evolution regarding MCL injury has occurred over the past 20 years, with modifications of the original surgical pr...

  5. Meniscus and ligament injuries

    International Nuclear Information System (INIS)

    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.)

  6. CT-arthrography of the cruciate ligaments

    International Nuclear Information System (INIS)

    The evaluation of the cruciate ligaments using CT in 218 patients shall be presented. An intraarticular administration of air must be performed. Special positionings are required in order to bring the axis of the cruciate ligaments into the cross-sectional plane of the CT. The normal appearance of the cruciate ligaments in CT-arthrography is described. A classification of the anterior cruciate ligament lesions with 4 different types is proposed. The four types of the anterior cruciate ligament lesions and the posterior cruciate ligament lesions are met with different frequency. For CT-arthrography a sensitivity of 93% and a specifity of 95% was found. In patients with previous reconstructive surgery of the cruciate ligaments the results can be objectively documented. Thus CT-arthrography can contribute in the diagnosis of postoperative complaints. (orig.)

  7. Ulnar Collateral Ligament Reconstruction

    Science.gov (United States)

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Background: Ulnar collateral ligament reconstruction (UCLR) is a common surgery performed in professional, collegiate, and high school athletes. Purpose: To report patient demographics, surgical techniques, and outcomes of all UCLRs performed at a single institution from 2004 to 2014. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent UCLR from January 1, 2004, through December 31, 2014, at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, athletic level, surgical technique, graft type, and complications. Data were collected prospectively, and patients were contacted via phone calls to obtain the return-to-sport rate, Conway-Jobe score, Andrews-Timmerman score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Continuous variable data were reported as weighted means, and categorical variable data were reported as frequencies with percentages. Results: A total of 187 patients (188 elbows) underwent UCLR during the study period (92% male; mean age, 19.6 ± 4.7 years; 78.2% right elbows). There were 165 baseball players (87.8% of all patients), 155 of whom were pitchers (82.5% of all patients). Ninety-seven (51.6%) were college athletes, 68 (36.2%) high school athletes, and 7 (3.7%) professional athletes at the time of surgery. The docking technique was used in 110 (58.5%) patients while the double-docking technique was used in 78 (41.5%). An ipsilateral palmaris longus graft was used in 110 (58.5%) patients while a hamstring autograft was used in 48 (25.5%) patients. The ulnar nerve was subcutaneously transposed in 79 (42%) patients. Clinical follow-up data were available on 85 patients. Mean follow-up was 60 ± 30.8 months. Overall, 94.1% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The mean KJOC score was 90.4 ± 6.7 and mean Andrews-Timmerman score was 92.5 ± 7

  8. 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 ...

  9. MR imaging findings in spring ligament insufficiency

    Energy Technology Data Exchange (ETDEWEB)

    Yao, L. [Department of Radiology, MRI, CCC Building, Georgetown University Medical Center, 3800 Reservoir Road, NW, Washington, DC 20007-2197 (United States); Gentili, A. [UCLA Department of Radiological Sciences, West Los Angeles VA Medical Center, CA (United States); Cracchiolo, A. [UCLA Department of Orthopedic Surgery, UCLA Center for the Health Sciences, 10833 LeConte Avenue, Los Angeles, CA 90024 (United States)

    1999-05-01

    Objective. Spring ligament insufficiency is associated with chronic posterior tibial tendon dysfunction, and may constitute an indication for surgical repair or reconstruction. This study examines the accuracy of MRI for the diagnosis of insufficiency of the spring ligament. Design and patients. Two experienced musculoskeletal radiologists independently scored the MRI findings in 13 cases of surgically proven spring ligament insufficiency and in 18 control subjects, using a standardized scoring system. Results. Insufficiency of the spring ligament was associated with increased signal heterogeneity on short TE spin echo images, and an increase in the thickness of the medial portion of the ligament. The sensitivity of MRI for the diagnosis of spring ligament insufficiency was 54-77%, while the specificity was 100%. MRI assessment of the plantar portion of the spring ligament was unreliable (kappa=0.33), but the assessment of global ligament integrity was substantially reproducible (kappa=0.76). Conclusion. The medial portion of the spring ligament can be reliably assessed on routine MRI. The findings of spring ligament insufficiency on MRI are only moderately sensitive but highly specific. (orig.) With 6 figs., 1 tab., 9 refs.

  10. Multiple-ligament injured knee

    Institute of Scientific and Technical Information of China (English)

    SUN Lei; NING Zhi-jie; ZHANG Hui; TIAN Min; NING Tin-min

    2006-01-01

    Objective: To explore the clinical characteristic of the multiple-ligament injured knee and evaluate the protocol,technique and outcome of treatment for the multipleligament injured knee.Methods: From October 2001 to March 2005, 9 knees with combined anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears in 9 patients were identified with clinical and arthroscopic examinations. Of them, 5 knees were combined with ruptures of posteromedial corner (PMC) and medial collateral ligament (MCL), 4 with disruptions of posterolateral corner ( PLC), 2 with popliteal vascular injuries and 1 with peroneal nerve injuries. Six patients were hospitalized in acute phase of trauma, 2 received repairs of popliteal artery and 4 had repairs of PMC and MCL. Reconstructions of ACL and PCL with autografts under arthroscope were performed in all patients at 4 to 10 weeks after trauma,including reconstruction of PLC with the posterior half of biceps femoris tendon tenodesis in 4 patients and reconstructions of PMC and MCL with femoral fascia in 1 patient.Results: No severe complications occurred at early stage after operation in the 9 patients. All of them were followed up for 10-39 months with an average of 23. 00 months ± 9.46 months. Lysholm score was 70-95 with an average of 85.00 ± 8.29. International Knee Documentation Committee (IKDC) score was from severely abnormal (Grade D) in 9 knees at initial examination to normal (Grade A) in 2 knees, nearly normal (Grade B ) in 6 knees and abnormal in 1 knee at the last follow-up. Of the 9 patients, 7 returned to the same activity level before injury and 2 were under the level.Conclusions: The multiple-ligament injured knee with severe instability is usually combined with other important structure damages. Therefore, careful assessment and treatment of the combined injuries are essential. Reconstructions of ACL and PCL under arthroscope, combined with repairs or reconstructions of the extraarticular ligaments

  11. Pediatric anterior cruciate ligament reconstruction

    OpenAIRE

    McConkey, Mark O.; Bonasia, Davide Edoardo; Amendola, Annunziato

    2011-01-01

    An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor. Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth disturbance. Delaying ACL reconstruction until maturity is possible but risks instability episodes and intra-articular damage. S...

  12. Enhanced Fibroblast Cellular Ligamentization Process to Polyethylene Terepthalate Artificial Ligament by Silk Fibroin Coating.

    Science.gov (United States)

    Jiang, Jia; Ai, Chengchong; Zhan, Zufeng; Zhang, Peng; Wan, Fang; Chen, Jun; Hao, Wei; Wang, Yaxian; Yao, Jinrong; Shao, Zhengzhong; Chen, Tianwu; Zhou, Liang; Chen, Shiyi

    2016-04-01

    Artificial ligaments utilized in reconstruction of anterior cruciate ligament (ACL) are usually made of polyethylene terepthalate (PET) because of its good mechanical properties in vivo. However, it was found that the deficiencies in hydrophilicity and biocompatibility of PET hindered the process of ligamentization. Therefore, surface modification of the PET is deemed as a solution in resolving such problem. Silk fibroin (SF), which is characterized by good biocompatibility and low immunogenicity in clinical applications, was utilized to prepare a coating on the PET ligament (PET+SF) in this work. At first, decrease of hydrophobicity and appearance of amino groups were found on the surface of artificial PET ligament after coating with SF. Second, mouse fibroblasts were cultured on the two different kinds of ligament in order to clarify the possible effect of SF coating. It was proved that mouse fibroblasts display better adhesion and proliferation on PET+SF than PET ligament according to the results of several technical methods including SEM observation, cell adhesive force and spread area test, and mRNA analysis. Meanwhile, methylthiazolyldiphenyl-tetrazolium bromide and DNA content tests showed that biocompatibility of PET+SF is better than PET ligament. In addition, collagen deposition tests also indicated that the quantity of collagen in PET+SF is higher than PET ligament. Based on these results, it can be concluded that SF coating is suggested to be an effective approach to modify the surface of PET ligament and enhance the "ligamentization" process in vivo accordingly. PMID:26526301

  13. MR imaging of alar and transverse atlantal ligament injuries

    International Nuclear Information System (INIS)

    Autopsy findings of ligaments of the upper cervical spine were compared with magnetic resonance imaging (MRI) findings. Ligaments were clearly shown as hypointensity on T1-weighted images and proton density images. Transverse images were useful in diagnosing alar and transverse atlantal ligament injuries. When there is a bilateral difference in the alar ligaments, ruptured ligament is suspected. Transverse ligament rupture was shown on interrupted hypointensity and as hyperintensity. MRI was capable of diagnosing alar ligament rupture in 8 of 11 patients, and transverse ligament rupture in all 3 patients. In 2 patients having Jefferson's fracture and injuried atlanoaxial subluxation encountered in the clinical practice, transverse ligament rupture was similarly observed as that in autopsy cases on MR images. Hyperintensity in the transverse ligament rupture area was seen even one year after injury. Injured transverse ligament was seen as swollen hyperintensity on sagittal images; and the hyperintensity was gradually decreased with the process of healing. (N.K.)

  14. Variations in meniscofemoral ligaments at anatomical study and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Cho, J.M.; Suh, J.S. [Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul (Korea, Republic of); Na, J.B. [Department of Diagnostic Radiology, Kyungsang National University, College of Medicine, Jinju (Korea, Republic of); Cho, J.H. [Department of Diagnostic Radiology, Ajou University College of Medicine, Suwon (Korea, Republic of); Kim, Y.; Yoo, W.K. [Department of Rehabilitation, Yonsei University College of Medicine, Seoul (Korea, Republic of); Lee, H.Y.; Chung, I.H. [Department of Anatomy, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1999-04-01

    Purpose To demonstrate variations in the meniscofemoral ligaments (ligaments of Wrisberg and Humphrey) at anatomical study and magnetic resonance (MR) imaging. Design Twenty-eight cadaveric knees were partially dissected for the examination of the meniscofemoral ligaments. One hundred knee MR examinations were reviewed by two experienced musculoskeletal radiologists. Proximal variations in the meniscofemoral ligaments at MR imaging were classified into three types according to the attachment site: type I, medial femoral condyle; type II, proximal half of the posterior cruciate ligament (PCL); type III, distal half of the PCL. Distal variations were classified into vertical or oblique types according to the orientation of the intermediate signal at the interface of the ligament and lateral meniscus. Results At anatomical study, six cases showed variations in the proximal insertion site of the meniscofemoral ligaments. At MR imaging 93 cases had one or more meniscofemoral ligaments, giving a total of 107 ligaments: 90 ligaments of Wrisberg and 17 ligaments of Humphrey. Forty-one ligaments of Wrisberg were type I, 28 type II, 19 type III, and with two indeterminate type, while 6 ligaments of Humphrey were type I and the remaining 11 were indeterminate. Seven cases showed no meniscofemoral ligament. Of the 107 meniscofemoral ligaments, the distal insertion orientation was of vertical type in 10 ligaments, oblique type in 70 and unidentified in 27. Conclusion An understanding of the high incidence of meniscofemoral ligament variations may help in the interpretation of knee MR studies. (orig.) With 7 figs., 1 tab., 16 refs.

  15. Anatomy of the ankle ligaments: a pictorial essay

    NARCIS (Netherlands)

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

    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

  16. 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…

  17. Chronic injuries of the cruciate ligaments

    International Nuclear Information System (INIS)

    The high incidence of cruciate ligament injuries as a result of acute knee trauma with hemartrosis and abuse of diagnostic arthroscopies call for a suitable radiological imaging of the central pivot. Computed Arthrotomography (CAT) was used to examine the knee joint in 20 cases of clinically suspected chronic cruciate ligament injury. The images were correlated with arthroscopic and/or arthrotomic findings. Thirteen lesions of the anterior cruciate ligament (ACL) (65%) were found, plus 1 lesion of the posterior cruciate ligament (PCL) (5%), 2 associated lesions of ACL + PCL (10%), and 4 normal cases. Confirmation of pathology was available in all cases but one by arthroscopy and/or surgery. The central pivot diseases were classified as follows: absence, detachement, partial or complete tear. CAT findings of cruciate ligament injuries are emphasized and the role of the technique as compared to arthroscopy is discussed. CAT is useful in 3-D evaluation of central pivot and detection of different cruciate ligament injuries, with high sensitivity-specifity for ACL and high specifity-moderate sensitivity for PCL. In the evaluation of the chronic unstable knee, CAT is highly accurate and gives the surgeon useful information towards the planning of therapeutic procedures. CAT is almost non-invasive, well tolerated and easy to perform in out-patients, which make it a first-choice procedure in the screening of chronic ligament injuries

  18. 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.

  19. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears

    International Nuclear Information System (INIS)

    Objective. To describe the MR features of mucoid degeneration of the anterior cruciate ligament (ACL) in a series of patients with MRI findings that were mistaken for tears in the majority of cases but who were found to have an intact ligament at arthroscopy. We will suggest a pathologic entity corresponding to this finding and describe some characteristic features that can be used to identify this entity on MRI.Design. A retrospective analysis of 10 MRI examinations of the knee was performed after arthroscopic evaluation. Prearthroscopic MRI findings had been interpreted as a tear in six patients prospectively and in the remaining four the diagnosis of mucoid degeneration was suggested and ultimately proven. All patients had an intact ACL by preoperative clinical examination, examination under anesthesia, and at arthroscopy.Results. MRI examinations demonstrated an ill-defined ACL, greater in girth than the normal ligament and characterized by increased signal on all sequences. The high-signal ligament was oriented in the normal direction of the ACL. The overall appearance of the ligament was retrospectively described as like a celery stalk. Arthroscopy demonstrated mechanically intact ligaments with a normal to expanded external appearance. Probing of three of the ligaments caused a material to be expressed and pathologic evaluation resulted in the diagnosis of cystic, mucoid degeneration.Conclusion. Mucoid degeneration and an intact ACL can be suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences is identified in a patient with a clinically intact ligament. (orig.)

  20. Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears

    Energy Technology Data Exchange (ETDEWEB)

    McIntyre, J. [San Francisco Magnetic Resonance Center, CA (United States); Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH (United States); Moelleken, S.; Tirman, P. [San Francisco Magnetic Resonance Center, CA (United States)

    2001-06-01

    Objective. To describe the MR features of mucoid degeneration of the anterior cruciate ligament (ACL) in a series of patients with MRI findings that were mistaken for tears in the majority of cases but who were found to have an intact ligament at arthroscopy. We will suggest a pathologic entity corresponding to this finding and describe some characteristic features that can be used to identify this entity on MRI.Design. A retrospective analysis of 10 MRI examinations of the knee was performed after arthroscopic evaluation. Prearthroscopic MRI findings had been interpreted as a tear in six patients prospectively and in the remaining four the diagnosis of mucoid degeneration was suggested and ultimately proven. All patients had an intact ACL by preoperative clinical examination, examination under anesthesia, and at arthroscopy.Results. MRI examinations demonstrated an ill-defined ACL, greater in girth than the normal ligament and characterized by increased signal on all sequences. The high-signal ligament was oriented in the normal direction of the ACL. The overall appearance of the ligament was retrospectively described as like a celery stalk. Arthroscopy demonstrated mechanically intact ligaments with a normal to expanded external appearance. Probing of three of the ligaments caused a material to be expressed and pathologic evaluation resulted in the diagnosis of cystic, mucoid degeneration.Conclusion. Mucoid degeneration and an intact ACL can be suspected when an apparently thickened and ill-defined ligament with increased signal intensity on all sequences is identified in a patient with a clinically intact ligament. (orig.)

  1. Arthrographic diagnosis of ruptured calcaneofibular ligament. I

    International Nuclear Information System (INIS)

    A new projection, oblique axial, is recommended for the arthrography of the acute sprained ankle for the correct diagnosis of a ruptured calcaneofibular ligament. Its value is experimentally confirmed. (Auth.)

  2. 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

  3. Three-dimensional computed tomography of the carpal ligaments.

    Science.gov (United States)

    Nanno, Mitsuhiko; Viegas, Steven F

    2009-03-01

    This article details a current perspective and accurate anatomical three-dimensional descriptions of the ligaments of the wrist. The carpometacarpal ligaments, the intercarpal ligaments, and the radiocarpal ligaments are described and illustrated using a unique combination of detailed dissection, computed tomography, and a three-dimensional digitization technique. Detailed information is also provided about the ligamentous attachments of the carpometacarpal joints, the carpal bones, and the distal radius. This study improves knowledge and understanding of the normal anatomy and mechanics of the radiocarpal and intercarpal ligaments and the carpometacarpal joints, and it should help in the assessment of radiographic images and treatment of various injuries and degenerative changes seen in the wrist. The knowledge of the ligaments will further serve as a foundation for understanding the anatomy of the ligaments, the biomechanics of the wrist, and the function of the individual ligaments and their roles in joint motion and stability. PMID:19235667

  4. Predisposition for temporomandibular joint disorders: loose ligaments.

    Science.gov (United States)

    Deodato, Francesco; Trusendi, Raffaello; Giorgetti, Roberto; Scalese, Marco U

    2006-07-01

    Loose ligaments are often a predisposing factor of temporomandibular joint (TMJ) disorders. This causal factor was analyzed in 701 subjects presenting at the TMJ and Posture Center of Siena University with TMJ pain or dysfunction. Along with the conventional jaw examination, a Carter and Wilkinson test as modified by Beighton was also done. We found a correlation among the parameters of age, gender, TMJ disorder, joint pain, muscle pain, and loose ligaments. PMID:16933458

  5. Novel Insights into Anterior Cruciate Ligament Injury

    OpenAIRE

    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 ligament in orthopaedic research. Hundreds of papers are published each year related to the ACL. However, the treatment options and techniques are still developing and increasing, indicating the diffic...

  6. MR imaging of the meniscofemoral ligament : incidence and classification

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jae Min; Yoo, Wjoo Kyoung; Suh, Jin Suck; Jeon, Pyeong Jeon; Hwang, Geum Joo; Kim, Yoo Cheol; Lee, Hae Yeon [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-05-01

    To demonstrate the incidence and variation of the meniscofemoral ligament in Koreans. A total of 100 MR studies of 95 patients were reviewed with special attention to the appearance and incidence of the meniscofemoral ligaments. The ligament. the ligament of Wrisberg was classified according to proximal insertion : type I, insertion at the posterofemoral condyle ; type II, insertion at the distal portion of the posterior cruciate ligament ; type III, insertion at the distal portion of the posterior cruciate ligament. on T2-weighted images, the high signal at the meniscal insertion of the meniscofemoral ligament was classified according to its shape. The ligament o Humprey was observed in 17 cases and the ligament of Wrisberg was in 90 : type I in 41 cases ; type II, 19 cases ; type III, in 28 cases ; unclassified , in 2 cases. In 77 cases, the cleft with high signal intensity was seen between the menicsofemoral ligament and the posterior cruciate ligament. From our results, the incidence of the ligament of Wrisberg on MRI was more prevelant than the ligament of Humprey. An exact knowledge of the meniscofemoral ligament could be helpful in distinguishing it from pathologic lesions.

  7. 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.

  8. The Cruciate Ligaments in Total Knee Arthroplasty.

    Science.gov (United States)

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction. PMID:27327919

  9. 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.)

  10. Magnetic resonance imaging of the wrist ligaments

    International Nuclear Information System (INIS)

    The advent of small arthroscopes has enabled the hand surgeon to visualize the ligaments of the wrist directly with resultant increased accuracy in diagnosing and treating pathology. Orthopaedists are now demanding a preoperative assessment and this, in turn, has necessitated that radiologists have a comprehensive understanding of wrist anatomy. High resolution MR imaging can identify the wrist ligaments reliably and provide information concerning their integrity. Interpretation is not straightforward; there is considerable anatomic variation, and there are perforations, defects and degenerative tears that can be troublesome in diagnosing injury. However, with experience and attention to anatomic detail, the radiologist can provide useful information regarding structural abnormalities. When injured, the ligaments of the wrist behave as other joint ligaments do. Findings following injury include discontinuity of normal striated bands, incomplete disruption, irregularities and alteration in normal signal. Fluid pooling around a ligament and concomitant bone injury are other clues to injury. The identification of such structural abnormalities may help to explain altered biomechanics and improve the management of patients following wrist injury. Copyright (2001) Blackwell Science Pty Ltd

  11. Longitudinal ligaments of the lumbar spine

    International Nuclear Information System (INIS)

    The diagnosis of disruption of the posterior longitudinal ligament in disk herniation is important in deciding between surgical or percutaneous management of HNP. The normal ligaments studied on spine specimens are better seen on long repetition time (TR), short echo time (TE) images and appear as linear structures with very low signal intensity on all pulse sequences surrounding the outer anulus. The authors prospectively imaged 20 HNPs in 18 patients who underwent surgery. In eight cases, the posterior longitudinal ligament was seen intact around the HNP on both short TR, short TE and long TR, short TE images. All were subligamentous at surgery. MR imaging demonstrated disruption of the longitudinal ligament in ten cases because of interruption, absence around the disk fragment, or interposition between disk and fragment. The ligament was disrupted at surgery in only eight of these cases. The two false-positive images showed a pseudointerruption related to a chemical shift antifact. The two remaining studies were qualified as questionable. The overall sensitivity of MR imaging was 100%, and its specificity was 77%

  12. STUDY OF ANTERIOR CRUCIATE LIGAMENT INJURY AND ITS MANAGEMENT

    OpenAIRE

    Tummala Venkata; Makkena Ravi; Purushotham; Yalamanchili Sumanth; Surapaneni Suresh; Kopuri Ravi

    2016-01-01

    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 in...

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

    International Nuclear Information System (INIS)

    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.)

  14. Biomechanical Evaluation of Ligamentous Stabilizers of the Scaphoid and Lunate

    OpenAIRE

    Short, Walter H.; Werner, Frederick W.; Green, Jason K.; Masaoka, Shunji

    2002-01-01

    This study evaluated the effects of sectioning the scapholunate interosseous ligament, radioscaphocapitate ligament, and scaphotrapezial ligament on the kinematics of the scaphoid and lunate. Eight cadaver upper extremities were placed in a wrist joint simulator and moved in continuous cycles of flexion-extension and radial-ulnar deviation. Positional data of the scaphoid and lunate were obtained in the intact state, after the scapholunate ligament was cut; after the scapholunate and scaphotr...

  15. Diagnosis and Management of Acute Knee Ligament Injuries

    OpenAIRE

    Hastings, David E.

    1990-01-01

    Knee ligament injuries are a common problem, especially in the athletic age group. The most common knee ligament injury is the so-called isolated anterior cruciate ligament tear. This is also the injury most likely to be missed. Isolated collateral ligament tears are generally managed non-operatively, but combined collateral and cruciate tears should be surgically repaired. “Isolated” anterior cruciate tears are generally repaired in the younger active athlete but are managed by hamstring exe...

  16. 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.)

  17. Differences in Men's and Women's Mean Ankle Ligamentous Laxity

    OpenAIRE

    Wilkerson, Ricky D; Mason, Melanie A

    2000-01-01

    The incidence of ligamentous ankle injuries is known to be one of the most common athletic injuries that exists. Recently, there has been a great deal of interest regarding the increased risk of female ligamentous injury, such as the anterior cruciate ligament, lateral ankle sprains and others. The purpose of this study is to evaluate whether or not normal lateral ankle ligamentous laxity is similar in male and female athletes. This study selects 22 male and 27 female college athletes who hav...

  18. MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament

    Energy Technology Data Exchange (ETDEWEB)

    MacMahon, P.J.; Kavanagh, E.C. [Mater Misericordiae University Hospital, Department of Radiology, Dublin 7 (Ireland); Dheer, S.; Morrison, W.B.; Zoga, A. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Raikin, S.M.; Elias, I. [Thomas Jefferson University Hospital, Rothman Institute, Philadelphia, PA (United States)

    2009-03-15

    The objective of this study was to assess the utility of MRI in diagnosing injury to the first interosseous cuneometatarsal (Lisfranc) ligament and to additionally determine the associated patterns of traumatic soft tissue and osseous injury. Fifteen patients (16 feet) who were referred for MRI evaluation of the Lisfranc ligament, and had operative exploration or examination under anesthesia, were included for analysis. Standard non-contrast MRI foot imaging was performed in all cases. Evaluation of the following components was performed: the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal metatarsal ligaments, soft tissue edema and fluid, and bone marrow edema and fractures. Surgical reports were regarded as the reference standard in all cases. Seven of 10 cases of grade 3 Lisfranc ligament injuries at surgery were correctly graded at MRI. No cases of surgically proven complete Lisfranc ligament tears (grade 3) were interpreted as normal at MRI. All Lisfranc ligament sprains (grade 2 or 3) at surgery were detected at MRI. Two of six cases reported as grade 1 injuries at MRI were normal at surgery. No cases of surgically proven normal or sprained Lisfranc ligaments were interpreted as grade 3 tears on MRI. Four of six of our cases of normal or sprained Lisfranc ligaments demonstrated fractures; while the minority of complete Lisfranc ligament tears (3/10) contained fractures. MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low. (orig.)

  19. MRI of injuries to the first interosseous cuneometatarsal (Lisfranc) ligament

    International Nuclear Information System (INIS)

    The objective of this study was to assess the utility of MRI in diagnosing injury to the first interosseous cuneometatarsal (Lisfranc) ligament and to additionally determine the associated patterns of traumatic soft tissue and osseous injury. Fifteen patients (16 feet) who were referred for MRI evaluation of the Lisfranc ligament, and had operative exploration or examination under anesthesia, were included for analysis. Standard non-contrast MRI foot imaging was performed in all cases. Evaluation of the following components was performed: the dorsal and plantar bundles of the Lisfranc ligament, the plantar tarsal metatarsal ligaments, soft tissue edema and fluid, and bone marrow edema and fractures. Surgical reports were regarded as the reference standard in all cases. Seven of 10 cases of grade 3 Lisfranc ligament injuries at surgery were correctly graded at MRI. No cases of surgically proven complete Lisfranc ligament tears (grade 3) were interpreted as normal at MRI. All Lisfranc ligament sprains (grade 2 or 3) at surgery were detected at MRI. Two of six cases reported as grade 1 injuries at MRI were normal at surgery. No cases of surgically proven normal or sprained Lisfranc ligaments were interpreted as grade 3 tears on MRI. Four of six of our cases of normal or sprained Lisfranc ligaments demonstrated fractures; while the minority of complete Lisfranc ligament tears (3/10) contained fractures. MRI is reasonably accurate at detecting traumatic injury to the Lisfranc ligament. However, in clinically suspected cases of traumatic Lisfranc ligament injury, true positive rate for sprain is low. (orig.)

  20. Lateral ligamentous injury to the carpus of a racing Greyhound

    International Nuclear Information System (INIS)

    The lateral collateral ligament of the ulna and the dorsolateral ligaments of the radiocarpal joint of a racing Greyhound were ruptured, resulting in instability of the carpus when the joint was flexed. This report describes a technique for making a ligament prosthesis, using the ulnaris lateralis tendon. Although the dog did not return to racing, the carpus was stable enough for general activity

  1. Carpal ligamentous disruptions and negative ulnar variance

    International Nuclear Information System (INIS)

    Negative ulnar variance is a condition in which the ulna is relatively shorter than the radius at the carpus. It was found in 21% of 203 normal wrists. We have observed an increased incidence (49%) of this anomaly in patients with carpal ligamentous instabilities (dorsiflexion instability, palmar flexion instability, scapholunate dissociation with rotary luxation of the scaphoid, and lunate and perilunate dislocations). While the reasons for this association have yet to be adequately delineated, the presence of a negative ulnar variant may serve as an impartial clue to the presence of ligamentous instability. Many carpal instabilities present with subtle radiographic findings requiring careful evaluation of radiographs. Patients with negative ulnar variance and histories suggestive of ligamentous instability should undergo careful radiologic evaluation to assure early diagnosis of carpal disruption. (orig.)

  2. 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)

  3. MR imaging of posterior cruciate ligament injuries

    International Nuclear Information System (INIS)

    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)

  4. Simultaneous reconstruction of anterior cruciate ligament (ACL) with autologous graft and of medial collateral ligament (MCL) with allograft

    OpenAIRE

    Aparicio, José Luis; Nardin, Lisandro; Savá, Matías S.

    2015-01-01

    Introduction: Over the last years, the incidence of multiple ligament injuries has increased significantly due to the rising number of traffic accidents in relation to their kinetics and due to higher sports demands. Among their various combinations, one of them is the lesion of anterior cruciate ligament (ACL) which is associated to medial collateral ligament responsible for them in a 13 %. Nowadays several techniques to the reconstruction of Anterior Cruciate Ligament (ACL) and Medial Colla...

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

    International Nuclear Information System (INIS)

    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.)

  6. 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.)

  7. Biological fixation in anterior cruciate ligament surgery

    Directory of Open Access Journals (Sweden)

    Chih-Hwa Chen

    2014-04-01

    Full Text Available Successful anterior cruciate ligament (ACL reconstruction with tendon graft requires extensive tendon-to-bone healing in the bone tunnels and progressive graft ligamentization for biological, structural, and functional recovery of the ACL. Improvement in graft-to-bone healing is crucial for facilitating early, aggressive rehabilitation after surgery to ensure an early return to pre-injury activity levels. The use of various biomaterials for enhancing the healing of tendon grafts in bone tunnels has been developed. With the biological enhancement of tendon-to-bone healing, biological fixation of the tendon graft in the tunnel can be achieved in ACL reconstruction.

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

    International Nuclear Information System (INIS)

    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

  9. Image-anatomic research of the alar ligament

    International Nuclear Information System (INIS)

    Objective: To detect position and morphous as well as coursing of the alar ligament, and to further investigate the sectional anatomy and CT and MRI imaging of the alar ligament. Methods: Twelve formalin fixed specimens including head and neck utilized, three of the twelve were observed in gross anatomy, nine of them were dissectioned. Fifty- one healthy volunteers from each group were selected to perform CT and MRI examination respectively. By combining gross and sectional anatomy. CT and MRI manifestations of the alar ligament were analyzed, the alar ligament width was measured. Results: Location and shape, as well as coursing of the alar ligament could be demonstrated clearly in gross and sectional anatomy. The transverse plane across the upper dens and the coronal plane by the middle dens were the optimal planes for demonstrating the alar ligament. The display ratio of the alar ligament was even 100% (51/51) in both images of CT and MRI. MRI had better advantages than CT in respect of demonstrating the alar ligament, PDWI (proton density weighted imaging, PDWI) is the most optimal sequence for the alar ligament. There were no significant differences of the alar ligament width between male and female and between the right and the left side (P>0.05). Conclusion: In combination with gross and sectional anatomy. CT and MRI could both provide an imageo-anatomic basis for diagnosis of the alar ligament trauma and malformation as well as infection. (authors)

  10. Cruciate ligament loading during common knee rehabilitation exercises.

    Science.gov (United States)

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-09-01

    Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system. PMID:23025167

  11. Reconstruction of the Scapholunate Ligament Using Capitohamate Bone-Ligament-Bone.

    Science.gov (United States)

    Nakamura, Toshiyasu; Abe, Koji; Iwamoto, Takuji; Ochi, Kensuke; Sato, Kazuki

    2015-11-01

    Background The biomechanical properties of the capitohamate (CH) ligament are equivalent to those of the scapholunate (SL) interosseous ligament. We reconstructed the SL ligament using the CH bone-ligament-bone substitute for chronic injury of the SL ligament. Patients and Methods Beginning in 2008, 15 wrists of 14 patients with an average age of 38 years underwent this procedure with a minimum follow-up of 2 years. Thirteen wrists had an SL joint gap more than 3 mm, and two had a complete SL ligament disruption with a severe dorsal intercalated segment instability (DISI) deformity. Kirschner wires (K-wires) were removed 8 weeks after the surgery, then active ROM exercise began. Pain (on visual analog scale [VAS]), wrist motion (angle), radiographic characteristics, such as SL gap (mm) and SL angle, and Modified Mayo Wrist Score (MMWS) were evaluated. Technique The SL joint was reduced by manipulation or with the use of joysticks, then temporary fixed with K-wires. A dorsal trough was then made between the scaphoid and the lunate. The proximal half of the CH ligament was harvested with attached bone from the capitate and hamate (CH bone-ligament-bone), inset into the SL trough, and fixed firmly with 1.2-mm diameter titanium screws in the scaphoid and lunate, respectively. Results The VAS improved from 77 preoperatively to 12 postoperatively. The average wrist extension/flexion was 74°/60°. There was no ossification of the reconstructed SL at the final follow-up. The SL gap improved from an average of 4.8 mm to an average of 2.1 mm, and the SL angle changed from 67° to 55°. The MMWS improved to 82 points postoperatively from a preoperative average of 47 with eight excellent, five good, and two fair results. PMID:26539327

  12. MR imaging features of chronically torn anterior cruciate ligament

    Energy Technology Data Exchange (ETDEWEB)

    Niitsu, Mamoru; Kuramochi, Masashi; Ikeda, Kotaroh; Fukubayashi, Tohru; Anno, Izumi; Itai, Yuji [Tsukuba Univ., Ibaraki (Japan). Inst. of Clinical Medicine

    1995-06-01

    Magnetic resonance (MR) images of 40 knee joints with arthroscopically proved chronic anterior cruciate ligament (ACL) tears were retrospectively evaluated. MRI demonstrated various features of chronic ACL tears: 19 knees revealed with no identifiable ligamentous structure, and 21 had residual ligamentous structures. These pseudoligaments, 14 discontinuous bands and seven continuous bands with elongation, were residual torn ligamentous fibers and/or synovial tissues. All the discontinuous bands were disrupted from the femoral attachment and were likely to traverse the lower intercondylar space. Six disrupted ligaments were attached to the lateral aspect of the posterior cruciate ligament (PCL). Coronal T2{sup *}-weighted gradient echo images showed better delineation of the disrupted femoral attachment and adhesion to the PCL. A chronic ACL tear with minimal elongation or with PCL attachment at a higher position may occasionally be difficult to distinguish from an intact ligament. (author).

  13. MR imaging features of chronically torn anterior cruciate ligament

    International Nuclear Information System (INIS)

    Magnetic resonance (MR) images of 40 knee joints with arthroscopically proved chronic anterior cruciate ligament (ACL) tears were retrospectively evaluated. MRI demonstrated various features of chronic ACL tears: 19 knees revealed with no identifiable ligamentous structure, and 21 had residual ligamentous structures. These pseudoligaments, 14 discontinuous bands and seven continuous bands with elongation, were residual torn ligamentous fibers and/or synovial tissues. All the discontinuous bands were disrupted from the femoral attachment and were likely to traverse the lower intercondylar space. Six disrupted ligaments were attached to the lateral aspect of the posterior cruciate ligament (PCL). Coronal T2*-weighted gradient echo images showed better delineation of the disrupted femoral attachment and adhesion to the PCL. A chronic ACL tear with minimal elongation or with PCL attachment at a higher position may occasionally be difficult to distinguish from an intact ligament. (author)

  14. MR imaging of cruciate ligament injury of the knee

    International Nuclear Information System (INIS)

    Diagnostic accuracy of MRI in cruciate ligament injury of the knee was evaluated on 41 knees which were confirmed by means of arthroscopy or arthrotomy. Normal and abnormal conditions of both anterior and posterior cruciate ligaments were correctly identified in 40 of 41 knees (98%). Diagnostic criteria of ligament injury on MRI were as follows: (1) interruption or discontinuity with a partially retained normal morphology of the ligament, (2) expansion or retraction of the width of the ligament, and (3) complete loss of the normal morphology of the ligament. T1-weighted sagittal images alone were satisfactory for diagnosis and additional proton and T2-weighted images were considered to be unnecessary in most cases. MR imaging is a reliable method for the detection of the cruciate ligament injury of the knee. (author)

  15. Three-dimensional imaging of the carpal ligaments.

    Science.gov (United States)

    Nanno, Mitsuhiko; Patterson, Rita M; Viegas, Steven F

    2006-11-01

    This article provides a new perspective and detailed anatomic description of the attachments of the carpometacarpal (CMC) ligaments, intercarpal ligaments, and radiocarpal ligaments, which are described and illustrated using a unique combination of detailed dissection, CT imaging, and three-dimensional digitization. Detailed information is also provided about the ligamentous attachments of the CMC joints, carpal bones, and distal radius. This information advances the current knowledge and understanding of the normal anatomy and its impact on the mechanics of the radiocarpal intercarpal ligaments and the CMC joints, and should help surgeons to assess and treat injuries and degenerative changes seen in the wrist and CMC joints. Furthermore, this additional knowledge of the ligaments will help to further understand wrist kinematics and, more precisely, the function of the individual ligaments and their roles in joint motion and stability and injuries. PMID:17097462

  16. Herniation of Small Bowel Loop through a Broad Ligament Defect Masquerading as Torsion of Ovarian Cyst

    OpenAIRE

    Babatola Bakare; Olumide Akadiri; Akinyemi Akinsoji Akintayo

    2013-01-01

    Torsion of ovarian cyst is a common cause of acute abdomen especially in women of reproductive age-group. It commonly presents with colicky abdominal pain associated with nausea and vomiting. It could however mimic acute intestinal obstruction. The patient was a 32-year-old multipara with no previous history of pelvic or abdominal surgery. She was admitted with colicky lower abdominal pain associated with repeated episodes of vomiting and nausea. Laboratory investigations were essentially nor...

  17. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M; Roemer, Frank W; Ranstam, Jonas; Lohmander, Stefan

    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...

  18. MR imaging of posterior cruciate ligament injury

    International Nuclear Information System (INIS)

    There is increasing awareness of the clinical importance of early detection and treatment of posterior cruciate ligament(PCL) injury. We evaluate the usefulness of Magnetic resonance(MR) imaging in the diagnosis of PCL injury. We retrospectively analysed the MR images of 140 cases with clinically suspected knee injury. Arthroscopic or surgical correlation was available in 63 cases. We observed the finding and extent of PCL injury and other associated abnormalities. The frequency of anterior and posterior meniscofemoral ligament was evaluated. Eleven PCL injuries were observed, six midsubstance tears, two tibial attachment tears, two femoral attachment tear, one laxity. The sensitivity, specificity and accuracy of MR imaging diagnosis are 100%, 98.1%, 98.4%. MR findings of PCL injury are discontinuity and focal mass formation, irregular increased signal intensity, detachment or redundancy of the ligament with avulsed bony fragment. In all cases of injured PCL, other associated abnormalities of adjacent structures were observed. Accessory anterior and posterior meniscofemoral ligaments were observed in 67.4%(87/129). MR imaging is useful in evaluation of presence or absence of PCL injury, accurate extent of PCL injury and other important associated abnormalities of adjacent structures

  19. Injury of the ankle joint ligaments

    International Nuclear Information System (INIS)

    The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination and clinical stress tests. If the clinical stress test is positive, stress radiography can be performed. There is, however, no consensus about the usefulness of stress radiography in acute ankle sprain, and in particular about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today, magnetic resonance imaging (MRI) is not used in this area, although it does allow controlled positioning of the foot and defined section visualization of injured lateral collateral ankle ligaments. In acute and chronic sinus tarsi injuries, MRI forms the established basis for diagnostic imaging, and can provide a definitive answer in most cases. MRI is also the method of choice for chronic posttraumatic pain with anterolateral impingement after rupture of the anterior talofibular ligament. Generally, for the evaluation of acute ankle injuries, MRI has developed to be the most important second-step procedure when projection radiology is non-diagnostic. (orig.)

  20. 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 liga

  1. Ganglion cyst of the posterior cruciate ligament

    OpenAIRE

    Ahmed, F.; Ibrahim, S A; Soliman, A.; Khirat, S

    2010-01-01

    A ganglion is a fluid cyst with a myxoid matrix that arises close to the tendons and joints. Its occurrence inside a joint is rare. Among the various pathological conditions producing impairment of the knee function, ganglia of the cruciate ligaments are quite rare.

  2. Causes of anterior cruciate ligament injuries

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2010-01-01

    Full Text Available 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.

  3. Imaging evaluation of traumatic ligamentous injuries of the ankle and foot.

    Science.gov (United States)

    Nazarenko, Anna; Beltran, Luis S; Bencardino, Jenny T

    2013-05-01

    Sports ankle injuries are very common worldwide. In the United States, it is estimated that 2 million acute ankle sprains occur each year, averaging to $318 to $914 per sprain. Magnetic resonance imaging is excellent for depicting normal ankle anatomy and can elegantly demonstrate ligamentous injuries of the ankle and associated conditions after ankle sprain. This article encompasses epidemiology, biomechanics, normal anatomy, and pathologic conditions of the ankle and foot ligaments. The specific ligaments discussed include the syndesmotic ligaments, lateral ligament complex of the ankle, deltoid ligament, spring ligament, ligaments of the sinus tarsi, and the Lisfranc ligament. PMID:23622094

  4. Neck ligament strength is decreased following whiplash trauma

    Science.gov (United States)

    Tominaga, Yasuhiro; Ndu, Anthony B; Coe, Marcus P; Valenson, Arnold J; Ivancic, Paul C; Ito, Shigeki; Rubin, Wolfgang; Panjabi, Manohar M

    2006-01-01

    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 < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. 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

  5. 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. PMID:24452928

  6. Value of 13-MHz high-frequency ultrasound of the lateral ankle ligaments and the anterior tibiofibular ligament

    International Nuclear Information System (INIS)

    Purpose: Determination of the value of 13-MHz high-frequency ultrasound in the diagnosis of acute injuries of the lateral ankle ligaments and the anterior tibiofibular ligament by comparison with MRI. Method: Sonography was performed prospectively in 64 acutely injured patients using a mechanical 13-MHz sector probe; for diagnosis of the anterior tibiofibular ligament a 15-MHz sector probe was employed during the course of this trial. Using a 0.2-T unit for MRI examination, T1-weighted (TR 580 ms, TE 24 ms) and T2-weighted (TR 3000 ms, TE 80 ms) spin-echo sequences were obtained in various oblique axial imaging planes. Results: In the differentiation of intact and injured ligaments, ultrasound and MRI agreed in 95.3/% of cases for the anterior fibulotalar ligament, in 88.3% for the fibulocalcanear ligament and in 85.0% for the anterior tibiofibular ligament. Conclusion: Lesions of the anterior talofibular and fibulocalcanear ligament can be accurately demonstrated by ultrasound if a 13-MHz sector scanner is used. The detection of lesions in the anterior tibiofibular ligament is more difficult. With increasing experience and by using a 15-MHz sector scanner, better results can be expected for this ligament. (orig.)

  7. 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

  8. MRI of injuries of the lateral ankle ligaments

    International Nuclear Information System (INIS)

    The most frequent sport injury of the ankle is located in the lateral ankle ligaments. The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and stress radiography, allowing a fair diagnosis for the daily routine. For the direct visualization and precise diagnosis of the lateral ankle ligaments MRI provides the best answer. MRI is used with controlled positioning of the foot, correct angulation of sequenzes, and distinct analysis of MR findings. Sinus tarsi ligaments and ligaments of the distal syndesmosis should be included to the report. In selected patients MRI allows the best evaluation of the extent of the lateral ankle ligaments. MRI is the method of choice for combined osteochondral injuries and soft tissue lesions too. (orig.)

  9. A rare variation of the round ligament of the liver

    Directory of Open Access Journals (Sweden)

    Kale A

    2009-06-01

    Full Text Available The round ligament of liver is formed by obliteration of the umblical vein, which exists in embryological life. We report an unusual variation of the round ligament of liver. During routine dissections, we encountered an unusual structure over rectus abdominis sheath of a 63-year-old male cadaver. This structure was determined to be the round ligament of liver. This ligament was not only more superficial than it normally should be, but also in an unusual manner: it reached the liver’s visceral surface after running on its way on the diaphragmatic surface of liver, thus the fissure for round ligament was not observed. Consequently this cadaver’s liver was not divided into lobes on the visceral surface. The residual lumen of the round ligament of liver is important for umbilical vein catheterization. We conclude that this rare variation may be important for catheterization and abdominal surgical procedures.

  10. MR imaging of anterior cruciate ligament tears

    Energy Technology Data Exchange (ETDEWEB)

    Takaki, Kazuhiro; Tomari, Kazuhide; Asao, Tsunenori [Shinbeppu Hospital, Oita (Japan)

    1995-09-01

    To investigate magnetic resonance (MR) imaging of anterior cruciate ligament (ACL) tears, the authors retrospectively reviewed 39 MR imaging examinations in 39 patients. We classified the MR imaging patterns of the torn ACL into four types. Torn ACL appears as a homogeneous iso-intensity mass on Type I images; as a continuous thin and waving low-intensity band with or without high-signal-intensity spots on the Type II images; as a disrupted band with a high-signal-intensity area on Type III images and as an absence of the ACL on Type IV images. We also report secondary lesions on MR imaging findings associated with tears of the ACL, posterior cruciate ligament index and bone bruising, in our patients. (author).

  11. MR imaging of anterior cruciate ligament tears

    International Nuclear Information System (INIS)

    To investigate magnetic resonance (MR) imaging of anterior cruciate ligament (ACL) tears, the authors retrospectively reviewed 39 MR imaging examinations in 39 patients. We classified the MR imaging patterns of the torn ACL into four types. Torn ACL appears as a homogeneous iso-intensity mass on Type I images; as a continuous thin and waving low-intensity band with or without high-signal-intensity spots on the Type II images; as a disrupted band with a high-signal-intensity area on Type III images and as an absence of the ACL on Type IV images. We also report secondary lesions on MR imaging findings associated with tears of the ACL, posterior cruciate ligament index and bone bruising, in our patients. (author)

  12. Lateral supporting ligament of the distal phalanx.

    Science.gov (United States)

    Winter, W G; Iwersen, L J; Johnson, E D

    1989-06-01

    A 49-year-old woman complained of 3 months of constant aching pain deep to the ingrown medial nail margin of her right hallux that was unaffected by shoe wear. Physical examination disclosed no purulence, discoloration, or obvious acute inflammation; an incurved medial nail plate was seen. There was mild chronic thickening of the medial nail fold. Tenderness was maximal 2 to 3 mm plantar to the medial edge of the nail. By roentgenogram, bony projections were seen arcing from the distal phalangeal tuft and the proximal metaphyseal flare toward each other. This was considered to be a "normal" radiological variant. A partial medial onychectomy and matricectomy (Winograd procedure) was performed. Further dissection 1 to 2 mm deeper along the medial phalangeal border revealed a 1-mm wide longitudinal ligament extending from the phalangeal distal tuft to the proximal metaphyseal flare. Bony projections and ligament were excised. The wound healed satisfactorily, and symptoms ceased. PMID:2744674

  13. Proliferation of the human periodontal ligament fibroblast by laser biostimulation: an in vitro study

    Science.gov (United States)

    Shelly, Ahuja; Shaila, Kothiwale; Kishore, Bhat

    2006-02-01

    Laser produces a monochormatic collimated and coherent radiation. In dentistry, diode lasers have been used predominantly for application which are broadly termed "Low level laser therapy (LLLT) or biostimulation (L.J. Walch 1997)". Periodontal ligament fibroblast (PDLF) have a key function in periodontal regeneration. Stimulatory effects on the proliferation of these cells could therefore be beneficial for the reestablishment of connective tissue attachment. The aim of this in vitro study was to evaluate the potential stimulatory effect of low level laser irradiation on the proliferation of PDLF.

  14. Posterior cruciate ligament's tibial insertions: topographic anatomy and morphometric study

    OpenAIRE

    Julio Cesar Gali; Hector Campora de Sousa Oliveira; Bruno Cesar Bracher Lisboa; Bruno DiSerio Dias; Fabiana de Godoy Casimiro; Edie Benedito Caetano

    2013-01-01

    OBJECTIVE: To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. MATERIAL AND METHODS: The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles' tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained wer...

  15. Neck ligament strength is decreased following whiplash trauma

    OpenAIRE

    Rubin Wolfgang; Ito Shigeki; Ivancic Paul C; Valenson Arnold J; Coe Marcus P; Ndu Anthony B; Tominaga Yasuhiro; Panjabi Manohar M

    2006-01-01

    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. Additiona...

  16. Human periodontal ligament stem cells repair mental nerve injury

    OpenAIRE

    Li, Bohan; Jung, Hun-Jong; Kim, Soung-Min; Kim, Myung-Jin; Jahng, Jeong Won; Lee, Jong-Ho

    2013-01-01

    Human periodontal ligament stem cells are easily accessible and can differentiate into Schwann cells. We hypothesized that human periodontal ligament stem cells can be used as an alternative source for the autologous Schwann cells in promoting the regeneration of injured peripheral nerve. To validate this hypothesis, human periodontal ligament stem cells (1 × 106) were injected into the crush-injured left mental nerve in rats. Simultaneously, autologous Schwann cells (1 × 106) and PBS were al...

  17. Ultrasonogrphic diagnosis of snapping annular ligament in the elbow

    Energy Technology Data Exchange (ETDEWEB)

    Chai, Jee Won; Kim Su Jin; Lim, Hyun Kyong; Bae, Kee Jeong [SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2015-01-15

    Elbow snapping by annular ligament is rare and may be difficult to diagnose, when this Epub ahead of print condition is not familiar. We report a case of elbow snapping by annular ligament diagnosed by ultrasonography, which was confirmed by arthroscopic observation. The ultrasonographic findings were thickening of the annular ligament and snapping in and out of the radiocapitellar joint during elbow flexion and extension on dynamic ultrasonography.

  18. Understanding acute ankle ligamentous sprain injury in sports

    OpenAIRE

    Fong Daniel TP; Chan Yue-Yan; Mok Kam-Ming; Yung Patrick SH; Chan Kai-Ming

    2009-01-01

    Abstract This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprai...

  19. Optimal management of ulnar collateral ligament injury in baseball pitchers

    OpenAIRE

    Hibberd EE; Brown JR; Hoffer JT

    2015-01-01

    Elizabeth E Hibberd,1 J Rodney Brown,2 Joseph T Hoffer21Department of Health Science, The University of Alabama, Tuscaloosa, AL, USA; 2Department of Intercollegiate Athletics, The University of Alabama, Tuscaloosa, AL, USAAbstract: The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching excee...

  20. Anterior Cruciate Ligament Injuries in Growing Skeleton

    OpenAIRE

    AlHarby, Saleh W.

    2010-01-01

    Anterior cruciate ligament (ACL) injuries in the adult patients are thoroughly studied and published in orthopedic literature. Until recently, little was known about similar injuries in skeletally growing patients. The more frequent involvement of this age group in various athletic activities and the improved diagnostic modalities have increased the awareness and interest of ACL injuries in skeletally immature patients. ACL reconstruction in growing skeleton is controversial and carries some ...

  1. Biomechanics and anterior cruciate ligament reconstruction

    OpenAIRE

    Vercillo Fabio; Dede Ozgur; Wu Changfu; Woo Savio; Noorani Sabrina

    2006-01-01

    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 biome...

  2. Current Trends in Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Kim, Ha Sung; Seon, Jong Keun; Jo, Ah Reum

    2013-01-01

    The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the...

  3. Familial predisposition to anterior cruciate ligament injury

    OpenAIRE

    Kenichi Goshima; Katsuhiko Kitaoka; Junsuke Nakase; Hiroyuki Tsuchiya

    2014-01-01

    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 in...

  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. 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...

  6. 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.

  7. Guideline on anterior cruciate ligament injury

    OpenAIRE

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

    2012-01-01

    textabstractThe 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? • Wh...

  8. Psychological Aspects of Anterior Cruciate Ligament Injuries

    OpenAIRE

    Ardern, Clare; Kvist, Joanna; Webster, Kate E.

    2016-01-01

    Impairment-based evaluation has, until recently, been the mainstay of orthopaedic research in anterior cruciate ligament (ACL) reconstruction. However, participation-based outcomes, in particular returning to sport, have lately garnered increased research attention. This is important because returning to sport is typically a main concern of injured athletes. Recent metaanalyses have demonstrated that the return to sport rate after ACL reconstruction is disappointingly low, and that a range of...

  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 reconstruction using the bone-posterior cruciate ligament-bone allograft

    Institute of Scientific and Technical Information of China (English)

    JIAO Chen; AO Ying-fang; LIU Ping; XIE Xing; LIU Chen; MA Yong

    2013-01-01

    Background AIIografts were widely used in anterior cruciate ligament (ACL) reconstruction for patients with ACL rupture of the knee.This study was to approve the feasibility of bone-posterior cruciate ligament-bone (BPCLB) allograft transplantation in ACL reconstruction.Methods Eight patients underwent ACL reconstructions with BPCLB allografts and were followed up for an average period of 32 months after operation.Results Subjective parameters including Intemational Knee Documentation Committee (IKDC),modified Larson knee ligament,Lysholm,and Tegner rating scales were much improved and side to side KT-2000 arthrometer difference was much less postoperatively.Pivot shift test was negative in all patients.The reconstructed ACL had satisfactory shape and tension.Conclusions BPCLB allograft is an optional choice forACL reconstruction.

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

    Institute of Scientific and Technical Information of China (English)

    Sunil Gurpur Kini; Karel du Pre; Warwick Bruce

    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.

  12. Magnetic resonance imaging in the evaluation of ligament injuries

    International Nuclear Information System (INIS)

    Magnetic resonance imaging has had a dramatic effect on the means by which we diagnose ligament injuries. Tears resulting from either acute trauma or overuse can be detected noninvasively, directing appropriate therapy be it conservative or surgical. For the elite athlete, earlier diagnosis leads to earlier intervention, or alternatively, a normal MRI examination can result in an earlier return to play. While MRI is accepted for the diagnosis of certain injuries such as complete tears of the cruciate ligaments of the knee, other injuries, such as partial cruciate ligament tears or tears of the intercarpal ligaments of the wrist, remain controversial. (orig.)

  13. Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures.

    Science.gov (United States)

    Desai, Mihir J; Kamal, Robin N; Richard, Marc J

    2015-08-01

    The prevalence of ligamentous injury associated with fractures of the distal radius is reported to be as high as 69% with injury to the scapholunate interosseous ligament and lunotriquetral interosseous ligament occurring in 16% to 40% and 8.5% to 15%, respectively. There is a lack of consensus on which patients should undergo advanced imaging, arthroscopy, and treatment and whether this changes their natural history. Overall, patients with high-grade intercarpal ligament injuries are shown to have longer-term disability and sequelae compared with those with lower-grade injuries. This article reviews the diagnosis and treatment options for these injuries. PMID:26205702

  14. Imaging of meniscus and ligament injuries of the knee.

    Science.gov (United States)

    Faruch-Bilfeld, M; Lapegue, F; Chiavassa, H; Sans, N

    2016-01-01

    Magnetic resonance imaging has now an indisputable role for the diagnosis of meniscus and ligament injuries of the knee. Some technical advances have improved the diagnostic capabilities of magnetic resonance imaging so that diagnoses, which may change the therapeutic approach, such as a partial tear of the anterior cruciate ligament or confirmation of unstable meniscal injuries, are now made easier. This article describes the essential about magnetic resonance imaging technique and pathological results for the menisci, collateral ligaments and damage to the central pivot of the cruciate knee ligaments. PMID:27452631

  15. Cruciate ligament reconstruction using LARS artificial ligament under arthroscopy: 81 cases report

    Institute of Scientific and Technical Information of China (English)

    HUANG Jian-ming; WANG Qian; SHEN Feng; WANG Zi-min; KANG Yi-fan

    2010-01-01

    Background There are many different materials used for ligament reconstruction. Currently, autograft, allograft, and artificial ligaments are used in the reconstruction. The objective of this study was to explore the clinical result of cruciate ligament reconstruction under arthroscopy.Methods Eighty-one cases were reconstructed with the LARS ligament under arthroscopy, including 43 cases of anterior cruciate ligament (ACL) injury, 20 cases of posterior cruciate ligament (PCL) injury, and 18 cases of ACL combined with PCL injuries of the knee. The follow up period was 10 to 49 months. The International Knee Documentation Committee (IKDC) and Lysholm knee score scales were used for functional evaluation. We examined the anterior and posterior stability of the knee with KT-1000.Results According to the Lysholm knee function score scale, the average preoperative score of (44.6±1.4) increased to a postoperative score of (82.8±2.5) in the ACL group and from (46.6±2.3) to (80.8±2.0) in the PCL group. In the ACL combined with PCL injury group, the preoperative score increased from (45.2±1.2) to (85.5±2.3). According to IKDC score standards, in ACL group we evaluated 19 cases as C and 24 cases as D, preoperatively, and postoperatively 27 cases as A, 14 cases as B and two cases as C. In the preoperative PCL group, we had 11 cases defined as C and nine cases as D that resolved to 12 cases as A, seven as B and one case of C in postoperative evaluation. In the ACL combined with PCL injury group we defined four cases as C and 14 as D during preoperative scoring. These patients had postoperative grades of six cases as A, 10 as B, and two cases as C. All of the results have statistical significance. Conclusions ACL, PCL, or combined ACL and PCL reconstruction using the LARS ligament under arthroscopy is a minimally invasive, safe and effective method to treat cruciate ligament injuries of the knee. Clinical results are satisfactory in the short term.

  16. 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

    OpenAIRE

    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 foetal (the cranial mesonephric and gonadal ligaments) and later life (the cranial mesonephric ligament derivatives). In human foetal anatomy textbooks ovarian suspensory ligament is generally app...

  17. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees.

    Science.gov (United States)

    Claes, Steven; Bartholomeeusen, Stijn; Bellemans, Johan

    2014-03-01

    The purpose of this study was to identify the newly described anterolateral ligament of the human knee on magnetic resonance imaging and to describe its eventual radiological abnormalities in anterior cruciate ligament-injured subjects. A retrospective cohort study on a series of consecutive subjects undergoing anterior cruciate ligament reconstructive surgery was performed. The MR images of 206 included knees were studied and the status of the anterolateral ligament status was judged to be either "non-visualized", "normal" or "abnormal". Of all the visualized anterolateral ligaments, 44 (21.3%) were considered uninjured, while 162 (78.8%) knees demonstrated radiological ALL abnormalities. The majority of ALL abnormalities were situated in the distal part of the ligament (77.8%). In conclusion, the anterolateral ligament can be identified on classic knee magnetic resonance images. Although anterior cruciate ligament injured subjects often demonstrated associated anterolateral ligament lesions, further research is needed in order to establish the clinical relevance of these highly frequent radiological abnormalities. PMID:24873084

  18. Clinical and radiographic outcome of cranial cruciate ligament reconstruction in dogs using frozen pattelar ligament allograft

    International Nuclear Information System (INIS)

    The purpose of the study was to evaluate the clinical and radiographic outcome of cranial cruciate ligament reconstruction using frozen pattelar ligament allograft at –20 ºC, fixed with interference screw and blount clamp. Ten crossbred dogs, between one and three years old, weightening 18 to 25 Kg, were submitted to left cranial cruciate desmotomy, based on the Pond & Nuki model. After 30 days, they were divided in two groups. In the group B, it was performed ligament reconstruction, and the group A received no treatment (control). The follow-up period was 90 days. Group B showed better limb function, less muscle hipotrophy and lower severity of the radiographic lesions in the knee when compared to control group (p value<0,05). Although the allografts were feasible macroscopically, it was observed slight cranial drawer moviment. It can be concluded that cranial cruciate ligament reconstruction using frozen pattelar tendon allograft improve limb function and decrease knee osteoarthritis progression at radiographic evaluation, but the joint was not completely stabilized. The interference screw and blount clamp were effective in graft fixation

  19. Integrating Hot and Cool Intelligences: Thinking Broadly about Broad Abilities

    Directory of Open Access Journals (Sweden)

    W. Joel Schneider

    2016-01-01

    Full Text Available Although results from factor-analytic studies of the broad, second-stratum abilities of human intelligence have been fairly consistent for decades, the list of broad abilities is far from complete, much less understood. We propose criteria by which the list of broad abilities could be amended and envision alternatives for how our understanding of the hot intelligences (abilities involving emotionally-salient information and cool intelligences (abilities involving perceptual processing and logical reasoning might be integrated into a coherent theoretical framework.

  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. Triplane ankle fracture with deltoid ligament tear and syndesmotic disruption

    OpenAIRE

    Cummings, Robert Jay

    2008-01-01

    In patients with immature skeletons, ligamentous injuries rarely accompany ankle fractures. In this article, we report about deltoid ligament tears and syndesmotic disruptions accompanying triplane ankle fractures in two children, and make recommendations as to the evaluation and treatment of children with such injuries.

  2. 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 e...

  3. Diagnosis of the cruciate ligaments by means of computed tomography

    International Nuclear Information System (INIS)

    284 patients with suspected cruciate ligament lesions were examined by means of computed tomography. The method of examination with two standard positions, the lateral and prone, are being presented. A classification of cruciate ligament lesions on the basis of morphological changes is introduced. Type I is characterized by a displacement of the torn ligament, whereas in Type II no displacement can be seen. In Type III a complete rupture is present. Type IV is associated with osseous involvement. An edema of the ligament and a decrease of the absorption values can be observed in Type V. CT-arthrography has proved to be a sensitive method in the diagnosis of the cruciate ligaments. (author)

  4. Infections after reconstructions of anterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Ristić Vladimir

    2014-01-01

    Full Text Available Introduction. Infections after anterior cruciate ligament reconstructions are rare, but, on the other hand, they are difficult to be treated. The aim of this study was to analyze causes of infections, risk factors, diagnostics, and possibilities of their prevention. Material and Methods. Seventeen deep infections (1.2% were found in 1425 patients who had undergone anterior cruciate ligament reconstructions. Fifteen patients were males and two were females. Out of 475 professional athletes nine (1.9% had this postoperative complication. Eleven patients with septic arthritis were allergic to penicillin. Three of them had immunosuppressive diseases. Results. Staphylococcus aureus was isolated in eleven cases (65%, other Staphylococcus and Streptococcus groups were found in four and three patients, respectively; while one patient had infection although the punctate was negative. Out of 965 patients with the patellar tendon grafts, ten (1.03% had this complication, while the incidence was 1.52% (7/460 in those with the hamstring grafts. Fifteen infections were acute with obvious symptoms within 14 days after surgery. Severe pain, limited range of motion, swelling of the knee joint and fever were the most common symptoms, while rubor and pus developed rarely. The infection was three times more frequent in the patients who had undergone surgery lasting more than 1.5 hour. Discussion and Conclusion. The following population groups are at risk of developing septic arthritis after anterior cruciate ligament reconstructions: professional athletes, those who are allergic to penicillin, and those with immunosuppressive diseases. Staphyllococus aureus is the most common cause of infection. The patients with the hamstring autografts have a higher risk than those with the patellar tendon grafts. Preventive measures that should be performed include aseptic conditions in operative rooms, irrigation of the graft before its placement into the bone tunnels

  5. Standardization of lesions of external bone ligaments

    International Nuclear Information System (INIS)

    In the time from March 1978 until September 1978, 100 patients having a lesion of the capsular ligament at the upper ankle joint immediately after an accident were examined. The manual X-ray diagnosis was compared with a diagnosis using a newly-created holding apparatus. This way of diagnosing was carried out at the same time on the same patient; this gave an optimal possibility of comparing the two ways of examination. Generally seen, apparative X-ray diagnosis achieved higher values thus giving the possibility of more exact classification as to the diagnosis and therapy. (orig./MG)

  6. 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. PMID:26917487

  7. MRI of anterior cruciate ligament autografts

    Energy Technology Data Exchange (ETDEWEB)

    Ogi, Shigeyuki; Ariizumi, Mitsuko; Yamagishi, Tsuneo [The Aoyama Tokyo Metropolitan office' s Hospital (Japan); Agata, Toshihiko; Tada, Shinpei; Fukuda, Kunihiko

    2000-09-01

    The purpose of this study was to assess the usefulness of MRI in the evaluation of autografts after anterior cruciate ligament reconstruction. The subjects were 110 patients with anterior cruciate ligament reconstruction using patellar tendon autografts who underwent clinical examination, MRI, and arthroscopy of the knee. T1- and T2-weighted MR images were obtained in sagittal plane. Clinical findings were categorized into three groups: normal, borderline, and abnormal. The MRI appearances of the autografts were categorized into three types: straight continuous band (type I), interrupted band (type II) and generalized increased intensity band (type III). The clinical findings and MRI findings were compared with arthroscopic findings. Ninety-six percent of the type I showed no autograft tear on arthroscopy. In comparison with the clinical findings, MRI was found to be well correlated with arthroscopic findings. In conclusion, if the clinical findings are normal, patients are to be followed-up without MRI and arthroscopy. However, if clinical findings are either borderline or abnormal, MRI should be performed prior to arthroscopy. (author)

  8. Inguinal endometriosis attaching to the round ligament

    International Nuclear Information System (INIS)

    We report a case of endometriosis in the right inguinal region, attached to the right round ligament in a 28-year-old woman. At the age of 20, laparoscopic left ovarian cystectomy and pelvic adhesiolysis for endometriosis was carried out. She noticed a right tender groin mass 7 months previously, and the tumour size fluctuated with the menstrual cycle. A poorly circumscribed elastic hard mass, measuring 3 cm in diameter, was palpated in her right inguinal region. Magnetic resonance imaging showed a 2.5 cm x 2.5 cm mass in the right inguinal canal and a 5.4 cm x 6.8 cm mass was seen in the left ovary. The mass enlarged during menstruation. The groin mass was removed, in addition to carrying out laparoscopic ovarian cystectomy. At operation, the groin mass was found to be in continuity with the round ligament of extraperitoneal portion. Histological diagnosis of endometriosis was made in both ovarian and inguinal tumours. After surgery, the pain disappeared completely. Worth mentioning is that MRI clearly showed the change of tumour size depending on the menstrual cycle, which aided in arriving at the correct diagnosis of endometriosis in an unusual location

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

    Energy Technology Data Exchange (ETDEWEB)

    Shahabpour, M., E-mail: maryam.shahabpour@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); De Maeseneer, M., E-mail: michel.demaeseneer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Pouders, C. [Department of Experimental Anatomy, Vrije Universiteit Brussel (Belgium); Van Overstraeten, L. [Department of Foot and Hand Surgery, Centre Hospitalier Regional de Wallonie Picarde, Tournai (Belgium); Ceuterick, P. [Department of Hand Surgery, Europa Ziekenhuizen, Brussels (Belgium); Fierens, Y. [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Goubau, J. [Department of Orthopaedic Surgery, UZ Brussel, Brussels (Belgium); De Mey, J. [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium)

    2011-02-15

    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 1.5 T 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.

  10. 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

  11. Double-contrast CT arthrography of the cruciate ligaments

    International Nuclear Information System (INIS)

    The value of computed tomography (CT) in evaluating the cruciate ligaments was assessed by studying an amputated knee in order to find the most suitable position for detecting minimal defects of the ligaments. The anterior cruciate ligament (ACL) or the posterior cruciate ligament (PCL), or both, of 60 patients (61 knees) were then examined by CT and the findings were compared with those of arthroscopy. Defects 3 mm in length were shown by CT. A sufficient quantity of air and an adequate amount of positive contrast medium were required to obtain an accurate picture of the ligaments. For the ACL, the sensitivity of CT was 96.6%, specificity was 95.5%, and accuracy was 96.1%. For the PCL, sensitivity was 78.6%, specificity was 91.7%, and accuracy was 84.6%. Ruptures of the cruciate ligaments shown by CT were classified into four types. Their CT images coincided significantly with their arthroscopic findings. This study shows double-contrast CT arthrography to be a valuable method for evaluating the cruciate ligaments, and especially the ACL. (author)

  12. Magnetic resonance imaging of ankle ligaments and tendon injuries

    International Nuclear Information System (INIS)

    Today MRI allows evaluation of the integrity of injured ankle ligaments. The major difficulty in MRI is inconsistency in visualization by inadequate appreciation of the three-dimensional orientation of each ankle ligament. Using this technique, 52 patients with sprained ankles underwent MRI. The integrity of rupture of the collateral lateral ligaments was obtained in all 52 ankles. Full-lenght visualization is essential for evaluation of the ankle ligaments with MRI. In these 52 patients the angle of tilt on the stress X-ray was compared with the rate of MRI findings showing an injury affecting two ligaments. We found that none of the patients in whom the angle of lateral tilt was less than 5 had rupture of two laterial ligaments, while 32% of patients with angles of tilt of 6-14 and 42% of those with angles of tilt over 15 on stress X-ray had two ruptured lateral ligaments. The advantages of MRI are that it offers the best visualization of the extent of the tendon lesion. MRI, however, seems to be superior to US in detecting and quantifying lesions of the Achilles tendon. Therefore, MRI may be indicated in particularly difficult cases of tendons injuries in the foot. (orig.)

  13. Immunohistological analysis of extracted anterior cruciate ligament graft impinged against posterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Kato So

    2011-11-01

    Full Text Available Abstract A young female athlete suffered from the residual instability of the knee after anterior cruciate ligament (ACL reconstruction with hamstring autograft. The 3-dimensional (3-D CT scan showed the "high noon" positioning of the primary femoral bone tunnel. The revision surgery with anatomic double-bundle technique was performed two years after the primary surgery and the femoral tunnels were created with the assistance of the 3-D fluoroscopy-based navigation. An arthroscopic examination confirmed the ACL graft impingement against posterior cruciate ligament (PCL when the knee was deeply flexed. The histological analysis of the resected primary ACL graft showed local inflammatory infiltration, enhanced synovial coverage and vascularization at the impinged site. The enhanced expression of vascular endothelial growth factor (VEGF at the impinged area when compared with non-impinged area was observed on immunohistochemical analysis. Abnormal mechanical stress by the impingement against PCL might have induced chronic inflammation and VEGF overexpression.

  14. 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. PMID:27077587

  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. 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 and...... similar endoscopic procedure and accelerated postoperative rehabilitation. Tunnel widening was determined using standardized anteroposterior (AP) and lateral X-rays adjusted for magnification. A limited series of MRIs was performed to validate these measurements. There was a significant difference in the...... degree of tunnel widening between the two groups. The mean increase in femoral tunnel area in the hamstring group was 100.4% compared with a decrease of 25% in the patella tendon group (P = <0.0001). In the tibial tunnel the mean increase in the hamstring group was 73.9% compared with a decrease of 2...

  17. MR imaging evaluation of anterior cruciate ligaments

    International Nuclear Information System (INIS)

    On 546 knees, the authors have obtained MR images (0.5 T or 1.5 T). The protocol included 5-mm-thick contiguous sagittal and oblique coronal images (in the plane of the anterior cruciate ligament [ACL]) and T1-, proton-density-, and T2-weighted sequences. In 174 patients, correlations with arthroscopic or surgical findings were available. In these cases, sagittal and oblique coronal images were retrospectively and separately read by two radiologists, who were blinded to other results. The mean accuracy of sagittal MR images alone was 88% for the depiction of partial and complete ACL tears, intraligamental bleeding, and scarring; the accuracy of oblique coronal images alone was 96%. Use of sagittal and oblique coronal images together achieved 98% accuracy

  18. Patellotibial contusions in anterior cruciate ligament tears.

    Science.gov (United States)

    Wissman, Robert D; England, Eric; Mehta, Kaushal; Nepute, Joshua; Von Fischer, Nathaniel; Apgar, Josh; Javadi, Ariyan

    2014-02-01

    Bone contusions are an important ancillary finding of many knee injuries. Not only are they a source of pain, they may suggest a mechanism of injury or a specific derangement of the knee joint. We have encountered a small number of patients being evaluated for anterior cruciate ligament (ACL) tears with unexplained patellar and tibial edema at magnetic resonance (MR) imaging. We present three individuals with contusions of the inferior patella with a corresponding contusion of the anteromedial tibial plateau. Internal derangements in these patients were similar to other individuals with acute ACL tears, however osseous contusions were more widespread. In conclusion, patellotibial contusions are rare and may indicate an injury with forces greater than usually encountered in most ACL tears. A careful search for uncommon associated injuries is prudent in these high-energy knee injuries. PMID:24037484

  19. Pathologic ligamentous constraint of the hip.

    Science.gov (United States)

    Crowninshield, R D; Johnston, R C; Brand, R A; Pedersen, D R

    1983-12-01

    A mathematic model of the hip capsule and lower extremity musculature was utilized to predict the forces present in the hip ligaments during locomotion. The results demonstrate principles and trends (rather than absolute results) in hip mechanics, the details of which are affected by the associated modeling assumptions. The active stretching of a hip joint capsule tightened by scarring or surgical transfer may appreciably increase the hip contact force. Capsular elements that prevent hip flexion and adduction play a major role in hip contact force exaggeration during common activities. The positive effect of maintaining the hip capsule to reduce total hip component dislocation contrasts with the potential negative effects of restricting joint motion and increasing the joint contact force. Increased joint loading due to capsular restriction may contribute to prosthetic component loosening. PMID:6641064

  20. Tibial Tuberosity-Posterior Cruciate Ligament Distance.

    Science.gov (United States)

    Daynes, Jake; Hinckel, Betina Bremer; Farr, Jack

    2016-08-01

    When trochlear dysplasia is present, it is difficult to measure the tibial tuberosity to trochlear groove (TT-TG) distance. A new measurement to assess tuberosity position was recently described by Seitlinger et al, which avoids the difficulty of identifying the TG as it references the posterior cruciate ligament (PCL). To evaluate the reproducibility of the Seitlinger et al findings, 42 knees in 41 patients with a documented history of recurrent patellar instability and 84 knees in patients with no history of patellar instability or patellofemoral symptoms were evaluated with magnetic resonance imaging. The TT-PCL distance was increased in the instability group (mean, 21.6 mm) compared with the control group (mean, 19.0 mm). The TT-PCL distance is an independent risk factor for patients with recurrent patellar instability. Its role in surgical planning remains to be determined. PMID:26509659

  1. Intra-articular ganglion cysts of the cruciate ligaments

    Energy Technology Data Exchange (ETDEWEB)

    Tyrrell, P.N.M.; Cassar-Pullicino, V.N.; McCall, I.W. [Department of Diagnostic Imaging and The Institute of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire (United Kingdom)

    2000-08-01

    Intra-articular ganglion cysts of the cruciate ligaments are associated with non-specific clinical signs and symptoms. Familiarity with the MR appearances in particular is important to make an accurate diagnosis, exclude associated abnormalities, and avoid misdiagnosis. (orig.)

  2. MR for assessing anterior cruciate ligament reconstructions by tendon grafts

    International Nuclear Information System (INIS)

    150 patients were examined via magnetic resonance (MR) after anterior cruciate (ACL) ligament reconstruction (76 patellar tendon grafts, 53 semitendinosous tendon grafts and 21 sutures). The results of MR were compared with clinical tests (Lachman, pivot-shift and anterior drawer test), in 2 cases with the operative findings, and in one case with arthroscopy findings. In 91% of patients with a clinically stable knee we found a continuous low-intensity ligamental structure. 10 patients were examined twice or more between 8 days and 6 months after surgery. Ligamental structures of low signal intensity did not significantly change their MR characteristics. MR is a valuable noninvasive method for evaluating ligament reconstructions. (orig./GDG)

  3. Ganglion cysts of the cruciate ligaments detected by MRI

    OpenAIRE

    Sumen, Y.; Ochi, M.; Deie, M.; Adachi, N.; Ikuta, Y.

    1999-01-01

     Eight patients with ganglion cysts arising from the cruciate ligaments of the knee joint underwent arthroscopic excision after the MR examination. The MR findings, clinical features and arthroscopic findings were evaluated comparatively.

  4. Scapholunate Interosseous Ligament Anatomy and Biomechanics.

    Science.gov (United States)

    Rajan, Prashant V; Day, Charles S

    2015-08-01

    Injury to the scapholunate interosseous ligament is one of the most common causes of carpal instability and can impart considerable compromise to the patient's hand function. However, the management of scapholunate ligament injuries remains a dynamic concept, especially with regard to the multitude of options and techniques that exist for its surgical treatment. We present a thorough review of scapholunate anatomy and morphology, and the role of the scapholunate articulations in the kinetics and pathomechanics of wrist instability. We also review the current literature on the biomechanical properties of the scapholunate ligament and its subcomponents. A sound understanding of the anatomy and biomechanics of the scapholunate ligament can clarify its instability and may better orient current reconstructive procedures or pioneer better future techniques. PMID:26143029

  5. Distal clavicle osteolysis following fixation with a synthetic ligament

    Directory of Open Access Journals (Sweden)

    Paul M.C Dearden

    2011-01-01

    Full Text Available We present a case of distal clavicle osteolysis following treatment of a chronic acromioclavicular joint dislocation with a synthetic ligament. The relevant literature is reviewed and discussed.

  6. Intra-articular ganglion cysts of the cruciate ligaments

    International Nuclear Information System (INIS)

    Intra-articular ganglion cysts of the cruciate ligaments are associated with non-specific clinical signs and symptoms. Familiarity with the MR appearances in particular is important to make an accurate diagnosis, exclude associated abnormalities, and avoid misdiagnosis. (orig.)

  7. Case report ganglion cysts of the bilateral cruciate ligaments.

    Science.gov (United States)

    Noda, M; Kurosaka, M; Maeno, K; Mizuno, K

    1999-01-01

    Ganglion cysts originating from the cruciate ligaments have been reported rarely. A 38-year-old woman developed symptoms of knee pain with 10 degrees loss of knee extension. Preoperative magnetic resonance imaging showed a well-demarcated cystic mass surrounding the posterior cruciate ligament so clearly that further examination was not recommended. Because examination under anesthesia confirmed full extension of the knee, we presumed that pain produced by compression caused the diminished extension, and that mechanical block was not the reason. During arthroscopic examination, a mass was impinged between the anterior cruciate ligament and the intercondylar notch when extension of the knee was attempted. The mass was resected and immediate improvement was noted. The patient had experienced the same episode in the contralateral knee and removal of a ganglion cyst on the cruciate ligament 10 years ago. At the latest follow-up she was completely symptom free in both knees without any sign of recurrence. PMID:10564867

  8. MR imaging of the posterior cruciate ligament of the knee

    International Nuclear Information System (INIS)

    The significance of posterior cruciate ligament (PCL) tears is controversial, and the reliability of physical examination has recently been questioned in the orthopedic literature. The authors reviewed the MR examinations of 60 patients. Normal anatomy of the PCL and surrounding structures, including the ligaments of Humphrey and Wrisberg, are identified on anatomic drawings and MR images. Changes in the PCl with varying degrees of flexion are demonstrated. Examples of tear and avulsions of the PCL confirmed with arthroscopy or arthrotomy are presented

  9. MR examination of the distensibility of healthy cruciate ligaments

    International Nuclear Information System (INIS)

    A functional MR study was performed using a Magnetom Open (0.2 Tesla, Fa. Siemens). We measured the length and width of the anterior and posterior cruciate ligament in volunteers (n=12), age 20-40. We examined in 4 knee positions between maximal extension and maximal flexion. Using the Wilcoxon test, the statistics do not show any significant difference between the length and width of the cruciate ligaments in the monoaxial movement. (orig./MG)

  10. Strain measurement at the knee ligament insertion sites

    OpenAIRE

    Hinterwimmer, S; Baumgart, R.; Plitz, W.

    2003-01-01

    We describe the modification of an existing method of ligament strain measurement at the knee joint in detail. At ten fresh joint specimens we used that technique where strain gauges are attached to the ligamentous insertions and origins. We both improved the preparation of the attachment site and the application of the strain gauges. In a special apparatus the specimens were moved from 0degrees extension to 100degrees flexion while simulating muscle strength and axial force. Testing was perf...

  11. Tissue Engineering Applications for Ligament and Tendon Reconstruction

    Institute of Scientific and Technical Information of China (English)

    J.C.H.; GOH; H.W.; OU; YANG; Z.G.; GE; S.L.; TOH

    2005-01-01

    Tendons and ligaments are subjected to high physiological loads. As such, injuries due to high impact activities are common. Due to the avascular nature of these connective tissues, the healing rate is rather slow. Currently the therapeutic options to treat tendon and ligament injuries are autografts, allografts and prosthetic devices. However, there are many disadvantages in using biological grafts, as well as concerns over long-term performance of synthetic prostheses. Therefore, further research for alte...

  12. MR imaging of the lateral collateral ligaments after ankle sprain

    International Nuclear Information System (INIS)

    35 patients with ankle sprain were examined by MRI and stress radiographs. 13 were operated afterwards, 22 patients underwent a functional conservative therapy and were examined by MRI and stress radiographs and second time after three months. MRI reports were correct in 12 of 13 operated cases. After conservative therapy we did not find any disrupted ankle ligament. MRI showed intact ligaments thickened by scar. (orig./MG)

  13. Current Role of Open Reconstruction of the Scapholunate Ligament

    OpenAIRE

    Luchetti, Riccardo; Atzei, Andrea; Cozzolino, Roberto; Fairplay, Tracy

    2013-01-01

    This paper is a review of the various surgical techniques used in repair or reconstruction of the scapholunate ligament according to the clinical stages and anatomic-pathologic findings. Arthroscopy permits a direct evaluation of the scapholunate injury and the status of the articular surfaces. Specific indications for each type of scapholunate ligament tear are proposed, from the different types of dorsal capsulodesis to bone–ligament–bone techniques and tenodesis procedures. The authors' pr...

  14. Rupture of Posterior Cruciate Ligament: Diagnosis and Treatment Principles

    OpenAIRE

    Lee, Beom Koo; Nam, Shin Woo

    2011-01-01

    Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascul...

  15. Medial collateral ligament injuries of the knee: current treatment concepts

    OpenAIRE

    Chen, Lan; Kim, Paul D.; Ahmad, Christopher S.; Levine, William N.

    2007-01-01

    The medial collateral ligament is one of the most commonly injured ligaments of the knee. Most injuries result from a valgus force on the knee. The increased participation in football, ice hockey, and skiing has all contributed to the increased frequency of MCL injuries. Prophylactic knee bracing in contact sports may prevent injury; however, performance may suffer. The majority of patients who sustain an MCL injury will achieve their pre-injury activity level with non-operative treatment alo...

  16. Ganglion Cyst of the Posterior Longitudinal Ligament Causing Lumbar Radiculopathy

    OpenAIRE

    Cho, Sung-Min; Rhee, Woo-Tack; Lee, Sang-Youl; Lee, Sang-Bok

    2010-01-01

    Degenerated conditions such as herniated disc or spinal stenosis are common etiologies of lumbar radiculopathy. Less common etiologies include spinal extradural cyst such as synovial cysts and ganglion cysts. Ganglion cyst of the posterior longitudinal ligament (PLL) of the spine is a rare entity that can result in classical sciatica. Posterior longitudinal ligament cyst has no continuity with the facet joint and has no epithelial lining. Two young male patients presented with unilateral scia...

  17. [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. PMID:26234038

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

    International Nuclear Information System (INIS)

    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.)

  19. Occipital condyle fracture and ligament injury: imaging by CT

    International Nuclear Information System (INIS)

    The true incidence of fracture of the occipital condyles is unknown. It may be associated with instability at the craniocervical joint. CT is the modality of choice for the demonstration of these fractures, but its use for imaging of the associated ligament injury has not been reported. In order to demonstrate normal anatomy, occipital condyle fracture and ligament injury, and to estimate the incidence of this lesion, 21 children and young adults with high-energy blunt craniocervical injury were examined prospectively. Thin-slice, axial, contiguous, CT was performed from the base of C2 to above the foramen magnum. Bone and soft tissue windows and coronal, sagittal, and curvilinear 2D reconstructions were performed. Five occipital condyle fractures were identified in four patients (19 %), with demonstration of alar ligament injury in two cases and local hematoma in one. In four, artifacts or rotation precluded assessment of ligaments. In all remaining cases normal bone and ligament anatomy was demonstrated. Fracture of the occipital condyles following craniocervical injury is not uncommon in children and young adults. Normal bone and ligament anatomy and pathology can be safely and clearly demonstrated in seriously injured patients and others using this CT technique. Increased awareness of this entity and a low threshold for performing CT should avoid the potentially serious consequences of a missed diagnosis. (orig.). With 8 figs., 2 tabs

  20. 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.)

  1. [PARTICULAR QUALITIES OF DIAGNOSTIC ACUTE LATERAL ANKLE LIGAMENT INJURIES].

    Science.gov (United States)

    Krasnoperov, S N; Shishka, I V; Golovaha, M L

    2015-01-01

    Delayed diagnosis of acute lateral ankle ligaments injury and subsequent inadequate treatment leads to the development of chronic instability and rapid progression of degenerative processes in the joint. The aim of our work was to improve treatment results by developing an diagnostic algorithm and treatment strategy of acute lateral ankle ligament injuries. The study included 48 patients with history of acute inversion ankle injury mechanism. Diagnostic protocol included clinical and radiological examination during 48 hours and after 7-10 days after injury. According to the high rate of inaccurate clinical diagnosis in the first 48 hours of the injury a short course of conservative treatment for 7-10 days is needed with follow-up and controlling clinical and radiographic instability tests. Clinical symptoms of ankle inversion injury showed that the combination of local tenderness in the projection of damaged ligaments, the presence of severe periarticular hematoma in the lateral department and positive anterior drawer and talar tilt tests in 7-10 days after the injury in 87% of cases shows the presence of ligament rupture. An algorithm for diagnosis of acute lateral ankle ligament injury was developed, which allowed us to determine differential indications for surgical repair of the ligaments and conservative treatment of these patients. PMID:27089717

  2. MRI assessment of mid-urethral ligament changes in female stress urinary incontinence

    International Nuclear Information System (INIS)

    Objective: To evaluate the MRI value in changes of mid-urethral ligament injury of female stress urinary incontinence (SUI). Methods: Comparison of MRI changes of mid-urethral ligament on 30 healthy female volunteers and 20 female SUI patients. Chi-square test was used to compare the form of SUI patient's mid-urethral support ligaments. Results: The female mid-urethral support ligaments were composed of 4 groups of ligaments, including the periurethral ligament and pubourethral ligaments (1 pair), and at both sides of the urethra's paraurethral ligaments (1 pair) and suburethral ligament lying dorsal urethra, connecting the urethra and pelvic arcus tendinous fasciae. In normal MRI, ligament was a thin strip and showed low signal on both T1WI and T2WI, T2WI sagittal and cross-section scan was the best combination to show the middle urethral support ligaments changes, with tension; 6 patients (20%) in the 30 patients normal control group could be seen tortuously and slack like around the urethra ligaments. Twenty SUI patients mid-urethral support ligaments were performance laxity or rupture,rates were 39% (47/120) and 42% (50/120) (χ2=43.191, P<0.05). On T2WI, the ligamentous laxity was floating,and loss tension, also could performance one side extension and thinner than the other side. The ligament rupture was performance of the signal interruption, ligament contracture and one end of ligament attachment points separation. Conclusion: MRI can objective effective evaluate the mid-urethral support ligaments' pathological changes in stress urinary incontinence patients. (authors)

  3. Broad Diphotons from Narrow States

    CERN Document Server

    An, Haipeng; Zhang, Yue

    2015-01-01

    ATLAS and CMS have each reported a modest diphoton excess consistent with the decay of a broad resonance at ~ 750 GeV. We show how this signal can arise in a weakly coupled theory comprised solely of narrow width particles. In particular, if the decaying particle is produced off-shell, then the associated diphoton resonance will have a broad, adjustable width. We present simplified models which explain the diphoton excess through the three-body decay of a scalar or fermion. Our minimal ultraviolet completion is a weakly coupled and renormalizable theory of a singlet scalar plus a heavy vector-like quark and lepton. The smoking gun of this mechanism is an asymmetric diphoton peak recoiling against missing transverse energy, jets, or leptons.

  4. Cochlear microphonic broad tuning curves

    Science.gov (United States)

    Ayat, Mohammad; Teal, Paul D.; Searchfield, Grant D.; Razali, Najwani

    2015-12-01

    It is known that the cochlear microphonic voltage exhibits much broader tuning than does the basilar membrane motion. The most commonly used explanation for this is that when an electrode is inserted at a particular point inside the scala media, the microphonic potentials of neighbouring hair cells have different phases, leading to cancelation at the electrodes location. In situ recording of functioning outer hair cells (OHCs) for investigating this hypothesis is exceptionally difficult. Therefore, to investigate the discrepancy between the tuning curves of the basilar membrane and those of the cochlear microphonic, and the effect of phase cancellation of adjacent hair cells on the broadness of the cochlear microphonic tuning curves, we use an electromechanical model of the cochlea to devise an experiment. We explore the effect of adjacent hair cells (i.e., longitudinal phase cancellation) on the broadness of the cochlear microphonic tuning curves in different locations. The results of the experiment indicate that active longitudinal coupling (i.e., coupling with active adjacent outer hair cells) only slightly changes the broadness of the CM tuning curves. The results also demonstrate that there is a π phase difference between the potentials produced by the hair bundle and the soma near the place associated with the characteristic frequency based on place-frequency maps (i.e., the best place). We suggest that the transversal phase cancellation (caused by the phase difference between the hair bundle and the soma) plays a far more important role than longitudinal phase cancellation in the broadness of the cochlear microphonic tuning curves. Moreover, by increasing the modelled longitudinal resistance resulting the cochlear microphonic curves exhibiting sharper tuning. The results of the simulations suggest that the passive network of the organ of Corti determines the phase difference between the hair bundle and soma, and hence determines the sharpness of the

  5. Ulnar Collateral Ligament Reconstruction; the Rush Experience

    Science.gov (United States)

    Erickson, Brandon J.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Verma, Nikhil N.; Nicholson, Gregory P.; Romeo, Anthony A.

    2016-01-01

    Objectives: Background: Ulnar collateral ligament reconstruction (UCLR) is now a common surgery performed in both professional, as well as high level athletes Purpose: To report the patient demographics, surgical techniques, and outcomes of all UCLR performed at a single institution from 2004-2014 Hypothesis: UCLR will be performed mostly in male pitchers and will have a complication rate of less than 5%. Methods: Methods: The surgical database of one institution was searched from January 1st 2004-December 31st 2014 for the current procedural terminology (CPT) code 24346 “Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)”. Charts were reviewed to determine patient age, gender, date of surgery, sport played, athletic level, surgical technique, graft type, and complications were recorded. Patients were contacted via phone calls to obtain the return to sport rate, Conway-Jobe score, Timmerman & Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Results: Results: One hundred eighty-nine patients underwent UCLR during the study period (92% male, average age 19.6 +/- 4.9 years, 77.8% were right elbows). There were 166 baseball players (87.8% of all patients), 156 of which were pitchers (82.5% of all patients). Ninety-eight (51.6%) were college athletes, 62 (36%) were high school athletes, and 25 (13.2%) were professional athletes at the time of surgery. The docking technique was used in 111 (58.7%) patients while the double docking technique was used in 78 (41.3%). An ipsilateral palmaris longus graft was used in 111 (58.7%) of patients while a hamstring autograft was used in 48 (25.4%) patients. The ulnar nerve was subcutaneously transposed in 79 (41.8%) patients. Overall 95.7% of patients were able to return to sport and had a Conway-Jobe score of good/excellent while 4.3% had a score of fair. The average KJOC score was 94.7 +/- 5.7 and average Timmerman-Andrews score was 93.7 +/- 7

  6. Cold experiments on ligament formation for blast furnace slag granulation

    International Nuclear Information System (INIS)

    Rotary cup atomization for molten slag granulation is an attractive alternative to water quenching. However, the mechanism of disintegration of molten slag must be assessed. In the present study, a glycerol/water mixture was substituted for molten slag, and the mechanism of ligament formation in a rotary cup was investigated using photos taken by a high-speed camera. The effects of the angular speed and inner depth of the rotary cup on ligament disintegration was investigated. The results showed that one state of disintegration may transform into another state as the angular speed of the rotary cup increases at a given liquid flow rate. During ligament formation, the number of ligaments increased with an increase in the angular speed of the rotary cup, and a decrease in the diameter of ligament and liquid drop was observed. Moreover, the initial point of disintegration of the ligament moved to the lip of the rotary cup as the angular speed increased. An equation describing the relationship between the diameter of the liquid drop and various factors was used to predict the diameter of the liquid drop. A rotary cup with an inner depth of 30 mm was the best choice for granulation. The results of the present study will be useful for designing devices used in molten slag granulation. - Highlights: ►The results can be used in the granulation of molten blast furnace slag. ► The three different states of disintegration occur as the angular speed of rotary cup increases. ► The mechanism of ligament disintegration is analyzed. ► Eq. can be used to predict the diameter of liquid drop. ► A rotary cup with an inner depth of 30 mm is optimal for granulation.

  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. Pitfalls of magnetic resonance imaging of alar ligament

    International Nuclear Information System (INIS)

    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.)

  9. MRI of anterior cruciate ligament healing

    Energy Technology Data Exchange (ETDEWEB)

    Ihara, Hidetoshi; Miwa, Megumi; Deya, Keizo; Torisu, Kenji [Kyushu Rosai Hospital, Kitakyushu (Japan)

    1996-03-01

    The purpose of this study was to evaluate using MRI the natural healing of the anterior cruciate ligament (ACL) when treated conservatively by early protective motion. Consecutive acute complete intraligamentous ruptures of the ACL in 50 cases that were allowed to heal without surgery were evaluated before and after 3 month treatment by MRI, arthroscopy, and stress radiographs. Twenty-nine of the 50 patients were also reevaluated 11 months from the initial injury, of which 7 were reevaluated again 24 months from the initial injury by MRI. The MR appearance of the treated ACL was categorized into four grades depending on homogeneity, straight band, and size. MR assessment of the ACL after 3 month treatment demonstrated a well defined normal-sized straight band in 37 cases (74%). There was a significant relationship between the 3 and 11 month MR evaluations (r. = 0.801, p < 0.0001). There were also significant relationships between the MR and arthroscopic evaluations (r, = 0.455, p < 0.005) and between the MR and stress radiographic evaluations (r, = 0.348, p < 0.025) after the 3 month treatment. MRI can demonstrate ACL healing when treated conservatively with early protective mobilization. 40 refs., 3 figs., 2 tabs.

  10. Approaching the ruptured anterior cruciate ligament.

    Science.gov (United States)

    Sarraf, Khaled M; Sadri, Amir; Thevendran, Gowreeson; Vedi, Vikas

    2011-08-01

    Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. At some point, the knee may lock, necessitating an arthroscopic meniscectomy. Tragically, this then hastens the progression of joint arthrosis and the decline of the joint function. While the burden of responsibility does not lie solely with the junior doctor or the general practitioner, it is often at the first consultation that the natural history of this devastating injury is decided. The ability to recognise, institute early management and reassure patients with ACL tears about the future is an invaluable asset to the non-specialist junior doctor. Once diagnosed, the responsibility of advising and further counselling of patients with ACL injuries is best left to the orthopaedic knee specialist. Family practitioners and emergency room doctors should not feel pressured to offer advice on specialist areas such as return to sports without reconstruction or indeed the need for reconstruction. Indeed, decisions to return to sports with ACL-deficient knees have all too often led to disastrous reinjury events to the articular cartilage and/or the menisci. PMID:21097944

  11. Guideline on anterior cruciate ligament injury.

    Science.gov (United States)

    Meuffels, Duncan E; Poldervaart, Michelle T; Diercks, Ron L; 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

    2012-08-01

    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

  12. 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. PMID:21529866

  13. In vivo length changes of wrist ligaments at full wrist extension.

    Science.gov (United States)

    Tan, J; Chen, J; Tang, J B

    2014-05-01

    The aim of this study was to investigate the length changes of carpal ligaments when loaded in full extension in vivo. We obtained computed tomography scans of the right wrists in three positions for six volunteers: neutral; 75° extension; and 75° extension with a further 10° of radial deviation. Nine ligaments were measured and analysed with computer modelling. The results showed that the radioscaphocapitate, long radiolunate, and ulnolunate ligaments lengthened the most at full wrist extension, suggesting that they were under greatest load. The radioscapholunate, ulnocapitate, and ulnotriquetral ligaments lengthened further with the addition of wrist radial deviation. At full extension, the dorsal intercarpal ligament inserting on the scaphoid was lengthened. The dorsal radiocarpal and dorsal intercarpal ligaments inserting on the trapezoid were shortened, suggesting reduced loading. In conclusion, a number of volar carpal ligaments lengthened significantly in full wrist extension and the ulnar carpal ligaments were further lengthened at wrist radial deviation. PMID:23571488

  14. Biomechanical study on the suture strength of ligament in cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    张春礼; 李起鸿; 杨柳

    2003-01-01

    Objective: To test the suture strength on the tendon or ligament end and evaluate the stitch in the reconstruction of cruciate ligament and its clinical application. Methods: Twenty-four specimens of patellar tendon with free ends were divided into 3 groups: Group I (3 Krackow stitches), Group II (2 Krackow stitches) and Group III (2 Krackow stitches with the first stitch passing through the tendon tissue as a modified Krackow stitch). These 3 groups were further divided into 6 subgroups according to different suture materials, No 1 Ethilon or stainless steel wire (φ= 0.4 mm). Tensile test was undertaken to find out the least stitches with efficient suture pattern. Results: Two Krackow locking stitches had stronger strength than 0.4 mm-diameter stainless steel wire. The fixation strength of 2 stitches with No 1 Ethilon was more than 80 N, superior to the failure strength of the material itself. The same strength was maintained if the first stitch was across the tendon tissue transversely. There was no statistically significant difference in the suture strength between 2 and 3 Krackow locking stitches. Conclusions: The suture strength is greater than the failure strength of the suture material. Less suture exposure can be achieved when the first stitch is across the tendon tissue while maintaining a comparable strength to other sutures. To attain higher suture strength, stronger materials or multiple strands rather than more stitches are preferred. Therefore, a rapid early rehabilitation of range of motion (ROM) is possible and reliable in practice.

  15. 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.

  16. 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.

  17. 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.

  18. Human periodontal ligament stem cells repair mental nerve injury*

    Institute of Scientific and Technical Information of China (English)

    Bohan Li; Hun-Jong Jung; Soung-Min Kim; Myung-Jin Kim; Jeong Won Jahng; Jong-Ho Lee

    2013-01-01

    Human periodontal ligament stem cells are easily accessible and can differentiate into Schwann cells. We hypothesized that human periodontal ligament stem cells can be used as an alternative source for the autologous Schwann cells in promoting the regeneration of injured peripheral nerve. To validate this hypothesis, human periodontal ligament stem cells (1 × 106) were injected into the crush-injured left mental nerve in rats. Simultaneously, autologous Schwann cells (1 × 106) and PBS were also injected as controls. Real-time reverse transcriptase polymerase chain reaction showed that at 5 days after injection, mRNA expression of low affinity nerve growth factor receptor was sig-nificantaly increased in the left trigeminal ganglion of rats with mental nerve injury. Sensory tests, histomorphometric evaluation and retrograde labeling demonstrated that at 2 and 4 weeks after in-jection, sensory function was significantly improved, the numbers of retrograde labeled sensory neurons and myelinated axons were significantly increased, and human periodontal ligament stem cells and autologous Schwann cells exhibited similar therapeutic effects. These findings suggest that transplantation of human periodontal ligament stem cells show a potential value in repair of mental nerve injury.

  19. Wrist ligament injuries: value of post-arthrography computed tomography

    International Nuclear Information System (INIS)

    Objective: To evaluate the use of post-arthrography high-resolution computed tomography in wrist ligament injuries.Design and patients: Thirty-six consecutive patients who had a history and clinical findings suggestive of ligamentous injuries of the wrist were prospectively studied. The findings of three-compartment arthrography and post-arthrography computed tomography (arthro-CT) were compared with those of arthroscopy. The evaluation concentrates on the detection and precise localization of ligament lesions in the triangular fibrocartilage (TFC), the scapholunate ligament (SLL) and the lunotriquetral ligament (LTL).Results: For TFC, SLL and LTL lesions, standard arthrography responded with a sensitivity and specificity of 85% and 100%, 85% and 100%, 80% and 100% respectively, while arthro-CT showed a sensitivity and specificity of 85% and 100%, 100% and 100%, 80% and 100% respectively. The precise localization of the lesions was possible only with arthro-CT.Conclusion: The sensitivity and specificity of standard arthrography and arthro-CT are similar, although the latter shows the site of tears or perforation with greater precision, while conventional arthrography demonstrates them indirectly. This precision is essential and may have clinical implications for the success of treatment procedures. (orig.)

  20. Ligamentous structures in foramen magnum: sectional anatomy, CT and MRI

    International Nuclear Information System (INIS)

    Objective: To study the thin sectional anatomy and CT and MR imaging of ligamentous structures of foramen magnum (FM). Methods: Six formalin fixed (10%) specimens including head and neck were selected, and each specimen was imaged with CT and MR. Three specimens were sectioned with frozen section technique, the others were sectioned with plastination. Ligamentous structures of FM on continuous thin sections were observed and compared with the images of CT and MRI. Results: Continuous sections of 3.0 mm slice thickness for the axial, coronal, and sagittal planes of FM sectioned with frozen section technique were obtained. Continuous thin sections of 1mm slice thickness for the axial, coronal, and sagittal planes of FM sectioned with plastination were obtained. The resulting sections demonstrated excellent distinction of ligamentous structures of FM (including ligamentum alare, ligamentum transversum, membrana tectoria, anterior obturator membrane of atlas, posterior obturator membrane of atlas, and anterior atlanto-axial ligament). A good overall correlation between sections and images of CT and MR was found. Conclusions: In combination with CT and MRI, continuous thin sections of FM offers a better understanding of ligamentous structures of FM. (authors)

  1. One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction

    OpenAIRE

    Acar, Baver; Başarır, Kerem; Armangil, Mehmet; Binnet, Mehmet Serdar

    2014-01-01

    Introduction: Main evidence of the heavy knee dislocations is the rupture of both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). There are limited sources for the treatment of both ligaments at a single stage. Materials-method: One-staged anatomic double-bundle ACL and PCL reconstruction technique has been applied to 2 cases aged 20 and 36 with traumatic knee dislocation. Lateral collateral ligament and posteriolateral corner reconstruction added to one case, and medi...

  2. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome.

    OpenAIRE

    Fardin Mirzatolooei

    2014-01-01

    Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction.

  3. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome.

    Science.gov (United States)

    Mirzatolooei, Fardin

    2014-01-01

    Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction. PMID:24901727

  4. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome.

    Directory of Open Access Journals (Sweden)

    Fardin Mirzatolooei

    2014-03-01

    Full Text Available Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction.

  5. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers

    Energy Technology Data Exchange (ETDEWEB)

    De Smet, Arthur A. [Department of Radiology, University of Wisconsin, Madison, Wisconsin (United States); Department of Radiology - E3/311, University of Wisconsin Hospital, 600 Highland Avenue, Madison, WI 53792 (United States); Winter, Thomas C. [Department of Radiology, University of Wisconsin, Madison, Wisconsin (United States); Best, Thomas M. [Department of Family Medicine, University of Wisconsin, Madison, Wisconsin (United States); Bernhardt, David T. [Department of Pediatrics, University of Wisconsin, Madison, Wisconsin (United States)

    2002-11-01

    Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability. (orig.)

  6. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers

    International Nuclear Information System (INIS)

    Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability. (orig.)

  7. Injured lateral ankle ligaments: technique and assessment of MRI

    International Nuclear Information System (INIS)

    56 patients with the clinical diagnosis of sprained ankles were investigated. Evaluation of the anterior (AFTL) and posterior fibulotalar ligament (PFTL) was performed with the foot in dorsiflexion (20 ) and of the fibulo calcanear ligament (FCL) in plantarflexion (45 ). Axial T1w-SE and T2w-TSE images were obtained. Full-length visualisation of ligmaments in one slice and the extent of injury were evaluated. 12 ankle injuries were confirmed by operation. With MRI full-length visualisation of lateral ankle ligaments was possible in 86%. A partial/complete rupture of the AFTL was noticed in 33/64% and of the FCI in 29/39%, and of the PFTL in 27/5%. Sensitivity/specificity of MRI when compared to surgery was 100/100% for injuries of the AFTL, 64/100% for the FCL, and 33/78% for the PFTL. (orig./MG)

  8. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS)

    DEFF Research Database (Denmark)

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

    2014-01-01

    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......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......: Baseline and follow-up 1.5 T MRI examinations from 20 patients of the KANON study, a randomized controlled study comparing a surgical and non-surgical treatment strategy, were assessed for up to six longitudinal visits using a novel MRI scoring system incorporating acute structural tissue damage and...

  9. A proposed index for residual periodontal ligament support.

    Science.gov (United States)

    Abe, Yasuhiko; Taji, Tsuyoshi; Hiasa, Kyou; Tsuga, Kazuhiro; Akagawa, Yasumasa

    2010-01-01

    An index was developed to estimate the residual periodontal ligament support for individual teeth during treatment planning for partially edentulous patients. The Residual Periodontal Ligament Index (rPLI) was derived from a formula that calculates the remaining area of periodontal attachment and the Normal Periodontal Ligament Index (nPLI). To illustrate the applicability of the rPLI, the total nPLI scores of the remaining teeth corresponding to Eichner subclasses of partial edentulism were charted by assessing the average occlusal support numerically. The rPLI is proposed to be a possible suitable tool for epidemiologic research on the progression of tooth loss and the survival rate of prostheses. PMID:20859566

  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

    amplitudes necessary to elicit reflexes from the ACL re-constructions were 2, 9 times higher than amplitudes that elicited reflexes from the PCL. Sensation and afferent reflex activity required a much stronger stimulus in the ACL graft compared to normal PCL. We suggest that the reason for this is that the......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...

  11. Ghost imaging with broad distance

    Institute of Scientific and Technical Information of China (English)

    段德洋; 张路; 杜少将; 夏云杰

    2015-01-01

    We present a scheme that is able to achieve the ghost imaging with broad distance. The physical nature of our scheme is that the different wavelength beams are separated in free space by an optical media according to the slow light or dispersion principle. Meanwhile, the equality of the optical distance of the two light arms is not violated. The photon correlation is achieved by the rotating ground glass plate (RGGP) and spatial light modulator (SLM), respectively. Our work shows that a monochromic ghost image can be obtained in the case of RGGP. More importantly, the position (or distance) of the object can be ascertained by the color of the image. Thus, the imaging and ranging processes are combined as one process for the first time to the best of our knowledge. In the case of SLM, we can obtain a colored image regardless of where the object is.

  12. MRI features of the anterolateral ligament of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Taneja, Atul K. [Hospital Israelita Albert Einstein, Musculoskeletal Radiology Division, Imaging Department, Sao Paulo, SP (Brazil); Hospital do Coracao (HCor), and Teleimagem, Musculoskeletal Imaging, Diagnostic Center, Sao Paulo, SP (Brazil); Miranda, Frederico C.; Braga, Cesar A.P.; Hartmann, Luiz G.C.; Santos, Durval C.B.; Rosemberg, Laercio A. [Hospital Israelita Albert Einstein, Musculoskeletal Radiology Division, Imaging Department, Sao Paulo, SP (Brazil); Gill, Corey M. [Department of Neurology and Cancer Center, Pappas Center for Neuro-Oncology, Boston, MA (United States)

    2014-11-27

    Evaluate the visibility and describe the anatomical features of the anterolateral ligament of the knee using MRI. Magnetic resonance imaging examinations of the knee were independently reviewed by two musculoskeletal radiologists and assessed for the visibility of the anterolateral ligament under direct cross-referencing of axial and coronal images as complete, partial, or non-visible. Distal insertion site (tibial, meniscal), distance to lateral tibial plateau, measurements (length, width, thickness), and associated imaging findings were also tabulated. Clinical and surgical records were also reviewed. Seventy MRI scans from 60 consecutive subjects were included in the study. Mean age was 40 years, body mass 74.9 kg, and height 1.72 m. The subject population was 53 % male, most of the knees were from the left side (51 %), and chronic pain was the main clinical symptom (40 %). Nine knees (13 %) had undergone previous surgery. The anterolateral ligament was identified in 51 % of the knees: completely visible in 11 % and partially visible in 40 %. In all visible cases, the distal insertion site was identified on the tibia, with a mean distance of 5.7 mm to the plateau. A completely visible ligament had a mean length of 33.2 mm, thickness of 5.6 mm, and width of 1.9 mm. Inter-observer agreement for ligament presence was significant (κ = 0.7). Statistical analyses showed a trend to be more visible in men, with a longer length compared with women. Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized. (orig.)

  13. MRI features of the anterolateral ligament of the knee

    International Nuclear Information System (INIS)

    Evaluate the visibility and describe the anatomical features of the anterolateral ligament of the knee using MRI. Magnetic resonance imaging examinations of the knee were independently reviewed by two musculoskeletal radiologists and assessed for the visibility of the anterolateral ligament under direct cross-referencing of axial and coronal images as complete, partial, or non-visible. Distal insertion site (tibial, meniscal), distance to lateral tibial plateau, measurements (length, width, thickness), and associated imaging findings were also tabulated. Clinical and surgical records were also reviewed. Seventy MRI scans from 60 consecutive subjects were included in the study. Mean age was 40 years, body mass 74.9 kg, and height 1.72 m. The subject population was 53 % male, most of the knees were from the left side (51 %), and chronic pain was the main clinical symptom (40 %). Nine knees (13 %) had undergone previous surgery. The anterolateral ligament was identified in 51 % of the knees: completely visible in 11 % and partially visible in 40 %. In all visible cases, the distal insertion site was identified on the tibia, with a mean distance of 5.7 mm to the plateau. A completely visible ligament had a mean length of 33.2 mm, thickness of 5.6 mm, and width of 1.9 mm. Inter-observer agreement for ligament presence was significant (κ = 0.7). Statistical analyses showed a trend to be more visible in men, with a longer length compared with women. Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized. (orig.)

  14. Retinoid-induced ossification of the posterior longitudinal ligament

    International Nuclear Information System (INIS)

    Vitamin A and its synthetic congeners are known to produce a variety of skeletal abnormalities in patients on prolonged treatment with these medications. Two patients are described who developed posterior longitudinal ligament ossification following treatment with the synthetic retinoid 13-cis-retinoic acid. In both cases, this finding became apparent after other retinoid-induced skeletal abnormalities were observed and was less marked than the ossification of the anterior longitudinal ligament. Although spinal cord compression did not occur in our patients, patients on long-term retinoid therapy should be carefully observed for this complication. (orig.)

  15. Medial patellofemoral ligament: Research progress in anatomy and injury imaging

    International Nuclear Information System (INIS)

    The medial patellofemoral ligament (MPFL) is considered as the most important soft tissue restraint providing medial stability of the patellofemoral joint. During patellar dislocation, the MPFL is subjected to severe stretching forces, resulting in injuries of the ligament in the most patients. With the development of medical imaging technology, a variety of non-invasive diagnostic imaging methods have been becoming important means in diagnosis of MPFL injury. In this paper, MPFL anatomy, the applications of medical imaging technology in diagnosis of MPFL injury and the distributions of MPFL injury site were reviewed. (authors)

  16. 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.

  17. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    Science.gov (United States)

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed. PMID:26545750

  18. Patella fracture following anterior cruciate ligament reconstruction: A case report

    OpenAIRE

    Milankov Miroslav; Kecojević Vaso; Ninković Srđan; Gajdobranski Đorđe R.

    2003-01-01

    Introduction The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL) rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002), 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. Case report An 18-year-old female patie...

  19. Active knee motion after cruciate ligament rupture. Stereoradiography.

    Science.gov (United States)

    Kärrholm, J; Selvik, G; Elmqvist, L G; Hansson, L I

    1988-04-01

    In 10 patients with an old injury of the anterior cruciate ligament, the three-dimensional movements of the knee joint were studied when the patients flexed their knees. Tibial motions were recorded using roentgen stereophotogrammetric analysis. Internal rotation and adduction of the tibia were reduced in the injured knees when compared with the intact knees; during flexion of the knee joint, the tibial intercondylar eminence occupied a more lateral and posterior position on the injured side. Our results may indicate that the knee joint is continuously exposed to abnormal stresses when the anterior cruciate ligament is torn. PMID:3364185

  20. Gd-DTPA enhanced MR-follow-up of autologous patellar ligament transplants for anterior cruciate ligament repair

    International Nuclear Information System (INIS)

    Eighteen patients with autologous patellar tendon transplant for reconstruction the anterior cruciate ligament were examined postoperatively. The time between operation and MR study was up to 3 weeks in ten patients, between 3 and 35 weeks in three patients and more than 35 weeks in five patients. In all patients, Gd-DTPA enhancement on the surface of the ligamentous transplant was visualized. This enhancement was between 1 and 10 mm thick. In all patients, complete stability of the knee joint was postoperatively. In 15 patients achieved flexion and extension were normal at the postoperative investigation. Three patients had a limitation of knee movement. In these MR studies, significant hyperplasia of the synovial membrane of the entire joint was diagnosed, explaining the persisting problems. Gd-DTPA-enhanced MR of the knee joint allows non-invasive documentation of remodelling following a patellar ligament transplant and possible complications. (orig.)

  1. MRI of rupture of the spring ligament complex with talo-cuboid impaction

    International Nuclear Information System (INIS)

    The spring ligament complex is essential for the stability of the longitudinal arch of the foot and includes the ligaments between the calcaneus and the talus at the superomedial to inferoplantar aspect of the foot. Tears of the spring ligament complex are most commonly degenerative in etiology and secondary to concomitant abnormality of the posterior tibial tendon. We report MRI findings in a 30-year-old man who presented with traumatic rupture of the spring ligament complex, seen following dislocation of the talonavicular joint. We also describe the previously unreported MRI features of talo-cuboid impaction secondary to disruption of the spring ligament complex. (orig.)

  2. MRI of rupture of the spring ligament complex with talo-cuboid impaction

    Energy Technology Data Exchange (ETDEWEB)

    Kavanagh, E.C. [University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA (United States); Koulouris, G. [Department of Radiology, Melbourne, VIC (Australia); Gopez, A.; Zoga, A.; Morrison, W.B. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Raikin, S. [Thomas Jefferson University Hospital, Department of Orthopedics, Philadelphia, PA (United States)

    2007-06-15

    The spring ligament complex is essential for the stability of the longitudinal arch of the foot and includes the ligaments between the calcaneus and the talus at the superomedial to inferoplantar aspect of the foot. Tears of the spring ligament complex are most commonly degenerative in etiology and secondary to concomitant abnormality of the posterior tibial tendon. We report MRI findings in a 30-year-old man who presented with traumatic rupture of the spring ligament complex, seen following dislocation of the talonavicular joint. We also describe the previously unreported MRI features of talo-cuboid impaction secondary to disruption of the spring ligament complex. (orig.)

  3. MR imaging evaluation of the injured and operatively reconstructed cruciate ligament

    International Nuclear Information System (INIS)

    One hundred fifty patients with recent or older cruciate ligament injuries have been examined with MR imaging, and the MR findings were compared with the operative results. Ninety-three percent of all cases with a complete rupture of the anteriorand/or posterior ligament were diagnosed preoperatively. One hundred fifteen patients with reconstruction of one or both cruciate ligaments have been examined, and their MR findings were compared with the clinical findings at orthopedic examination. With a standardized MR technique identical to that used in patients with rupture of the cruciate ligaments, there was a good correlation between MR and clinical findings, for stable as well as unstable ligament reconstruction

  4. Experience of CT arthrography of the cruciate ligaments of the knee

    International Nuclear Information System (INIS)

    CT arthrography of the cruciate ligaments in 512 patients has shown that this new procedure provides a reproducible method for demonstrating these ligaments and for making a confident diagnosis of abnormalities. A classification of cruciate ligament lesions into five injury types was introduced in order to distinguish the morphological CT findings. The indication for CT arthrography of the cruciate ligaments is uncertainty after clinical examination. CT can help materially in deciding on treatment and in planning surgery, particularly in cases of possible knee joint instability with a long history, in recent cases with marked muscle spasm and in patients with isolated anterior ligament rupture. (orig.)

  5. 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.

  6. Biological and Biomechanical Evaluation of the Ligament Advanced Reinforcement System (LARS AC) in a Sheep Model of Anterior Cruciate Ligament Replacement: A 3-Month and 12-Month Study

    OpenAIRE

    Viateau, Véronique; MANASSERO, Mathieu; ANAGOSTOU, Fani; GUERARD, Sandra; Mitton, David; Migonney, Véronique

    2013-01-01

    PurposeThe purposes of this study were to assess tissue ingrowth within the Ligament Advanced Reinforcement System (LARS) artificial ligament (LARS AC; LARS, Arc sur Tille, France) and to study the biomechanical characteristics of the reconstructed knees in a sheep model of anterior cruciate ligament (ACL) replacement.MethodsTwenty-five female sheep underwent excision of the proximal third of the left ACL and intra-articular joint stabilization with a 44-strand polyethylene terephthalate liga...

  7. Ghost imaging with broad distance

    Science.gov (United States)

    Duan, De-Yang; Zhang, Lu; Du, Shao-Jiang; Xia, Yun-Jie

    2015-10-01

    We present a scheme that is able to achieve the ghost imaging with broad distance. The physical nature of our scheme is that the different wavelength beams are separated in free space by an optical media according to the slow light or dispersion principle. Meanwhile, the equality of the optical distance of the two light arms is not violated. The photon correlation is achieved by the rotating ground glass plate (RGGP) and spatial light modulator (SLM), respectively. Our work shows that a monochromic ghost image can be obtained in the case of RGGP. More importantly, the position (or distance) of the object can be ascertained by the color of the image. Thus, the imaging and ranging processes are combined as one process for the first time to the best of our knowledge. In the case of SLM, we can obtain a colored image regardless of where the object is. Project supported by the National Natural Science Foundation of China (Grant Nos. 61178012, 11204156, 11304179, and 11247240), the Specialized Research Fund for the Doctoral Program of Higher Education of China (Grant Nos. 20133705110001 and 20123705120002), the Scientific Research Foundation for Outstanding Young Scientists of Shandong Province, China (Grant No. BS2013DX034), and the Natural Science Foundation of Shandong Province, China (Grant No. ZR2012FQ024).

  8. 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.

  9. Tensions in the anterior and posterior cruciate ligaments of the knee during passive loading: predicting ligament loads from in situ measurements.

    Science.gov (United States)

    Vahey, J W; Draganich, L F

    1991-07-01

    Cruciate ligament tensions were predicted for anteroposterior (AP) tibial translation at 20 degrees, 30 degrees, 80 degrees, and 90 degrees of knee flexion based on in vitro measurements from six cadaver knees. A three-dimensional trigonometric equation was derived to calculate cruciate ligament tension as functions of AP force applied to the tibia and knee flexion angle (KFA). AP forces less than or equal to 150 N were applied. Ligament tension increased with applied AP force. The relationship between ligament tension and applied AP force appeared linear, but a Hotteling's T2 test failed to demonstrate a linear relationship. Tensions in the anterior cruciate ligament (ACL) attained magnitudes of approximately equal to 140 N. Tensions in the posterior cruciate ligament (PCL) attained magnitudes of approximately equal to 220 N. An analysis was performed to determine the sensitivity of ligament tension to hypothetical errors in the experimentally measured parameters used to compute ligament tension. The new method we report can be used to determine tensions in the ligaments of the knee or other joints for various loading conditions. PMID:2045979

  10. The role of the transverse carpal ligament in carpal stability: an in vitro study.

    Science.gov (United States)

    Tengrootenhuysen, Mike; van Riet, Roger; Pimontel, Paul; Bortier, Hilde; Van Glabbeek, Francis

    2009-08-01

    A biomechanical in vitro study was performed on 16 fresh frozen cadaver forearms to investigate the role of the transverse carpal ligament (TCL) in carpal stability. The distance between the scaphoid and hamate was measured, as a reference for the length of the TCL. Distances were recorded in both loaded and unloaded conditions after gradual sectioning of the transverse carpal ligament, the palmar scapholunate, long radiolunate ligament and radioscapholunate ligament. The largest increase in spread of the carpal bones (55.3% of total spread) was noted after loading with the ligament intact. Thereafter, sectioning of the TCL resulted in a further 32.9% increase in the distance between the scaphoid and the hamate. We conclude that the intact carpal bones-ligament complex displays some elasticity. Progressive sectioning of the TCL ligament under loading further opens the palmar arch. Nevertheless it appears that the carpal arch will still retain reasonable intrinsic stability even without an intact TCL. PMID:19774812

  11. Secondary signs of anterior cruciate ligament tear at MR imaging

    International Nuclear Information System (INIS)

    The value of secondary signs of anterior cruciate ligament (ACL) tear was evaluated. MR images of 47 knees, 15 with normal, 6 with acutely torn and 26 with chronically torn ACLs confirmed at arthroscopy, were reviewed. Lateral and medial anterior tibial translocations (ATT), posterior cruciate ligament (PCL) bowing ratio and depth of lateral femoral notch (LFN) were measured. The degrees of lateral and medial ATTs and the PCL bowing ratio of the chronically torn ACLs were significantly higher than those of normal ACLs. With cutoff values of 5-mm lateral ATT, 2.5-mm medial ATT and 0.35-PCL bowing ratio, torn ligaments were distinguished from intact ligaments with accuracies of over 80%. Depth of LFN was less sensitive and less accuracies. All knees with lateral ATT of 6.4 mm medial ATT of 3.5 mm, PCL bowing ratio of 0.43 and LFN depth of 1.5 mm or more had torn ACLs. Higher correlations were revealed between lateral ATT and medial ATT, and also between lateral ATT and PCL bowing ratio. Combined criteria of lateral ATT and PCL bowing ratio indicated the highest diagnostic value as a reliable secondary sign of torn ACLs. (author)

  12. Ossification of the posterior longitudinal ligament of the lumbar spine

    International Nuclear Information System (INIS)

    The ossification on the cervical posterior longitudinal ligament (OPLL) is widely known and studied in Japan where a roentgenological incidence of 2.6% adults affected has been found. Data concerning the ossification of the lumbar posterior longitudinal ligament are few and occasional. An epidemiological survey on lumbar OPLL was performed by the authors in Matsumoto, Japan, on a total of 972 subjects, 554 of whom over the age of 35, by means of X-ray of the lumbar spine. Ossification of the lumbar posterior longitudinal ligament was detected in 23 subjects (2.9%), with no significant difference between males (3.0%) and females (2.8). Lumbar OPLL was absent in the 238 subjects aged less than 34; it was most prevalent after the age of 45 (5.1% in males and 4.5% in females). The ossification developed in two ways: continuous ossified layer extending over several vertebrae; circumscribed ossification of the ligament corresponding to the level of the invertebral disk (retrodiscal type). The results of this epidemiological survey showed a roentgenological incidence of lumbar OPLL of the same magnitude than that of cervical OPLL

  13. Enthesiopathy of the short radial collateral ligaments in racing greyhounds

    International Nuclear Information System (INIS)

    In a radiographic survey of the carpi of 100 racing greyhounds there was a 14 per cent incidence of enthesiopathy of the origin of the straight part of the short radial collateral ligament. Enthesiopathy was not identified as a clinical problem in any case, nor was there historical evidence of any adverse effect on performance

  14. SPECT bone scintigraphy of medial collateral ligament/meniscus injury

    International Nuclear Information System (INIS)

    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 99mTc-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

  15. Tendinography for diagnosing injuries to tendons and ligaments

    International Nuclear Information System (INIS)

    A radiographic method of tendinography is described. In rabbits no inflammatory reaction in the Achilles tendon was observed 12 to 15 days after injection of contrast medium. Effects of examination of two healthy subjects and a patient with a traumatic condition are described. Suitable amounts and concentrations of contrast medium for examinations of Achilies tendon and cruciate ligaments are discussed. (Auth.)

  16. 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.

  17. Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

    Science.gov (United States)

    Palmanovich, Ezequiel; Shabat, Shay; Brin, Yaron S; Feldman, Viktor; Kish, Benny; Nyska, Meir

    2015-01-01

    Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn. PMID:26253476

  18. 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.

  19. Telomere length of anterior crucial ligament after rupture

    DEFF Research Database (Denmark)

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

    2011-01-01

    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) and there...

  20. Miniopen coracohumeral ligament release and manipulation for idiopathic frozen shoulder

    Directory of Open Access Journals (Sweden)

    Abdelsalam Eid

    2012-01-01

    Full Text Available In the management of idiopathic frozen shoulder, manipulation under anaesthesia is known to have serious potential complications including fractures and intra-articular injuries. Arthroscopy is a safer treatment modality but requires special instruments, experience, and involves added cost. The aim of this work was to study the use of miniopen Coracohumeral ligament release and manipulation of the shoulder as a safe and simple method of treating idiopathic frozen shoulder that could be performed as a quick procedure under short duration anaesthesia obtaining a significant improvement of shoulder function while avoiding complications that are feared to occur with the use of manipulation under anaesthesia. Miniopen Coracohumeral ligament release is performed through a 3-cm incision. The Coracohumeral ligament is divided, and then the shoulder is manipulated without undue force. A case series including fifteen patients (19 shoulders with idiopathic frozen shoulder operated by this technique is described. Miniopen Coracohumeral ligament release and manipulation is a quick procedure that may be performed under short duration anaesthesia obtaining a significant improvement of shoulder function meanwhile avoiding complications that are feared to occur with the use of manipulation under anaesthesia.

  1. Comparison of MRI and arthrography in the diagnosis of intercarpal ligament injury

    International Nuclear Information System (INIS)

    Of 500 cases undergoing wrist arthrography at this hospital since 1984-, 40 ligaments of 37 wrists in which injury to the scapho-lunate ligament (S-L, 22 ligaments) or luno-triquetral ligament (L-T, 18 ligaments) was confirmed and both MRI and wrist arthrography were performed within the 3-month period before surgery were investigated. On arthrography the presence/absence of communication between the midcarpal joint (M-C) and radiocarpal joint (R-C) and its location were determined. S-L and L-T on routine MR coronal images are depicted as a low-signal small triangular area. The presence, absence of injuries to these structures was determined, and the two compared with the site of ligament injury confirmed by arthroscopy. On arthrography the site of leakage and site of ligament injury were consistent in 19 of 22 at S-L ligament (86.4%), 15 of 18 at L-T ligament (83.3%), totally 34 of 40 cases (accuracy=85%). In 16 of 22 S-L ligament (72.7%) and 11 of 18 L-T ligament (61.1%), totally 27 cases in which ligament injury was discernible on MRI the accuracy was 67.5%, which was a lower figure as compared with arthrography. On arthrography the site of communication between R-C and M-C was largely consistent with the site of ligament injury, and the site of injury could be relatively easily diagnosed At the presently feasible resolution of MRI accurate grasp of the findings is difficult and so with respect to the diagnosis of ligament injury wrist arthrography is superior to MRI. (K.H.)

  2. 77 FR 50144 - Broad Stakeholder Survey

    Science.gov (United States)

    2012-08-20

    ... SECURITY Broad Stakeholder Survey AGENCY: National Protection and Programs Directorate, DHS. ACTION: 60-day... comments concerning the Broad Stakeholder Survey. DATES: Comments are encouraged and will be accepted until... across the Nation. The Broad Stakeholder Survey is designed to gather stakeholder feedback on...

  3. 76 FR 34087 - Broad Stakeholder Survey

    Science.gov (United States)

    2011-06-10

    ... SECURITY Broad Stakeholder Survey AGENCY: National Protection and Programs Directorate, DHS. ACTION: 60-day... comments concerning the Broad Stakeholder Survey. DATES: Comments are encouraged and will be accepted until.... The Broad Stakeholder Survey is designed to gather stakeholder feedback on the effectiveness of...

  4. 78 FR 20119 - Broad Stakeholder Survey

    Science.gov (United States)

    2013-04-03

    ... SECURITY Broad Stakeholder Survey AGENCY: National Protection and Programs Directorate, DHS. ACTION: 30-day... soliciting comments concerning the Broad Stakeholder Survey. DHS previously published this ICR in the Federal... responders across the Nation. The Broad Stakeholder Survey is designed to gather stakeholder feedback on...

  5. Patella fracture following anterior cruciate ligament reconstruction: A case report

    Directory of Open Access Journals (Sweden)

    Milankov Miroslav

    2003-01-01

    Full Text Available Introduction The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002, 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. Case report An 18-year-old female patient, a handball player, suffered an acute rupture of anterior cruciate ligament of the left knee, so arthroscopic bone-tendon-bone reconstruction of the anterior cruciate ligament was performed. After adequate skin incision, a bone graft was taken from the patella and upper part of trapezoid tibia, which was 25 mm long, 10 mm wide and 5 mm thick, together with a part of patellar ligament. After the remains of the anterior cruciate ligament had been arthroscopically removed, tunnels were made in tibia and femur and a graft was inserted and fixed with two metal interference screws. Knee stability was tested, and drainage was put in the knee joint. The wound was closed by layers. The quadriceps exercises and passive knee movements started immediately. Full range of movements was accomplished six weeks later when the patient started to walk with full weight-bearing on her operated leg. Three weeks later, (nine weeks after the operation, the patient has accidentally lost her balance and fell. A transverse, dislocated fracture of the left patella was diagnosed and osteosynthesis of the fractured patella with two Kirschner wires and a metallic loop was performed. Postoperatively, full range of movement was allowed. Six months later, the patient felt no pain, there was no swelling, full range of knee movement was achieved, while the Lachman Test was identical in both knees and the pivot shift test was negative. Discussion Fracture of patella after ACL reconstruction is

  6. Study on the nuchal ligament ossification on lateral cephalometric radiograph

    International Nuclear Information System (INIS)

    The purpose of this study was to assess the prevalence and radiographic characteristics of the nuchal ligament ossification on lateral cephalometric radiographs in Koreans. I review and interpreted the lateral cephalometric radiographs from 4,558 patients (1,857 males and 2,701 females, age range from 2 to 79 years) who visited the Kyungpook National University Dental Hospital from January 1, 2008 to February 3, 2009. I grouped the shapes of nuchal ligament ossification as round, rod-like, and segmented shape. And localized the ossification as the involvement of anterior cervical vertebral body. The data were analyzed by using chi-squared test with two-tailed and at a 5% significance level. Among those who showed the nuchal ligament ossification, the mean age of the 143 males was 51.1 and that of the 97 females was 48.0 years. It was not observed completely below teens, and was observed 1% in twenties, 6.1% in thirties, 18.6% in forties, and 26.3% over fifties. It was significantly prevalent in older age group (P<0.01) and in males than females among the same age group (P<0.05). The shapes of nuchal ligament ossification were as follows in order of frequency : rod-like (49.2%), round (30.4%), and segmented (20.4%). The highest involvement of ossification was found at the level of C5 (67.9%), C4 (29.2%), C6 (22.9%), C3 (3.3%), C7 (2.9%), C2 (0.8%), and C1 (0.4%). The nuchal ligament ossifications on lateral cephalometric radiographs were showed as round, rodlike, or segmented shape. The nuchal ligament ossification is often observed after the age of 40 and is observed more frequently in males than females. The highest shape of nuchal ligament ossification was rod-like shape and the highest involvement of cervical spine was C5.

  7. Experimental investigation on ligament formation for molten slag granulation

    International Nuclear Information System (INIS)

    During the dry granulation for molten blast furnace slag, rotary cup is used to atomize the molten slag. In this study, the mechanism of ligament formation for molten slag granulation was investigated. The results indicated that the transition equations from direct drop formation to ligament formation and ligament formation to sheet formation, obtained from glycerol/water mixture, can identify the type of disintegration for molten blast furnace slag granulation. Due to short wavelength of dilational wave along molten slag ligaments, the diameter of slag particles decreased with an increase in angular speed, and more and more slag particles were far away from the center of rotary cup. The slag particles diameter decreased with an increase in rotary cup diameter. The empirical equation can be used to predict the diameter of slag particles obtained by ligament formation for molten slag granulation at high angular speed. Because of slight change in viscosity and surface tension when the temperature of molten slag was over than 1300 °C, there was no change in diameter and mass fraction of slag particles with an increase in molten slag temperature. All the results could provide guidance for the design of industrial plant for molten blast furnace slag granulation. - Highlights: • Dry granulation for molten blast furnace slag is an attractive alternative to wet granulation. • Transition equation can be used to identify state of disintegration for molten slag granulation. • The diameter of slag particles decreased as an increase in angular speed and diameter of rotary cup. • There was no change in diameter of slag particles with an increase in molten slag temperature

  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. Simultaneous reconstruction of anterior cruciate ligament and posterior cruciate ligament by using allogeneic patellar tendon under arthroscopy

    Institute of Scientific and Technical Information of China (English)

    ZHOU Li-ping; ZHEN Min-qing; XU Zhong-he

    2005-01-01

    Objective: To evaluate operative effects of a new method to reconstruct anterior crucial ligament (ACL) and posterior crucial ligament (PCL) simultaneously by using patellar tendon under arthroscopy.Methods: From November 1999 to November 2003,the injured ACL and PCL of 11 patients were fixated with compressed screws and reconstructed under arthroscopy with the bone-patellar tendon-bone treated with deep hypothermia and T radiation. At the same time, 2 patients were treated with medial collateral ligament (MCL)reconstruction, 3 with lateral collateral ligament (LCL)reconstruction, 1 with meniscus suture and 4 with whole or partial resection.Results: All patients were followed up for 12-26months (average 16.5 months ). The Lysholm score method was employed to evaluate the knee function. The average preoperative score was 45.3 and the postoperative score was 86.4. Anterior drawer test (ADT) was positive in 11 knees preoperatively and feeble positive in one knee postoperatively. Lachman test was positive in 11 knees preoperatively and in one postoperatively, and feebly positive in two postoperatively. Posterior drawer test was positive in 11 knees preoperatively and feebly positive in 2postoperatively. There were 2 knees with tolerable pain and 2 with knee flexion of 5°-20°.Conclusions: As for simultaneous reconstruction of ACL and PCL under arthroscopy, ailogeneic bone-patellar tendon-bone can not only avoid injury and complication caused by autografting, but also help rehabilitation of the knee function.

  10. Morphometric parameters as risk factors for anterior cruciate ligament injuries: A MRI case-control study

    Directory of Open Access Journals (Sweden)

    Stijak Lazar

    2014-01-01

    Full Text Available Background/Aim. The anterior cruciate ligament (ACL is the most frequently injured ligament of the knee, representing 50% of all knee injuries. The aim of this study was to determine the differences in the morphometry of knee injury patients with an intact and a ruptured anterior cruciate ligament. Methods. The study included 33 matched pairs of patients divided into two groups: the study group with the diagnosis of anterior cruciate ligament rupture, and the control group with the diagnosis of patellofemoral pain but no anterior cruciate ligament lesion. The patients were matched on the basis of 4 attributes: age, sex, type of lesion (whether it was profession- related, and whether the lesion was left- or right-sided. Measurements were carried out using magnetic resonance imaging (MRI. Results. The anterior and posterior edges of the anterior cruciate ligament in the control group were highly significantly smaller (p 0.05. The patients in the control group showed a shorter but wider anterior cruciate ligament in comparison to their matched pairs. The control group of patients was also characterized by the correlation between the width of the intercondylar notch and the width of the anterior cruciate ligament, which was not the case in the study group. Conclusions. According to the results of our study we can say that a narrow intercondylar notch contains a proportionally thin anterior cruciate ligament, but we cannot say that this factor necessarily leads to rupture of the anterior cruciate ligament.

  11. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction.

    Directory of Open Access Journals (Sweden)

    Xiangkai Zhang

    Full Text Available 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.

  12. MR imaging of anterior cruciate ligament injury: associated findings

    International Nuclear Information System (INIS)

    Authors investigated the associated findings and their value in the diagnosis of anterior cruciate ligament (ACL) injury in MR image. The knee MR images of 47 patients with ACL injury (complete;24, partial;23) and 61 patients with normal ACL confirmed by the knee arthroscopy or operation were reviewed retrospectively. The degree of anterior translocation of tibia and the degree of posterior cruciate ligament (PCL) buckling were evaluated. The prevalence and pattern of associated adjacent bone, ligament and meniscus injuries were studied. The means(± 2 standard errors) of anterior translocation were different significantly in statistical analysis (ρ < 0.001, student t-test) between injury group (7.51 ± 1.16 mm) and normal group (-0.56 ± 0.92mm). In the level of 5mm of anterior translocation for the criteria of ACL injury, the sensitivity, specificity, accuracy were 78.7%, 89.5%, 84.3% for each. The means of PCL buckling ratio were also different statistically between injury group(0.23 ± 0.02) and normal group(0.17 ± 0.01)(ρ < 0.001). In the level of 0.20 for diagnostic criteria of ACL injury, the sensitivity, specificity, accuracy were 71.4%, 83.6%, 78.4% for each. Thirty one medial meniscus tear (66%), thirteen lateral meniscus tear (28%), ten medial collateral ligament injury (28%), one PCL injury(2%) were associated with ACL injury. The twenty nine bone marrow changes were found in twenty patients (43%) which included acutely injured seven patients. In acute cases, the bone marrow changes were depicted as diffuse or focal high signal intensity lesions in lateral femoral or tibial condyles in contrast to the changes in chronic cases depicted as focal low signal intensity lesions in variable location. Lateral femoral condylar notch depression were found in nine patients (19%) and avulsion fractures of anterior tibial spine in four patients(9%). The associated findings with ACL injury (anterior translocation, buckling of PCL, associated bone, ligament and

  13. Understanding acute ankle ligamentous sprain injury in sports

    Directory of Open Access Journals (Sweden)

    Fong Daniel TP

    2009-07-01

    Full Text Available Abstract This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL which possesses the lowest ultimate load among the lateral ligaments at the ankle. For extrinsic risk factors to ankle sprain injury, prescribing orthosis decreases the risk while increased exercise intensity in soccer raises the risk. For intrinsic factors, a foot size with increased width, an increased ankle eversion to inversion strength, plantarflexion strength and ratio between dorsiflexion and plantarflexion strength, and limb dominance could increase the ankle sprain injury risk. Players with a previous sprain history, players wearing shoes with air cells, players who do not stretch before exercising, players with inferior single leg balance, and overweight players are 4.9, 4.3, 2.6, 2.4 and 3.9 times more likely to sustain an ankle sprain injury. The aetiology of most ankle sprain injuries is incorrect foot positioning at landing – a medially-deviated vertical ground reaction force causes an explosive supination or inversion moment at the subtalar joint in a short time (about 50 ms. Another aetiology is the delayed reaction time of the peroneal muscles at the lateral aspect of the ankle (60–90 ms. The failure supination or inversion torque is about 41–45 Nm to cause ligamentous rupture in simulated spraining tests on cadaver. A previous case report revealed that the ankle joint reached 48 degrees inversion and 10 degrees internal rotation during an accidental grade I ankle ligamentous sprain injury during a dynamic cutting trial in laboratory. Diagnosis techniques and grading systems vary, but the management of ankle ligamentous sprain injury is mainly conservative

  14. Irrigation of meniscus and cruciate ligament of the knee.

    Directory of Open Access Journals (Sweden)

    Homero F. Bianchi

    2010-09-01

    Full Text Available During this paper a revision of the irrigation of the meniscus and cruciate ligaments is made. 25 fresh dissected preparations were used: 24 fetal between the 8th and 9th months of gestation and one knee adult. It concludes that the meniscus possess a perimeniscal single artery source and a medial perimeniscal artery than in the majority of cases consists of an arterial anastomosis between one anterior and another posterior arteries from different source, to ensure the blood supply of the side of the meniscus, allowing the reintegration or conservation of the external part of the meniscus in agreement with the pathology and inclusive the meniscus allograft transplantation. The vessels of the cruciate ligaments, branches from middle knee artery are longitudinal, reason for which techniques of sutures when repairing the injury in early form should respect this provision.

  15. Clinics in diagnostic imaging. 141. Complete anterior cruciate ligament tear.

    Science.gov (United States)

    Lim, Hollie M Y; Peh, Wilfred C G

    2012-09-01

    A 38-year-old man presented with right knee pain and swelling following a football injury. Magnetic resonance (MR) imaging showed a complete anterior cruciate ligament (ACL) tear and lateral meniscal tears. The torn ACL was repaired with a graft obtained from the semitendinosus muscle, and the menisci were debrided. The mechanisms of injury to the ACL are varied and may be due to direct or indirect contact with the knee as well as with twisting injuries. Knowledge of the ACL's normal anatomy, together with MR imaging technique and understanding of the appearance of the lesion on MR examination, is crucial to aid in the identification of an ACL tear. Diagnosis of an ACL tear should be based on direct MR imaging signs, although indirect signs may be helpful, particularly in chronic tears. Other associated injuries to be aware of include meniscal and other ligamentous injuries. Normal ACL graft and post-ACL graft reconstruction complications are also briefly discussed. PMID:23023908

  16. Ganglion cyst of the posterior cruciate ligament in a child.

    Science.gov (United States)

    Hameed, Shamsi Abdul; Sujir, Premjit; Naik, Monappa A; Rao, Sharath K

    2012-04-01

    Ganglion cysts are more commonly associated with the anterior cruciate ligament than the posterior cruciate ligament (PCL). A literature review showed that all reported cases of ganglion cysts to date involved adults. We report a rare case of ganglion cyst in the PCL of a four-year-old boy, and discuss its aetiology, clinical presentation, imaging features and management. Ganglion cysts of the PCL may be confused with meniscal cysts arising from tears of the posterior horn of the medial meniscus on magnetic resonance (MR) imaging. Hence, the posterior horn of the medial meniscus has to be carefully evaluated to rule out a tear. MR imaging is the method of choice to confirm diagnosis, and arthroscopic resection is a safe treatment modality even in children. PMID:22511069

  17. Diagnosis of ligament injuries in the superior ankle joint

    International Nuclear Information System (INIS)

    Nearly 40 years after ankle arthrography was first introduced, the anterior and inversion stress views of the ankle are still widely preferred as a noninvasive method of evaluating ligament injuries in the upper ankle. We consider the stress test, bilaterally performed using a standardized stress apparatus, as a basic examination by which to differentiate between slight and severe sprain. Intensive muscel splinting due to painful swelling can sometimes be treated by injection of local anesthetic. Like many authors, we perform ankle arthrography in cases where there is a significant difference between the clinical findings and the stress test. The technique of ankle arthrography can be readily learned and is extremely accurate in delineating the extent of ligamentous injury produced by moderate or severe ankle sprains. It can be performed in any X-ray department. (orig.)

  18. Biomechanical properties of the transverse carpal ligament under biaxial strain.

    Science.gov (United States)

    Holmes, Michael W R; Howarth, Samuel J; Callaghan, Jack P; Keir, Peter J

    2012-05-01

    The transverse carpal ligament (TCL) influences carpal stability and carpal tunnel mechanics, yet little is known about its mechanical properties. We investigated the tissue properties of TCLs extracted from eight cadaver arms and divided into six tissue samples from the distal radial, distal middle, distal ulnar, proximal radial, proximal middle, and proximal ulnar regions. The 5% and 15% strains were applied biaxially to each sample at rates of 0.1, 0.25, 0.5, and 1%/s. Ligament thickness ranged from 1.22 to 2.90 mm. Samples from the middle of the TCL were thicker proximally than distally (p carpal bone attachments. These properties contribute to the understanding of carpal tunnel mechanics that is critical to understanding disorders of the wrist. PMID:22042748

  19. Progenitor cell populations in the periodontal ligament of mice

    International Nuclear Information System (INIS)

    Stem cells in a variety of renewal tissues exhibit a slow rate of cell proliferation. The periodontal ligament of mouse molars was examined for the presence of slowly cycling progenitor cells to provide evidence for the existence of stem cells in this tissue. A pulse injection of 3H-thymidine was administered and mice were sacrificed between 1 hour and 14 days after injection. Analysis of radioautographs using percentage of labeled cells and grain counts demonstrated that a population of label-retaining cells within 10 micron of blood vessels traversed the cell cycle more slowly than proliferating cells located greater than 10 micron from blood vessels. These data suggest that there is a slowly dividing population of progenitor cells in paravascular sites in mouse molar periodontal ligament which may be stem cells

  20. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction

    OpenAIRE

    Xiangkai Zhang; Tomoki Aoyama; Ryota Takaishi; Shinya Higuchi; Shigehito Yamada; Hiroshi Kuroki; Tetsuya Takakuwa

    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 l...

  1. Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1.5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears. (orig.)

  2. Graded stress radiography in acute injury to the lateral ligaments of the ankle

    International Nuclear Information System (INIS)

    The diagnostic accuracy of graded stress radiography in 26 patients with acute injury to the lateral ankle ligaments has been compared with findings at arthrography and surgery. Measuring talar tilt angles and anterior talar displacement over a range of pressures applied to the distal tibia using a commercially available stress device allows diagnostic distinction between isolated anterior talofibular ligament injury and a combined lesion that involves the calcaneofibular ligament. The results compare well with arthrographic and surgical findings. (orig.)

  3. Mystery of alar ligament rupture: Value of MRI in whiplash injuries - biomechanical, anatomical and clinical studies

    International Nuclear Information System (INIS)

    Purpose: Whiplash injury of the cervical spine is a frequent issue in medical expertise and causes enormous consequential costs for motor insurance companies. Some authors accuse posttraumatic changes of alar ligaments to be causative for consequential disturbances. Materials and methods: Review of recent studies on biomechanics, anatomical and clinical MR imaging. Results: Biomechanical experiments can not induce according injuries of alar ligaments. Although MRI provides excellent visualization of alar ligaments, the range of normal variants is high. (orig.)

  4. Quantification of Collagen Organization and Extracellular Matrix Factors within the Healing Ligament

    OpenAIRE

    Chamberlain, Connie S.; Crowley, Erin M.; Kobayashi, Hirohito; Eliceiri, Kevin W.; Vanderby, Ray

    2011-01-01

    Ligament healing of a grade III injury (i.e. a complete tear) involves a multifaceted chain of events that forms a neoligament, which is more scar-like in character than the native tissue. The remodeling process may last months or even years with the injured ligament never fully recovering pre-injury mechanical properties. With tissue engineering and regenerative medicine, understanding the normal healing process in ligament and quantifying it provide a basis to create and assess innovative t...

  5. Chronic Multiple Knee Ligament Injuries: Epidemiological Analysis of More Than One Hundred Cases

    OpenAIRE

    Rosalvo Zosimo Bispo Júnior; Cezar Teruyuki Kawano; Alexandre Vieira Guedes

    2008-01-01

    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 ...

  6. Injury Thresholds of Knee Ligaments Under Lateral–Medial Shear Loading: An Experimental Study

    OpenAIRE

    MO, Fuhao; Arnoux, Pierre-Jean; ZAHIDI, Omar; Masson, Catherine

    2013-01-01

    Knee ligament injuries frequently cause devastating impairment to the injured. In car–pedestrian impact accidents, lateral–medial shear displacement is one of principal mechanisms of knee ligament injuries. The current study aims to investigate injury thresholds of knee ligaments under lateral–medial shear loading to improve pedestrian safety. Methods: Ten isolated human knee joints without surrounding muscles were tested under dynamic lateral–medial shear loading in 2...

  7. Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Ferber, A.; Grebe, P.; Thelen, M. [Department of Radiology, Johannes Gutenberg University Mainz (Germany); Runkel, M. [Department of Traumatologic and Reconstructive Surgery, Johannes Gutenberg University Mainz (Germany); Berger, S. [Department of Pediatric Surgery, Johannes Gutenberg University Mainz (Germany)

    1999-04-01

    The aim of this study was to evaluate the ability of MRI to display injuries of the lateral collateral ligamentous complex in patients with an acute ankle distorsion trauma. The MR examinations of 36 patients with ankle pain after ankle distorsion were evaluated retrospectively without knowledge of clinical history, outcome and/or operative findings. The examinations were performed on a 1.5-T whole-body imager using a flexible surface coil. The signs for ligamentous abnormality were as follows: complete or partial discontinuity, increased signal within, and irregularity and waviness of the ligament. The results were compared with operative findings in 18 patients with subsequent surgical repair. Eighteen patients with conservative therapy had a follow-up MR examination after 3 months. There was 1 sprain, 3 partial and 32 complete tears of the anterior talofibular ligament, and 5 sprains, 5 partial, and 7 complete tears of the calcaneofibular ligament. There were no lesions of the posterior talofibular ligament. Compared with surgery, MRI demonstrated in 18 of 18 cases the exact extent of anterior talofibular ligament injuries and underestimated the extent in 2 of 8 cases of calcaneofibular ligament injury. In patients with follow-up MRI after conservative therapy, a thickened band-like structure was found along the course of the injured ligament in 17 of 18 cases. The absence of ligament repair after conservative treatment was confirmed during operative revision in one case. The MRI technique allows for grading of the extent of injury of the lateral collateral ligamentous complex after acute ankle strain. It seems to be suitable for monitoring the healing process after conservative-functional treatment of ligament tears. (orig.) With 5 figs., 2 tabs., 26 refs.

  8. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

    OpenAIRE

    Domnick, Christoph; Raschke, Michael J.; Herbort, Mirco

    2016-01-01

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal o...

  9. Resect or not to resect: the role of posterior longitudinal ligament in lumbar total disc replacement

    OpenAIRE

    Cakir, Balkan; Richter, Marcus; Schmoelz, Werner; Schmidt, René; Reichel, Heiko; Wilke, Hans Joachim

    2009-01-01

    With regard to the literature, several factors are considered to have an impact on postoperative mobility after lumbar total disc replacement (TDR). As TDR results in a distraction of the ligamentous structures, theoretically the postoperatively disc height and ligamentous integrity have also an influence on biomechanics of a treated segment. The purpose of the study was to evaluate the influence of posterior longitudinal ligament (PLL) resection and segmental distraction on range of motion (...

  10. Prevention of anterior cruciate ligament injury in the female athlete

    OpenAIRE

    Silvers, Holly Jacinda; Mandelbaum, Bert R.

    2007-01-01

    The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the...

  11. Anatomic double-bundle anterior cruciate ligament recon-struction

    OpenAIRE

    Dai, Xue-Song

    2012-01-01

    【Abstract】Objective: To retrospectively evaluate the early results of anatomic double-bundle anterior cruci-ate ligament (ACL) reconstruction and compare with the results of native ACL of the contralateral knee. Methods: The results of a consecutive series of 118 patients receiving arthroscopic ACL reconstruction were evaluated. Eight patients were lost to the latest follow-up, leaving a total of 110 patients available for study within at least 3 years’ clinical fol...

  12. Managing ankle ligament sprains and tears: current opinion

    OpenAIRE

    McGovern RP; Martin RL

    2016-01-01

    Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected st...

  13. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System

    OpenAIRE

    Fitzgerald, Judd; Saluan, Paul; Richter, Dustin L.; Huff, Nathan; Schenck, Robert C.

    2015-01-01

    Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved ...

  14. Extraforaminal ligament attachments of the thoracic spinal nerves in humans

    OpenAIRE

    Kraan, G.A.; Hoogland, P. V. J. M.; Wuisman, P. I. J. M.

    2009-01-01

    An anatomical study of the extraforaminal attachments of the thoracic spinal nerves was performed using human spinal columns. The objectives of the study are to identify and describe the existence of ligamentous structures at each thoracic level that attach spinal nerves to structures at the extraforaminal region. During the last 120 years, several mechanisms have been described to protect the spinal nerve against traction. All the described structures were located inside the spinal canal pro...

  15. Anterior Cruciate Ligament injury, Patient Variables, Outcomes and Knee Osteoarthritis

    OpenAIRE

    Neuman, Paul

    2010-01-01

    The ruptured anterior cruciate ligament (ACL) leads to immediate symptoms that severely affect the individual and receives great attention among the scientific community, yet there is still no consensus on the optional form of treatment. An ACL injury is also a well known high risk factor for the development of knee osteoarthritis (OA) some decades later. Knee OA development after an ACL injury is multi-factorial. All patient variables must be further explored before better guidelines on ACL ...

  16. FUNCTIONAL OUTCOME OF ARTHROSCOPIC RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT TEARS

    Directory of Open Access Journals (Sweden)

    Ashok Kumar

    2016-02-01

    Full Text Available BACKGROUND Anterior Cruciate Ligament (ACL tear is the most common serious ligamentous injury to the knee joint. Anterior Cruciate Ligament (ACL injury is quite common among young active population, athletes and contact sports. The exact incidence of anterior cruciate ligament tears is not known as the cases are being under reported. The ACL is the primary stabilizer against anterior translation of the tibia on the femur and is important in counteracting rotation and valgus stress. MATERIALS AND METHODS Between November 2012 to October 2014, 34 consecutive patients who underwent arthroscopic assisted ACL reconstructions in the Department of Orthopedics and Traumatology, King George Hospital, Visakhapatnam were the material in our study. Age groups between 18 to 45 years considered. We utilised both BPTB and Quadrupled hamstring graft depending on the patient’s age, outcome testing in all cases was performed at the latest follow-up (at least 6 months. Post-operative physiotherapy rehabilitation protocol followed for 06 months. RESULTS Standard protocol of Lysholm and IKDC knee scoring system were used for evaluation of the results of the surgery during followup. Patients were evaluated periodically at preop, 3 months, 6 months, 12 months, 18 months and 24 months. CONCLUSION Patients with isolated ACL injury had better outcome compared to patients who underwent associated meniscectomy. Most common mechanism of injury was activity of sports in 20 patients. Postoperatively at 3 months, anterior drawer’s was 1+ in 6, 29 (85.2% patients had normal range of motion; 29 (85.29% patients had 5/5 quadriceps power (MRC grading 94% of them had 5/5 power at latest followup. No significant difference between outcomes of BPTB and Hamstrings graft. Functional outcome of our study were similar to the previously published studies.

  17. Lower Extremity Malalignments and Anterior Cruciate Ligament Injury History

    OpenAIRE

    Braham, Rebecca A.; Jennifer H. Dorfman; Jay Hertel

    2004-01-01

    To identify if lower extremity malalignments were associated with increased propensity of a history of anterior cruciate ligament (ACL) ruptures in males and females using a case control design. Twenty subjects (10 males, 10 females) had a history of ACL injury and twenty (10 males, 10 females) had no history of ACL injury. Subjects were assessed for navicular drop, quadriceps angle, pelvic tilt, hip internal and external rotation range of motion, and true and apparent leg length discrepancie...

  18. Anterior Cruciate Ligament Injury Prevention Training in Female Athletes

    OpenAIRE

    Noyes, Frank R.; Barber Westin, Sue D.

    2012-01-01

    Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests. Objective: To determine if ACL injury prevention programs have a positive influence on both injury rates and athletic performance tests in female athletes. Data sources: In August 2011, a search was conducted (1995–August 2011) of the PubMed, Science Direct, and CINAHL databases. Study sel...

  19. Basic science of anterior cruciate ligament injury and repair

    OpenAIRE

    Kiapour, A. M.; Murray, M. M.

    2014-01-01

    Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonp...

  20. Controversies in Knee Rehabilitation: Anterior Cruciate Ligament Injury

    OpenAIRE

    Failla, Mathew J.; Arundale, Amelia J.H.; Logerstedt, David S.; Snyder-Mackler, Lynn

    2015-01-01

    Controversy in management of athletes exists after anterior cruciate ligament injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no re-injury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to pre-injury sports. Using these criterions, we will review the success rates of current management strategies after ACL injury and provide recommendations for the couns...

  1. Trial analysis of swine's periodontal ligament with Bragg grating sensors

    Science.gov (United States)

    Menegotto, G. F.; Grabarski, L.; Kalinowski, H. J.; Simões, J. A.

    2009-10-01

    In this work it is reported the measurement of the differential strain between the dental and bone tissues under effect of an applied load. Slices of swine mandible, containing the premolar tooth, are cut and measured in fresh condition. The strain is measured using fibre Bragg grating sensors glued to both tissues. In the measured range the results show a linear behaviour and confirm the importance of the periodontal ligament in the load transfer mechanism.

  2. Carpal ligamentous laxity with bilateral perilunate dislocation in Marfan syndrome

    International Nuclear Information System (INIS)

    A case of persistent bilateral perilunate dislocation unrelated to trauma in a patient with Marfan syndrome is discussed. This finding is believed to be a manifestation of the generalized ligamentous laxity occurring in this disorder. Radiographs of eight additional Marfan syndrome patients failed to demonstrate similar carpal instability. Because some carpal derangements are dynamic events, stress views or wrist fluoroscopy may be necessary to demonstrate unsuspected carpal instability in Marfan patients. (orig.)

  3. Carpal ligamentous laxity with bilateral perilunate dislocation in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Pennes, D.R.; Braunstein, E.M.; Shirazi, K.K.

    1985-01-01

    A case of persistent bilateral perilunate dislocation unrelated to trauma in a patient with Marfan syndrome is discussed. This finding is believed to be a manifestation of the generalized ligamentous laxity occurring in this disorder. Radiographs of eight additional Marfan syndrome patients failed to demonstrate similar carpal instability. Because some carpal derangements are dynamic events, stress views or wrist fluoroscopy may be necessary to demonstrate unsuspected carpal instability in Marfan patients.

  4. Do cells contribute to tendon and ligament biomechanics?

    Directory of Open Access Journals (Sweden)

    Niels Hammer

    Full Text Available Acellular scaffolds are increasingly used for the surgical repair of tendon injury and ligament tears. Despite this increased use, very little data exist directly comparing acellular scaffolds and their native counterparts. Such a comparison would help establish the effectiveness of the acellularization procedure of human tissues. Furthermore, such a comparison would help estimate the influence of cells in ligament and tendon stability and give insight into the effects of acellularization on collagen.Eighteen human iliotibial tract samples were obtained from nine body donors. Nine samples were acellularized with sodium dodecyl sulphate (SDS, while nine counterparts from the same donors remained in the native condition. The ends of all samples were plastinated to minimize material slippage. Their water content was adjusted to 69%, using the osmotic stress technique to exclude water content-related alterations of the mechanical properties. Uniaxial tensile testing was performed to obtain the elastic modulus, ultimate stress and maximum strain. The effectiveness of the acellularization procedure was histologically verified by means of a DNA assay.The histology samples showed a complete removal of the cells, an extensive, yet incomplete removal of the DNA content and alterations to the extracellular collagen. Tensile properties of the tract samples such as elastic modulus and ultimate stress were unaffected by acellularization with the exception of maximum strain.The data indicate that cells influence the mechanical properties of ligaments and tendons in vitro to a negligible extent. Moreover, acellularization with SDS alters material properties to a minor extent, indicating that this method provides a biomechanical match in ligament and tendon reconstruction. However, the given protocol insufficiently removes DNA. This may increase the potential for transplant rejection when acellular tract scaffolds are used in soft tissue repair. Further research

  5. Tibiofemoral Alignment: Contributing Factors to Noncontact Anterior Cruciate Ligament Injury

    OpenAIRE

    Boden, Barry P.; Breit, Ilan; Sheehan, Frances T

    2009-01-01

    Background: The mechanisms of noncontact anterior cruciate ligament injury remain undefined. The purpose of this study was to identify the tibiofemoral alignment in the lateral compartment of the knee for three variations of a one-limb landing in noncontact sports activities: the safe, provocative, and exaggerated provocative positions. These positions were chosen on the basis of a previous study that measured the average joint angles of the limb at the point of ground contact for athletes wh...

  6. Popliteal artery injury during posterior cruciate ligament reconstruction

    OpenAIRE

    Marcos Henrique Frauendorf Cenni; Bruno Fajardo do Nascimento; Guilherme Galvão Barreto Carneiro; Rodrigo Cristiano de Andrade; Lúcio Flávio Biondi Pinheiro Júnior; Oscar Pinheiro Nicolai

    2015-01-01

    This study reports a case of popliteal artery injury during arthroscopic reconstruction of the posterior cruciate ligament. The evolution of the injury is described and comments are made regarding the anatomy of this artery and potential risks of this surgical technique. This study had the aims of alerting the medical community, especially knee surgeons, regarding a severe surgical complication and discussing the ways of preventing it.

  7. Concomitant ligamentous and meniscal injuries in floating knee

    OpenAIRE

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

    2015-01-01

    Background: To identify and characterize the concomitant ligamentous and meniscal injuries in floating knee. Methods: 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. Results: Through arthroscopic and open surgical examinations, a medial meniscal tear was detected in 14 (37.8%) cases and ...

  8. Fracture of the patella after the anterior cruciate ligament reconstruction

    OpenAIRE

    Milović Milan; Bojat Veselin; Kovačev Nemanja; Rašović Predrag; Milankov Miroslav

    2012-01-01

    Introduction. Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. Material and Methods. We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%). The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was ca...

  9. Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction

    OpenAIRE

    Chahla, Jorge; Nitri, Marco; Civitarese, David; Dean, Chase S.; Moulton, Samuel G.; LaPrade, Robert F.

    2016-01-01

    The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the n...

  10. Proprioception and performance after anterior cruciate ligament rupture

    OpenAIRE

    Katayama, Masayoshi; Higuchi, Hiroshi; Kimura, Masashi; Kobayashi, Atsushi; Hatayama, Kazuhisa; Terauchi, Masanori; Takagishi, Kenji

    2004-01-01

    The aim of this study was to investigate the characteristics of proprioception in patients with an anaterior-cruciate-ligament (ACL)-injured knee and to determine whether there is a correlation between proprioception and performance. We studied 32 patients with unilateral isolated ACL ruptures. Proprioception of the knee was evaluated by examining the joint position sense. Functional performance was evaluated with the one-leg hop (OLH) and one-leg vertical jump (OLV) tests. The mean error ang...

  11. Injury of the ankle joint ligaments; Bandverletzungen des Sprunggelenks

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, M.J. [Institut fuer Radiologie, Landesklinikum Waldviertel Horn, Horn (Austria); Karl Landsteiner Institut, St. Poelten (Austria)

    2007-03-15

    The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination and clinical stress tests. If the clinical stress test is positive, stress radiography can be performed. There is, however, no consensus about the usefulness of stress radiography in acute ankle sprain, and in particular about the cut-off talar tilt angle beyond which a two-ligament rupture would be certain, ranging from 5 to 30 . Today, magnetic resonance imaging (MRI) is not used in this area, although it does allow controlled positioning of the foot and defined section visualization of injured lateral collateral ankle ligaments. In acute and chronic sinus tarsi injuries, MRI forms the established basis for diagnostic imaging, and can provide a definitive answer in most cases. MRI is also the method of choice for chronic posttraumatic pain with anterolateral impingement after rupture of the anterior talofibular ligament. Generally, for the evaluation of acute ankle injuries, MRI has developed to be the most important second-step procedure when projection radiology is non-diagnostic. (orig.) [German] Die Diagnose einer lateralen Bandverletzung nach einem Sprunggelenktrauma basiert auf der Anamnese, der klinischen Untersuchung und klinischen Stresstests. Bei positiven klinischen Stresstests kann eine Stressradiographie durchgefuehrt werden. Es gibt keine Uebereinstimmung hinsichtlich des Stellenwerts der Stressradiographie beim frischen Supinationstrauma des Sprunggelenks, insbesondere fuer den Winkel der Aufklappbarkeit bei einer Zweibandverletzung, der von 5 -30 reicht. Die MRT wird bei dieser Indikation zurzeit nur in Einzelfaellen benutzt, obwohl sie mit definierter Fusspositionierung und Ausrichtung der Untersuchungsebene eine ausgezeichnete Beurteilung der Sprunggelenkbaender erlaubt. Sie ist im besonderen Masse geeignet, akute und chronische Verletzungen des Sinus tarsi zu beurteilen. Bei chronischen Beschwerden nach Bandverletzung ist die MRT zur

  12. MRI in acute ligamentous injuries of the ankle.

    Science.gov (United States)

    Martella, Ilenia; Azzali, Emanuele; Milanese, Gianluca; Praticò, Francesco Emanuele; Ruggirello, Margherita; Trunfio, Vincenzo; Parziale, Raffaele; Corrado, Michele; Della Casa, Giovanni; Capasso, Raffaella; De Filippo, Massimo

    2016-01-01

    Ankle sprains are the most common lower limb injuries and affect more frequently young athletes; imaging is needed for an accurate diagnosis of such traumatic injuries. The purpose of this review is to analyse the magnetic resonance (MR) findings of both normal and pathological ankle's ligaments; indeed, MRI is the gold standard for the diagnosis of acute traumatic injuries and is useful for differentiation of the causes of ankle instability as well as for pre-operative planning. PMID:27467862

  13. Do Cells Contribute to Tendon and Ligament Biomechanics?

    Science.gov (United States)

    Hammer, Niels; Huster, Daniel; Fritsch, Sebastian; Hädrich, Carsten; Koch, Holger; Schmidt, Peter; Sichting, Freddy; Wagner, Martin Franz-Xaver; Boldt, Andreas

    2014-01-01

    Introduction Acellular scaffolds are increasingly used for the surgical repair of tendon injury and ligament tears. Despite this increased use, very little data exist directly comparing acellular scaffolds and their native counterparts. Such a comparison would help establish the effectiveness of the acellularization procedure of human tissues. Furthermore, such a comparison would help estimate the influence of cells in ligament and tendon stability and give insight into the effects of acellularization on collagen. Material and Methods Eighteen human iliotibial tract samples were obtained from nine body donors. Nine samples were acellularized with sodium dodecyl sulphate (SDS), while nine counterparts from the same donors remained in the native condition. The ends of all samples were plastinated to minimize material slippage. Their water content was adjusted to 69%, using the osmotic stress technique to exclude water content-related alterations of the mechanical properties. Uniaxial tensile testing was performed to obtain the elastic modulus, ultimate stress and maximum strain. The effectiveness of the acellularization procedure was histologically verified by means of a DNA assay. Results The histology samples showed a complete removal of the cells, an extensive, yet incomplete removal of the DNA content and alterations to the extracellular collagen. Tensile properties of the tract samples such as elastic modulus and ultimate stress were unaffected by acellularization with the exception of maximum strain. Discussion The data indicate that cells influence the mechanical properties of ligaments and tendons in vitro to a negligible extent. Moreover, acellularization with SDS alters material properties to a minor extent, indicating that this method provides a biomechanical match in ligament and tendon reconstruction. However, the given protocol insufficiently removes DNA. This may increase the potential for transplant rejection when acellular tract scaffolds are used in

  14. Platelets lysate-based membranes for periodontal ligament regeneration

    OpenAIRE

    Babo, P. M.; Santo, Vítor E.; Duarte, Ana Rita C.; Gomes, Manuela E.; Reis, R. L.

    2013-01-01

    The periodontal ligament (PDL) is a group of specialized connective tissue fibers that attach a tooth to the alveolar bone where it is deployed. These fibers help the tooth withstand the substantial compressive forces which occur during chewing and remain embedded in the bone. Periodontitis is a prevalent infection disease that causes the destruction of the tooth supportive tissues including the PDL. Given its low ability of regeneration in adult patients, concerted efforts have been made to ...

  15. Anatomic anterior cruciate ligament reconstruction using an individualized approach

    Directory of Open Access Journals (Sweden)

    Carola F. van Eck

    2014-01-01

    Full Text Available Anterior cruciate ligament (ACL reconstruction is one of the most commonly performed orthopaedic procedures. Recently, there has been a shift in interest towards reconstruction techniques that more closely restore the native anatomy of the ACL. This review paper discusses our approach to individualized anatomic ACL reconstruction, including the anatomy of the ACL, the physical exam, imaging modalities, the surgical technique for anatomic reconstruction including pre- and intraoperative considerations and our postoperative rehabilitation protocol.

  16. Non-traumatic Thickening of the Anterior Cruciate Ligament

    International Nuclear Information System (INIS)

    To describe the magnetic resonance (MR) imaging findings of non-traumatic thickening of the anterior cruciate ligament (ACL) and to evaluate the associated lesions. Between January 2003 and August 2005, 44 knees of 44 patients who had thickened ACLs on MR images and had no history of knee trauma were analyzed retrospectively. The normal thickness of the ACL was measured on axial T2-weighted images of 40 healthy adult knees. The MR imaging findings of the thickened ACLs and associated lesions were analyzed. In 40 cases of healthy knees, the thickness of the proximal ACL was 3-6 mm. In 44 cases of non-traumatic thickening of the ACL, the thickness of the proximal ACL was 8-14 mm. There was an increased signal intensity and ill-defined border in all cases of thickened ACLs, linear low-signal intensity fibers parallel to the long axis of the thickened ACL (celery stalk appearance) in 24 cases, and entrapment in 10 cases. With respect to associated lesions, there was osteoarthritis in 40 cases, meniscal tears in 42 cases, and degeneration of the posterior cruciate ligament in 7 cases. Non-traumatic thickening of the ACL was associated with osteoarthritis and meniscal tears in almost all cases and showed increased signal intensity and ill-defined borders simulating acute ligamentous tears

  17. ARTHROSCOPIC RECONSTRUCTION OF ANTERIO R CRUCIATE LIGAMENT TEARS: OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Thimma Reddy

    2015-09-01

    Full Text Available BACKGROUND: Anterior knee instability associated with rupture of the ACL (Anterior Cruciate Ligament is a disabling clinical problem. The ACL has a poor capacity for intrinsic repair. Thus for patients who have knee symptoms related to ACL deficiency, one may consider ligament reconstruction as a means of stabilizing the T ibio - F emoral articulation and restoring high level function of the knee joint. Arthroscopically assisted ACLR ( ACL Reconstruction has the advantage of being minimally invasive, accurate graft placement, less disturbance of normal tissue resulting in quicker recovery and rehabilitation, minimal hospital stay and very less infection rate. MATERIAL AND METHODS: Between April 2012 to May 2013, 30 patients who underwent arthroscopic assisted ACL reconstructions using either bone - patellar tendon - bone auto graft ( BTB or Quadrupled hamstring auto graft ( QHG or Quadriceps tendon graft ( QTG in the Department of Orthopaedics and Traumatology, Osmania Medical College, Hyderabad, Andhra Pradesh is the material in our study. CONCLUSIONS : Arthroscopic reconstruction of Anterior Cruciate Ligament is a reliable, safe procedure. It helps in the early restoration of function and stability of the Knee joint and helps the patient to get back to his normal activity much earlier than with the traditional open surgical methods. The choice of the graft does not play a major role in the function of the knee in the long run.

  18. Collagenolytic activity is produced by rabbit ligaments and tendon

    International Nuclear Information System (INIS)

    The authors examined the patellar tendon (PT), anterior cruciate ligament (ACL) and medial collateral ligament (MCL) from normal rabbits for collagenase activity. All three connective tissues contain large amounts of collagen and the catabolism of this structural protein is important to their integrity. The authors cultured each tissue in serum free medium for 14 days. Collagenase was produced by all three connective tissues after a lag period of up to 7 days, as detected by the 14C-glycine peptide-release assay. Culture media that did not express enzyme the authors found to contain inhibitory activity. The collagenases and inhibitors from each tissue have been quantitated and characterized. After 9 days the collagenase activity for the rabbit periarticular tissues was 6.1 (PT), 4.4 (MCL) and 8.6 (ACL) units per milligram of secreted protein. The cleavage site of all three collagenases was found to be similar to that observed for rabbit skin collagenase, and generation of reaction products TC/sup A/ and TC/sup B/ was demonstrated by collagenases from PT, MCL and ACL. These results suggest that the metabolism of ligaments and tendon is regulated by the production of zymogen, active collagenase and inhibitor, similar to other connective tissues. The role of these components in joint injury and joint diseases is currently being investigated

  19. Non-traumatic Thickening of the Anterior Cruciate Ligament

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Hyun Jun; Park, Jin Gyoon; Song, Sang Gook [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-08-15

    To describe the magnetic resonance (MR) imaging findings of non-traumatic thickening of the anterior cruciate ligament (ACL) and to evaluate the associated lesions. Between January 2003 and August 2005, 44 knees of 44 patients who had thickened ACLs on MR images and had no history of knee trauma were analyzed retrospectively. The normal thickness of the ACL was measured on axial T2-weighted images of 40 healthy adult knees. The MR imaging findings of the thickened ACLs and associated lesions were analyzed. In 40 cases of healthy knees, the thickness of the proximal ACL was 3-6 mm. In 44 cases of non-traumatic thickening of the ACL, the thickness of the proximal ACL was 8-14 mm. There was an increased signal intensity and ill-defined border in all cases of thickened ACLs, linear low-signal intensity fibers parallel to the long axis of the thickened ACL (celery stalk appearance) in 24 cases, and entrapment in 10 cases. With respect to associated lesions, there was osteoarthritis in 40 cases, meniscal tears in 42 cases, and degeneration of the posterior cruciate ligament in 7 cases. Non-traumatic thickening of the ACL was associated with osteoarthritis and meniscal tears in almost all cases and showed increased signal intensity and ill-defined borders simulating acute ligamentous tears

  20. Reconstruction of chronic acromioclavicular joint disruption with artificial ligament prosthesis

    Institute of Scientific and Technical Information of China (English)

    Devendra Kumar Chouhan; Uttam Chand Saini; Mandeep Singh Dhillon

    2013-01-01

    Objective:Management of Rockwood type 3 acromioclavicular disruptions is a matter of debate.Should we adopt conservative or operative measures at first presentation? It is not clear but most of the evidences are in favour of conservative management.We present our experience in managing these patients surgically.Methods:We present a prospective series of eight cases of chronic Rockwood type 3 acromioclavicular joint disruptions treated surgically.Anatomical reconstruction of the coracoclavicular ligament was done by artificial braided polyester ligament prosthesis.Results:All the patients were able to perform daily activities from an average of the 14th postoperative day.All patients felt an improvement in pain,with decrease in average visual analogue scale from preoperative 6.5 points (range 3-9 points) to 2.0 points (range 0-5 points),Constant score from 59% to 91% and American Shoulder and Elbow Surgeons shoulder score from 65 to 93 points postoperatively.These results improved or at least remained stationary on midterm follow-up,and no deterioration was recorded at an average follow-up of 46 months.Conclusion:This midterm outcome analysis of the artificial ligament prosthesis is the first such follow-up study with prosthesis.Our results are encouraging and justify the further use and evaluation of this relatively new and easily reproducible technique.

  1. Postoperative MRI findings after anterior cruciate ligament reconstruction. A prospective study with 50 patients

    International Nuclear Information System (INIS)

    Aim: Identification of typical postoperative change after anterior cruciate ligament reconstruction (sutures, tendon grafts) and comparison with clinical tests and ultrasound. Patients and methods: 50 patients with anterior cruciate ligament ruptures were examinated with MRI (1.0 T, surface coil, sagittal T1-3DFT-Fast and sagittal spin-echo), US and clinical function tests (Lachmann, pivot-shift, anterior drawer test). Results: In 19 of 21 patients with continuous low-intensity ligament structures in the MRI, knee stability was very good or good in the clinical tests and US. In 17 of 20 patients with a diagnosis of partial rupture at MRI, we also found a stable knee. 5 of 7 patients with the MRI-signs of ligament rupture showed knee stability at US and clinical tests. Furthermore, at MRI we found minor effusions in 10 patients, meniscus tears in 8 patients and ligament impingement in 2 patients. Conclusion: MRI is a valuable method for evaluating and assessing anterior ligament reconstructions. We found a good correlation between the continuous low-intensity ligaments at MRI and knee-stability. In contrast there is a bad correlation between discontinuous ligament structures at MRI and clinical stability of the knee. MRI seems to provide more information than US and clinical tests (for example: minor effusion, meniscus tears, ligament impingement, bone lesions). (orig.)

  2. Abscess Formation of the Round Ligament of the Liver: Report of a Case

    Directory of Open Access Journals (Sweden)

    Ikeda,Eiji

    2008-12-01

    Full Text Available Abscess formation of the round ligament of the liver is very rare. We report a case of a 70-year-old female with abscess of the round ligament after an endoscopic papillotomy for choledocholithiasis. On the 21st day following papillotomy, abscess formation of the round ligament was found by ultrasonographic examination. Surgical treatment was performed because conservative therapy was not effective. The purulent fluid and necrotic tissue at the round ligament were completely removed. Cultures obtained from the abscess grew Staphylococcus epidermidis, but the mechanism of abscess formation in this case remains unclear.

  3. MRI of the lateral ankle ligaments: value of three-dimensional orientation

    International Nuclear Information System (INIS)

    Purpose: To determine the three-dimensional orientation of the lateral ankle ligaments with MRI. Materials and Methods: Twenty healthy volunteers without previous injury to the ankle were included in the study. With the right ankle in the normal anatomic position stabilized in a splint, coronal T2-weighted spin-echo sequences (TSE) were obtained. The three-dimensional orientation was determined by placing paths through the ligaments and by measuring the angles between corresponding tangents and the three main imaging planes. Results: Using the calculated angles, full-length visualization of the lateral ligaments of the ankle was achieved. The angles deviating from the axial imaging plane were 18.0 degrees for the anterior talofibular ligament, 52.3 degrees for the calcaneofibular ligament and 28.2 degrees for the posterior talofibular ligament. Conclusion: MRI enables the exact determination of the three-dimensional orientation of the lateral ankle ligaments. Orienting the imaging planes according to the calculated angular deviation allows the full-length visualization of the ligaments and is the basis for optimal imaging of the lateral ankle ligaments. (orig.)

  4. Alar ligaments: radiological aspects in the diagnosis of patients with whiplash injuries

    International Nuclear Information System (INIS)

    Post-traumatic changes of the alar ligaments have been proposed to be the cause of chronic pain in patients after whiplash injury of the cervical spine. In addition to an asymmetric dens position, widening of the atlantodental distance to more than 12 mm can be an indirect sign of an alar ligament rupture. CT is recommended for detection of a avulsion fracture of the occipital condyle. Isolated ruptures of the alar ligaments are best visualized on MRI. In patients with chronic impairments after whiplash injuries changes of the alar ligaments on MRI must be differentiated from normal variants in healthy individuals. (orig.)

  5. Tuberculous abscess in hepatoduodenal ligament: Evaluation with contrast-enhanced computed tomography

    Institute of Scientific and Technical Information of China (English)

    Peng Dong; Bin Wang; Ye-Quan Sun

    2008-01-01

    Two patients with tuberculous abscess in the hepatoduodenal ligament were studied. Both patients underwent contrast-enhanced computed tomography (CT) scan. The abscess showed a low density with an irregular thick wall in the hepatoduodenal ligament on CT images, the margin was poorly defined. Contrastenhanced CT images showed the contrast-enhanced thick wall, homogeneous and peripheral-enhanced lymph nodes. Although features of the tuberculous abscess in the hepatoduodenal ligament could be conspicuously shown with contrast-enhanced CT, further experience is needed to evaluate the potential value of CT in detecting early tuberculous abscess in relation to other entities in the hepatoduodenal ligament.

  6. 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…

  7. 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

    these patients (42% females) who had completed the knee-specific questionnaire, Knee injury and Osteoarthritis Outcome Score (KOOS), and 5255 (52%) who had completed the generic score of health status, EQ-5D, before surgery and were included in this study. Independent t tests were used to study sex......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%) of...

  8. Smaller Anterior Cruciate Ligament Diameter Is a Predictor of Subjects Prone to Ligament Injuries: An Ultrasound Study

    OpenAIRE

    2015-01-01

    Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who ...

  9. Outcome of hamstring ligament harvest for Anterior Cruciate Ligament reconstruction with allograft versus autograft: a clinical trial

    Directory of Open Access Journals (Sweden)

    Mehdi Moghtadaei

    2013-11-01

    Full Text Available Background: The goal of this study was to evaluate, functional capacity of the knee in flexion and internal rotation after hamstring ligament harvest for Anterior Cruciate Ligament (ACL reconstruction.Methods: Fifty patients (male and 18-45 years old with isolated ACL injury, randomly allocated in two equal groups (in one group, ACL reconstruction was performed with Tibialis Posterior allograft and in another group with quadruple hamstring ligament auto graft and before and 6 months after surgery in both groups isokinetic flexion strength and isometric internal rotation strength of knee evaluated with Biodex System 4 dynamometer and rotational torque recorder, in order. Isokinetic flexion strength evaluated in sitting and prone position; the later position was performed for deep flexion strength evaluation. Also subjective and objective assessment of all patients pre operatively and 6 months post operatively was documented with International Knee Documentation Committee (IKDC questionnaire. In this study for first time, rotational torque strength of knee was recorded with new design measure, from isometric aspect and not isokinetic.Results: Although significant improvements in IKDC scores, flexion and internal rotation capacity of the knee were observed in both groups, post operatively in respect to pre operatively; there was no significant difference between 2 groups. (P<0.05 or more than 95% confidence Interval of the differenceConclusion: This study demonstrates that ACL reconstruction surgery, improves knee performance in flexion and internal rotation, regardless of hamstring tendon harvesting. Considering potential complications of allograft (for example: transfer of harmful diseases from donor to recipient, it is logical to use hamstring auto graft ligament for ACL reconstruction surgery. Because result of this study is not longstanding follow up and limited to male sex, for more worthfull conclusion, we suggest future study in both sex

  10. Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF.

    Science.gov (United States)

    Zheng, Nan; Yuan, Xiao-Ying; Li, Yun-Fei; Chi, Yan-Yan; Gao, Hai-Bin; Zhao, Xin; Yu, Sheng-Bo; Sui, Hong-Jin; Sharkey, John

    2014-01-01

    Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1-C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections). As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case). This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL). In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL). The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal. PMID:25084162

  11. Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF.

    Directory of Open Access Journals (Sweden)

    Nan Zheng

    Full Text Available Few studies have been conducted specifically on the dense connective tissue located in the posterior medial part of the cervical epidural space. This study was undertaken to examine the presence of this connection between the cervical dura mater and the posterior wall of spinal canal at the level of C1-C2. 30 head-neck specimens of Chinese adults were used. Gross dissection was performed on the suboccipital regions of the 20 specimens. Having been treated with the P45 plastination method, 10 specimens were sliced (9 sagittal and 1 horizontal sections. As a result, a dense fibrous band was identified in the nuchal ligament of 29 specimens (except for one horizontal section case. This fascial structure arose from the tissue of the posterior border of the nuchal ligament and then projected anteriorly and superiorly to enter the atlantoaxial interspace. It was termed as to be named ligament (TBNL. In all 30 specimens the existence of a fibrous connection was found between the posterior aspect of the cervical dura mater and the posterior wall of the spinal canal at the level of the atlas to the axis. This fibrous connection was identified as vertebrodural ligament (VDL. The VDL was mainly subdivided into three parts, and five variations of VDL were identified. These two structures, TBNL and VDL, firmly link the posterior aspect of cervical dura mater to the rear of the atlas-axis and the nuchal region. According to these findings, the authors speculated that the movements of the head and neck are likely to affect the shape of the cervical dural sleeve via the TBNL and VDL. It is hypothesized that the muscles directly associated with the cervical dural sleeve, in the suboccipital region, may work as a pump providing an important force required to move the CSF in the spinal canal.

  12. Arthrographic differential diagnosis between ruptures of the anterior talofibular ligament, the joint capsule and the anterior tibiofibular ligament

    International Nuclear Information System (INIS)

    Aus einem Studium der Literatur, chirurgischen Befunden und Untersuchungen an Leichen kann es als unwahrscheinlich angesehen werden, dass bei einer Fussverstauchung vom Inversionstyp ein Riss des vorderen tibiofibularen Ligraments haeufig zusammen mit einem Gelenkkapselriss und einem seitlichen Baenderriss auftritt. Entgegen der Beobachtung anderer Verfasser fanden wir, dass ein Riss des vorderen tibiofularen Ligaments in keiner Weise aus dem Vorhandensein oder Nichtvorhandensein folgender arthrographischer Befunde geschlossen werden konnte: a) kontrastfreie Zone, b) tibiofibularer Rezessus, oder c) beide zusammen. Ein Gelenkkapselriss kann angenommen werden, wenn Kontrastmittel aus dem Gelenk in das weiche Gewebe austritt, ohne unterhalb oder seitlich in den Aussenknoechel zu dringen. Ein Austritt des Kontrastmittels unterhalb und seitlich des Aussenknoechels deutet auf einen Riss des vorderen tabofibularen Ligaments hin. Die anatomischen Zusammenhaenge zwischen Bandverbindung, Gelenkkapsel, tibiofibularem Rezessus und dem vorderen talofibularen Ligament wurden an Leichen und waehrend der chirurgischen Eingriffe studiert. Ausbreitung des Kontrastmittels im weichen Gewebe wird wahrscheinlich bestimmt durch die Anordnung und Beschaedigung der Weichteile und durch die Groesse des entstandenen Haematoms und folgt dem Weg des kleinsten Widerstandes. (orig.)

  13. Multi-slice CT and MRI findings of the Listranc's ligament injuries

    International Nuclear Information System (INIS)

    Objective: To explore the multislice CT and MRI features of the Lisfranc's ligament injuries. Methods: In 23 cases of the tarsometatarsal joins injuries, 16 are men and 7 are women. The average age is 37 years(range 17-67 years). Ten cases are induced by the direct force and 13 cases are caused by the indirect force. All of the 23 cases were examined by the Siemens 64-slice CT scan, and then reformatted the tarsometatarsal joins with the MPR, CPR, SSD and VR. Ten of 23 cases were examined by oblique axial, sagittal and coronal view of the Siemens 1.5 T MRI. Results: On CT, the distance between the second metatarsus base and the medial cuneiform showed increase in 14 cases and the distance between the base of the second metatarsus and the first metatarsus was over 2 mm. In addition, the inside base of the second metatarsus and the lateral edge of the first cuneiform bone revealed fractures in 5 cases, respectively. The above CT characteristics may suggest the injuries of Lisfranc's ligament. Ten of the 14 cases were examined by MRI. The Lisfranc ligament was found to have injuries in these cases. The injuries were divided into 3 types: type I (Lisfranc ligament breaks) was 5 cases; type II (Lisfranc ligament shape is complete, but accompanied with avulsion fracture of the second metatarsal bone basis interior margin of attachment point of Lisfranc ligament) was 4 cases; and type III (Lisfranc ligament shape is complete, but accompanied with avulsion fracture of exterior margin of the inside cuneiform of attachment point of Lisfranc ligament) was 1 case. Conclusion: CT can demonstrate local soft tissue swelling, suggesting the Lisfranc ligament damage, and demonstrate clearly avulsion fracture of attachment point of Lisfranc ligament, but MRI can appraise accurately the Lisfranc ligament injuries. (authors)

  14. Modeling of failure mode in knee ligaments depending on the strain rate

    Directory of Open Access Journals (Sweden)

    Hyman William

    2002-01-01

    Full Text Available Abstract Background The failure mechanism of the knee ligament (bone-ligament-bone complex at different strain rates is an important subject in the biomechanics of the knee. This study reviews and summarizes the literature describing ligament injury as a function of stain rate, which has been published during the last 30 years. Methods Three modes of injury are presented as a function of strain rate, and they are used to analyze the published cases. The number of avulsions is larger than that of ligament tearing in mode I. There is no significant difference between the number of avulsions and ligament tearing in mode II. Ligament tearing happens more frequently than avulsion in mode III. Results When the strain rate increases, the order of mode is mode I, II, III, I, and II. Analytical models of ligament behavior as a function of strain rate are also presented and used to provide an integrated framework for describing all of the failure regimes. In addition, this study showed the failure mechanisms with different specimens, ages, and strain rates. Conclusion There have been several a numbers of studies of ligament failure under various conditions including widely varying strain rates. One issue in these studies is whether ligament failure occurs mid-ligament or at the bone attachment point, with assertions that this is a function of the strain rate. However, over the range of strain rates and other conditions reported, there has appeared to be discrepancies in the conclusions on the effect of strain rate. The analysis and model presented here provides a unifying assessment of the previous disparities, emphasizing the differential effect of strain rate on the relative strengths of the ligament and the attachment.

  15. The role of extrinsic ligaments in maintaining carpal stability - A prospective statistical analysis of 85 arthroscopic cases.

    Science.gov (United States)

    Van Overstraeten, Luc; Camus, Emmanuel J

    2016-02-01

    Several biomechanical studies have shown that the scapholunate (SL) and lunotriquetral (LT) ligaments are not the only stabilizers of the proximal carpal row. However, no study has yet analyzed the range of ligament lesions leading to instability in vivo. Arthroscopy has been used to assess the condition of the wrist's extrinsic ligaments by palpating and tensioning the various ligament and capsule structures. In this prospective study, this arthroscopic method was used in 85 cases of wrist sprain without static instability to evaluate the correlation between lesions of the intrinsic and extrinsic carpal ligaments and carpal instability. In SL instability, a scapholunate interosseous ligament (SLIL) lesion was statistically correlated with lesions of the long radiolunate ligament (P<0.05). There also was a statistically significant correlation between lesions of the SLIL and the radioscaphocapitate, scaphotrapezial and dorsal intercarpal ligaments. There was a correlation between the stage of SL instability and the number of lax extrinsic ligaments (P<0.05) but not with the severity of the extrinsic ligament lesions. In LT instability, a LT interosseous ligament lesion was statistically correlated with lesions of the dorsal intercarpal ligament (P<0.05). There also was a correlation between the stage of LT instability and the number (P<0.005) and severity (P<0.001) of the extrinsic ligament lesions. Arthroscopy can reveal hidden radiographic instability and can also be used to define the number and severity of injured ligaments. In carpal instability, a lesion of one intrinsic carpal ligament was associated with a lesion of one or more extrinsic ligaments. PMID:27117018

  16. Histological and ultrastructural evaluation of the early healing of the lateral collateral ligament epiligament tissue in a rat knee model

    OpenAIRE

    Kinov Plamen S; Vidinov Nikolai K; Georgiev Georgi P

    2010-01-01

    Abstract Background In this study, we evaluated the changes which occurred in the epiligament, an enveloping tissue of the ligament, during the ligament healing. We assessed the association of epiligament elements that could be involved in ligament healing. Methods Thirty-two 8-month old male Wistar rats were used in this study. In twenty-four of them the lateral collateral ligament of the knee joint was surgically transected and was allowed to heal spontaneously. The evaluation of the epilig...

  17. Androgen action during male sex differentiation includes suppression of cranial suspensory ligament development

    NARCIS (Netherlands)

    J.M.A. Emmen (Judith); A. McLuskey; J.A. Grootegoed (Anton); A.O. Brinkmann (Albert)

    1998-01-01

    textabstractThe cranial suspensory ligament is located on the border of the cranial (mesonephric) mesentery in adult female mammals, which runs between the cranial pole of the internal genitalia and the dorsal abdominal wall. Absence of the cranial suspensory ligament i

  18. Effects of Shuanghuangbu on the total protein content and ultrastructure in cultured human periodontal ligament cells

    Institute of Scientific and Technical Information of China (English)

    许彦枝; 邹慧儒; 王小玲; 刘世正; 王永军

    2004-01-01

    Background Successful periodontal regeneration depends on the migration, proliferation and differentiation of periodontal ligament cells in periodontal defects. The total protein content and the ultrastructure demonstrate the metabolizability and activity of periodontal ligament cells. This study was conducted to observe the effects of Shuanghuangbu, a mixture of medicinal herbs, on the total protein content and the ultrastructure of human periodontal ligament cells.Methods Periodontal ligament cells were grown to confluence and then cultured in Dulbecco's modified eagle medium (DMEM) supplemented with Shuanghuangbu over the concentration range of 0 to 1000 μg/ml. The total protein content in cultured cells was determined by using Coommasie brilliant blue technique. Periodontal ligament cells were incubated in 0 and 100 μg/ml Shuanghuangbu decoction for 5 days, then observed through transmission electron microscope.Results The total protein content of human periodontal ligament cells increased in each experiment group added 10-1000 μg/ml Shuanghuangbu respectively, and the effect of 100 μg/ml was excellent. Under the transmission electron microscope, there were more rough endoplasmic reticulums and mitochodrias in the experiment group than those in the control group. Conclusion Shuanghuangbu stimulates the protein synthesis of human periodontal ligament cells and improves human periodontal ligament cells' metabolizability and activity.

  19. Acute and chronic tears of anterior cruciate ligament : role of gadolinium-enhanced MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Jung; Jee, Won Hee; Im, Soo A; Chun, Ho Jong; Jung, Hyun Seouk; Kim, Soo Young; Kwon, Tae An; Song, Sun Wha; Choi, Kyu Ho [Catholic Univ. Medical College. Kangnam St. Mary' s Hospital, Seoul (Korea, Republic of)

    1998-07-01

    To evaluate the efficacy of fat-suppressed gadolinium-enhanced MR imaging in differentiating acute from chronic ligament tears of anterior cruciate ligament. Materials and Methods : MR images of 22 patients with arthroscopically proven complete tear of the anterior cruciate ligament were retrospectively reviewed. The interval between injury and MR examination was one day to seven years. When ligament tear was detected on MR image with three months of injury, the case was considered acute;if detected after three months had elapsed, it was judged to be chronic. The extent of contrast enhancement was graded as 1, 2 or 3; grade 1, enhancement was confined to the expected ligament region; grade 2, enhancement extended to the joint capsule; grade 3, enhancement extended beyond the joint capsule. The grades of contrast enhancement correlated with the acute and chronic stages of ligament tears. Associated bone bruise and/or adjacent soft tissue edema were also evaluated. Results : Among 15 patients with acute ligament tear, nine (60%) showed grade 3 enhancement; among seven in whom tearing was chronic, four (57%) showed grade 1 enhancement. Bone bruising was present in 100% of acute tears (15/15) and 29 % of chronic tears (2/7). Soft tissue edema was associated in 87% of acute tears (13/15) and 29% of chronic tears(2/7). Conclusion : Fat-suppressed gadolinium-enhanced MR imaging could help differentiate acute from chronic tears of anterior cruciate ligament, as well as bone bruising and tissue edema.

  20. Acute and chronic tears of anterior cruciate ligament : role of gadolinium-enhanced MR imaging

    International Nuclear Information System (INIS)

    To evaluate the efficacy of fat-suppressed gadolinium-enhanced MR imaging in differentiating acute from chronic ligament tears of anterior cruciate ligament. Materials and Methods : MR images of 22 patients with arthroscopically proven complete tear of the anterior cruciate ligament were retrospectively reviewed. The interval between injury and MR examination was one day to seven years. When ligament tear was detected on MR image with three months of injury, the case was considered acute;if detected after three months had elapsed, it was judged to be chronic. The extent of contrast enhancement was graded as 1, 2 or 3; grade 1, enhancement was confined to the expected ligament region; grade 2, enhancement extended to the joint capsule; grade 3, enhancement extended beyond the joint capsule. The grades of contrast enhancement correlated with the acute and chronic stages of ligament tears. Associated bone bruise and/or adjacent soft tissue edema were also evaluated. Results : Among 15 patients with acute ligament tear, nine (60%) showed grade 3 enhancement; among seven in whom tearing was chronic, four (57%) showed grade 1 enhancement. Bone bruising was present in 100% of acute tears (15/15) and 29 % of chronic tears (2/7). Soft tissue edema was associated in 87% of acute tears (13/15) and 29% of chronic tears(2/7). Conclusion : Fat-suppressed gadolinium-enhanced MR imaging could help differentiate acute from chronic tears of anterior cruciate ligament, as well as bone bruising and tissue edema

  1. Ultrasonographic assessment of the proximal digital annular ligament in the equine forelimb

    International Nuclear Information System (INIS)

    Ultrasonography was used with 6 normal cadaver forelimbs of Dutch Warmblood horses to delineate the ultrasonographic anatomy of the palmar pastern region, with emphasis on the proximal digital annular ligament. Using a 5.5 MHz sector scanner, the thin proximal digital annular ligament was not visible on offset sonograms. Only if the digital sheath in the normal limb was distended was the distal border of this ligament outlined. In all normal limbs the palmarodistal thickness of the combined skin-proximal digital annular ligament layer in the mid-pastern region was 2 mm. The flexor tendons and distal sesamoidean ligaments were easily identified as hyperechoic structures. Distension of the digital sheath in the normal limbs clearly outlined the anechoic digital sheath pouches. In 4 lame horses ultrasonography aided the diagnosis of functional proximal digital annular ligament constriction. In all 4 diseased forelimbs ultrasonography demonstrated thickening of the skin-proximal digital annular ligament layer and distension of the digital sheath. In one of these limbs the distended digital sheath was also thickened. The flexor tendons and distal sesamoidean ligaments were normal. There was no radiographic evidence of additional bone or joint lesions

  2. The diagnostic accuracy of MRI for injuries to the cruciate ligaments

    International Nuclear Information System (INIS)

    Lesions of the anterior cruciate ligaments may be demonstrated by MRI with an accuracy of 99%. Standardised technique with sagittal and coronal projections produces excellent results. Localisation of the site of rupture can be achieved in 95% of cases. MRI provides a valuable method for diagnosing lesions of the cruciate ligaments. (orig.)

  3. Calcification of the alar ligament of the cervical spine in a patient with rheumatoid arthritis

    OpenAIRE

    Soubai, Rahma Boussaadani; Tahiri, Latifa; Abourazzak, Fatima Zahra; Tizniti, Siham; Harzy, Taoufik

    2012-01-01

    Calcification of the alar ligament is rare. It usually develops as a result of traumatic injury and is especially prominent in the elderly. CT scanning is the gold standard of the diagnosis. We report a case of a calcification of the transverse and alar ligament in a patient with rheumatoid arthritis.

  4. Correlation between bone contusion and ligament, menisci injury of knee joint

    International Nuclear Information System (INIS)

    Objective: To evaluate the correlation between bone contusion and ligament, meniscus injury of knee joint with MR imaging. Methods: Thirty-five patients with acute trauma of knee joint were studied retrospectively. All eases showed negative on X-ray and bone cont, -sion on MR imaging. Results: in all patients, ligament and meniscus injury were seen in 25 cases (71%), incorporate anterior cruciate ligament injury in 12 cases, posterior cruciate ligament in 6, tibial collateral ligament in 8 cases, fibular collateral ligament in 6 cases, medial meniscus tear in 4 cases, lateral meniscus tear in 5 cases, and hydrops in 29 cases. There were only 3 patients with ligament or meniscus injury but no bone contusion during the same period. Conclusion: It is necessary to check by MR for the patients with acute trauma of knee joint, who have clinical symptom such as ache, swelling, move un-freely showing bone contusion on MR Imaging but without any abnormality on X-ray in order to avoid failure in diagnosing injury of ligament and meniscus. (authors)

  5. Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique

    Directory of Open Access Journals (Sweden)

    Gobezie Reuben

    2009-01-01

    Full Text Available Abstract Background Symptomatic Acromioclavicular (AC dislocations have historically been surgically treated with Coracoclavicular (CC ligament reconstruction with transfer of the Coracoacromial (CA ligament. Tensioning the CA ligament is the key to success. Methods Seventeen patients with chronic, symptomatic Type III AC joint or acute Type IV and V injuries were treated surgically. The distal clavicle was resected and stabilized with CC ligament reconstruction using the CA ligament. The CA ligament was passed into the medullary canal and tensioned, using a modified 'docking' technique. Average follow-up was 29 months (range 12–57. Results Postoperative ASES and pain significantly improved in all patients (p = 0.001. Radiographically, 16 (94% maintained reduction, and only 1 (6% had a recurrent dislocation when he returned to karate 3 months postoperatively. His ultimate clinical outcome was excellent. Conclusion The docking procedure allows for tensioning of the transferred CA ligament and healing of the ligament in an intramedullary bone tunnel. Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability.

  6. News You Can Use: The Knee Anterolateral Ligament and the ISAKOS Journal.

    Science.gov (United States)

    Lubowitz, James H; Provencher, Matthew T; Rossi, Michael J; Brand, Jefferson C

    2016-05-01

    The knee anterolateral ligament may be fiction, but we thought it fact. As true anatomic restoration of the anterior cruciate ligament (ACL) may not be possible today, we are open to the possibility that lateral augmentation of ACL reconstruction could be of benefit in some patients. PMID:27151446

  7. Collateral ligament reconstruction of the chronic thumb injury with bio-tenodesis screw fixation

    DEFF Research Database (Denmark)

    Gvozdenovic, Robert; Boeckstyns, Michel

    2014-01-01

    We describe a new technique for the reconstruction of chronic lesions of the collateral ligaments of the metacarpophalangeal ligaments of the thumb, using a Bio-Tenodesis screw for the fixation of a tendon graft in a triangular manner with proximal apex and allowing early mobilization, starting 2...

  8. Mechanisms of anterior cruciate ligament injury in basketball - Video analysis of 39 cases

    NARCIS (Netherlands)

    Krosshaug, Tron; Nakamae, Atsuo; Boden, Barry P.; Engebretsen, Lars; Smith, Gerald; Slauterbeck, James R.; Hewett, Timothy E.; Bahr, Roald

    2007-01-01

    Background: The mechanisms of anterior cruciate ligament injury in basketball are not well defined. Purpose: To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations. Study Design: Case series; Level of evidence, 4. Methods: Six international

  9. The demonstration of lesions of the cruciate ligaments by MR tomography

    International Nuclear Information System (INIS)

    The cruciate ligaments of the knee joint can be demonstrated by magnetic resonance tomography, without using invasive methods. High resolution coils and section thickness of less than 5 mm are necessary. Sixty-six patients and volunteers were examined; the results show that the normal cruciate ligaments present as homogeneous zones of low signal intensity within the surrounding fat. Injuries to the cruciate ligaments interrupt the image of the ligaments, change their anatomical position or produce a signal of intermediate intensity. Eighteen operations were carried out on fifteen patients with cruciate ligament injuries and there was good agreement between the MR and the operative findings. Sixteen patients had had previous cruciate surgery and in these there was only partial correlation with the clinical findings. (orig)

  10. Radiographic evaluation of new orthopedic surgical techniques for cruciate and medial collateral ligament knee reconstruction

    International Nuclear Information System (INIS)

    The normal postoperative radiographic appearance of ligamentous knee reconstructions, postoperative complications, and potential pitfalls are presented. Anterior cruciate ligament repair with bone-patella tendon-bone grafts is evaluated in terms of hardware position, location of the drill holes, and change in position, fracture, or healing of the bone graft itself. Posterior cruciate ligament injuries may be repaired similarly with a bone-patella tendon-bone graft or may involve entirely soft-tissue reconstruction, in which case they are evaluated by location of the drill holes and hardware position. Medial collateral ligament repairs are evaluated entirely by hardware position, based on an anatomic understanding of the normal origin and insertion of the ligament

  11. Reconstruction of ACL Ligament rupture: results of 96 operation

    Directory of Open Access Journals (Sweden)

    Tahmasebi MN

    2009-04-01

    Full Text Available "nBackground: Anterior Cruciate Ligament (ACL is one of the main knee stabilizing ligaments. Because of high incidence of ACL tearing especially in young athletes its reconstruction is very important. The aim of this study was to evaluate short-term results of anterior cruciate ligament ruptures using four strand hamstring auto graft and Bone patellar tendon autograph. "nMethods: The study group included 96 patients (3 female and 93 male with ACL teared who had been referred to our center in 5 years period (2002-2007. The subject which were Accessed in this study included meniscal injury concomitant chondral injury, determine the most common cause of ACL tearing, comparision of IKDC and lysholm score in all patients before and after surgery, and limitation of rang of motion of knee post operation. "nResults: Involvement was in the right knee in 38 patients and in the left knee in 58 patients. Mean age of patients was 27.6 years (19-48. Mean surgical delay was 18 month (1-77. The most common cause of tear was playing soccer. Meniscal injury was in 78 patients. (Medial meniscus in 63 patients, lateral meniscus in 29 patients Concommitent chondral injury was in 54 patients (56.25%. 68% of patients returned to preoperative functions sport activity. There was no limitation in extension and there was 6 patients limitation in flexion about 20º. In last visit of patients IKDS in class A and B was 96. "nConclusion: It is seem that arthroscopic reconstruction of ACL is a safe and good method in treatment of Knee stability. Use of IKDC and lysholm score for comparision of patients before and after surgery is helpful. The operation should be done early after injury. Reconstruction of ACL in older patients in the abscense of DJD is effective.

  12. MRI appearance of the superior transverse scapular ligament

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Bredella, Miriam A.; Chang, Connie Y.; Torriani, Martin; Huang, Ambrose J. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States)

    2015-11-15

    The superior transverse scapular ligament (STSL) forms the roof of the suprascapular notch, which is the most common location of entrapment of the suprascapular nerve, a cause of shoulder pain and weakness. The purpose of this study is to determine the frequency of visualization of the STSL on routine shoulder MRIs, to identify the sequences and imaging planes on which it is visualized most frequently, and to describe its typical MRI appearance, none of which have been previously addressed in the radiologic literature. One hundred twenty-one consecutive shoulder MRIs were reviewed for the presence or absence of the STSL, including the imaging plane and sequence that best depicted the ligament. Dimensions of the ligament were recorded. Fifty four of 121 shoulder MRIs were technically adequate for visualization of the STSL, and it was identified on 51 of these studies (94 %). There was no statistically significant difference between 1.5-T and 3-T systems. The best individual sequence for visualizing the STSL was the sagittal T1-weighted sequence, in which the STSL was visible on 75/80 technically adequate sequences (94 %). The sagittal plane was the best plane for visualizing the STSL, in which it was visible on 65/69 technically adequate studies (94 %). The STSL on average measured 12.8 ± 1.5 mm in transverse dimension. The STSL can be visualized on the majority of shoulder MRIs and is best seen on sagittal T1-weighted images on our imaging protocol. Evaluation of the STSL can potentially help in identifying pathologic conditions affecting the suprascapular nerve. (orig.)

  13. Morphology of the medial collateral ligament of the knee

    Directory of Open Access Journals (Sweden)

    Gill Thomas J

    2010-09-01

    Full Text Available Abstract Background Quantitative knowledge on the anatomy of the medial collateral ligament (MCL is important for treatment of MCL injury and for MCL release during total knee arthroplasty (TKA. The objective of this study was to quantitatively determine the morphology of the MCL of human knees. Methods 10 cadaveric human knees were dissected to investigate the MCL anatomy. The specimens were fixed in full extension and this position was maintained during the dissection and morphometric measurements. The outlines of the insertion sites of the superficial MCL (sMCL and deep MCL (dMCL were digitized using a 3D digitizing system. Results The insertion areas of the superficial MCL (sMCL were 348.6 ± 42.8 mm2 and 79.7 ± 17.6 mm2 on the tibia and femur, respectively. The insertion areas of the deep MCL (dMCL were 63.6 ± 13.4 mm2 and 71.9 ± 14.8 mm2 on the tibia and femur, respectively. The distances from the centroids of the tibial and femoral insertions of the sMCL to the tibial and femoral joint line were 62.4 ± 5.5 mm and 31.1 ± 4.6 mm, respectively. The distances from the centroids of dMCL in the tibial insertion and the femoral insertion to the tibial and femoral joint line were 6.5 ± 1.3 mm and 20.5 ± 4.2 mm, respectively. The distal portion of the dMCL (meniscotibial ligament - MTL was approximately 1.7 times wider than the proximal portion of the dMCL (meniscofemoral ligament - MFL, whereas the MFL was approximately 3 times longer than the MTL. Conclusions The morphologic data on the MCL may provide useful information for improving treatments of MCL-related pathology and performing MCL release during TKA.

  14. Ossified Posterior Longitudinal Ligament With Massive Ossification of the Anterior Longitudinal Ligament Causing Dysphagia in a Diffuse Idiopathic Skeletal Hyperostosis Patient

    OpenAIRE

    Murayama, Kazuhiro; Inoue, Shinichi; Tachibana, Toshiya; Maruo, Keishi; Arizumi, Fumihiro; Tsuji, Shotaro; Yoshiya, Shinichi

    2015-01-01

    Abstract Descriptive case report. To report a case of a diffuse idiopathic skeletal hyperostosis (DISH) patient with both massive ossification of the anterior longitudinal ligament (OALL) leading to severe dysphagia as well as ossification of the posterior longitudinal ligament (OPLL) causing mild cervical myelopathy, warranting not only an anterior approach but also a posterior one. Although DISH can cause massive OALL in the cervical spine, severe dysphagia resulting from DISH is a rare occ...

  15. Anatomical reconstruction of the anterior cruciate ligament: a logical approach

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali

    2015-08-01

    Full Text Available ABSTRACT We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP and femoral tunnel drilling through an accessory anteromedial portal (AMP. The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-intechnique is used and also can be used for double-bundle ACL reconstruction.

  16. Anciliary findings of anterior cruciate ligament injuries on MR images

    International Nuclear Information System (INIS)

    Two MR findings have been noted in patients with documented anterior cruciate ligament (ACL) injuries: a cartilaginous defect in lateral femoral condyle and a posterosuperior bulge in the synovium adjacent to the proximal third of the ACL. The purpose of this paper is to assess the specificity of these findings, comparing a randomly chosen population with a group of patients with proved ACL ruptures. Twenty-three patients without any ACL abnormality on MR images were compared with a group of 22 patients with ACL lesions. Every ACL lesion was confirmed either arthroscopically or surgically. The control group included subjects with normal knees and various knee injuries

  17. Transtibial Tunnel Placement in Posterior Cruciate Ligament Reconstruction

    OpenAIRE

    Tompkins, Marc; Keller, Thomas C.; Milewski, Matthew D.; Gaskin, Cree M.; Brockmeier, Stephen F.; Hart, Joseph M.; Miller, Mark D.

    2014-01-01

    Background: It is common to place the posterior cruciate ligament (PCL) tibial tunnel with a transtibial technique using a guide that attempts to place the center of the tunnel 1 to 1.5 cm distal to the tibiofemoral joint. It is unknown how well this technique will re-create the native tibial footprint of the PCL. Purpose: To evaluate the accuracy of tibial tunnel placement using a transtibial technique. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees from 10 donors un...

  18. A nonlinear poroelastic model for the periodontal ligament

    Science.gov (United States)

    Favino, Marco; Bourauel, Christoph; Krause, Rolf

    2016-05-01

    A coupled elastic-poroelastic model for the simulation of the PDL and the adjacent tooth is presented. A poroelastic constitutive material model for the periodontal ligament (PDL) is derived. The solid phase is modeled by means of a Fung material law, accounting for large displacements and strains. Numerical solutions are performed by means of a multigrid Newton method to solve the arising large nonlinear system. Finally, by means of numerical experiments, the biomechanical response of the PDL is studied. In particular, the effect of the hydraulic conductivity and of the mechanical parameters of a Fung potential is investigated in two realistic applications.

  19. Arthrography of the ankle - diagnostic method in ligamental injuries

    International Nuclear Information System (INIS)

    Results were analyzed of 143 arthrographies in patients with severe distortions of the ankle: 97 men and 46 women at mean age 34,3 years. Arthrography was realized by Gordon's original technique. The following X-ray diagnostic features were considered evidential for demonstration of the ligamental apparatus of the joint: 1. Extracapsular presence of contrast matter beneath and aside for the lateral maleolus with spread in cranial direction; 2. 'effluence' of contrast matter around the medial maleolus in the antero-posterior roentgenogram; 3. Absence of contrast-matter-free zone on lateral roentgenography. The author's arthrographic interpretations were confirmed on the subsequent operative correction

  20. Radiological diagnosis of fibulo-talar ligamentous lesions

    International Nuclear Information System (INIS)

    Of 343 patients with sprained ankles the results of conventional stress a.p. roentgenograms in supination and stressed X-ray in lateral view with a device, similar to the technique, described by Noesberger, are compared. In 63 of 91 pathological findings the lesions could only be diagnosed in X-rays in lateral view. The advantages and disadvantages of both techniques are discussed. In our opinion the stressed X-ray in lateral projection are a useful method for diagnosis of ligamentous lesions of the ankle joint. (orig.)

  1. Periodontal ligament stem cells: an update and perspectives.

    Science.gov (United States)

    Chamila Prageeth Pandula, P K; Samaranayake, L P; Jin, L J; Zhang, Chengfei

    2014-05-01

    Chronic periodontitis is a serious infectious and inflammatory oral disease of humans worldwide. Conventional treatment modalities are effective for controlling periodontal disease. However, the regeneration of damaged periodontal tissues remains a major challenge in clinical practice due to the complex structure of the periodontium. Stem cell-based regenerative approaches combined with the usage of emerging biomaterials are entering a new era in periodontal regeneration. The present review updates the current knowledge of periodontal ligament stem cell-based approaches for periodontal regeneration, and elaborates on the potentials for clinical application. PMID:24610628

  2. Novel technique for ulnar collateral ligament reconstruction of the elbow.

    Science.gov (United States)

    Acevedo, Daniel C; Lee, Brian; Mirzayan, Raffy

    2012-11-01

    Ulnar collateral ligament (UCL) reconstruction of the elbow has been shown to restore function in overhead athletes with valgus instability. Since the initial description of using bone tunnels for reconstruction, many modifications to the surgical technique have been introduced, including the modified Jobe technique, the docking technique, fixation with interference screws, and button fixation. The authors introduce a technique that uses a button on each of the humeral and ulnar sides for fixation. This method allows proper tensioning of the graft and provides immediate secure fixation that relies on metal implants as opposed to sutures over bone bridges alone. PMID:23127439

  3. 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...... MR images. Curvature (mm(-1)) was determined for femur, tibia, medial/lateral femur, trochlea, medial/lateral tibia. Age, sex, treatment, BMI, meniscal injury, osteochondral fracture on baseline MR images were tested for association. RESULTS: Over 5 years, curvature decreased in each region (P < 0...

  4. A historical perspective on ankle ligaments reconstructive surgery.

    Science.gov (United States)

    Di Matteo, Berardo; Tarabella, Vittorio; Filardo, Giuseppe; Tomba, Patrizia; Viganò, Anna; Marcacci, Maurilio; Zaffagnini, Stefano

    2016-04-01

    Ankle sprains are by far the most common injuries treated by sport medicine physicians. Treatment is mainly conservative, but in some cases surgical intervention is required. The aim of the present manuscript is to give an insight into the origins and developments of ankle ligaments reconstructive surgery, underlining the fundamental steps that marked the transition from a mere conservative approach to surgical treatment options. In this historical note, the most illustrious figures who contributed to this particular field of orthopaedic practice are also acknowledged. Level of evidence V. PMID:26718639

  5. Proprioceptive exercises for ankle ligament injury: a CAT

    Directory of Open Access Journals (Sweden)

    Raúl Aguilera Eguía

    2013-06-01

    Full Text Available This CAT (Critically Appraised Topic answered the question: In recreational athletes suffering from chronic ankle sprain, can proprioceptive exercises reduce its recurrence?The clinical question was analyzed in three parts: patient, intervention and outcome. The purpose was to test the validity, results and effectiveness of proprioceptive exercises in recreational athletes suffering from chronic ankle sprain to reduce its recurrence from the article "Effectiveness of proprioceptive exercises for ankle ligament injury in adults: A systematic literature and meta-analisys "Postle”1 (2012.

  6. Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Chahla, Jorge; Nitri, Marco; Civitarese, David; Dean, Chase S; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the native PCL footprint more closely and to restore normal knee kinematics. We detail our technique for an anatomic double-bundle PCL reconstruction using Achilles and anterior tibialis tendon allografts. PMID:27284530

  7. Return to Play Following Ankle Sprain and Lateral Ligament Reconstruction.

    Science.gov (United States)

    Shawen, Scott B; Dworak, Theodora; Anderson, Robert B

    2016-10-01

    Ankle sprains are the most common musculoskeletal injury occurring during athletics. Proper initial treatment with supportive pain control, limited immobilization, early return to weight bearing and range of motion, and directed physical therapy are essential for preventing recurrent injury. Reconstruction of the lateral ligaments is indicated for patients with continued instability and dysfunction despite physical therapy. Return to athletic activity should be reserved for athletes who have regained strength, proprioception, and range of motion of the injured ankle. Athletes with a history of an ankle sprain should be prophylactically braced or tapped to reduce risk of recurrent injury. PMID:27543408

  8. Potential wrist ligament injury in rescuers performing cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Robert Curran

    2013-01-01

    Full Text Available Wrist pain in rescuers performing chest compressions as part of cardiopulmonary resuscitation has been reported anecdotally and recently in the literature. Studies have indicated that rescuers apply as much as 644 N of force to the victim′s chest with each compression, while standards require one hundred compressions per minute. Recent research suggests that forces transmitted through the rescuers′ wrists of less than 10% of those seen during the performance of chest compressions significantly strain the scapholunate ligament. Biomechanical research should be performed to further evaluate this possible correlation. Compensation for worker injury maybe involved.

  9. Anterior cruciate ligament injury in indoor ball games.

    Science.gov (United States)

    Ebstrup, J F; Bojsen-Møller, F

    2000-04-01

    Three videorecorded incidents of knee injuries inflicted during indoor ball games are reported. Injuries and especially anterior cruciate ligament ruptures seemed to be triggered in varus loaded knees by femural external rotation, or in valgus loaded knees by femural internal rotation with the pivot shifted to the lateral femurotibial compartment. The observations suggest that it may be to the players' advantage to be trained in not letting their knees sag medially or laterally during side-stepping or sudden changes in speed. PMID:10755283

  10. Sonography of injury of the ulnar collateral ligament of the elbow - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T. [Department of Radiology, North Shore University Hospital, 825 Northern Boulevard, 11021, Great Neck, NY (United States); Adler, Ronald S. [Department of Imaging and Nuclear Medicine, Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY (United States); Friedman, Lawrence [Department of Radiology, Hamilton Health Sciences - Henderson Division, 711 Concession Street, L8V 1C3, Hamilton, Ontario (Canada)

    2004-07-01

    The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. Eight non-professional male baseball pitchers, ages 13-35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months. In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment. Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology. (orig.)

  11. Sonography of injury of the ulnar collateral ligament of the elbow - initial experience

    International Nuclear Information System (INIS)

    The purpose of this study is to describe the sonographic appearance of injuries of the ulnar collateral ligament (UCL) of the elbow. Eight non-professional male baseball pitchers, ages 13-35 years, with medial elbow pain and clinical suspicion of ulnar collateral ligament injury, were referred for imaging. All eight underwent sonography of the affected and contralateral asymptomatic elbow, and six also underwent MR imaging. Neither valgus stress nor power Doppler was used during the sonographic examinations. Time from onset of symptoms to imaging was 1.5 weeks to 6 months. Three patients had surgical confirmation of their injuries, with time from imaging to surgery of 2 days to 9 months. In four patients, the UCL was ruptured, manifest sonographically in three cases as discontinuity of the normally hyperechoic ligament with anechoic fluid in the gap and in one case as non-visualization of the ligament with heterogeneous echogenicity in the expected location of the ligament. Two adolescent patients had avulsions of the UCL from the medial epicondyle, with sonographic demonstration of the avulsed echogenic bony fragment in both cases. One patient had a mild sprain, manifest as mild thickening and decreased echogenicity of the ligament sonographically compared with the contralateral normal elbow, with mild surrounding hypoechoic edema. The eighth patient had a small partial tear of the deep surface of the distal aspect of the ligament, visualized as a hypoechoic focus between the deep surface of the ligament and its ulnar attachment. Tears of the ulnar collateral ligament are manifested sonographically as non-visualization of the ligament or alteration of the normal morphology. (orig.)

  12. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leao

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVES: To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G, by means of the Knee Society Score (KSS and the Lysholm scale. METHODS: This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. RESULTS: From the statistical analysis, it could be seen that the patients' functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results ( p= >0.05, in all the comparisons. CONCLUSIONS: The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery.

  13. BROAD PHONEME CLASSIFICATION USING SIGNAL BASED FEATURES

    Directory of Open Access Journals (Sweden)

    Deekshitha G

    2014-12-01

    Full Text Available Speech is the most efficient and popular means of human communication Speech is produced as a sequence of phonemes. Phoneme recognition is the first step performed by automatic speech recognition system. The state-of-the-art recognizers use mel-frequency cepstral coefficients (MFCC features derived through short time analysis, for which the recognition accuracy is limited. Instead of this, here broad phoneme classification is achieved using features derived directly from the speech at the signal level itself. Broad phoneme classes include vowels, nasals, fricatives, stops, approximants and silence. The features identified useful for broad phoneme classification are voiced/unvoiced decision, zero crossing rate (ZCR, short time energy, most dominant frequency, energy in most dominant frequency, spectral flatness measure and first three formants. Features derived from short time frames of training speech are used to train a multilayer feedforward neural network based classifier with manually marked class label as output and classification accuracy is then tested. Later this broad phoneme classifier is used for broad syllable structure prediction which is useful for applications such as automatic speech recognition and automatic language identification.

  14. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience

    Directory of Open Access Journals (Sweden)

    Betina Bremer Hinckel

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. METHOD: The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM, apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10 and whether they would be prepared to go through this operation again. RESULTS: Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07. Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. CONCLUSION: Reconstruction of the

  15. Reconstruction of medial patellofemoral ligament using quadriceps tendon combined with reconstruction of medial patellotibial ligament using patellar tendon: initial experience☆

    Science.gov (United States)

    Hinckel, Betina Bremer; Gobbi, Riccardo Gomes; Bonadio, Marcelo Batista; Demange, Marco Kawamura; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-01-01

    Objective To describe a surgical technique for anatomical reconstruction of the medial patellofemoral ligament using the quadriceps tendon, combined with reconstruction of the medial patellotibial ligament using the patellar tendon; and to present the initial results from a case series. Method The proposed technique was used on a series of cases of patients with diagnoses of patellofemoral instability and indications for surgical treatment, who were attended by the Knee Group of HC-IOT, University of São Paulo. The following were evaluated before and after the operation: range of motion (ROM), apprehension test, lateral translation test, patellar inclination test, inverted J sign, subluxation upon extension, pain from compression of the patella and pain from contraction of the quadriceps. After the operation, the patients were asked whether any new episode of dislocation had occurred, what their degree of satisfaction with the surgery was (on a scale from 0 to 10) and whether they would be prepared to go through this operation again. Results Seven knees were operated, in seven patients, with a mean follow-up of 5.46 months (±2.07). Four patients who presented apprehension before the operation did not show this after the operation. The lateral translation test became normal for all the patients, while the patellar inclination test remained positive for two patients. The patients with an inverted J sign continued to be positive for this sign. Five patients were positive for subluxation upon extension before the operation, but all patients were negative for this after the operation. None of the patients presented any new episode of dislocation of the patella. All of them stated that they were satisfied: five gave a satisfaction score of 9 and two, a score of 10. All of them said that they would undergo the operation again. Only one patient presented a postoperative complication: dehiscence of the wound. Conclusion Reconstruction of the medial patellofemoral ligament

  16. Giant Broad Line Regions in Dwarf Seyferts

    CERN Document Server

    Devereux, Nick

    2015-01-01

    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 seen in the most luminous quasars. Secondly, the size of the BLR is not correlated with the central continuum luminosity, an observation that distinguishes them from their reverberating counterparts. Collectively, these early results suggest that non-reverberating dwarf Seyferts are a heterogeneous group and not simply scaled versions of each other. Careful inspection reveals broad H Balmer emission lines with single peaks, double peaks, and a combination of the two, suggesting that the broad emission lines are produced in kinematically distinct regions centered on the black hole (BH). Because the gravitational field strength is already known for these objects, by virtue of knowing their BH mass, ...

  17. Anterior cruciate ligament of the knee - MRI protocol

    International Nuclear Information System (INIS)

    Full text: MRI examination of the knee lesions is golden standard in nowadays diagnostic. It gives valuable information for conventional, physiatrics and/or arthroscopic microinvasive treatment. Three planar MRI examinations and 3D reconstructions are highly precise in the analysis of the intra and periarticular structures, with exceptions of anterior cruciatre ligament (ACL). Direct contact with the roof of the intercondilar fossa (in the full extension during the examination) and its specific orientation makes visualisation of ACL diagnostically problematic. In a period from 2004 to presence, precise protocol for MRI visualisation of ACL was established, tested and applied as 'Angled biplanar reconstruction in the parasagital and paratransversal planes (patient-related and arbitrary selected in full extension)', on T2, 2 mm slice and 0,2 mm gap. Five hundred patients are examined in Clinical Center of Montenegro during mentioned period of time. Angled biplanar reconstruction gives visualisation of ACL superiority to examination in flexion, and it is adapted to the concrete morphology of the patients ACL. It was not depend of the volume of knee and, finally, takes less time to perform. Beside the ligament is shown at three to six slices, which is more than with the standard techniques. Precise visualisation of ACL is contribution to effectiveness of MRI of the knee injuries that helps in staging of conventional physiatric treatment. Beside it decrees number of diagnostic arthroscopies and arthroscopic interventions to bee microinvasive and effective in therapeutic treatment

  18. Magnetic resonance imaging of anterior cruciate ligament rupture

    Directory of Open Access Journals (Sweden)

    Chiang Hongsen

    2004-07-01

    Full Text Available Abstract Background Magnetic resonance (MR imaging is a useful diagnostic tool for the assessment of knee joint injury. Anterior cruciate ligament repair is a commonly performed orthopaedic procedure. This paper examines the concordance between MR imaging and arthroscopic findings. Methods Between February, 1996 and February, 1998, 48 patients who underwent magnetic resonance (MR imaging of the knee were reported to have complete tears of the anterior cruciate ligament (ACL. Of the 48 patients, 36 were male, and 12 female. The average age was 27 years (range: 15 to 45. Operative reconstruction using a patellar bone-tendon-bone autograft was arranged for each patient, and an arthroscopic examination was performed to confirm the diagnosis immediately prior to reconstructive surgery. Results In 16 of the 48 patients, reconstructive surgery was cancelled when incomplete lesions were noted during arthroscopy, making reconstructive surgery unnecessary. The remaining 32 patients were found to have complete tears of the ACL, and therefore underwent reconstructive surgery. Using arthroscopy as an independent, reliable reference standard for ACL tear diagnosis, the reliability of MR imaging was evaluated. The true positive rate for complete ACL tear diagnosis with MR imaging was 67%, making the possibility of a false-positive report of "complete ACL tear" inevitable with MR imaging. Conclusions Since conservative treatment is sufficient for incomplete ACL tears, the decision to undertake ACL reconstruction should not be based on MR findings alone.

  19. [Results of ligament reconstruction in advanced scapholunate dissociation].

    Science.gov (United States)

    Wieloch, P T; Martini, A-K; Daecke, W

    2005-04-01

    Scapholunate dissociation is one of the most common disorders of the wrist. Untreated it might lead to osteoarthrosis (scapholunate advanced collapse, SLAC wrist). Choosing the best surgical treatment option is still challenging, especially in cases of carpal collapse in combination with beginning osteoarthrosis of the radial styloid and the proximal pole of the scaphoid. We report the results of a homogenous group of eight patients with reducible carpal collapse and beginning arthrosis treated by reconstruction of the scapholunate ligament. The operation was performed 66 (range: 20 to 252) months after trauma. The average length of follow-up was two years. Five patients stated general improvement, while three reported a change for the worse. At follow-up, the average total range of motion of the operated wrist was decreased by 16 % compared to the unaffected side. The average grip-strength (measured with a Jamar dynamometer) was 77 % of the uninvolved wrist. The DASH score was 43 +/- 25. In three cases the Martini score showed a good or an excellent result. The average scapholunate angle was 72.3 degrees preoperatively and decreased to 61.0 degrees at follow-up. At follow-up as well as pre- and postoperatively the carpal height ratio showed pathologic mean values. Therefore, reconstruction of the carpal alignment was not achieved in most of the cases. Progression of the osteoarthrosis has to be expected. Reconstruction of the scapholunate ligament for treatment of carpal collapse with beginning osteoarthrosis therefore remains an unsolved problem. PMID:15877269

  20. The story of anterior cruciate ligament reconstruction--Part 1.

    Science.gov (United States)

    Schindler, Oliver S

    2012-05-01

    Once upon a time the anterior cruciate ligament (ACL) enjoyed a relatively unchartered existence, when only a fall from a jousting horse or chariot might have sent a knight or gladiator into early retirement due to an unstable knee. In today's world of high speed travel and an ever increasing number of sports enthusiasts, injuries of the ACL are almost common place with a yearly incidence of about 35 per 100,000 of the population. Although we have known about the existence of the cruciate ligaments since they were first described by Galen over 2000 years ago, awareness of their function and the consequences of their loss were not appreciated until much later. Robert Adams observed the first clinical case of an ACL tear in 1837 but treatment in those days was largely conservative and surgery was reserved for life threatening conditions as mortality was high. The first ACL repair was performed in 1895 by Mayo-Robson of Leeds and was followed by Grekow and Hey Groves who initiated ACL reconstruction with autologous tissue between 1914 and 1920, almost as we know it today. PMID:22720509

  1. REHABILITATION PROTOCOL AFTER ISOLATED POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    Science.gov (United States)

    de Paula Leite Cury, Ricardo; Kiyomoto, Henry Dan; Rosal, Gustavo Fogolin; Bryk, Flávio Fernandes; de Oliveira, Victor Marques; de Camargo, Osmar Pedro Arbix

    2015-01-01

    To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject. PMID:27047844

  2. Variations in cell morphology in the canine cruciate ligament complex.

    Science.gov (United States)

    Smith, K D; Vaughan-Thomas, A; Spiller, D G; Clegg, P D; Innes, J F; Comerford, E J

    2012-08-01

    Cell morphology may reflect the mechanical environment of tissues and influence tissue physiology and response to injury. Normal cruciate ligaments (CLs) from disease-free stifle joints were harvested from dog breeds with a high (Labrador retriever) and low (Greyhound) risk of cranial cruciate ligament (CCL) rupture. Antibodies against the cytoskeletal components vimentin and alpha tubulin were used to analyse cell morphology; nuclei were stained with 4',6-diamidino-2-phenylindole, and images were collected using conventional and confocal microscopy. Both cranial and caudal CLs contained cells of heterogenous morphologies. Cells were arranged between collagen bundles and frequently had cytoplasmic processes. Some of these processes were long (type A cells), others were shorter, thicker and more branched (type B cells), and some had no processes (type C cells). Processes were frequently shown to contact other cells, extending longitudinally and transversely through the CLs. Cells with longer processes had fusiform nuclei, and those with no processes had rounded nuclei and were more frequent in the mid-substance of both CLs. Cells with long processes were more commonly noted in the CLs of the Greyhound. As contact between cells may facilitate direct communication, variances in cell morphology between breeds at a differing risk of CCL rupture may reflect differences in CL physiology. PMID:22465617

  3. Median arcuate ligament syndrome: a nonvascular, vascular diagnosis.

    Science.gov (United States)

    Skeik, Nedaa; Cooper, Leslie T; Duncan, Audra A; Jabr, Fadi I

    2011-07-01

    Median arcuate ligament syndrome (MALS) is often diagnosed when idiopathic, episodic abdominal pain is associated with dynamic compression of the proximal celiac artery by fibers of the median arcuate ligament. The character of the abdominal pain is often postprandial and associated with gradual weight loss from poor food intake, suggestive of chronic mesenteric ischemia. However, the pathognomonic imaging feature of dynamic, ostial celiac artery compression with expiration does not consistently predict clinical improvement from revascularization. Proposed but unproven pathophysiological mechanisms include neurogenic pain from compression of the splanchnic nerve plexus and intermittent ischemia from compression of the celiac artery. Alterations in blood flow and ganglion compression are both associated with delayed gastric emptying, another physiological correlate of the clinical syndrome. Published reports describe a variable response to revascularization and nerve plexus resection suggest a need for translational research to better characterize this poorly understood clinical entity. We illustrate the current gaps in our knowledge of MALS with the case of a 51-year-old woman with a 4-year history of chronic abdominal pain who responded to a combination of ganglion resection and celiac artery reconstruction. PMID:21536596

  4. MR Imaging of Supraspinous Ligament Injury in the Thoracolumbar Spine

    International Nuclear Information System (INIS)

    We wanted to evaluate the MRI features and their diagnostic accuracy for SSL injury in the thoracolumbar spine. From December 2003 to June 2006, among 42 surgically treated patients with spinal fracture, the 35 patients who underwent MRI and who were surgically evaluated for SSL injury were included in this study. The sagittal MR images were evaluated for the presence of SSL injury and its level, location and distraction gap, the level and compression ratio of the fractured body, and the presence of ISL or yellow ligament injury and posterior osseous fracture. The sensitivity, specificity and accuracy of MRI were calculated. The distraction gap of the SSL and the compression ratio of the fractured body or posterior osseous fracture were statistically analyzed. Thirty-one among the 33 patients with surgically confirmed SSL injury were diagnosed on MRI. SSL injury was mostly seen at the thoracolumbar junction and near the upper spinous process. The mean distraction gap was 4.3 mm. The level of the fractured body was most commonly in the lower vertebra of the injured SSL level and the mean compression ratio was 21.8%. Combined SSL, ISL and yellow ligament injury were mostly seen. The sensitivity, specificity and accuracy were 93.9%, 50% and 91.4%, respectively. There was a statistically significant difference of the distraction gap of the injured SSL depending on the presence of posterior osseous fracture. MRI is an accurate modality for evaluating SSL injury and the associated findings

  5. [Ligament ruptures of the lower extremity in the elderly].

    Science.gov (United States)

    Herbort, M; Raschke, M J

    2011-08-01

    There is an increasing incidence of ligament ruptures of the lower extremities in older patients. This higher incidence is caused by the typical current demographic changes in the population and the higher level of activity and athletic motivation of the older people in our society. In this review we address the most important ligament ruptures of the lower extremity in the old patient. Quadriceps tendon and Achilles tendon ruptures are mostly the result of degenerative and abrasion changes. The ACL rupture on the other hand occurs spontaneously after adequate trauma and without former degenerative changes especially in highly active patients. For a differentiated treatment of the older patient with tendon ruptures, secondary diseases, an increased risk and complication profile and a potentially decreased compliance during rehabilitation must be taken into consideration before indicating operative or conservative therapy. There are no strict age-related limitations for indication of an operative treatment of tendon ruptures in the older patient. In this patient group a differentiated treatment decision is recommended. PMID:21766204

  6. Surgical treatment of grade Ⅲ collateral ligament injury of knee joint caused by military training

    Directory of Open Access Journals (Sweden)

    Qiang ZHANG

    2011-08-01

    Full Text Available Objective To explore the method and effect of surgical treatment on grade Ⅲ collateral ligament injuries caused by military training.Methods Sixteen cases of grade Ⅲ collateral ligament injuries caused by military training were involved in the present study.Injuries to insertion of collateral ligament was repaired with suture anchor,fresh rupture of medial collateral ligament parenchyma was sutured directly,old rupture of medial collateral ligament parenchyma was repaired by direct suture and strengthening with autologous semitendinosus-gracilis tendon graft,while both fresh and old rupture of lateral collateral ligament parenchyma was reconstructed with autologous semitendinosus-gracilis tendon graft.Knee function was assessed 1 year after operation by Lysholm scores and compared with that before the operation.Results All the 16 patients were followed-up for 12 to 33 months with a mean of 20.5 months.The Lysholm knee scores of 1 year after peration(92.45±4.03 was significantly higher than that before operation(56.45±11.03,P < 0.05.Conclusions For the grade Ⅲ collateral ligament injuries caused by military training,the treatment principle was early diagnosis and early operation,and different surgical methods should be used according to the injury types for the sake of obtaining best therapeutic effects.

  7. Elastic properties of Thiel-embalmed human ankle tendon and ligament.

    Science.gov (United States)

    Liao, Xiaochun; Kemp, Sandy; Corner, George; Eisma, Roos; Huang, Zhihong

    2015-10-01

    Thiel embalming is recommended as an alternative to formalin-based embalming because it preserves tissue elasticity, color, and flexibility in the long term, with low infection and toxicity risk. The degree to which Thiel embalming preserves elasticity has so far been assessed mainly by subjective scoring, with little quantitative verification. The aim of this study is to quantify the effect of Thiel embalming on the elastic properties of human ankle tendons and ligament. Biomechanical tensile tests were carried out on six Thiel-embalmed samples each of the peroneus longus, peroneus brevis, and calcaneal tendons, and the calcaneofibular ligament, with strain rates of 0.25%s(-1), 2%s(-1), and 8%s(-1). The stress-strain relationship was calculated from the force-extension response with cross-sectional area and gauge length. Young's modulus was determined from the stress-strain curve. The results showed that the tendon and ligament elasticity were lower after Thiel embalming than the literature values for fresh nonembalmed tendons and ligament. The biomechanical tensile test showed that the measured elasticity of Thiel-embalmed tendons and ligaments increased with the strain rate. The Thiel embalming method is useful for preserving human ankle tendons and ligaments for anatomy and surgery teaching and research, but users need to be aware of its softening effects. The method retains the mechanical strain rate effect on tendons and ligament. PMID:25707906

  8. Anatomy and histology of apical support: a literature review concerning cardinal and uterosacral ligaments.

    Science.gov (United States)

    Ramanah, Rajeev; Berger, Mitchell B; Parratte, Bernard M; DeLancey, John O L

    2012-11-01

    The objective of this work was to collect and summarize relevant literature on the anatomy, histology, and imaging of apical support of the upper vagina and the uterus provided by the cardinal (CL) and uterosacral (USL) ligaments. A literature search in English, French, and German languages was carried out with the keywords apical support, cardinal ligament, transverse cervical ligament, Mackenrodt ligament, parametrium, paracervix, retinaculum uteri, web, uterosacral ligament, and sacrouterine ligament in the PubMed database. Other relevant journal and textbook articles were sought by retrieving references cited in previous PubMed articles. Fifty references were examined in peer-reviewed journals and textbooks. The USL extends from the S2 to the S4 vertebra region to the dorsal margin of the uterine cervix and/or to the upper third of the posterior vaginal wall. It has a superficial and deep component. Autonomous nerve fibers are a major constituent of the deep USL. CL is defined as a perivascular sheath with a proximal insertion around the origin of the internal iliac artery and a distal insertion on the cervix and/or vagina. It is divided into a cranial (vascular) and a caudal (neural) portions. Histologically, it contains mainly vessels, with no distinct band of connective tissue. Both the deep USL and the caudal CL are closely related to the inferior hypogastric plexus. USL and CL are visceral ligaments, with mesentery-like structures containing vessels, nerves, connective tissue, and adipose tissue. PMID:22618209

  9. MR imaging of the anterior intermeniscal ligament: classification according to insertion sites

    Energy Technology Data Exchange (ETDEWEB)

    Aydingoez, Uestuen; Kaya, Ayten [Department of Radiology, Hacettepe University Medical Center, Ankara (Turkey); Atay, Ahmet Oe.; Doral, Nedim M. [Department of Orthopaedics and Traumatology, Hacettepe University Medical Center, Ankara (Turkey); Oeztuerk, Halil M. [Department of Radiology, SSK Ankara Hospital, Ankara (Turkey)

    2002-04-01

    Our objective was to study the frequency of anterior intermeniscal ligament on MR imaging and to make a classification according to its insertion sites on MR images. Sagittal T1-weighted and thin-section transverse T2*-weighted MR images of the knee were prospectively evaluated in 229 subjects without significant synovial effusion or total rupture of the anterior cruciate ligament. By using thin-section transverse images, the ligament was classified into three types according to its insertion sites (type A: between anterior horns of medial and lateral menisci; type B: between anterior horn of medial meniscus and anterior margin of lateral meniscus; type C: between anterior margins of medial and lateral menisci). On sagittal images location of the ligament was determined with respect to a line drawn between anterior of the tibial epiphysis and posterior of the intercondylar notch to look for a relation between its type on transverse images and location on sagittal images. Separately, arthroscopy was made in 36 patients to verify the MR assessment of the presence of the ligament. Anterior intermeniscal ligament was found in 53% of the subjects. Type B was the most common group (58%). Magnetic resonance imaging has a sensitivity and a specificity of 67 and 100%, respectively, in the detection of the ligament. Types A and C had a statistically significant location posterior and anterior, respectively, to the master line on sagittal images. In arthroscopy, the ligament was either cord-like (67%) or flat (33%) in appearance. Routine sagittal MR images can help identify anterior intermeniscal ligament. (orig.)

  10. FUNCTIONAL OUTCOME OF ARTHROSCOPY ASSISTED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING BONE PATELLAR TENDON BONE AUTOGRAFT

    Directory of Open Access Journals (Sweden)

    Vinod Kumar

    2015-04-01

    Full Text Available INTRODUCTION: The anterior cruciate ligament (ACL is one of the most frequently injured ligaments in the human body. 1 The Anterior Cruciate ligament (ACL is the primary stabilizer of the knee and prevents the knee against anterior translation. 2 It is also important in counteracting rotational and valgus stress. 1 The middle third of the patellar tendon autograft for ACL reconstruction can be readily procured and firmly fixed. 3 It can tolerate the loads produced by an intensive rehabilitation programme. 3 Fixation of bone plugs using interference screws provides sufficient stability to meet the demand of a vigorous postoperative protocol. 3 It remains the gold standard for ACL reconstruction. 3 This study is to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction using bone patellar tendon bone autograft. METHODS: This study was conducted in Kempegowda Institute of Medical Sciences Hospital from November 2012 to April 2014. During this period 20 cases of adult patients with ACL deficient patients were selected according to the inclusion criteria. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction using bone - patellar tendon - bone autograft in terms of range of motion, postoperative knee stability, graft site morbidity and subjective knee functions. RESULTS: Results of our study showed that arthroscopy assisted anterior cruciate ligament reconstruction with bone - patellar tendon - bone autograft could effectively improve knee stability and functions after surgery without any complication. CONCLUSION : Arthroscopy assisted anterior cruciate l igament reconstruction with bone - patellar tendon - bone autograft is an excellent treatment option for anterior cruciate ligament deficient knees. It provides a stable knee and reduces postoperative morbidity and enables early rehabilitation. The functional outcome of arthroscopy assisted anterior

  11. Plasma Redshift in the Broad Line Region

    CERN Document Server

    Hansen, Peter M

    2013-01-01

    Astronomical properties of the broad line emission region (BLR) of active galactic nuclei (AGN) and quasi-stellar objects (QSO) are used to formulate a model of dynamic and electromagnetic scattering characteristics. The results of this modeling show that the observed redshift of these objects may be more complex than that from recession alone due to ionization or plasma effects.

  12. Broad resonances and beta-decay

    DEFF Research Database (Denmark)

    Riisager, K.; Fynbo, H. O. U.; Hyldegaard, S.;

    2015-01-01

    Beta-decay into broad resonances gives a distorted lineshape in the observed energy spectrum. Part of the distortion arises from the phase space factor, but we show that the beta-decay matrix element may also contribute. Based on a schematic model for p-wave continuum neutron states it is argued...

  13. Keratinocyte growth factor mRNA expression in periodontal ligament fibroblasts

    DEFF Research Database (Denmark)

    Dabelsteen, S; Wandall, H H; Grøn, B;

    1997-01-01

    Keratinocyte growth factor (KGF) is a fibroblast growth factor which mediates epithelial growth and differentiation. KGF is expressed in subepithelial fibroblasts, but generally not in fibroblasts of deep connective tissue, such as fascia and ligaments. Here we demonstrate that KGF mRNA is...... expressed in periodontal ligament fibroblasts, and that the expression is increased upon serum stimulation. Fibroblasts from human periodontal ligament, from buccal mucosa, from gingiva, and from skin were established from explants. Alkaline phosphatase activity was used as an indicator of the periodontal...

  14. The stress-tenogram in the diagnosis of ruptures of the lateral ligament of the ankle

    International Nuclear Information System (INIS)

    The stress-tenogram is a radiological technique for the investigation of injuries to the lateral ligament of the ankle, and combines the information previously provided by inversion and anterior stress radiographs, and the peroneal tenogram. It is designed to differentiate between stable and unstable ankles, and between isolated ruptures of the anterior talofibular ligament and combined tears of the anterior talofibular and calcaneofibular ligaments. A high degree of diagnostic accuracy has been confirmed at operative repair in a group of thirty-two patients. (author)

  15. Three-dimensional magnetic resonance imaging for ruptures of the lateral ligaments of the ankle

    International Nuclear Information System (INIS)

    The accuracy has been determined of three-dimensional MRI in visualizing the anterior talofibular and the calcaneofibular ligament in young athletes with an acute severe sprain of the lateral ligaments of the ankle by comparing these findings with those found at operation and evaluating three-dimensional fast imaging with steady state precession (3D FISP) as a diagnostic aid to operative planning for tears of both the anterior talofibular and the calcaneofibular ligament in younger competitive athletes. (author). 20 refs.; 2 figs

  16. 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.

  17. Location and tension of the medial palpebral ligament.

    Science.gov (United States)

    Hwang, Kun; Huan, Fan; Nam, Yong Seok; Han, Seung Ho; Kim, Dae Joong

    2013-11-01

    The aim of this study was to elucidate the precise anatomic location and tension of the medial palpebral ligament (MPL). Eleven hemifaces of 10 fresh Korean adult cadavers were used in this study. Nine specimens were used for measurement of dissection and tension, and 2 were used for histologic study. Measurements of tensile strength of each part of the MPL and Horner muscle were performed using a force gauge.The MPL consisted of 2 layers in all specimens dissected. The superficial layer of the palpebral ligament (SMPL) was observed from the anterior lacrimal crest to the upper and lower tarsal plates. The deep layer of the palpebral ligament (DMPL) lay from the anterior lacrimal crest to the posterior lacrimal crest, covering the lacrimal sac. The Horner muscle was observed at the posterior lacrimal crest just lateral to the attachment of the DMPL and ran laterally to the tarsal plate deep to the SMPL. The SMPL began at 4.5 ± 2.3 mm lateral to the nasomaxillary suture line to the upper and lower tarsal plates. Its transverse length was 9.6 ± 1.5 mm, and vertical width was 2.4 ± 0.7 mm, and its thickness was 4.5 ± 2.3 mm. The transverse length of the DMPL was 3.7 ± 0.4 mm, and its vertical width was 2.9 ± 1.3 mm, with a thickness of 0.3 ± 0.1 mm. The transverse length of the Horner muscle was 7.6 ± 1.9 mm, and its vertical width was 4.06 ± 1.5 mm, with a thickness of 0.4 ± 0.1 mm. The tensile strength of the SMPL was 13.4 ± 3.2 N, that of the DMPL was 4.1 ± 1.7 N, and that for Horner muscle was 9.0 ± 3.1 N. The tensile strength of the SMPL was significantly higher than that of the DMPL (P = 0.003).We reconfirmed that the MPL consisted of 2 layers: superficial layer and deep layer. Our results might be of use in surgeries of the medial canthi. PMID:24220420

  18. In Vivo Study of Ligament-Bone Healing after Anterior Cruciate Ligament Reconstruction Using Autologous Tendons with Mesenchymal Stem Cells Affinity Peptide Conjugated Electrospun Nanofibrous Scaffold

    Directory of Open Access Journals (Sweden)

    Jingxian Zhu

    2013-01-01

    Full Text Available Electrospinning nanofibrous scaffold was commonly used in tissue regeneration recently. Nanofibers with specific topological characteristics were reported to be able to induce osteogenic differentiation of MSCs. In this in vivo study, autologous tendon grafts with lattice-like nanofibrous scaffold wrapping at two ends of autologous tendon were used to promote early stage of ligament-bone healing after rabbit ACL reconstruction. To utilize native MSCs from bone marrow, an MSCs specific affinity peptide E7 was conjugated to nanofibrous meshes. After 3 months, H-E assessment and specific staining of collagen type I, II, and III showed direct ligament-bone insertion with typical four zones (bone, calcified fibrocartilage, fibrocartilage, and ligament in bioactive scaffold reconstruction group. Diameters of bone tunnel were smaller in nanofibrous scaffold conjugated E7 peptide group than those in control group. The failure load of substitution complex also indicated a stronger ligament-bone insertion healing using bioactive scaffold. In conclusion, lattice-like nanofibrous scaffold with specific MSCs affinity peptide has great potential in promoting early stage of ligament-bone healing after ACL reconstruction.

  19. Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Weiling [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Sharp-Grossmont Hospital, Department of Radiology, La Mesa, CA (United States); Peduto, Anthony J. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Westmead Hospital and Western Clinical School of Sydney University, Department of Radiology, Sydney (Australia); Aguiar, Rodrigo O.C. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Universidade Federal do Rio de Janeiro, Rio de Janerio (Brazil); Trudell, Debra J.; Resnick, Donald L. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States)

    2007-07-15

    To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

  20. Proliferative activity in the juxtaradicular human periodontal ligament.

    Science.gov (United States)

    Sayaniwas, M; Hilliges, M; Lindskog, S

    1999-08-01

    The aim of the present study was to evaluate cell proliferation, assessed by MIB 1, with respect to the type and the distribution of proliferating cells in the healthy juxtaradicular periodontal ligament (PDL) from completely formed human teeth. Immunohistochemical markers against vimentin, CD68 and S-100 were used to characterize cell type. The applicability of the immunohistochemical method on explants of human PDL was also evaluated. The results indicated that under physiological conditions, the majority of the proliferating cells in the PDL were mesenchymal cells predominantly located paravascularly in the middle third of the PDL. Furthermore, MIB 1 reacting with the Ki-67 antigen together with the avidin-biotin-complex technique was proved to be an efficient marker of cell proliferation in explants of human PDL. PMID:10815567

  1. Anterior cruciate ligament assessment using arthrometry and stress imaging.

    Science.gov (United States)

    Rohman, Eric M; Macalena, Jeffrey A

    2016-06-01

    Arthrometry and stress imaging are useful clinical tools for the objective assessment of anterior cruciate ligament (ACL) integrity. They are most frequently used for the diagnosis of a complete ACL tear when other workup is equivocal, in conjunction with history and clinical exam findings. Other applications include the diagnosis of partial ACL tears, injury prognosis, and post-operative monitoring. However, further studies are needed to validate these uses. Many different devices and techniques exist for objective examination, which have been compared in recent literature. Reliability and validity measures of these methods vary, and often depend upon examiner familiarity and skill. The KT series of devices is the current gold standard for arthrometry, although the newer robotic GNRB device shows promising early results. Newer methods of data interpretation have been developed for stress imaging, and portable technology may impact this field further. PMID:26984335

  2. Radiological evidence for the triple bundle anterior cruciate ligament.

    Science.gov (United States)

    MacKay, James W; Whitehead, Harry; Toms, Andoni P

    2014-10-01

    The anterior cruciate ligament (ACL) has traditionally been described as having two bundles--one anteromedial and one posterolateral. This has been challenged by studies proposing the existence of a third, intermediate, bundle with distinct functional significance, an arrangement that has been described in a number of domesticated animal species. No radiological evidence for the triple bundle ACL has previously been described. A prevalence study was carried out on 73 consecutive human knee magnetic resonance (MR) studies to determine the number of visible bundles, excluding individuals with a history of ACL injury or mucoid degeneration. A triple bundle ACL was demonstrated in 15 out of 73 human knees (20.5%, 95% confidence interval 12.9-31.2%). This is the first radiological description of the human triple bundle ACL. There was MR imaging evidence of a triple bundle ACL in approximately one fifth of human knees in this study. PMID:24890455

  3. MR evaluation of the knee following anterior cruciate ligament reconstruction

    International Nuclear Information System (INIS)

    This paper evaluates the role of MR imaging of the knee after anterior cruciate ligament (ACL) reconstruction. Seventy-five MR examinations were performed in 52 patients following ACL reconstruction with patellar tendon autografts. MR imaging demonstrated a well-defined autograft in 63 of 70 clinically stable autografts. Of 5 clinically lax reconstructions, none appeared will defined on MR images. Compared with the clinical examination, MR imaging was 90.7% accurate. MR imaging demonstrated time-related healing of the patellar tendon donor site, with persistent thickening indicative of tendinitis. Positions of the femoral and tibial bone tunnels could be assessed. Knee joint effusions tended to resolve completely within 7 months after operations, with the presence and degree of effusion in the earlier postoperative interval being unrelated to the clinical outcome. Ancillary disorders in the knee, such as meniscal tears and osteochondral defects, could also be evaluated in this postoperative population

  4. Round Ligament of Uterus Leiomyoma: An Unusual Cause of Dyspareunia

    Directory of Open Access Journals (Sweden)

    Ozer Birge

    2015-01-01

    Full Text Available Round ligament of uterus leiomyoma is a rare, benign tumor of the vulva. Its incidence is not known exactly, and the mean age ranges from 13 to 70. Although clinical properties of benign and malignant diseases in the vulvar area are frequently similar, early diagnosis and treatment are essential. Local excision is recommended as definitive therapy. We present an 28-year-old female without any birth with a mass in anterior vaginal wall diagnosed as vulvar leiomyoma. In conclusion, a brief review of relevant literature emphasizes that leiomyomas are quite rare outside of the uterus but they might occur in any tissue or organ containing smooth muscle, spontaneously or parasitically after the spreading effect of an accident or surgical trauma. Clinicians should be alert especially for the diagnosis in a tissue with smooth muscle content.

  5. Anterior cruciate ligament reconstruction graft harvesting: pitfalls and tips.

    Science.gov (United States)

    McGuire, David A; Hendricks, Stephen D

    2007-12-01

    Surgical treatment for anterior cruciate ligament deficiency has relied predominantly on reconstruction with autografts. Grafts taken from patients' own central third of their patellar tendon, bone-patellar tendon bone, or one or more of the hamstring tendons, semitendinosus, and gracilis, constitute the majority of grafts used for these purposes. Although there is no single graft option that clearly outperforms another, an abundance of articles replete with complications associated with harvest and use are available from peer-reviewed journals. It is these complications and their prevention that will be addressed in the following chapter. The idea in mind is that the reader might adopt these techniques to improve their patient outcomes by minimizing, or eliminating, the ongoing problems that such complications produce. PMID:18004217

  6. Simultaneous bilateral ganglion cysts of the anterior cruciate ligaments.

    Science.gov (United States)

    Demircay, Emre; Ofluoglu, Demet; Ozel, Omer; Oztop, Pinar

    2015-04-01

    Intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are rare, and bilateral ganglion cysts are even rarer. These cysts may cause intermittent or chronic nonspecific knee discomfort. Although three cases of bilateral ganglion cysts have been reported in the literature, the knees were not simultaneously affected in those cases. Herein, we report the case of a 56-year-old woman who presented with simultaneous bilateral ganglion cysts of the ACL that were symptomatic. She was successfully treated with arthroscopic resection and debridement. We also present a brief review of the literature, highlighting the aetiology, diagnosis and management of ganglion cysts of the ACL. To the best of our knowledge, this is the first report of simultaneous bilateral intra-articular ganglion cysts of the ACL. PMID:25917477

  7. [Increase in surgical treatment of anterior cruciate ligament injury].

    Science.gov (United States)

    Meuffels, D E

    2009-01-01

    An anterior cruciate ligament (ACL) rupture is a very common musculoskeletal injury. The number of ACL reconstructions is increasing, both in the Netherlands and worldwide. Substantial progress has been made in surgical technique: from open to arthroscopic procedures. An ACL reconstruction will not diminish the chance of osteoarthritis, and the biomechanical properties of the knee will never be the same as before the trauma. An ACL reconstruction does, however, reduce the chance of instability, or 'giving way', which is the most important indication for surgical intervention. There are insufficient long-term results described in the literature to indicate either surgery or conservative measures as the treatment of choice. Treatment should be individually determined, taking into consideration factors such as: pattern of symptoms, degree of instability, desire to practise sport, age and willingness to commit to a 9-month rehabilitation programme. PMID:21401972

  8. Flow over an Erodible Broad Crested Weir

    Directory of Open Access Journals (Sweden)

    Dr. K. C.Sahu

    2015-01-01

    Full Text Available The overtopping flow of water over an earthen embankment causes erosion of soil from its surfaces and the eroded surface of the embankment acts as a Broad crest weir. But the longitudinal profile of the weir goes on changing with time of erosion. Hence crest height of the weir goes changing in accelerated flow condition. In this paper, the discharge equation for this type of flow situation is established for different types of soils used in the embankment. Then, the experiments have been carried out as the analogous rigid beds of the captured eroded profiles at any time of erosion of the broad crested weir to compare the discharge equation and to study the energy loss in dislodging the soil from the surface of the weir and transporting them down stream.

  9. Broad line regions in Seyfert-1 galaxies

    International Nuclear Information System (INIS)

    To reproduce observed emission profiles of Seyfert galaxies, rotation in an accretion disk has been proposed. In this thesis, the profiles emitted by such an accretion disk are investigated. Detailed comparison with the observed profiles yields that a considerable fraction can be fitted with a power-law function, as predicted by the model. The author analyzes a series of high quality spectra of Seyfert galaxies, obtained with the 2.5m telescope at Las Campanas. He presents detailed analyses of two objects: Mkn335 and Akn120. In both cases, strong evidence is presented for the presence of two separate broad line zones. These zones are identified with an accretion disk and an outflowing wind. The disk contains gas with very high densities and emits predominantly the lower ionization lines. He reports on the discovery of very broad wings beneath the strong forbidden line 5007. (Auth.)

  10. Broad iron lines in Active Galactic Nuclei

    CERN Document Server

    Fabian, A C; Reynolds, C S; Young, A J

    2000-01-01

    An intrinsically narrow line emitted by an accretion disk around a black hole appears broadened and skewed as a result of the Doppler effect and gravitational redshift. The fluorescent iron line in the X-ray band at 6.4-6.9keV is the strongest such line and is seen in the X-ray spectrum of many active galactic nuclei and, in particular, Seyfert galaxies. It is an important diagnostic with which to study the geometry and other properties of the accretion flow very close to the central black hole. The broad iron line indicates the presence of a standard thin accretion disk in those objects, often seen at low inclination. The broad iron line has opened up strong gravitational effects around black holes to observational study with wide-reaching consequences for both astrophysics and physics.

  11. Accuracy of MRI patterns in evaluating anterior cruciate ligament tears

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the different patterns of anterior cruciate ligament (ACL) tears on MRI and the prevalence and accuracy of these patterns. Images were obtained on high-tesla and low-tesla units and the results compared to determine whether field strength affects the interpretation using the grading system. In 172 patients who underwent knee MRI (109 knees with high-tesla units and 63 knees with low-tesla units) and arthroscopy, there was a total of 91 arthroscopically proven ACL tears. Five patterns of ACL tears were observed and designated as type 1 (diffuse increase in signal on T2-weighted images and enlargement of the ligament, 48%); type 2 (horizontally oriented ACL, 21%); type 3 (nonvisualization of the ACL, 18%); type 4 (discontinuity of the ACL, 11%); and type 5 (vertically oriented ACL, 2%). The positive predictive value (PPV) for type 2, 4, and 5 patterns was 100% for both field strengths; for type 3 PPV was just above 80% for both field strengths. The PPV value for type 1 was 90% for the high-tesla unit and 79% for the low-tesla, unit, which was not statistically significant. Combining the results of both field strengths, the overall sensitivity and specificity were 93% and 89%, respectively. Arthroscopic results were also used to determine the association between meniscal and ACL tears. Only 13% of ACL tears were isolated, the rest being associated with meniscal tears. Forty-five percent of medial meniscal and 50% of lateral meniscal tears were associated with an ACL tear, and 94% of ACLs were torn when both menisci were torn. (orig.)

  12. Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure

    Directory of Open Access Journals (Sweden)

    Diego Protásio de Vasconcelos

    2015-02-01

    Full Text Available OBJECTIVE: To make a comparative analysis on three femoropatellar radiographic parameters, between knees with chronic failure of the anterior cruciate ligament (ACL and normal knees.METHODS: Thirty volunteer patients with a diagnosis of unilateral isolated chronic ACL injury for more than one year and a normal contralateral knee were selected. Digital radiographs were produced for all the patients, on both knees in absolute lateral view at 30° of flexion, with and without load-bearing on one leg, and in axial view of the patella at 30°. The Caton-Deschamps patellar height index, Merchant patellar congruence angle and Laurin lateral patellar tilt angle were measured on the radiographs obtained from the normal knees and knees with ACL injuries, and comparative analysis was performed between these two groups.RESULTS: The patellar height was statistically significantly lower (p< 0.001 in the knees with ACL failure than in the normal knees, both on radiographs without loading and on those with single-foot loading. The Merchant patellar congruence angle was significantly smaller (p < 0.001 in the normal knees and the lateral patellar tilt angle was smaller (p < 0.001 in the knees with ACL failure.CONCLUSION: Chronic ACL failure gave rise to a statistically significant change in the femoropatellar radiographic values studied (p < 0.001. Knees with injuries to this ligament presented lower patellar height values, greater tilt and lateral displacement of the patella, in relation to the femoral trochlea, in comparison with the normal contralateral knees.

  13. Correlation of Magnetic Resonance Imaging With Knee Anterolateral Ligament Anatomy

    Science.gov (United States)

    Helito, Camilo Partezani; Helito, Paulo Victor Partezani; Bonadio, Marcelo Batista; Pécora, José Ricardo; Bordalo-Rodrigues, Marcelo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2015-01-01

    Background: Anatomic and magnetic resonance imaging (MRI) studies have recently characterized the knee anterolateral ligament (ALL). So far, no study has focused on confirming whether the evaluated MRI parameters truly correspond with ALL anatomy. Purpose: To assess the validity of MRI in detecting the ALL using an anatomic evaluation as reference. Study Design: Descriptive laboratory study. Methods: A total of 13 cadaveric knees were subjected to MRI and then to anatomic dissection. Dissection was performed according to previous anatomic study methodology. MRIs were performed with a 0.6- to 1.5-mm slice thickness and prior saline injection. The following variables were analyzed: distance from the origin of the ALL to the origin of the lateral collateral ligament (LCL), distance from the origin of the ALL to its bifurcation point, maximum length of the ALL, distance from the tibial insertion of the ALL to the articular surface of the tibia, ALL thickness, and ALL width. The 2 sets of measurements were analyzed using the Spearman correlation coefficient (ρ) and Bland-Altman plots. Results: The ALL was clearly observed in all dissected knees and MRI scans. It originated anterior and distal to the LCL, close to the lateral epycondile center, and showed an anteroinferior path toward the tibia, inserting between the Gerdy tubercle and the fibular head, around 5 mm under the lateral plateau. The ρ values tended to increase together for all studied variables between the 2 methods, and all were statistically significant, except for thickness (P = .077). Bland-Altman plots showed a tendency toward a reduction of ALL thickness and width by MRI compared with anatomic dissection. Conclusion: MRI scanning as described can accurately assess the ALL and demonstrates characteristics similar to those seen under anatomic dissection. Clinical Relevance: MRI can accurately characterize the ALL in the anterolateral region of the knee, despite the presence of structures that might

  14. Anterior cruciate ligament injury and reconstruction among university students.

    Science.gov (United States)

    Freedman, K B; Glasgow, M T; Glasgow, S G; Bernstein, J

    1998-11-01

    The consequences of athletic injuries extend beyond the musculoskeletal system. Depression, anger, and tension have been observed in athletes with athletic injuries. It was hypothesized that among student athletes, the psychologic impact of injury may be seen as a drop in academic performance. Thirty-eight students who had an anterior cruciate ligament injury and subsequent reconstruction were evaluated retrospectively by academic transcript and questionnaire to measure their academic performance before their injury, in the semester of their injury, and in the semester after their surgery. The patients were compared with randomly selected undergraduate control subjects. To evaluate any effect of the timing of the surgery on academic performance, the patients were separated into two groups, according to the timing of their reconstruction: those who had surgery during the academic semester, and those who elected to wait for a school break. There was a significant drop in grade point average of 0.3 grade points during the semester of injury among all injured students. Compared with those who had surgery during a break, the students who had surgery during the semester received more frequently the grade of failure (6% versus 0%) or incomplete (33% versus 9%). These students also missed more school days (10.5 days versus 1.5 days) and examinations (2.2 examinations versus 0.1 examinations). Only 47% of students who had surgery during the semester were satisfied with their decision for surgical timing, compared with 96% satisfied with the timing during an academic break. Acute anterior cruciate ligament rupture, and surgical reconstruction during an academic semester, have a significant academic effect in university students. PMID:9917686

  15. Clinical characteristics of 4355 patients with anterior cruciate ligament injury

    Institute of Scientific and Technical Information of China (English)

    MEI Yu; AO Ying-fang; WANG Jian-quan; MA Yong; ZHANG Xin; WANG Jia-ning; ZHU Jing-xian

    2013-01-01

    Background Clinical features of anterior cruciate ligament (ACL) injury are important for its prevention,diagnosis and treatment.However,few studies have reported such data,especially in China.The purpose of this study was to describe the clinical characteristics of ACL injury on a large cohort.Methods Between 1993 and 2007,a total of 4355 ACL deficient inpatients (612 athletes and 3743 non-athletes) were registered.Data were collected using a special database system.And the distributions of characteristics in different groups were compared and analyzed statistically.Results All subjects were confirmed with ACL tear during surgery.Statistical analysis revealed that the percentage of females in Athlete Group was significantly higher than that in Non-athlete Group (56.05% vs.24.95%,P<0.001).This study also found that sports trauma was the main cause of ACL tears.Soccer,basketball,judo,wrestling and track and field were the five most responsible activities for athletes.The average injury time for athletes was significantly shorter than that for non-athletes (413.3 days vs.717.5 days,P<0.001).Three thousand nine hundred and eight cases were ordered ACL reconstruction (76.04% single-bundle,18.30% double-bundle).Three hundred and forty-five patients (7.92%)were combined with other ligaments injuries,2667 (61.24%) were found with various grades of cartilage lesions,and 3377 (77.54%) were found with meniscal injury.Conclusions Sports trauma was the main cause of ACL tears in China,and reconstruction had become the principal surgical choice.In order to restore knee joint stability and reduce the incidence of cartilage and meniscal injury,patienttailored ACL reconstruction should be suggested at the right moment.

  16. Medial plica after reconstruction of anterior cruciate ligament

    Institute of Scientific and Technical Information of China (English)

    YIN Yu; WANG Jian-quan; HE Zhen-ming

    2009-01-01

    Background The medial plica may be caused by direct trauma or joint degeneration,which also could be iatrogenic.There have been few reports in the literature discussing incidence of the medial plica caused by an operation on the knee joint,specifically after the reconstruction of anterior cruciate ligament (ACL).In this study,we aimed to evaluate and analyze the relationship between the incidence of the medial plica and reconstruction of the ACL.Methods A retrospective case series study was conducted to review the findings of 1085 patients between 2003 and 2007,who underwent second-look arthroscopy after reconstruction of the ACL (between 2002 and 2006).The correlation of the incidence of medial plica with the stability of the knee joint,the time from onset of injury to reconstruction surgery,the associated injuries,and the rate of progress during postoperative rehabilitation were analyzed.Results We found that 722 patients had the structure of a medial plica.The incidence after reconstruction of the anterior cruciate ligament (66.5%) was significantly higher than usually reported.All these medial plica had avascular fibrotic and thickened edges.An excision of pathologic medial plica and fat pad synovial fringes were done.The incidences were significantly different between the two groups with their reconstruction operation time,from onset of injury to surgery (less than one month or over 2 years),and the progress rate of postoperative rehabilitation (knee flexion could not be over 90° in four weeks).The incidence was not different between the groups with knee stable conditions.Conclusions Medial plica is more common in patients after reconstruction of ACL.More associated injuries and more rehabilitation difficulties can increase the medial plica incidence.

  17. Fracture of the patella after the anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Milović Milan

    2012-01-01

    Full Text Available Introduction. Fracture of the patella, after harvesting the central third of the patellar tendon for a bone-tendon-bone autograft, is a rare complication. Material and Methods. We made 1714 reconstructions of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and 7 patients had fracture of the patella (0.42%. The fracture was immediately recognized in the patients with vertical non-displaced patellar fracture and the broken screw osteosynthesis was carried out without changes in the rehabilitation period. One patient was treated non-operatively and patellar fracture in four patients was treated with operative reduction and osteosynthesis. Results. The patients were invited for the check-up 5 years (2-8 years after surgery on average. The mean Lysholm score was 92 (85-100. All of them continued to engage in sporting activities at the same or greater level after 9 months on average (6-12 months. In all patients the Lachman test was with the firm stop compared to the other leg. X-ray changes in the patella were found in 2 patients who had multifragmentary fractures. Discussion and Conclusion. The fracture of patella can be prevented by avoiding to take too much bone graft, by using the most precise tools for cutting, while rehabilitation must be carefully planned. The optimal treatment of the fracture of the patella after the reconstruction of the anterior cruciate ligament is a firm osteosynthesis, which allows healing of the bone and continuation of the rehabilitation program.

  18. Fourier evaluation of broad Moessbauer spectra

    International Nuclear Information System (INIS)

    It is shown by the Fourier analysis of broad Moessbauer spectra that the even part of the distribution of the dominant hyperfine interaction (hyperfine field or quadrupole splitting) can be obtained directly without using least-square fitting procedures. Also the odd part of this distribution correlated with other hyperfine parameters (e.g. isomer shift) can be directly determined. Examples for amorphous magnetic and paramagnetic iron-based alloys are presented. (author)

  19. A Broad View of Macroeconomic Stability

    OpenAIRE

    José Antonio Ocampo

    2005-01-01

    This paper recommends a broad concept of macroeconomic stability, whereby “sound macroeconomic frameworks” include not only price stability and sound fiscal policies, but also a well-functioning real economy, sustainable debt ratios and healthy public and private sector balance sheets. These multiple dimensions imply using multiple policy instruments. The paper elaborates a framework for developing countries that involves active use of counter-cyclical macroeconomic policies (exchange rate, m...

  20. Crx broadly modulates the pineal transcriptome

    OpenAIRE

    Rovsing, Louise; Clokie, Samuel; Bustos, Diego M.; Rohde, Kristian; Steven L Coon; 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 p...

  1. Relativistic redshifts in quasar broad lines

    International Nuclear Information System (INIS)

    The broad emission lines commonly seen in quasar spectra have velocity widths of a few percent of the speed of light, so special- and general-relativistic effects have a significant influence on the line profile. We have determined the redshift of the broad Hβ line in the quasar rest frame (determined from the core component of the [O III] line) for over 20,000 quasars from the Sloan Digital Sky Survey Data Release 7 quasar catalog. The mean redshift as a function of line width is approximately consistent with the relativistic redshift that is expected if the line originates in a randomly oriented Keplerian disk that is obscured when the inclination of the disk to the line of sight exceeds ∼30°-45°, consistent with simple active galactic nucleus unification schemes. This result also implies that the net line-of-sight inflow/outflow velocities in the broad-line region are much less than the Keplerian velocity when averaged over a large sample of quasars with a given line width.

  2. Relativistic redshifts in quasar broad lines

    CERN Document Server

    Tremaine, Scott; Liu, Xin; Loeb, Abraham

    2014-01-01

    The broad emission lines commonly seen in quasar spectra have velocity widths of a few per cent of the speed of light, so special- and general-relativistic effects have a significant influence on the line profile. We have determined the redshift of the broad H-beta line in the quasar rest frame (determined from the core component of the [OIII] line) for over 20,000 quasars from the Sloan Digital Sky Survey DR7 quasar catalog. The mean redshift as a function of line width is approximately consistent with the relativistic redshift that is expected if the line originates in a randomly oriented Keplerian disk that is obscured when the inclination of the disk to the line of sight exceeds ~30-45 degrees, consistent with simple AGN unification schemes. This result also implies that the net line-of-sight inflow/outflow velocities in the broad-line region are much less than the Keplerian velocity when averaged over a large sample of quasars with a given line width.

  3. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

    Directory of Open Access Journals (Sweden)

    G. Cerulli

    2014-01-01

    Full Text Available The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments.

  4. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Servei de Diagnostic per Imatge, Unitat de Diagnostic d' Alta Tecnologia (UDIAT), Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); UDIAT, c/ Parc Tauli, s/n, 08208 Sabadell (Barcelona) (Spain); Valls, Rafael [Servei de Diagnostic per Imatge, Unitat de Diagnostic d' Alta Tecnologia (UDIAT), Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); Yuguero, Mariano [Servei de Traumatologia i Ortopedia, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain); Saez, Amparo [Servei de Anatomia Patologica, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2004-06-01

    We report a case of a mucoid degeneration of the anterior cruciate ligament (ACL) that produced osseous erosion of the medial aspect of the lateral femoral condyle. The MRI findings and differential diagnosis are discussed. (orig.)

  5. The Value of 3.0-Tesla MRI in Diagnosing Scapholunate Ligament Injury

    OpenAIRE

    Spaans, Anne J; Minnen, Paul van; Prins, Hendrik J.; Korteweg, Mies A.; Schuurman, Arnold H.

    2013-01-01

    Objective To determine the sensitivity and specificity of 3.0-tesla (T) magnetic resonance imaging (MRI) and a dedicated hand coil in diagnosing scapholunate ligament (SLL) injury compared with intraoperative findings.

  6. Acromioclavicular dislocation: postoperative evaluation of the coracoclavicular ligaments using magnetic resonance☆

    Science.gov (United States)

    Faria, Rafael Salomon Silva; Ribeiro, Fabiano Rebouças; Amin, Bruno de Oliveira; Tenor Junior, Antonio Carlos; da Costa, Miguel Pereira; Filardi Filho, Cantídio Salvador; Batista, Cleber Gonçalves; Brasil Filho, Rômulo

    2015-01-01

    Objective To radiologically evaluate the healing of the coracoclavicular ligaments after surgical treatment for acromioclavicular dislocation. Methods Ten patients who had undergone surgical treatment for acromioclavicular dislocation via a posterosuperior route at least one year earlier were invited to return for radiological assessment using magnetic resonance. This evaluation was done by means of analogy with the scale described in the literature for studying the healing of the anterior cruciate ligament of the knee and for measuring the healed coracoclavicular ligaments. Results A scar structure of fibrous appearance had formed in 100% of the cases. In 50% of the cases, the images of this structure had a good appearance, while the other 50% were deficient. Conclusion Late postoperative evaluation using magnetic resonance, on patients who had been treated for acute acromioclavicular dislocation using a posterosuperior route in the shoulder, showed that the coracoclavicular ligaments had healed in 100% of the cases, but that this healing was deficient in 50%. PMID:26229916

  7. The Effects of Dense/Nanometer Hydroxyapatite on Proliferation and Osteogenetic Differentiation of Periodontal Ligament Cells

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    The objective of this study is to investigate possible effects of nanometer powder of hydroxyapatite on proliferation of periodontal ligament cells. With sol-gel method, the nanometer hydroxyapatite powder were fabricated. The primary periodontal ligament cells were cultured on dense panicle hydroxyapatite and nanometer particle hydroxyapatite. The effects on proliferation of periodontal ligament cell were examined in vitro with MTT( methyl thiazolil tetracolium) test. The intercellular effects were observed with scanning electron microscopy and energy dispersive X-ray analyzer. In addition, the influence of two materials on osteogenetic differentiation was determined with measurement of ALP ( alkaline phosphatase) activity. It is concluded that nanometer hydroxyapatite can promote proliiferation and osteogenetic differentiation of periodontal ligament cells and it may become absorbable agent in osseous restoration.

  8. High-resolution MR imaging evaluation of anterior cruciate ligament tears

    International Nuclear Information System (INIS)

    MR imaging (1.5-T unit) was performed on 165 knees to evaluate tears of the anterior cruciate ligament. Images were obtained in the sagittal and coronal plates using proton density, T1- and T2-weighted sequences. Correlation with arthroscopic findings was obtained in 50 patients, 12 of whom had torn anterior cruciate ligaments. T2-weighted coronal images were 100% sensitive and 97% specific for demonstrating anterior cruciate ligament tears. While no false-negative studies were recorded, the sagittal and proton density images were least specific, with a sensitivity of 100% and specificity of 84%. The authors' results indicate that when the integrity of the anterior cruciate ligament is in question, T2-weighted coronal images should be obtained

  9. Rehabilitation in Patients with Anterior Cruciate Ligament Reconstruction Using Auxiliary Platelet-Rich Plasma Therapy

    Directory of Open Access Journals (Sweden)

    Albu Daniel – Emil

    2016-06-01

    Full Text Available Background: The main target after successful AnteriorCruciate Ligament (ACL reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma may improve clinical outcomes.

  10. Effect of physiotherapy attendance on outcome after anterior cruciate ligament reconstruction: a pilot study

    OpenAIRE

    Feller, J; Webster, K.; Taylor, N.; Payne, R.; Pizzari, T.

    2004-01-01

    Background: In many centres patients are routinely referred for physiotherapy after anterior cruciate ligament (ACL) reconstruction. However, to date the role and amount of supervised physiotherapy required has not been clearly established.

  11. Intra-articular ganglion arising from the meniscofemoral ligament of Humphrey

    International Nuclear Information System (INIS)

    We present a case of an intra-articular ganglion of the knee arising from the anterior meniscofemoral ligament of Humphrey. The MR imaging and arthroscopic appearance of the lesion are illustrated. (orig.)

  12. Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques.

    Science.gov (United States)

    Domnick, Christoph; Raschke, Michael J; Herbort, Mirco

    2016-02-18

    The influences and mechanisms of the physiology, rupture and reconstruction of the anterior cruciate ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. PMID:26925379

  13. Closed patella fracture combined with cruciate ligament injury:a case control study

    Institute of Scientific and Technical Information of China (English)

    LI Han; WANG Wei; LIU Yue-ju; CHEN Wei; ZHANG Qi; LI Xu; ZHU Lian

    2013-01-01

    Background Patellar fracture and cruciate ligament injury are a common consequence of traumatic knee injury.Patellar fracture combined with cruciate ligament injury is rarely reported,although the mechanisms of two things are similar.This study aimed to evaluate the incidence of closed patella fracture combined with cruciate ligament injury.Methods From 2012 March 1 to June 30,magnetic resonance images of 60 patients with unilateral closed patellar fracture were studied in our institution.The mean age of the patients at presentation was 40.2 years (range,13-64 years) and 48 patients were men.First,patients were divided according to the cause of injury.Twenty-eight patients had highenergy trauma from a falling injury or motor vehicle accident,and 32 patients had low-energy trauma resulting from a tumbling injury.Second,according to the fracture pattern,31 patients had a transverse fracture and 29 patients had a comminuted fracture.Results We found seven cases of closed patellar fracture combined with cruciate ligament injury among 60 patients,including two cases of a completely ruptured posterior cruciate ligament,two with a partially torn posterior cruciate ligament,and three with a partially torn anterior cruciate ligament.The percentage of this combined injury was 11.6% (7/60).The incidence of a combined injury of the cruciate ligament with a comminuted fracture (6/29,20.7%) was significantly higher than that with a transverse fracture (1/31,3.2%,P <0.05).The most common mechanism of injury in patellar fracture combined with cruciate ligament injury was high-energy trauma from road traffic accidents (94%),whereas in the patellar fracture alone,it was tumbling (62%).The incidence of combined injury with high-energy trauma (6/28,21.4%) was significantly higher than that with low-energy trauma (1/32,3.1%,P <0.05).Conclusions These data suggest that high-energy trauma often results in a comminuted patellar fracture,which is often combined with

  14. Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study

    OpenAIRE

    Sônia Regina Panzarini; Denise Pedrini; Wilson Roberto Poi; Celso Koogi Sonoda; Daniela Atili Brandini; José Carlos Monteiro de Castro

    2008-01-01

    The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were exa...

  15. Side-to-Side Differences in Anterior Cruciate Ligament Volume in Healthy Control Subjects

    OpenAIRE

    Jamison, S T; Flanigan, D C; Nagaraja, H.N.; Chaudhari, A M W

    2009-01-01

    Examination of anterior cruciate ligament (ACL) anatomy is of great interest both in studying injury mechanisms and surgical reconstruction. However, after a typical acute ACL rupture it is not possible to measure the dimensions of the ACL itself due to concomitant or subsequent degeneration of the remaining ligamentous tissue. The contralateral ACL may be an appropriate surrogate for measuring anatomical dimensions, but it remains unknown whether side-to-side differences preclude using the c...

  16. The relationship between posterior tibial slope and anterior cruciate ligament injury

    OpenAIRE

    Ristić Vladimir; Maljanović Mirsad; Peričin Branislav; Harhaji Vladimir; Milankov Miroslav

    2014-01-01

    Introduction. The aim of this study was to identify an increased posterior tibial slope as a possible risk factor for anterior cruciate ligament injury. Material and Methods. Sixty patients were divided into two groups (with and without anterior cruciate ligament rupture). The posterior tibial slope on the lateral and medial condyles was measured by sagittal magnetic resonance imaging slices by means of computerized method using circles to determine tibial ...

  17. A retrospective study of dogs with cranial cruciate ligament rupture: 32 cases (2006-2012)

    OpenAIRE

    Madalena Bach; José Ademar Villanova Junior; Ubirajara Iobe Tasqueti; Cláudia Turra Pimpão; Antonia Maria Binder do Prado; Pedro Vicente Michellotto Junior

    2015-01-01

    Rupture of the cranial cruciate ligament (RLCCr) is one of the most common injuries in the dog and the leading cause of degenerative joint disease (DAD) of the knee. Untreated animals exhibit degenerative joint changes in a few weeks and severe changes within a few months. The severity of degeneration appears to be directly proportional to body size and age. Systemic inflammatory joint diseases are associated with the rupture of this ligament. The aim of this study was to characterize the pop...

  18. A method for the 3-D quantification of bridging ligaments during crack propagation

    International Nuclear Information System (INIS)

    This letter shows how a hole-closing algorithm can be used to identify and quantify crack-bridging ligaments from a sequence of X-ray tomography images of intergranular stress corrosion cracking. This allows automatic quantification of the evolution of bridging ligaments through the crack propagation sequence providing fracture mechanics insight previously unobtainable from fractography. The method may also be applied to other three-dimensional materials science problems, such as closing walls in foams.

  19. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    OpenAIRE

    David Simon; Randy Mascarenhas; Bryan M. Saltzman; Meaghan Rollins; Bach, Bernard R.; Peter MacDonald

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the...

  20. Androgen action during male sex differentiation includes suppression of cranial suspensory ligament development

    OpenAIRE

    Emmen, Judith; McLuskey, A.; Grootegoed, Anton; Brinkmann, Albert

    1998-01-01

    textabstractThe cranial suspensory ligament is located on the border of the cranial (mesonephric) mesentery in adult female mammals, which runs between the cranial pole of the internal genitalia and the dorsal abdominal wall. Absence of the cranial suspensory ligament in male mammals depends upon exposure of its primordium to fetal testicular androgens and is a prerequisite for testis descent. Female rats were exposed to 5alpha-dihydrotestosterone propionate at different stages of genital dev...

  1. Reliability of ultrasound imaging in the assessment of the dorsal Lisfranc ligament

    OpenAIRE

    Rettedal, David D; Graves, Nathan C; Marshall, Joshua J; Frush, Katherine; Vardaxis, Vassilios

    2013-01-01

    Background The Lisfranc ligament plays an integral role in providing stability to the midfoot. Variable clinical presentations and radiographic findings make injuries to the Lisfranc ligament notoriously difficult to diagnose. Currently, radiographic evaluation is the mainstay in imaging such injuries; however, ultrasound has been suggested as a viable alternative. The objective of this study was to evaluate the intra-rater and inter-rater reliability in the measurement of the length of the d...

  2. Ganglion cysts of the cruciate ligaments: a series of 31 cases and review of the literature

    OpenAIRE

    Mao Yongtao; Dong Qirong; Wang Yi

    2012-01-01

    Abstract Background A case series for ganglion cyst of the cruciate ligament with MRI findings, clinical presentation, and management options along with review of literature is presented. Methods Of 8663 consecutive patients referred for knee MR imaging, 31 were diagnosed with ganglion cysts of the cruciate ligaments, including 21 men and 10 women of ages 12 to 73 years (mean: 37). A review of charts revealed that knee pain was the chief complaint in all cases. Arthroscopic debridement of gan...

  3. Meniscal and cruciate ligaments tears diagnosed with MR imaging versus arthroscopy

    International Nuclear Information System (INIS)

    MR studies of knee joints in 37 patients were performed. The clinical diagnostics was traumatic lesions of menisci or cruciate ligaments. Arthroscopy of the knee joint was performed in 21 patients. MR showed meniscal lesion in 25 patients and anterior cruciate ligament (ACL) lesions in 18 patients. Arthroscopy showed meniscal lesions in 16 of 21 patients and ACL lesions in 11 of 21 patients. MR correlated with arthroscopy in 16 of examined menisci and 15 of 21 examined ACL. (author)

  4. Achondroplasia manifesting as enchondromatosis and ossification of the spinal ligaments: a case report

    Directory of Open Access Journals (Sweden)

    Al Kaissi Ali

    2008-08-01

    Full Text Available Abstract Introduction A girl presented with achondroplasia manifested as mild knee pain associated with stiffness of her back. A skeletal survey showed enchondroma-like metaphyseal dysplasia and ossification of the spinal ligaments. Magnetic resonance imaging of the spine further clarified the pathological composites. Case presentation A 7-year-old girl presented with the classical phenotypic features of achondroplasia. Radiographic documentation showed the co-existence of metaphyseal enchondromatosis and development of spinal bony ankylosis. Magnetic resonance imaging showed extensive ossification of the anterior and posterior spinal ligaments. Additional features revealed by magnetic resonance imaging included calcification of the peripheral vertebral bodies associated with anterior end-plate irregularities. Conclusion Enchondromas are metabolically active and may continue to grow and evolve throughout the patient's lifetime; thus, progressive calcification over a period of years is not unusual. Ossification of the spinal ligaments has a specific site of predilection and often occurs in combination with senile ankylosing vertebral hyperostosis. Nevertheless, ossification of the spinal ligaments has been encountered in children with syndromic malformation complex. It is a multifactorial disease in which complex genetic and environmental factors interact, potentially leading to chronic pressure on the spinal cord and nerve roots with subsequent development of myeloradiculopathy. Our patient presented with a combination of achondroplasia, enchondroma-like metaphyseal dysplasia and calcification of the spinal ligaments. We suggest that the development of heterotopic bone formation along the spinal ligaments had occurred through an abnormal ossified enchondral mechanism. We postulate that ossification of the spinal ligaments and metaphyseal enchondromatous changes are related to each other and represent impaired terminal differentiation of

  5. Optimal Contrast Agent Staining of Ligaments and Tendons for X-Ray Computed Tomography

    OpenAIRE

    Balint, Richard; Lowe, Tristan; Shearer, Tom

    2016-01-01

    X-ray computed tomography has become an important tool for studying the microstructures of biological soft tissues, such as ligaments and tendons. Due to the low X-ray attenuation of such tissues, chemical contrast agents are often necessary to enhance contrast during scanning. In this article, the effects of using three different contrast agents—iodine potassium iodide solution, phosphotungstic acid and phosphomolybdic acid—are evaluated and compared. Porcine anterior cruciate ligaments, pat...

  6. Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm

    OpenAIRE

    Patel, Shelain; Potty, Anish; Taylor, Emma J.; Sorene, Elliot D.

    2010-01-01

    The management of injury to the ulnar and radial collateral ligaments at the metacarpophalangeal joint of the thumb is complex. Treatment is dependent upon a number of factors with a wide variety of options for each ligament. Inadequate treatment has the potential to lead to a poor functional outcome. We present the relevant clinical anatomy, mechanism of injury, methods of treatment available and suggest a single treatment algorithm for use in the management of these injuries.

  7. Physical Examination and Imaging of the Acute Multiple Ligament Knee Injury

    OpenAIRE

    Manske, Robert C.; Prohaska, Daniel

    2008-01-01

    Examination and evaluation of the patient a with multiple ligament injured knee is a complicated process and best done in a methodical, comprehensive fashion with a particular emphasis placed on assessment of supporting soft tissues. Tissues that can be damaged during this devastating injury include bones, ligaments, meniscus, articular cartilage, and neurovascular structures. Uses of diagnostic imaging and the physical examination process will be described in this article.

  8. A new method to examine the cruciate ligaments in the acute stage of injury

    International Nuclear Information System (INIS)

    A new plane is described in which it is possible to visualize both the cruciate ligaments using computed tomography, in patients with acute injuries. In those cases the knee is in Bonnet's position, i.e. 30 degrees flexed. Initially, an optimum CT examination schedule for the cruciate ligaments was determined in a cadaver study, subsequently patients were investigated. Advantages and disadvantages are discussed. 5 refs.; 6 figs

  9. The impact of combined meniscus tear on quality of life after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Harhaji Vladimir V.

    2016-01-01

    Full Text Available Introduction. An anterior cruciate ligament injury represents a significant epidemiological problem worldwide, especially due to involving young, sporty and active working-age population. This study has been conducted in order to compare the quality of life of patients who had isolated anterior cruciate ligament tear and of those who suffered from an associated meniscal injury. Material and Methods. This study included 185 patients who had undergone reconstruction of the anterior cruciate ligament at the Department of Orthopedic Surgery and Traumatology in Novi Sad from January 1st, 2012 to December 31st, 2012. The patients were divided into 2 groups: group A consisted of patients who had anterior cruciate ligament reconstruction only, and group B consisted of patients who had partial meniscectomy in addition to the anterior cruciate ligament reconstruction. The follow-up period was 12 months. Results. Distribution of patients by gender was significantly in favor of men. In our study, 146 patients were male and 39 patients were female. The average age of patients was 26.1 years overall (16-55 years, being 26.9 years for men, and 23.3 years for female patients. Out of 185 patients, 110 had an isolated anterior cruciate ligament injury, while 75 suffered both meniscus, internal or external, and anterior cruciate ligament injury. Conclusion. The comparison of the quality of life of patients in both groups showed no statistically significant difference. Therefore, we were not able to prove the hypothesis about the superior quality of life of those patients who had suffered from a ruptured anterior cruciate ligament only.

  10. Delayed diagnosis of isolated alar ligament rupture:A case report

    Institute of Scientific and Technical Information of China (English)

    Robin; A; Kaufmann; Ingo; Marzi; Thomas; J; Vogl

    2015-01-01

    Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.

  11. Intraarticular ganglion between the cruciate ligaments of the knee. A case report

    International Nuclear Information System (INIS)

    Intraarticular ganglion cysts arising from the cruciate ligaments are rare. Only 9 cases have been described in the literature. Only in one case was the diagnosis suggested before operation by the appearance on MR imaging. We report a case of a patient presenting with a bone erosion in the proximal tibial epiphysis caused by an intraarticular ganglion cyst arising from the anterior cruciate ligament. (orig.)

  12. Intraarticular ganglion between the cruciate ligaments of the knee. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kaatee, R. (Dept. of Medical Imaging, Landspitalinn, Univ. Hospital, Reykjavik (Iceland)); Kjartansson, O. (Dept. of Medical Imaging, Landspitalinn, Univ. Hospital, Reykjavik (Iceland)); Brekkan, A. (Dept. of Medical Imaging, Landspitalinn, Univ. Hospital, Reykjavik (Iceland))

    1994-09-01

    Intraarticular ganglion cysts arising from the cruciate ligaments are rare. Only 9 cases have been described in the literature. Only in one case was the diagnosis suggested before operation by the appearance on MR imaging. We report a case of a patient presenting with a bone erosion in the proximal tibial epiphysis caused by an intraarticular ganglion cyst arising from the anterior cruciate ligament. (orig.).

  13. The Effects of Prehabilitation on the Outcome of Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Shaarani, Shahril

    2012-01-01

    Introduction: Anterior cruciate ligament injury results in quadriceps femoris atrophy. The effects of atrophy can persist after 5 years post anterior cruciate ligament reconstruction (ACLR) and can prolong rehabilitation [4]. Prehabilitation has been defined as preparing an individual to withstand a stressful event through enhancement of functional capacity before surgery [5]. We hypothesise that a preoperative exercise programme would enhance postoperative recovery. Aims: To determine the...

  14. A Combined Procedure For Irreducible Dislocation Of Patella In Children With Ligamentous Laxity: A Preliminary Report

    OpenAIRE

    Inan, Muharrem; Sarikaya, Ilker; Seker, Ali; Beng, Kubilay

    2015-01-01

    Objectives: Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. Most common complaints due to this condition are inability to walk, delayed walking and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity. Patients and Methods: Fourteen knees of nine patients operated by a single surgeon between 2009-2012 were ...

  15. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique

    OpenAIRE

    Prince, Matthew R.; Stuart, Michael J.; King, Alexander H.; Sousa, Paul L.; Levy, Bruce A.

    2015-01-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal a...

  16. Evaluation of Short Term Outcomes of Transportal Femoral Cross Pin Fixation in Anterior Cruciate Ligament Reconstruction

    OpenAIRE

    Zehir, Sinan; Şahin, Ercan; Çalbıyık, Murat; Kalem, Mahmut; İpek, Deniz; Songür, Murat

    2014-01-01

    Objectives: Many fixation techniques are currently in use for femoral side graft fixation at ACL reconstruction surgery. Short term success following ACL reconstruction highly depends on fixation strength of the graft. In this study we report short term results of anterior cruciate ligament reconstruction using double hamstring tendon autograft using double cross pin for femoral tunnel fixation. Methods: Between years 2009 and 2013, 51 male adult anterior cruciate ligament injury cases treate...

  17. Repair of acute injuries of the lateral ligament complex of the ankle by suture anchors

    OpenAIRE

    Liu, Xiang-Fei; Fang, Yang; Cao, Zhong-Hua; Li, Guang-Feng; Guo-qing YANG

    2015-01-01

    Objective: The objective of this study was to investigate the clinical curative effect of stage I repair of acute injuries of the lateral ligament complex of the ankle by the application of suture anchors. Methods: We retrospectively analyzed 18 cases of III degree acute injuries of the lateral ligament complex of the ankle. Results: There were statistically significant differences in preoperative and last follow-up VAS pain scores and AOFAS ankle hind-foot function scores. The X-ray talus di...

  18. Psychological Rehabilitation From Anterior Cruciate Ligament–Medial Collateral Ligament Reconstructive Surgery

    OpenAIRE

    McArdle, Siobhain

    2010-01-01

    Background: Research has shown that some of the more common psychological responses to injury (ie, depression, anger, anxiety) are amplified in cases of traumatic injury. Hypothesis/Purpose: An 18-year-old male scholarship soccer player who, owing to a perceived deliberate injurious tackle by an opposition player, tore the medial collateral ligament and anterior cruciate ligament of his right knee. A psychological case perspective is presented. Study Design: Retrospective case report. Results...

  19. Regional differences within the human supraspinous and interspinous ligaments: a sheet plastination study

    OpenAIRE

    Johnson, Gillian M; Zhang, Ming

    2002-01-01

    The extent to which neighboring muscles and the fascia contribute to the formation of the supraspinous and interspinous ligaments is not clear from the literature. The purpose of this investigation is to examine the midline attachments of tendons and the posterior layer of thoracolumbar fascia in order to determine their respective contributions to the formation of these ligaments throughout the thoracolumbar spine. Study of the dense connective tissue organization in the posterior ligamentou...

  20. Simulation of Anterior Cruciate Ligament Deficiency in a Musculoskeletal Model with Anatomical Knees

    OpenAIRE

    Guess, Trent M.; Stylianou, Antonis

    2012-01-01

    Abnormal knee kinematics and meniscus injury resulting from anterior cruciate ligament (ACL) deficiency are often implicated in joint degeneration even though changes in tibio-femoral contact location after injury are small, typically only a few millimeters. Ligament reconstruction surgery does not significantly reduce the incidence of early onset osteoarthritis. Increased knowledge of knee contact mechanics would increase our understanding of the effects of ACL injury and help guide ACL reco...

  1. Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review.

    OpenAIRE

    Nicodeme J.D.; Löcherbach C.; Jolles B.M.

    2014-01-01

    PURPOSE: Reconstruction of the posterior cruciate ligament (PCL) yields less satisfying results than anterior cruciate ligament reconstruction with respect to laxity control. Accurate tibial tunnel placement is crucial for successful PCL reconstruction using arthroscopic tibial tunnel techniques. A discrepancy between anatomical studies of the tibial PCL insertion site and surgical recommendations for tibial tunnel placement remains. The objective of this study was to identify the optimal pla...

  2. Tibial tunnel placement in posterior cruciate ligament reconstruction: a systematic review

    OpenAIRE

    Nicodeme, Jean-Damien; Loecherbach, C; Jolles, B M

    2013-01-01

    Purpose Reconstruction of the posterior cruciate ligament (PCL) yields less satisfying results than anterior cruciate ligament reconstruction with respect to laxity control. Accurate tibial tunnel placement is crucial for successful PCL reconstruction using arthroscopic tibial tunnel techniques. A discrepancy between anatomical studies of the tibial PCL insertion site and surgical recommendations for tibial tunnel placement remains. The objective of this study was to identify the optimal plac...

  3. Time-dependent damage in predictions of fatigue behaviour of normal and healing ligaments

    Science.gov (United States)

    Thornton, Gail M.; Bailey, Soraya J.; Schwab, Timothy D.

    2015-08-01

    Ligaments are dense fibrous tissues that connect bones across a joint and are exposed daily to creep and fatigue loading. Ligaments are tensile load-bearing tissues; therefore, fatigue loading will have a component of time-dependent damage from the non-zero mean stress and cycle-dependent damage from the oscillating stress. If time-dependent damage is not sufficient to completely predict the fatigue response, then cycle-dependent damage could be an important contributor. Using data from normal ligaments (current study and Thornton et al., Clin. Biomech. 22:932-940, 2007a) and healing ligaments (Thornton and Bailey, J. Biomech. Eng. 135:091004-1-091004-6, 2013), creep data was used to predict the fatigue response considering time-dependent damage. Relationships between creep lifetime and test stress or initial strain were modelled using exponential or power-law regression. In order to predict fatigue lifetimes, constant rates of damage were assumed and time-varying stresses were introduced into the expressions for time-dependent damage from creep. Then, the predictions of fatigue lifetime were compared with curvefits to the fatigue data where exponential or power-law regressions were used to determine the relationship between fatigue lifetime and test stress or initial strain. The fatigue prediction based on time-dependent damage alone greatly overestimated fatigue lifetime suggesting that time-dependent damage alone cannot account for all of the damage accumulated during fatigue and that cycle-dependent damage has an important role. At lower stress and strain, time-dependent damage was a greater relative contributor for normal ligaments than healing ligaments; however, cycle-dependent damage was a greater relative contributor with incremental increases in stress or strain for normal ligaments than healing ligaments.

  4. Conventional radiographic investigation of the knee following operative repair of ligamentous injuries and after plastic ligament replacement

    International Nuclear Information System (INIS)

    Characteristic radiological findings following operative repair of the ligaments of the knee joint are described and related to the type of operative procedure. The operations depend on a number of basic principles which are discussed in detail. The majority of these surgical procedures are not apparent radiographically. It is only by having a knowledge of the individual procedures and of the resulting functional changes in the knee joint, that the informed radiologist can make a correct assessment of the post-operative radiographs. Defects resulting from bone drilling can be recognised tomographically in the early postoperative phase, or if they persist for any reason. This could be confirmed by experiments in pigs' knees. (orig.)

  5. Ganglion cysts of the cruciate ligaments. MR findings with clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Huang, G.S.; Hsueh, C.-J.; Juan, C.J.; Chen, C.Y. [Tri-Service General Hospital and National Defense Medical Center, Taipei (China). Dept. of Radiology; Lee, C.H. [Tri-Service General Hospital and National Defense Medical Center, Taipei (China). Dept. of Orthopedic Surgery; Chan, W.P. [Taipei Medical Univ., Wan Fang Hospital, Taipei (China). Dept. of Radiology; Taylor, J.A.M. [New York Chiropractic College, Seneca Falls, NY (United States). Dept. of Diagnosis; Yu, J.S. [Ohio State Univ. Medical Center, Columbus, OH (United States). Dept. of Radiology

    2002-07-01

    Purpose: To evaluate the MR findings of ganglion cysts of the cruciate ligaments in correlation with clinical findings. Material and Methods:We reviewed 12 patients with ganglion cysts of the cruciate ligaments obtained from a medical record of 4153 consecutive patients referred for knee MR examinations. All patients presented with chronic knee pain and 4 had restriction of knee motion. The MR imaging findings of the cysts were evaluated and correlated with clinical manifestations. Results:Seven ganglion cysts were found in the posterior cruciate ligaments and 5 in the anterior cruciate ligaments. All cysts were lobulated (n=7) or fusiform (n=5) in shape, 1.8-4.5 cm in size, along the posterior surface in the proximal or distal end of the ligaments. Ten patients had arthroscopic resection or aspiration of their cysts, became symptom free and had no recurrence on follow-up MR examinations. Two cysts reduced in size spontaneously by conservative treatment. Conclusion:MR imaging can offer useful information in detection and diagnosis of patients with chronic knee pain due to ganglion cysts of the cruciate ligaments. The size and location of the ganglion cysts can attribute to the clinical manifestations.

  6. MR imaging diagnosis of posterior cruciate ligament injury: importance of ancillary findings

    International Nuclear Information System (INIS)

    To evaluate the importance of two ancillary findings of anterior tibial plateau bruise/fracture and popliteus muscle strain on MR diagnosis of posterior cruicate ligament injury. We retrospectively evaluated 48 patients with confirmed posterior cruciate ligament tear. We studied the incidence of anterior tibial plateau injury and popliteus muscle strain, and the specificity of popliteus muscle strain with or without bony injury. A complete tear of the posterior cruciate ligament was noted in 37 cases, a partial tear in 11. Anterior tibial plateau lesion was found in 21 of 48 cases (44%); This total was made up of 17/37 PCL complete tears (46%) and 4/11 partial tears (36%). The difference in the incidence of complete and partial tears is not statistically significant. Popliteus muscle injury was found in 20 of 48 cases (42%), the total consisted of 19/37 PCL complete tears (51%) and 1/11 partial tears (10%). The incidence of 42% is relatively high, approximating that of bony injury. The difference in the incidence of complete and partial tears is statistically significant (p < 0.006). Specificity for posterior cruciate ligament tear is 69%(20/29), and when concomitant with anterior tibial plateau injury is 94%(16/17). As in the case of anterior cruciate ligament injury, these documented ancillary findings of anterior tibial plateau and popliteus muscle injuries are very helpful when MR diagnosis of posterior cruciate ligament injury itself and differentiation of partial and complete rupture are doubtful

  7. MR imaging diagnosis of posterior cruciate ligament injury: importance of ancillary findings

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Kang Ik; Lee, Jong Hwa; Kim, Young Sun; Lee, Jung Hwoi; Ki, Tae Sung [Ulsan Univ. Hospital, Seoul (Korea, Republic of); Park, Jong Oag [Daejun Sungsim Hospital, Daejun (Korea, Republic of)

    1997-04-01

    To evaluate the importance of two ancillary findings of anterior tibial plateau bruise/fracture and popliteus muscle strain on MR diagnosis of posterior cruicate ligament injury. We retrospectively evaluated 48 patients with confirmed posterior cruciate ligament tear. We studied the incidence of anterior tibial plateau injury and popliteus muscle strain, and the specificity of popliteus muscle strain with or without bony injury. A complete tear of the posterior cruciate ligament was noted in 37 cases, a partial tear in 11. Anterior tibial plateau lesion was found in 21 of 48 cases (44%); This total was made up of 17/37 PCL complete tears (46%) and 4/11 partial tears (36%). The difference in the incidence of complete and partial tears is not statistically significant. Popliteus muscle injury was found in 20 of 48 cases (42%), the total consisted of 19/37 PCL complete tears (51%) and 1/11 partial tears (10%). The incidence of 42% is relatively high, approximating that of bony injury. The difference in the incidence of complete and partial tears is statistically significant (p < 0.006). Specificity for posterior cruciate ligament tear is 69%(20/29), and when concomitant with anterior tibial plateau injury is 94%(16/17). As in the case of anterior cruciate ligament injury, these documented ancillary findings of anterior tibial plateau and popliteus muscle injuries are very helpful when MR diagnosis of posterior cruciate ligament injury itself and differentiation of partial and complete rupture are doubtful.

  8. Ganglion cysts of the cruciate ligaments. MR findings with clinical correlation

    International Nuclear Information System (INIS)

    Purpose: To evaluate the MR findings of ganglion cysts of the cruciate ligaments in correlation with clinical findings. Material and Methods:We reviewed 12 patients with ganglion cysts of the cruciate ligaments obtained from a medical record of 4153 consecutive patients referred for knee MR examinations. All patients presented with chronic knee pain and 4 had restriction of knee motion. The MR imaging findings of the cysts were evaluated and correlated with clinical manifestations. Results:Seven ganglion cysts were found in the posterior cruciate ligaments and 5 in the anterior cruciate ligaments. All cysts were lobulated (n=7) or fusiform (n=5) in shape, 1.8-4.5 cm in size, along the posterior surface in the proximal or distal end of the ligaments. Ten patients had arthroscopic resection or aspiration of their cysts, became symptom free and had no recurrence on follow-up MR examinations. Two cysts reduced in size spontaneously by conservative treatment. Conclusion:MR imaging can offer useful information in detection and diagnosis of patients with chronic knee pain due to ganglion cysts of the cruciate ligaments. The size and location of the ganglion cysts can attribute to the clinical manifestations

  9. Optimal Contrast Agent Staining of Ligaments and Tendons for X-Ray Computed Tomography.

    Science.gov (United States)

    Balint, Richard; Lowe, Tristan; Shearer, Tom

    2016-01-01

    X-ray computed tomography has become an important tool for studying the microstructures of biological soft tissues, such as ligaments and tendons. Due to the low X-ray attenuation of such tissues, chemical contrast agents are often necessary to enhance contrast during scanning. In this article, the effects of using three different contrast agents-iodine potassium iodide solution, phosphotungstic acid and phosphomolybdic acid-are evaluated and compared. Porcine anterior cruciate ligaments, patellar tendons, medial collateral ligaments and lateral collateral ligaments were used as the basis of the study. Three samples of each of the four ligament/tendon types were each assigned a different contrast agent (giving a total of twelve samples), and the progression of that agent through the tissue was monitored by performing a scan every day for a total period of five days (giving a total of sixty scans). Since the samples were unstained on day one, they had been stained for a total of four days by the time of the final scans. The relative contrast enhancement and tissue deformation were measured. It was observed that the iodine potassium iodide solution penetrated the samples fastest and caused the least sample shrinkage on average (although significant deformation was observed by the time of the final scans), whereas the phosphomolybdic acid caused the greatest sample shrinkage. Equations describing the observed behaviour of the contrast agents, which can be used to predict optimal staining times for ligament and tendon X-ray computed tomography, are presented. PMID:27078030

  10. Interspinous Ligament Lidocaine and Steroid Injections for the Management of Baastrup's Disease: A Case Series

    Science.gov (United States)

    Okada, Kentaro; Inoue, Gen; Orita, Sumihisa; Eguchi, Yawara; Nakamura, Junichi; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Gou; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Toyone, Tomoaki; Yamauchi, Kazuyo; Takahashi, Kazuhisa

    2014-01-01

    Study Design Prospective study. Purpose To examine the long-term effects of interspinous ligament injections of local anesthetics and steroids for the treatment of Baastrup's diseases. Overview of Literature Baastrup's disease is associated with axial low back pains. Baastrup's disease has been more recently described as the "kissing spinous processes" disease. Several authors have reported methods for the diagnosis and treatment of the disease. However, there has been only one report of patients receiving interspinous ligament injections of agents for the treatment of Baastrup's disease. Methods Seventeen patients showed severe low back pains between spinous processes at L3-L4 or L4-L5. X-ray imaging, computed tomography, and magnetic resonance imaging revealed kissing spinous processes, consolidation of spinous process, or inflammation of an interspinous ligament. Pain reliefs after lidocaine and dexamethasone administration into interspinous ligament as therapy for low back pains were being examined and followed up. Results Low back pain scores significantly improved immediately after injection of the agents into interspinous ligaments. At final follow-up (1.4 year), low back pain scores significantly improved as compared with before the treatment. Conclusions Findings from the current study indicate that lidocaine and dexamethasone administration into interspinous ligament in patients diagnosed with Baastrup's disease is effective for managing the pain associated with this disease. PMID:24967039

  11. MR Analysis of the Transverse Ligament in the Late Stage of Whiplash Injury

    International Nuclear Information System (INIS)

    Purpose: To analyse and classify structural changes in the transverse ligament in the late stage of whiplash injury by use of high-resolution MRI, and to evaluate the reliability of our classification. Material and Methods: Ninety-two whiplash-injured (2-9 years previously, mean 6 years) and 30 non-injured individuals underwent proton-weighted MR imaging of the craniovertebral junction in three orthogonal planes. Structural changes in the transverse ligaments were graded twice (grades 1-3) based on increased signal, independently by 3 radiologists with a 4-month interval. Inter- and intraobserver statistics were calculated by ordinary and weighted kappa (K). Results: Image quality was excellent in 109 cases and slightly reduced in 13. Twenty-two out of 30 ligaments in the control group were classified as normal (73%) compared with only 32 out of 92 in the injured group (36%). Two or all 3 observers agreed in their grading in 101 out of 122 ligaments (83%). Intraobserver agreement (weighted K) was fair to good (0.33-0.73). Pair-wise interobserver agreement was fair (0.24-0.39). Reasons for divergent grading were insufficient knowledge of normal variations, low signal intensity in the peridental soft tissue obscuring the ligament and interpretation flaw. Conclusion: Whiplash trauma can damage the transverse ligament. By use of high-resolution proton-weighted MR images such lesions can be detected and classified. The reliability of this classification still needs improvement

  12. Dynamic high-resolution US of ankle and midfoot ligaments: normal anatomic structure and imaging technique.

    Science.gov (United States)

    Sconfienza, Luca Maria; Orlandi, Davide; Lacelli, Francesca; Serafini, Giovanni; Silvestri, Enzo

    2015-01-01

    The ankle is the most frequently injured major joint in the body, and ankle sprains are frequently encountered in individuals playing football, basketball, and other team sports, in addition to occurring in the general population. Imaging plays a crucial role in the evaluation of ankle ligaments. Magnetic resonance imaging has been proven to provide excellent evaluation of ligaments around the ankle, with the ability to show associated intraarticular abnormalities, joint effusion, and bone marrow edema. Ultrasonography (US) performed with high-resolution broadband linear-array probes has become increasingly important in the assessment of ligaments around the ankle because it is low cost, fast, readily available, and free of ionizing radiation. US can provide a detailed depiction of normal anatomic structures and is effective for evaluating ligament integrity. In addition, US allows the performance of dynamic maneuvers, which may contribute to increased visibility of normal ligaments and improved detection of tears. In this article, the authors describe the US techniques for evaluation of the ankle and midfoot ligaments and include a brief review of the literature related to their basic anatomic structures and US of these structures. Short video clips showing dynamic maneuvers and dynamic real-time US of ankle and midfoot structures and their principal pathologic patterns are included as supplemental material. Use of a standardized imaging technique may help reduce the intrinsic operator dependence of US. Online supplemental material is available for this article. PMID:25590396

  13. Grading Anterior Cruciate Ligament Graft Injury after Ligament Reconstruction Surgery: Diagnostic Efficacy of Oblique Coronal MR Imaging of the Knee

    International Nuclear Information System (INIS)

    Objective : The purpose of this study was to evaluate the diagnostic efficacy of using additional oblique coronal MRI of the knee for grading anterior cruciate ligament (ACL) graft injury after ligament reconstruction surgery. Materials and Methods : We retrospectively reviewed 51 consecutive MR knee examinations of 48 patients who underwent both ACL reconstruction and follow-up arthroscopy. The MR examinations included the orthogonal axial, sagittal, coronal images and the oblique coronal T2-weighted images, which were oriented in parallel with the course of the femoral intercondylar roof. Two radiologists independently evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique coronal imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results. Weighted kappa statistics were used to analyze the diagnostic accuracies of the knee MRI with and without the additional oblique coronal imaging. For each evaluation, the observers reported a confidence level for grading the ACL graft injuries in the two imaging groups. Result : The weighted kappa values according to the routine knee MRI were 0.555 (reader 1) and 0.515 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.666 (reader 1) and 0.611 (reader 2). The mean confidence levels by each reader were significantly higher (p < 0.01, paired t-test) with the additional oblique coronal imaging than by using the routine knee MRI alone. Conclusion : The additional use of oblique coronal MRI of the knee improves both the diagnostic accuracy and confidence for grading ACL graft injury

  14. Grading Anterior Cruciate Ligament Graft Injury after Ligament Reconstruction Surgery: Diagnostic Efficacy of Oblique Coronal MR Imaging of the Knee

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Gyu; Hong, Sung Hwan; Choi, Ja Young; Jun, Woo Sun; Choi, Jung Ah; Park, Eun Ah; Kang, Heung Sik; Kwon, Jong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2008-04-15

    Objective : The purpose of this study was to evaluate the diagnostic efficacy of using additional oblique coronal MRI of the knee for grading anterior cruciate ligament (ACL) graft injury after ligament reconstruction surgery. Materials and Methods : We retrospectively reviewed 51 consecutive MR knee examinations of 48 patients who underwent both ACL reconstruction and follow-up arthroscopy. The MR examinations included the orthogonal axial, sagittal, coronal images and the oblique coronal T2-weighted images, which were oriented in parallel with the course of the femoral intercondylar roof. Two radiologists independently evaluated the status of the ACL grafts with using the routine knee MRI and then with adding the oblique coronal imaging. The severity of ACL graft injury was graded using a 3-point system from MR images as intact, partial tear or complete tear, and the results were compared with the arthroscopic results. Weighted kappa statistics were used to analyze the diagnostic accuracies of the knee MRI with and without the additional oblique coronal imaging. For each evaluation, the observers reported a confidence level for grading the ACL graft injuries in the two imaging groups. Result : The weighted kappa values according to the routine knee MRI were 0.555 (reader 1) and 0.515 (reader 2). The inclusion of additional oblique coronal imaging increased the weighted kappa values to 0.666 (reader 1) and 0.611 (reader 2). The mean confidence levels by each reader were significantly higher (p < 0.01, paired t-test) with the additional oblique coronal imaging than by using the routine knee MRI alone. Conclusion : The additional use of oblique coronal MRI of the knee improves both the diagnostic accuracy and confidence for grading ACL graft injury.

  15. The Medial and Posteromedial Ligamentous and Capsular Structures of the Knee: Review of Anatomy and Relevant Imaging Findings.

    Science.gov (United States)

    Pedersen, Roar R

    2016-02-01

    The medial and posteromedial regions of the knee are important for knee stability but also frequently injured. Medial ligaments and capsule are primary and secondary stabilizers of valgus, rotation, and anterior and posterior translation. In the setting of rupture of the cruciate ligaments, it is important to identify injuries in this region because it can possibly alter the treatment strategy and even delay or prevent successful reconstruction of the cruciate ligaments. Injuries may occur to the superficial and deep medial collateral ligament, the posterior oblique ligament, the posteromedial capsule, and the semimembranosus tendon and its attachments. Meniscocapsular separation is associated with these injuries, and if normal movement of the meniscus and tension of the capsule and ligaments is altered, instability and eventually osteoarthritis may occur. Injuries to the posteromedial corner may be underdiagnosed. This article reviews the anatomy and imaging findings in the medial and posteromedial regions of the knee. PMID:27077583

  16. A Multibody Knee Model Corroborates Subject-Specific Experimental Measurements of Low Ligament Forces and Kinematic Coupling During Passive Flexion.

    Science.gov (United States)

    Kia, Mohammad; Schafer, Kevin; Lipman, Joseph; Cross, Michael; Mayman, David; Pearle, Andrew; Wickiewicz, Thomas; Imhauser, Carl

    2016-05-01

    A multibody model of the knee was developed and the predicted ligament forces and kinematics during passive flexion corroborated subject-specific measurements obtained from a human cadaveric knee that was tested using a robotic manipulator. The model incorporated a novel strategy to estimate the slack length of ligament fibers based on experimentally measured ligament forces at full extension and included multifiber representations for the cruciates. The model captured experimentally measured ligament forces (≤ 5.7 N root mean square (RMS) difference), coupled internal rotation (≤ 1.6 deg RMS difference), and coupled anterior translation (≤ 0.4 mm RMS difference) through 130 deg of passive flexion. This integrated framework of model and experiment improves our understanding of how passive structures, such as ligaments and articular geometries, interact to generate knee kinematics and ligament forces. PMID:26926010

  17. MRI of injuries of the lateral ankle ligaments; MRT bei Verletzungen der lateralen und angrenzenden Baender des Sprunggelenks

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, Martin [Landesklinikum Waldviertel Horn, Horn (Austria). Inst. fuer Radiologie und Interventionelle Radiologie

    2011-09-15

    The most frequent sport injury of the ankle is located in the lateral ankle ligaments. The diagnosis of lateral collateral ankle ligament trauma is based on patient history, clinical examination, and stress radiography, allowing a fair diagnosis for the daily routine. For the direct visualization and precise diagnosis of the lateral ankle ligaments MRI provides the best answer. MRI is used with controlled positioning of the foot, correct angulation of sequenzes, and distinct analysis of MR findings. Sinus tarsi ligaments and ligaments of the distal syndesmosis should be included to the report. In selected patients MRI allows the best evaluation of the extent of the lateral ankle ligaments. MRI is the method of choice for combined osteochondral injuries and soft tissue lesions too. (orig.)

  18. Arthroscopic reconstruction of the posterior cruciate ligament. MR studies for bone tunnel positioning and comparison with physical findings

    International Nuclear Information System (INIS)

    The success of arthroscopic cruciate ligament construction depends on several factors., such as patient selection, current surgical execution and postoperative rehabilitation. Technical considerations include graft choice, positioning, fixations, intercondylar notch enlargement, and new ligament tensioning. Graft acceptance is effected by all these factors. Tunnel position is of great importance both for bio mechanical reasons and optimal function of the new ligament, and to avoid stress, friction, abnormal strain, and/or damage to the reconstructed ligament. Many orthopedic and radiographic literature studies discuss the exact site of anterior cruciate ligament insertion for the best possible anatomical reconstruction, In contrast, the debate over the insertional area and anatomical landmarks is open for the posterior cruciate ligament (PCL), because of the difficult execution of this type of reconstruction and the smaller number of candidate

  19. 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.

  20. Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

    Directory of Open Access Journals (Sweden)

    Jung Ho-Joong

    2009-05-01

    Full Text Available Abstract Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis. The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons. With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to

  1. A framework for parametric modeling of ankle ligaments to determine the in situ response under gross foot motion.

    Science.gov (United States)

    Nie, Bingbing; Panzer, Matthew Brian; Mane, Adwait; Mait, Alexander Ritz; Donlon, John-Paul; Forman, Jason Lee; Kent, Richard Wesley

    2016-09-01

    Ligament sprains account for a majority of injuries to the foot and ankle complex, but ligament properties have not been understood well due to the difficulties in replicating the complex geometry, in situ stress state, and non-uniformity of the strain. For a full investigation of the injury mechanism, it is essential to build up a foot and ankle model validated at the level of bony kinematics and ligament properties. This study developed a framework to parameterize the ligament response for determining the in situ stress state and heterogeneous force-elongation characteristics using a finite element ankle model. Nine major ankle ligaments and the interosseous membrane were modeled as discrete elements corresponding functionally to the ligamentous microstructure of collagen fibers and having parameterized toe region and stiffness at the fiber level. The range of the design variables in the ligament model was determined from existing experimental data. Sensitivity of the bony kinematics to each variable was investigated by design of experiment. The results highlighted the critical role of the length of the toe region of the ligamentous fibers on the bony kinematics with the cumulative influence of more than 95%, while the fiber stiffness was statistically insignificant with an influence of less than 1% under the given variable range and loading conditions. With the flexibility of variable adjustment and high computational efficiency, the presented ankle model was generic in nature so as to maximize its applicability to capture the individual ligament behaviors in future studies. PMID:26712301

  2. [Magnetic resonance imaging features of a caudal cruciate ligament rupture associated with a suspected bone bruise lesion in a dog].

    Science.gov (United States)

    Schmohl, M; Konar, M; Tassani-Prell, M; Rupp, S

    2014-04-16

    In this case study we describe a surgically confirmed caudal cruciate ligament rupture in a 10-year-old Border Collie. Magnetic resonance imaging (MRI) demonstrated a complete rupture of the caudal cruciate ligament, a suspected bone bruise lesion on the proximolateral tibia and a muscle strain injury of the M. flexor digitorum lateralis. In human medicine, bone bruise lesions in MRI have been described as "footprint injuries" and can thereby explain the mechanism of trauma in ligament injuries. The combination of the MRI findings in this case can help to understand how the rarely diagnosed isolated rupture of the caudal cruciate ligament occurred in this dog. PMID:24737186

  3. Unilateral sacrospinous ligament fixation for treatment of genital prolapse

    Institute of Scientific and Technical Information of China (English)

    PENG Ping; ZHU Lan; LANG Jing-he; WANG Wen-yan; SHI Hong-hui

    2010-01-01

    Background Genital prolapse affects 30% of middle-aged and older women and is becoming a major public health concern. Sacrospinous ligament fixation is an effective and safe procedure for vaginal vault prolaps with a low recurrence and complication rate. This study aimed to investigate the efficacy and safety of unilateral sacrospinous ligament fixation (SSLF) for the management of pelvic organ prolapse (POP).Methods Forty patients with severe prolapse of pelvic organ undergoing unilateral SSLF were retrospectively studied.In this study, all patients were staged by the value of POP-Q. All procedures were performed by a senior physician. The characteristics of these patients and their immediate and short-term post-operative outcome were recorded. All patients were seen six weeks and six months after the surgery. The evaluation included standardized questionnaire and site-specific vaginal examination by one physician.Results The average operation time was 65-92 minutes. The average blood loss was 83-188 ml. The average hospitalization time was 6.1 days. The average cost was 5885 yuan. The average day of urethral catheter removal after the operation was 2.1 days. The incidence of postoperative morbidity was 17.1%. One (2.4%) patient had hematoma in the right pelvic. The mean length of postoperative follow-up for 35 patients was 13.1 months. The rate of follow-up was 87.5%. One (2.9%) patient showed recurrent vaginal vault prolapse six months after the surgery. The objective success rate of pelvic organ prolapse was 85% (34/40). There was significant difference between the POP-Q of Aa, Ba, Ap, Bp,and D before and after operation (P <0.001 ). Five (14.3%) patients complained lower back pain, gluteal pain or right groin pain. Three (8.6%) patients developed de novo stress incontinence. Vaginal disabsorbable sutures were found in three (8.6%) patients. One (2.9%) patient had de novo urge incontinence.Conclusions Unilateral SSLF was both cost and treatment effective

  4. Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: Magnetic resonance imaging evaluation at 3T and comparison with arthroscopy

    International Nuclear Information System (INIS)

    To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential

  5. Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: Magnetic resonance imaging evaluation at 3T and comparison with arthroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Ka Young; Choi, Yun Sun; Lee, Seok Hoon; Kim, Jin Su; Young, Ki Won; Jeong, Min Sun; Kim, Dae Jung [Eulji Hospital, Eulji University, Seoul (Korea, Republic of)

    2015-10-15

    To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.

  6. Lumbosacral interspinous ligament rupture associated with acute intrinsic spinal muscle degeneration

    International Nuclear Information System (INIS)

    The objective of this study was to demonstrate lumbosacral interspinous ligament rupture, with or without related acute intrinsic spinal muscle degeneration. This study consisted of a prospective imaging analysis of consecutive 100 MRI studies in adult patients (mean age 56 years) presenting with low back pain. Alterations from the normal in the inter- and perispinal structures of the spine and perispinal soft tissues (e.g., spinal ligaments, perispinal muscles) were sought based upon studies on young volunteers without low back pain (n=10; mean age 23 years). Compared with the group without low back pain, many index cases (n=71, 71%) demonstrated hyperintensity (i.e., sprain or frank ligamentous rupture) of the interspinous ligament(s) on T2-weighted, fat-suppressed MRI studies at one (20 of 71, 28%) or multiple (51 of 71, 72%) levels. Associated intrinsic spinal muscle (e.g., interspinalis, multifidus muscles) degeneration was observed in a minority of cases overall (n=7, 7%), but was only seen in association with cases also demonstrating interspinous ligament degeneration/rupture (7 of 71, 10%). Lumbosacral interspinous ligament sprain or frank rupture, as well as related acute-subacute autotraumatic intrinsic spinal muscle rupture/degeneration, may be overlooked by many observers if fat-suppressed, T2-weighted MRI is not acquired. These musculoligamentous alterations are on occasion the only abnormalities recognized on MRI of the lumbosacral spine and may theoretically be sources of low back morbidity that potentially may respond to specific therapy. Because this study was an observational one, based solely upon medical imaging, future research must focus upon the correlation of the relevance of these findings with an age-matched asymptomatic control group and longitudinal clinicoradiologic therapeutic trials. (orig.)

  7. A broad view of model validation

    International Nuclear Information System (INIS)

    The safety assessment of a nuclear waste repository requires the use of models. Such models need to be validated to ensure, as much as possible, that they are a good representation of the actual processes occurring in the real system. In this paper we attempt to take a broad view by reviewing step by step the modeling process and bringing out the need to validating every step of this process. This model validation includes not only comparison of modeling results with data from selected experiments, but also evaluation of procedures for the construction of conceptual models and calculational models as well as methodologies for studying data and parameter correlation. The need for advancing basic scientific knowledge in related fields, for multiple assessment groups, and for presenting our modeling efforts in open literature to public scrutiny is also emphasized. 16 refs

  8. Buildup factors for broad gamma beams

    International Nuclear Information System (INIS)

    The paper deals with buildup factors for the photon number and the exposure in broad conical beams penetrating through iron slabs. Using the Monte Carlo method, the dependence on the thickness of the slabs is calculated for various geometrical configurations of the 137Cs radiation source, the slab and the detector. The same dependence has also been measured for 137Cs and 60Co. The results show the dependence of the buildup factor B on the collimation angle α (B increases with increasing α), on the distance a between the source and the slab (B increases with increasing a), and on the distance b between the detector and the slab (B decreases with increasing b). Comparison of the obtained results with those from model configurations shows that in the latter case errors may range up to nearly 100%. (author)

  9. Broad-band acoustic hyperbolic metamaterial

    CERN Document Server

    Shen, Chen; Sui, Ni; Wang, Wenqi; Cummer, Steven A; Jing, Yun

    2015-01-01

    Acoustic metamaterials (AMMs) are engineered materials, made from subwavelength structures, that exhibit useful or unusual constitutive properties. There has been intense research interest in AMMs since its first realization in 2000 by Liu et al. A number of functionalities and applications have been proposed and achieved using AMMs. Hyperbolic metamaterials are one of the most important types of metamaterials due to their extreme anisotropy and numerous possible applications, including negative refraction, backward waves, spatial filtering, and subwavelength imaging. Although the importance of acoustic hyperbolic metamaterials (AHMMs) as a tool for achieving full control of acoustic waves is substantial, the realization of a broad-band and truly hyperbolic AMM has not been reported so far. Here, we demonstrate the design and experimental characterization of a broadband AHMM that operates between 1.0 kHz and 2.5 kHz.

  10. Crx broadly modulates the pineal transcriptome

    DEFF Research Database (Denmark)

    Rovsing, Louise; Clokie, Samuel; Bustos, Diego M;

    2011-01-01

    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 < 0.05). Of these, one of the most highly up-regulated (18-fold) was Hoxc4, a member of the Hox gene family, members of which are known to control gene expression cascades. During a 24-h period, a set of 51 genes exhibited differential day/night expression in pineal glands of wild...... influences differential night/day gene expression in this tissue. Some effects of Crx deletion on the pineal transcriptome might be mediated by Hoxc4 up-regulation....

  11. Magnetohydrodynamic stability of broad line region clouds

    CERN Document Server

    Krause, Martin; Burkert, Andreas

    2012-01-01

    Hydrodynamic stability has been a longstanding issue for the cloud model of the broad line region in active galactic nuclei. We argue that the clouds may be gravitationally bound to the supermassive black hole. If true, stabilisation by thermal pressure alone becomes even more difficult. We further argue that if magnetic fields should be present in such clouds at a level that could affect the stability properties, they need to be strong enough to compete with the radiation pressure on the cloud. This would imply magnetic field values of a few Gauss for a sample of Active Galactic Nuclei we draw from the literature. We then investigate the effect of several magnetic configurations on cloud stability in axi-symmetric magnetohydrodynamic simulations. For a purely azimuthal magnetic field which provides the dominant pressure support, the cloud first gets compressed by the opposing radiative and gravitational forces. The pressure inside the cloud then increases, and it expands vertically. Kelvin-Helmholtz and colu...

  12. LOWER EXTREMITY MALALIGNMENTS AND ANTERIOR CRUCIATE LIGAMENT INJURY HISTORY

    Directory of Open Access Journals (Sweden)

    Rebecca A. Braham

    2004-12-01

    Full Text Available To identify if lower extremity malalignments were associated with increased propensity of a history of anterior cruciate ligament (ACL ruptures in males and females using a case control design. Twenty subjects (10 males, 10 females had a history of ACL injury and twenty (10 males, 10 females had no history of ACL injury. Subjects were assessed for navicular drop, quadriceps angle, pelvic tilt, hip internal and external rotation range of motion, and true and apparent leg length discrepancies. Statistical analysis was performed to identify differences in these measures in regard to injury history and gender, and to identify if any of these measures were predictive of ACL injury history. Increased navicular drop and anterior pelvic tilt were found to be statistically significant predictors of ACL injury history regardless of gender. Limbs that had previously suffered ACL ruptures were found to have increased navicular drop and anterior pelvic tilt compared to uninjured limbs. Based on the results of this retrospective study, the lower extremity malalignments examined do not appear to predispose females to tearing their ACLs more than males.

  13. Evaluation of anterior cruciate ligament grafts with MRI

    International Nuclear Information System (INIS)

    This study was performed to know whether or not anterior cruciate ligament (ACL) graft can be qualitatively evaluated by MRI. Subjects were 96 knees of 96 patients aging 23.4 y in a mean. Materials were autografts in 80 cases and allografts in the remainders. Reconstructive surgery was carried out arthroscopically. MRI was performed with GE Signa 1.5 T superconducting apparatus with T1-weighted conditions for the sagittal image of 3 mm thick slice at 1.5, 3, 6, 9, 12 and 24 months after surgery. Correlations of signal intensities of reconstructed ACL were examined with graft materials, stage of MRI after surgery, and knee laxity. MRI well imaged reconstructed ACL and was useful to evaluate the position of the graft, its thickness and tension. No difference of the images was found in ACL graft materials. Signal intensity of the brightness did not change definitely with time. Thus MRI was found to be inappropriate for evaluating quality or process of reconstructed ACL. (H.O.)

  14. Basic principles of aggressive rehabilitation after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Dubljanin-Raspopović Emilija

    2005-01-01

    Full Text Available Rehabilitation after ACL (anterior cruciate ligament reconstruction has drastically changed over the last decade, with the adoption of a more aggressive approach, right from the first day after surgery. Progress in the effectiveness of rehabilitation is based on improvements in operative techniques, as well as on the encouraging results of histological studies regarding graft healing. Despite a huge amount of research papers on this topic, a rehabilitation golden standard still has not been established, due to the complexity of this problem. In this review, we point out the basic principles of rehabilitation after arthroscopically assisted ACL reconstruction based on actual practices, as well as the importance of specific procedures for the prevention of complications during the postoperative period. The importance of range-of-motion exercises, early weight bearing, an appropriate gait scheme, patella mobilisation, pain and oedema control, as well as stretching and balance exercises is explained. The functional advantages of closed kinetic chain exercises, as well as their influence on the graft are also described, in comparison to open kinetic chain exercises. The fundamentals of returning to sports are revealed and the specific aspects of rehabilitation regarding graft choice are pointed out. While waiting for new clinical investigations, which are expected to enable the establishment of a rehabilitation golden standard, the outlined principles should be followed. The complexity of this injury requires treatment in highly specialised institutions.

  15. Occult bony lesions associated with anterior cruciate ligament injury

    International Nuclear Information System (INIS)

    To examine bony lesions associated with anterior cruciate ligament (ACL) injuries, magnetic resonance (MR) imaging was performed on 55 knees with ACL injuries. With respect to the period between ACL injuries and MR imaging, the knees were divided into acute (within one month), subacute (from one month to one year) and chronic (over one year) groups, containing 19, 16 and 20 knees, respectively. Occult bony lesions not shown in roentgenography were observed more frequently in the acute group (13/19) than in the other two groups (subacute group, 5/16; chronic group, 1/20), located in the lateral compartment of the knee joint. In the acute group, bony lesions had high signal intensity on T2-weighted images and low signal intensity on proton density images. In the subacute and chronic groups, bony lesions were less pronounced and had low signal intensity on T2-weighted images. These findings suggest that bony lesions are frequently associated with and occur simultaneously with ACL injury. (author)

  16. Risk Factors for Revision Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    Ponce, Brent A; Cain, E Lyle; Pflugner, Ryan; Fleisig, Glenn S; Young, Bradley L; Boohaker, Hikel A; Swain, Thomas A; Andrews, James R; Dugas, Jeffrey R

    2016-05-01

    Purpose The purpose of this study was to identify risk factors for revision surgery following primary anterior cruciate ligament (ACL) reconstruction. Methods A retrospective analysis of 2,965 patients who underwent a primary ACL reconstruction were separated into two groups: those who returned to our center for revision of their reconstruction (n = 67) and those who did not return to our center for revision of their reconstruction (n = 2,898). Patient characteristics assessed at the time of primary reconstruction include age, gender, graft type, graft source, meniscal and/or chondral injury, sport, side of effected extremity, level of competition, and surgeon. Multivariable analyses were performed to identify significant, independent associations with the need for revision. Results The portion of patients who returned for revision reconstruction after primary ACL reconstruction was 2.3% (67/2,965). Age (p sport type (p = 0.007), and level of participation (p sport type or level of competition, age (p = 0.014) and surgeon (p = 0.041) were independently associated with revision. Gender, extremity (R vs. L), meniscal or chondral injury, and graft characteristics were not associated with revision. Conclusion Revision of primary ACL reconstructions is independently associated with age and choice of surgeon at the time of primary reconstruction. PMID:26238768

  17. Complications of anterior cruciate ligament reconstruction: MR imaging

    International Nuclear Information System (INIS)

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. (orig.)

  18. Complications of anterior cruciate ligament reconstruction: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Papakonstantinou, Olympia; Chung, Christine B.; Chanchairujira, Kullanuch; Resnick, Donald L. [Department of Radiology, Veterans Affairs Medical Center, University of California, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States)

    2003-05-01

    Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using autografts or allografts is being performed with increasing frequency, particularly in young athletes. Although the procedure is generally well tolerated, with good success rates, early and late complications have been documented. As clinical manifestations of graft complications are often non-specific and plain radiographs cannot directly visualize the graft and the adjacent soft tissues, MR imaging has a definite role in the diagnosis of complications after ACL reconstruction and may direct subsequent therapeutic management. Our purpose is to review the normal MR imaging of the ACL graft and present the MR imaging findings of a wide spectrum of complications after ACL reconstruction, such as graft impingement, graft rupture, cystic degeneration of the graft, postoperative infection of the knee, diffuse and localized (i.e., cyclops lesion) arthrofibrosis, and associated donor site abnormalities. Awareness of the MR imaging findings of complications as well as the normal appearances of the normal ACL graft is essential for correct interpretation. (orig.)

  19. Mucoid degeneration of the anterior cruciate ligament: Management and outcome

    Directory of Open Access Journals (Sweden)

    Vivek Pandey

    2014-01-01

    Full Text Available Background: Mucoid degeneration (MD is a rare pathological affection of the anterior cruciate ligament (ACL. Mucinous material within the substance of ACL produces pain and limited motion in the knee. This series describes the clinicoradiological presentation of patients with mucoid ACL, partial arthroscopic debridement of ACL and outcomes. Materials and Methods: During a period of 3 years, 11 patients were included based upon the clinical suspicion, magnetic resonance imaging (MRI findings, arthroscopic features and histopathologic confirmation of MD of ACL. Result: Six patients were male and five were female with median age of 40 years (range 21-59 years. All patients complained of knee pain with median duration of 5 months (range 1-24 months. All patients had painful deep flexion with 63.6% (N = 7 reporting trivial trauma before the onset of symptoms. MRI revealed MD of ACL in all with associated cyst in three patients. Partial debridement of ACL was done in ten and complete in one patient. None of them required notchplasty. Histopathology confirmed the diagnosis in all of them. At the mean followup of 13.81 months (range 6-28 months, all patients regained complete flexion and none complained of instability. Conclusion: Prior knowledge of condition with high index of suspicion and careful interpretation of MRI can establish the diagnosis preoperatively. It responds well to partial debridement of ACL and mucinous material without development of instability.

  20. Soft-Tissue Loop for Medial Patellofemoral Ligament Reconstruction.

    Science.gov (United States)

    Miswan, Mohd Fairudz Bin Mohd; Al-Fayyadh, Mohamed Zubair Mohamed; Seow Hui, Teo; Mohamed Ali, Mohamed Razif Bin; Ng, Wuey Min

    2016-04-01

    A patient with patellar instability frequently presents with anterior knee pain, patellar subluxation, or dislocation. Medial patellofemoral ligament (MPFL) has a key role for normal patella tracking and stability. Reconstruction of the MPFL using a hamstring graft is a commonly used procedure for the treatment of chronic lateral subluxation of patella. Anchor sutures and bony tunnels are used for the patellar attachment of the graft. This can be associated with complications such as patella fracture; besides, it does not produce an anatomical reconstruction for the native MPFL that can alter the direction of tension applied on the patella. To overcome these problems, a soft-tissue loop technique is used for MPFL reconstruction. During this procedure, a semitendinosus graft was passed through the prepatellar extensor retinaculum and secured with sutures. The free ends of the graft were then passed between the second and third layers of the medial patellofemoral retinaculum and fixed to a femoral tunnel on the medial femoral condyle with an interference screw. The desired amount of tension on the graft is achieved under direct vision of patella tracking arthroscopically. We found this method to be relatively safe and fast. It is more anatomical and can avoid the complications during the conventional bony procedures. PMID:27354953

  1. Evaluation of pain after arthroscopically assisted anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Brown, D W; Curry, C M; Ruterbories, L M; Avery, F L; Anson, P S

    1997-01-01

    Pain after arthroscopically assisted anterior cruciate reconstruction was examined during the first 5 postoperative days to evaluate its intensity and duration. One hundred consecutive patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft were examined. During surgery, ketorolac (60 mg) was given intravenously and 0.25% bupivicaine (1 ml/kg total) was injected into the joint space and the graft donor site. After surgery, all patients received scheduled doses of oral acetaminophen (650 mg) and ketorolac (10 mg) four times a day, and they were allowed to take oral oxycodone (5 to 10 mg) every 2 hours as needed. Pain scores at rest and with activity reached a maximum on the 2nd postoperative morning. Oxycodone consumption also peaked on the 2nd postoperative day. Eighty-nine (89%) patients reported overall pain as mild or moderate, and 95 patients (95%) reported either excellent or good overall relief of pain. The 5-day cumulative mean of visual analog scale pain scores for attempting straight leg raises was significantly higher for patients unable to successfully perform that activity than for patients who were able to perform it. The association between elevated pain scores and diminished ability to perform straight leg raises suggests that pain may inhibit function and therefore early rehabilitation. PMID:9079170

  2. Managing ankle ligament sprains and tears: current opinion.

    Science.gov (United States)

    McGovern, Ryan P; Martin, RobRoy L

    2016-01-01

    The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. PMID:27042147

  3. Partial tearing of the anterior cruciate ligament: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Eduardo Frois Temponi

    2015-02-01

    Full Text Available Partial tears of the anterior cruciate ligament (ACL are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction and classical (anatomical reconstruction.

  4. Treatment of acute lateral ankle ligament rupture in the athlete. Conservative versus surgical treatment.

    Science.gov (United States)

    Lynch, S A; Renström, P A

    1999-01-01

    Acute lateral ankle ligament sprains are common in young athletes (15 to 35 years of age). Diagnostic and treatment protocols vary. Therapies range from cast immobilisation or acute surgical repair to functional rehabilitation. The lateral ligament complex includes 3 capsular ligaments: the anterior tibiofibular (ATFL), calcaneofibular (CFL) and posterior talofibular (PTFL) ligaments. Injuries typically occur during plantar flexion and inversion; the ATFL is most commonly torn. The CFL and the PTFL can also be injured and, after severe inversion, subtalar joint ligaments are also affected. Commonly, an athlete with a lateral ankle ligament sprain reports having 'rolled over' the outside of their ankle. The entire ankle and foot must be examined to ensure there are no other injuries. Clinical stability tests for ligamentous disruption include the anterior drawer test of ATFL function and inversion tilt test of both ATFL and CFL function. Radiographs may rule out treatable fractures in severe injuries or when pain or tenderness are not associated with lateral ligaments. Stress radiographs do not affect treatment. Ankle sprains are classified from grades I to III (mild, moderate or severe). Grade I and II injuries recover quickly with nonoperative management. A non-operative 'functional treatment' programme includes immediate use of RICE (rest, ice, compression, elevation), a short period of immobilisation and protection with a tape or bandage, and early range of motion, weight-bearing and neuromuscular training exercises. Proprioceptive training on a tilt board after 3 to 4 weeks helps improve balance and neuromuscular control of the ankle. Treatment for grade III injuries is more controversial. A comprehensive literature evaluation and meta-analysis showed that early functional treatment provided the fastest recovery of ankle mobility and earliest return to work and physical activity without affecting late mechanical stability. Functional treatment was complication

  5. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves

    International Nuclear Information System (INIS)

    Highlights: •Medial and lateral tendons: the different muscles forming these tendons can be followed up to the insertion. The imaging anatomy is reviewed. •Medial and lateral ligaments: the anatomy is complex and specialized imaging planes and arm positions are necessary for accurate assessment. •Biceps tendon: the anatomy of the distal biceps and lacertus fibrosus are discussed and illustrated with cadaveric correlation. •US imaging of the nerves about the elbow and visualization of the possible compression points is discussed. -- Abstract: The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne

  6. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves

    Energy Technology Data Exchange (ETDEWEB)

    De Maeseneer, Michel, E-mail: Michel.demaeseneer@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Brigido, Monica Kalume, E-mail: Mbrigido@med.umich.edu [Department of Radiology, University of Michigan, Ann Arbor, MI (United States); Antic, Marijana, E-mail: Misscroa@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Lenchik, Leon, E-mail: Llenchik@wakehealth.edu [Department of Radiology, Wake Forest University, Winston-Salem, NC (United States); Milants, Annemieke, E-mail: Annemieke.Milants@gmail.com [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium); Vereecke, Evie, E-mail: Evie.Vereecke@kuleuven-kulak.be [Department of Anatomy, KULAK, Katholieke Universiteit Leuven, Campus Kortrijk, Kortrijk (Belgium); Jager, Tjeerd [Aalsters Stedelijk Ziekenhuis, Aalst (Belgium); Shahabpour, Maryam, E-mail: Maryam.Shahabpour@uzbrussel.be [Department of Radiology, Universitair Ziekenhuis Brussel, Brussels (Belgium)

    2015-04-15

    Highlights: •Medial and lateral tendons: the different muscles forming these tendons can be followed up to the insertion. The imaging anatomy is reviewed. •Medial and lateral ligaments: the anatomy is complex and specialized imaging planes and arm positions are necessary for accurate assessment. •Biceps tendon: the anatomy of the distal biceps and lacertus fibrosus are discussed and illustrated with cadaveric correlation. •US imaging of the nerves about the elbow and visualization of the possible compression points is discussed. -- Abstract: The high resolution and dynamic capability of ultrasound make it an excellent tool for assessment of superficial structures. The ligaments, tendons, and nerves about the elbow can be fully evaluated with ultrasound. The medial collateral ligament consists of an anterior and posterior band that can easily be identified. The lateral ligament complex consists of the radial collateral ligament, ulnar insertion of the annular ligament, and lateral ulnar collateral ligament, easily identified with specialized probe positioning. The lateral ulnar collateral ligament can best be seen in the cobra position. On ultrasound medial elbow tendons can be followed nearly up to their common insertion. The pronator teres, flexor carpi radialis, palmaris longus, and flexor digitorum superficialis can be identified. The laterally located brachioradialis and extensor carpi radialis longus insert on the supracondylar ridge. The other lateral tendons can be followed up to their common insertion on the lateral epicondyle. The extensor digitorum, extensor carpi radialis brevis, extensor digiti minimi, and extensor carpi ulnaris can be differentiated. The distal biceps tendon is commonly bifid. For a complete assessment of the distal biceps tendon specialized views are necessary. These include an anterior axial approach, medial and lateral approach, and cobra position. In the cubital tunnel the ulnar nerve is covered by the ligament of Osborne

  7. Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study.

    Science.gov (United States)

    Panzarini, Sônia Regina; Pedrini, Denise; Poi, Wilson Roberto; Sonoda, Celso Koogi; Brandini, Daniela Atili; Monteiro de Castro, José Carlos

    2008-01-01

    The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion) treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP), Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09%) was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86%). There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed. PMID:18949308

  8. Knee function after anterior cruciate ligament reconstruction with patellar or hamstring tendon: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SHI Dong-liang; YAO Zhen-jun

    2011-01-01

    Background There is currently no consensus regarding the best graft type for anterior cruciate ligament reconstruction.Therefore,the aim of this study was to investigate the effects of patellar and hamstring tendon grafts on long-term knee function after anterior cruciate ligament reconstruction.Methods This meta-analysis was conducted according to the methodological guidelines outlined by the Cochrane Collaboration.An electronic search of the literature was performed and all trials published between January 1966 and August 2011 comparing knee function after anterior cruciate ligament reconstruction using patellar tendon grafts with knee function after reconstruction with hamstring tendon grafts were pooled.Six studies were included in the final meta-analysis.Results Anterior cruciate ligament reconstruction using hamstring tendon grafts resulted in greater pain upon kneeling than reconstruction using pateliar tendon grafts (P=0.001).However,both grafts resulted in similar levels of anterior tibial translation,and similar results regarding isokinetic extension/flexion tests,Lysholm scores,and the stair-hop test (P >0.05).Conclusion Anterior cruciate ligament reconstruction using patellar or hamstring tendon grafts results in similar long-term knee function.

  9. Tissue engineering bone-ligament complexes using fiber-guiding scaffolds

    Science.gov (United States)

    Park, Chan Ho; Rios, Hector F.; Jin, Qiming; Sugai, James V.; Padial-Molina, Miguel; Taut, Andrei D.; Flanagan, Colleen L.; Hollister, Scott J.; Giannobile, William V.

    2011-01-01

    Regeneration of bone-ligament complexes destroyed due to disease or injury is a clinical challenge due to complex topologies and tissue integration required for functional restoration. Attempts to reconstruct soft-hard tissue interfaces have met with limited clinical success. In this investigation, we manufactured biomimetic fiber-guiding scaffolds using solid free-form fabrication methods that custom fit complex anatomical defects to guide functionally-oriented ligamentous fibers in vivo. Compared to traditional, amorphous or random-porous polymeric scaffolds, the use of perpendicularly oriented microchannels provides better guidance for cellular processes anchoring ligaments between two distinct mineralized structures. These structures withstood biomechanical loading to restore large osseous defects. Cell transplantation using hybrid scaffolding constructs with guidance channels resulted in predictable oriented fiber architecture, greater control of tissue infiltration, and better organization of ligament interface than random scaffold architectures. These findings demonstrate that fiber-guiding scaffolds drive neogenesis of triphasic bone-ligament integration for a variety of clinical scenarios. PMID:21993234

  10. Dental trauma involving root fracture and periodontal ligament injury: a 10-year retrospective study

    Directory of Open Access Journals (Sweden)

    Sônia Regina Panzarini

    2008-09-01

    Full Text Available The purpose of this retrospective study was to analyze the cases of traumatic dental injuries involving root fracture and/or periodontal ligament injury (except avulsion treated at the Discipline of Integrated Clinic, School of Dentistry of Araçatuba, São Paulo State University (UNESP, Brazil, from January 1992 to December 2002. Clinical and radiographic records from 161 patients with 287 traumatized teeth that had sustained root fracture and/or injuries to the periodontal ligament were examined. The results of this survey revealed that subluxation (25.09% was the most common type of periodontal ligament injury, followed by extrusive luxation (19.86%. There was a predominance of young male patients and most of them did not present systemic alterations. Among the etiologic factors, the most frequent causes were falls and bicycle accidents. Injuries on extraoral soft tissues were mostly laceration and abrasion, while gingival and lip mucosa lacerations prevailed on intraoral soft tissues injuries. Radiographically, the most common finding was an increase of the periodontal ligament space. The most commonly performed treatment was root canal therapy. Within the limits of this study, it can be concluded that traumatic dental injuries occur more frequently in young male individuals, due to falls and bicycle accidents. Subluxation was the most common type of periodontal ligament injury. Root canal therapy was the type of treatment most commonly planned and performed.

  11. Distribution of 3H-fucose in the transseptal ligament of the mouse

    International Nuclear Information System (INIS)

    The present study demonstrated 3H-fucose distribution in three regions of the transseptal ligament; the middle, mesial (adjacent to the first molar tooth) and distal (adjacent to the second molar tooth) thirds; og 6-week- and 6-month-old Swiss mice. Incorporation of the isotope was rapid and maximal peaks occurred at 3 hours in most regions of 6-month and at 12 h in most regions of 6-wk animals: highest grain counts were over the middle third of the ligament of 6-wk animals (p<0.001). During incorporation, mean grain counts were significantly different as a function of age (p<0.001), region (p<0.01) and time (p<0.001) and there was a significant interaction between region and time (p<0.005). Grain removal occurred at a slower rate: there were significant differences in mean grain counts as a function of age (p<0.001), region (p<0.001) and time (p<0.001) and a significant interaction between time and region (p<0.001) and between time, region and age (p<0.001). The highest rate of grain removal was in the middle third of the ligament of 6-wk animals. Half-life of labeled glycoproteins was shortest in the ligament of 6-wk animals. The study suggested regional differences in metabolism of fucose-containing glycoproteins of the transseptal ligament: highest turnover rates in the 1) middle third, and 2) young animals. (author)

  12. Magnetic resonance imaging identification of muscular and ligamentous structures of the female pelvic floor

    International Nuclear Information System (INIS)

    The objective was to determine the frequency and to assess the interobserver agreement of identification of muscular and ligamentous pelvic floor structures using magnetic resonance imaging. The method: twenty asymptomatic female volunteers (aged 20-80 years old; mean: 50) were submitted to magnetic resonance imaging (1.5 T) examinations of the pelvis. Turbo spin-echo sequences were employed to obtain T1 and T2 weighted images on axial and sagittal planes. Two independent observers evaluated the scans in order to identify the levator ani (coccygeal, pubococcygeal, iliococcygeal and puborectalis muscles), obturatorius internus and urethral sphincter muscles, and the pubovesical and pubourethral ligaments. The frequency and the interobserver agreement of the identification of the anatomical structures were assessed (kappa statistic - κ). The results: the frequency of identification of the structures ranged from 50 to 100%, and was slightly lower for identification of the ligaments. Interobserver agreement was as follows: levator ani and obturatorius internus muscle (κ=1), pubococcygeal (κ=0.62), iliococcygeal (κ=0.86), puborectalis (κ= 0.27), coccygeal (κ=0) and urethral sphincter muscles (κ=1), pubovesical (κ=0.50) and pubourethral (κ=0.58) ligaments. The conclusion: magnetic resonance imaging of the pelvis allowed precise identification of the main muscular and ligamentous pelvic floor structures in most individuals, whereas interobserver agreement was considered good. (author)

  13. “Floating popliteus tendon injury” in a mutiple-ligament knee injury: one case report and arthroscopy-assisted reconstruction

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jin; FENG Hua; HONG Lei; WANG Xue-song; ZHANG Hui

    2011-01-01

    A patient with both a femoral attachment injury (peel-off injury) and musculotendinous junction avulsion of the popliteus,a so-called “floating popliteus tendon injury”,received arthroscopy-assisted popliteus reconstruction.The injured ligaments were addressed in the same procedure,including mini-open direct repair of the femoral avulsed fibular collateral ligament (FCL),suture repair of the grade 3 medial collateral ligament (MCL),and reconstruction of the posterior cruciate ligament (PCL).

  14. Multiple Looping Technique for Tibial Fixation in Posterior Cruciate Ligament Reconstruction of the Knee

    OpenAIRE

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak; Lee, Jae Woo

    2015-01-01

    The outcomes of posterior cruciate ligament reconstruction may be negatively affected by insufficient tibial tunnel fixation due to relatively lower bone density of the proximal tibia. We introduce a new technique of tibial fixation for posterior cruciate ligament reconstruction using free tendon Achilles allograft that is less affected by the bone density of the tibial metaphysis.

  15. Neutralization of low energy broad ion beam

    International Nuclear Information System (INIS)

    The paper is devoted to experimental and theoretical investigation of a low energy broad ion beam space charge and current compensation and ion-beam plasma (IBP), which would be created in transport space of the beam. The beam had cylindrical symmetry. The continuous uniform and hole tube like ion beams are used in the experiments. Different channels of electron appearing have been investigated for cases of neutralization due to secondary γ-electrons from the target and by electrons from glow cathode-neutralizer with metal or dielectric target. Results of neutralizing electrons energy distributions function measurements are presented as well as dependences of electron temperature and self-consisted plasma potential vs. beam parameters, ambient gas pressure, neutralizer parameters. Role of the thermoelectrons and dependence of IBP parameters on neutralizer area, location and potential are discussed. Significant role in neutralization of spatial collisional processes has been revealed even in neutralization by thermocathode. On the base of the experimental results self-consistent theoretical model have been developed, which describes the behavior of intense ion beam passing through the neutral gas at low pressure within conductive walls. The collisionless approach is used which means absence of collisional relaxation of the beam. This theory is used to derive the plasma potential and electron temperature within the beam

  16. Ulnar Collateral Ligament Repair: An Old Idea With a New Wrinkle.

    Science.gov (United States)

    Dugas, Jeffrey R

    2016-01-01

    At our practice, we have successfully treated thousands of overhead athletes with the modified Jobe technique of ulnar collateral ligament (UCL) repair. We used this technique regardless of the amount and location of the pathology encountered at the time of surgery. We asked whether the availability of modern anchor and suture technology, vast clinical experience with these injuries and their outcomes, and even biologic additives could be applied to some of these patients to achieve an equal or superior outcome in less time. This led us to create a construct that could be used to not only repair the torn native UCL tissue to bone, but also span the anatomic native ligament from its origin to its insertion. This construct includes an ultra-strong collagen coated tape attached at the anatomic insertions of the ligament using two 3.5-mm nonabsorbable PEEK corkscrew anchors and a suture through the eyelet of one of the anchors. PMID:26991563

  17. Morinda citrifolia leaves enhance osteogenic differentiation and mineralization of human periodontal ligament cells.

    Science.gov (United States)

    Boonanantanasarn, Kanitsak; Janebodin, Kajohnkiart; Suppakpatana, Prapan; Arayapisit, Tawepong; Rodsutthi, Jit-aree; Chunhabundit, Panjit; Boonanuntanasarn, Surintorn; Sripairojthikoon, Wanida

    2014-01-01

    This present study investigated the potential of Morinda citrifolia leaf aqueous extract to induce osteogenic differentiation and matrix mineralization of human periodontal ligament (hPDL) cells. Human periodontal ligament cells were cultured in complete medium, ascorbic acid with β-glycerophosphate, or Morinda citrifolia leaf aqueous extract. Morinda citrifolia leaf aqueous extract significantly increased alkaline phosphatase activity compared to culturing in complete medium or ascorbic acid with β-glycerophosphate. Matrixcontaining mineralized nodules were formed only when the cells were cultured in the presence of Morinda citrifolia leaf aqueous extract. These nodules showed positive alizarin red S staining and were rich in calcium and phosphorus according to energy dispersive X-ray analysis. In conclusion, Morinda citrifolia leaf extract promoted osteogenic differentiation and matrix mineralization in human periodontal ligament cells, a clear indication of the therapeutic potential of Morinda citrifolia leaves in bone and periodontal tissue regeneration. PMID:24682022

  18. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves

    Energy Technology Data Exchange (ETDEWEB)

    Kijowski, Richard; Tuite, Michael; Sanford, Matthew [University of Wisconsin Hospital, Department of Radiology, Madison, WI (United States)

    2005-01-01

    Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears of the ulnar collateral ligament and lateral collateral ligament of the elbow with high sensitivity and specificity. Magnetic resonance imaging can determine the extent of tendon pathology in patients with medial epicondylitis and lateral epicondylitis. Magnetic resonance imaging can detect tears of the biceps tendon and triceps tendon and can distinguishing between partial and complete tendon rupture. Magnetic resonance imaging is also helpful in evaluating patients with nerve disorders at the elbow. (orig.)

  19. Diagnostic value of stress radiography in lesions of the lateral ligaments of the ankle

    International Nuclear Information System (INIS)

    The diagnostic accuracy of inversion and anterior stress radiography in rupture of the lateral ligaments of the ankle joint was assessed in 56 patients undergoing surgery. In inversion stress radiography, 58% of the patients with confirmed rupture of the lateral ligaments of the ankle had a talar tilt of 10 degrees or more, allowing a predicitive value of a positive test of 94%. In anterior stress radiography, 53% of the patients had a posterior tibiotalar distance of 9 mm or more, allowing a predictive value of a positive test of 81%. In measurements of talar tilt and anterior displacement of the talus values higher than normal in the injured ankle may be a sign of a rupture of the lateral ligament. (orig.)

  20. The diagnosis of ligament injuries of the ankle joint using pressure during exposures

    International Nuclear Information System (INIS)

    Pressure exerted against the ankle joint during lateral exposures shows a typical form of subluxation of the talus in respect of the tibia if there has been rupture of the anterior fibulo-talar ligament. This displacement can be quantified by using the standard technique of Seiler and Holzrichter. Retrospective evaluation of exposures carried out with pressure in 206 patients with stretching or rupture of the ligaments of the ankle joint have shown that stretching can be diagnosed if the joint space reaches 7 mm, and a rupture can be diagnosed with a joint space of 11 mm. If there is a difference of more than 5 mm in the joint space of the two joints, a rupture is present. With these criteria, 85% of all ligament injuries can be correctly diagnosed. In the remaining 15%, early arthrography provides the necessary information. (orig.)

  1. Magnetic resonance imaging of the elbow. Part II: Abnormalities of the ligaments, tendons, and nerves

    International Nuclear Information System (INIS)

    Part II of this comprehensive review on magnetic resonance imaging of the elbow discusses the role of magnetic resonance imaging in evaluating patients with abnormalities of the ligaments, tendons, and nerves of the elbow. Magnetic resonance imaging can yield high-quality multiplanar images which are useful in evaluating the soft tissue structures of the elbow. Magnetic resonance imaging can detect tears of the ulnar collateral ligament and lateral collateral ligament of the elbow with high sensitivity and specificity. Magnetic resonance imaging can determine the extent of tendon pathology in patients with medial epicondylitis and lateral epicondylitis. Magnetic resonance imaging can detect tears of the biceps tendon and triceps tendon and can distinguishing between partial and complete tendon rupture. Magnetic resonance imaging is also helpful in evaluating patients with nerve disorders at the elbow. (orig.)

  2. [Revision of the anterior cruciate ligament in TransFix(R)- and OATS(R)-technique].

    Science.gov (United States)

    Attmanspacher, W; Dittrich, V; Stedtfeld, H W

    2002-10-01

    Transplant failure after anterior cruciate ligament-plastic is a typical complication. In larger collectives, revisions amount to about 8-12 % of the reconstructive operations of the anterior cruciate ligament. The number of revisions is also growing in our clinic and makes at present 11 %. There are different reasons of transplant failure. Many mistakes occur as a result of technical pitfalls during the preparation. A new "adequate trauma" is rarely the cause of a rerupture. In this paper a new concept of revision in failed anterior cruciate ligament reconstructions will be presented, which can be frequently performed as one-step technique even in bone tunnel enlargement or sclerosis of the tunnel. Our results in 21 cases will be discussed with the literature. In our opinion the TransFix(R) technique, if necessary in conjunction with the OATS(R) technical equipment, is a reproducable alternative for one step revision surgery and should be recommended. PMID:12410451

  3. Effect of storage media on the proliferation of periodontal ligament fibroblasts

    International Nuclear Information System (INIS)

    The effect of storage media, which are routinely used in replantation, upon the proliferative capacity of periodontal ligament fibroblasts, was compared with the effect of a tissue culture medium. The periodontal tissue was obtained from mandibular central incisors of White New Zealand rabbits. The experiments were performed in fibroblasts derived during second subculture. The storage media were physiologic salt solution, Ringer's solution and Rivanol; the tissue culture medium was alpha-minimum essential medium without nucleosides. The incubation period was 1 hour. [3H]-thymidine incorporation and cell counts were taken to indicate changes in the proliferative capacity of the fibroblasts. The tissue culture experiments showed that the proliferative ability of the periodontal ligament fibroblasts was dependent upon the composition of the storage medium. Physiologic salt solution, Ringer's solution and Rivanol were unable to maintain the metabolism of the fibroblasts. alpha-MEM medium, however, was capable of stimulating proliferation of the periodontal ligament fibroblasts

  4. Clinical and radiographic evaluation of a polyester prosthesis in dogs with cranial cruciate ligament rupture

    International Nuclear Information System (INIS)

    Clinical and radiographic findings after intra-articular replacement of cranial cruciate ligament with a polyester prosthesis using a modified over-the-top technique were evaluated in six dogs. Seven surgeries were done due to bilateral involvement of the cranial cruciate ligament in one dog. Clinical evaluation was performed on postoperative days 3, 10 and 40, and radiographic evaluation was done at 5 and 24 months after surgery in five dogs, where signs of progressive degenerative joint disease were confirmed. Resolution of clinical signs was observed from 25 to 68 days after surgery as evaluated by dog owners. Overall function of joint movement after surgery was classified as good. Two dogs presented fraying of the implant after surgery. It was concluded that the polyester prosthesis, as implanted in these dogs, was not a satisfactory replacement for the injured ligament, as better results may be obtained with less invasive and simpler techniques

  5. Radiographer led supplementary anterior cruciate ligament MRI sequences: Technical report

    International Nuclear Information System (INIS)

    Aims: To compare different supplementary MRI sequences of the ACL to arthroscopy and determine the diagnostic performance of each sequence. To ascertain whether radiographers could identify patients requiring supplementary MRI sequences of anterior cruciate ligament (ACL) tears, without a supervising radiologist. Methods: The study had ethical approval and two hundred and thirty one consecutive prospective MRI patients with mechanical knee symptoms (77 females, 154 males, of mean age 43.5, range 18–82 years) gave written informed consent. They then had a knee arthroscopy within seven days of the MRI. This was a pragmatic study to see if the six general MRI radiographers, each with over four years experience, could evaluate the ACL on routine orthogonal sequences (sagittal T1, Gradient Echo T2, Coronal STIR and axial fat suppressed dual echo). If they identified no ACL, then two 3D volume sequences (Dual Echo Steady State and Fast Low Angle Shot) and 2D limited sagittal oblique T1 sequences were also performed. Patients requiring extra sequences, missed by the radiographers, were recalled. The MRI sequences were independently evaluated in a blinded fashion by two consultant radiologists and a specialist radiology registrar and compared to the subsequent knee arthroscopy, as the gold standard, to determine the diagnostic performance statistics. Results: The cohort was on the knee arthroscopy weighting list and comprised 205 patients with chronic, 20 acute and 6 acute on chronic mechanical knee symptoms. There were no posterior cruciate, medial, or lateral collateral ligament tears at arthroscopy, used as the gold standard. The arthroscopy was normal and the radiographers correctly did not scan the extra sequence in 140 patients (72%) who then had normal arthroscopies. The radiographers did perform additional ACL sequences in 63 patients (27%). Of these, 10 patients had a partial and 12 complete ACL tears. Only two patients (0.9%) were recalled for additional

  6. Quantitative comparison of ligament formulation and pre-strain in finite element analysis of the human lumbar spine.

    Science.gov (United States)

    Hortin, Mitchell S; Bowden, Anton E

    2016-11-01

    Data has been published that quantifies the nonlinear, anisotropic material behaviour and pre-strain behaviour of the anterior longitudinal, supraspinous (SSL), and interspinous ligaments of the human lumbar spine. Additionally, data has been published on localized material properties of the SSL. These results have been incrementally incorporated into a previously validated finite element model of the human lumbar spine. Results suggest that the effects of increased ligament model fidelity on bone strain energy were moderate and the effects on disc pressure were slight, and do not justify a change in modelling strategy for most clinical applications. There were significant effects on the ligament stresses of the ligaments that were directly modified, suggesting that these phenomena should be included in FE models where ligament stresses are the desired metric. PMID:27007776

  7. Anterior cruciate ligament reconstruction in a patient with Athetoid cerebral palsy: a case report

    Directory of Open Access Journals (Sweden)

    Tajima Takuya

    2012-10-01

    Full Text Available Abstract Recent years have seen ACL reconstruction performed in a broad range of patients, regardless of age, sex or occupation, thanks to great advances in surgical techniques, instrumentation and the basic research. Favorable results have been reported; however, we have not been able to locate any reports describing ACL reconstruction in patients with athetoid cerebral palsy. We present herein a previously unreported anterior cruciate ligament (ACL reconstruction performed in a patient with athetoid cerebral palsy. The patient was a 25-year-old woman with level II athetoid cerebral palsy according to the Gross Motor Function Classification System. She initially injured her right knee after falling off a bicycle. Two years later, she again experienced right-knee pain and a feeling of instability. A right-knee ACL tear and avulsion fracture was diagnosed upon physical examination and confirmed with magnetic resonance imaging (MRI and X-ray examination at that time. An ACL reconstruction using an autologous hamstring double-bundle graft was performed for recurrent instability nine years after the initial injury. Cast immobilization was provided for 3 weeks following surgery and knee extension was restricted for 3 months with the functional ACL brace to prevent hyperextension due to involuntary movement. Partial weight-bearing was started 1 week postoperatively, with full weight-bearing after 4 weeks. The anterior drawer stress radiography showed a 63% anterior displacement of the involved tibia on the femur six months following the surgery, while the contralateral knee demonstrated a 60% anterior displacement of the tibia. The functional ACL functional brace was then removed. A second-look arthroscopy was performed 13 months after the ACL reconstruction, and both the anteromedial and posterolateral bundles were in excellent position as per Kondo’s criteria. The Lachman and pivot shift test performed under anesthesia were also negative. An

  8. Revision Anterior Cruciate Ligament Reconstruction in Military Personnel.

    Science.gov (United States)

    Balazs, George C; Grimm, Patrick D; Donohue, Michael A; Keblish, David J; Rue, John-Paul

    2016-08-01

    This study aims to report the clinical and functional outcomes of revision anterior cruciate ligament (ACL) reconstruction in a young, active duty military population. Patients undergoing revision ACL reconstruction were enrolled in an institutional clinical database and followed prospectively. The primary outcomes were patients' scores on a timed run, as compared with recorded scores before reinjury. Secondary outcomes included scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the International Knee Documentation Committee subjective (IKDC subjective), the Short Form - 36 health survey (SF-36) version 2, the Single Assessment Numeric Evaluation (SANE), and the Tegner activity scale. A total of 13 patients were identified who met the inclusion criteria and had complete follow-up. The mean age at revision ACL reconstruction was 20.5 years (range, 19-22 years), and mean follow-up was 40.2 months (range, 13-66 months). All patients underwent a single stage revision ACL reconstruction with ipsilateral bone-patellar tendon-bone autograft, ipsilateral hamstring autograft, or bone-tendon-bone allograft. Mean physical readiness test (PRT) score at final follow-up was not statistically different than documented preinjury PRT score (77.9 vs. 85.5, p > 0.05), nor was the mean run time (7:12 vs. 6:43/mile, p > 0.05). Significant improvements exceeding published minimal clinically important differences were seen in SANE score, SF-36 physical component summary score, KOOS sports and recreation, KOOS quality of life, WOMAC pain score, and WOMAC function score. Patients undergoing revision ACL reconstruction at our facility show good recovery of baseline physical performance as measured by the semiannual PRT and timed run test, and significant improvements in patient-reported outcome scores. Level of Evidence Level IV, case series. PMID:26524090

  9. Managing ankle ligament sprains and tears: current opinion

    Directory of Open Access Journals (Sweden)

    McGovern RP

    2016-03-01

    Full Text Available Ryan P McGovern,1 RobRoy L Martin,1,2 1Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, 2Centers for Sports Medicine – University of Pittsburgh, Pittsburgh, PA, USA Abstract: The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI, interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI. Keywords: reinjury, chronic ankle instability, rehabilitation techniques, diagnosis, intervention, athlete

  10. Ultrasonographic test for complete anterior cruciate ligament injury

    Directory of Open Access Journals (Sweden)

    Piotr Grzelak

    2015-01-01

    Full Text Available Background: Although ultrasound (US has a wide range of applications in orthopedic diagnostics, sonographic evaluation of traumatic anterior cruciate ligament (ACL insufficiency is still inadequate. There is a growing need for diagnostic tests that allow for simple and reliable assessment of ACL instability. This investigation aims to evaluate feasibility of sonographic technique for diagnosing complete ACL insufficiency. Materials and Methods: Eighty three consecutive patients suspected of ACL injury were examined with sonographic, dynamic test of anterior instability. The translation of the intercondylar eminence against the patellar tendon was measured in the injured and opposite (injured knee. Subsequent magnetic resonance imaging was performed on all patients. Forty-seven of them underwent a further arthroscopy. Five patients have been examined for the 2 nd time to evaluate interclass and intraclass agreement and bias. Results: Complete ACL insufficiency has been confirmed in 37 patients. In those individuals, the total anterior knee translation and the difference between two joints (side-to-side difference were significantly increased (8.67 mm standard deviation [SD] 2.65 mm in the affected knee versus 2.88 mm SD 1.26 mm in uninjured joint; P < 0.001. Based on a threshold of 2.0 mm for the side-to-side difference and 5.0 mm for the absolute translation, the sonographic test was found to have a sensitivity and specificity of 91.9% and 95.6%, respectively. Conclusions: The present technique supports the clinician with additional fast and noninvasive diagnostic procedure that can facilitate the evaluation of anterior knee instability.

  11. Factors affecting proprioceptive recovery after anterior cruciate ligament reconstruction

    Institute of Scientific and Technical Information of China (English)

    ZHOU Mou-wang; GU Li; CHEN Ya-ping; YU Chang-long; AO Ying-fang; HUANG Hong-shi; YANG Yan-yan

    2008-01-01

    Background Proprioception plays an important role in knee movements.Since there are controversies surrounding the overall recovery time of proprioception following surgery,it is necessary to define the factors affecting proprioceptive recovery after anterior cruciate ligament (ACL) reconstruction and to investigate the relationship between proprioception and muscle strength.Methods A total of 36 patients who had their ACL reconstructed with a semitendinosus/gracilis graft (reconstructed group:6 months post-surgery) and 13 healthy adults without any knee injury (control group) were included in the study.Knee proprioception was evaluated with a passive reproduction test.Isokinetic strength was measured using the Biodex System.Statistical analysis was used to compare proprioception of the reconstructed group versus the control group,and to define causal factors,including sex,hamstring/quadriceps ratio,and the course of injury before reconstruction.We also investigated the correlation between the passive reproduction error and quadriceps index.Results There was a significant difference in proprioception between the reconstructed and control groups (P <0.05).When the course of injury before reconstruction was less than 4 months,there was a linear correlation with proprioception 6 months after the operation (r=0.713,P <0.05).There was a positive correlation between post-surgery proprioception and the quadriceps index at 6 months post-surgery.Conclusions Impaired knee proprioception is observed 6 months after ACL reconstruction.Within 4 months of injury,early undertaking of reconstruction is associated with better proprioception outcome.Patients with enhanced proprioception have a better quadriceps index.

  12. Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears

    International Nuclear Information System (INIS)

    Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion

  13. Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo; Lee, Jae Gue; Park, Ji Seon; Ryu, Kyung Nam [Kyunghee Univ., Seoul (Korea, Republic of)

    2004-02-01

    Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion.

  14. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

    2015-10-15

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

  15. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

    International Nuclear Information System (INIS)

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

  16. The Influence of Component Alignment and Ligament Properties on Tibiofemoral Contact Forces in Total Knee Replacement.

    Science.gov (United States)

    Smith, Colin R; Vignos, Michael F; Lenhart, Rachel L; Kaiser, Jarred; Thelen, Darryl G

    2016-02-01

    The study objective was to investigate the influence of coronal plane alignment and ligament properties on total knee replacement (TKR) contact loads during walking. We created a subject-specific knee model of an 83-year-old male who had an instrumented TKR. The knee model was incorporated into a lower extremity musculoskeletal model and included deformable contact, ligamentous structures, and six degrees-of-freedom (DOF) tibiofemoral and patellofemoral joints. A novel numerical optimization technique was used to simultaneously predict muscle forces, secondary knee kinematics, ligament forces, and joint contact pressures from standard gait analysis data collected on the subject. The nominal knee model predictions of medial, lateral, and total contact forces during gait agreed well with TKR measures, with root-mean-square (rms) errors of 0.23, 0.22, and 0.33 body weight (BW), respectively. Coronal plane component alignment did not affect total knee contact loads, but did alter the medial-lateral load distribution, with 4 deg varus and 4 deg valgus rotations in component alignment inducing +17% and -23% changes in the first peak medial tibiofemoral contact forces, respectively. A Monte Carlo analysis showed that uncertainties in ligament stiffness and reference strains induce ±0.2 BW uncertainty in tibiofemoral force estimates over the gait cycle. Ligament properties had substantial influence on the TKR load distributions, with the medial collateral ligament and iliotibial band (ITB) properties having the largest effects on medial and lateral compartment loading, respectively. The computational framework provides a viable approach for virtually designing TKR components, considering parametric uncertainty and predicting the effects of joint alignment and soft tissue balancing procedures on TKR function during movement. PMID:26769446

  17. Broad spectrum anthelmintic potential of Cassia plants

    Institute of Scientific and Technical Information of China (English)

    Suman Kundu; Saptarshi Roy; Larisha Mawkhleing Lyndem

    2014-01-01

    Objective: To study the in vitro anthelmintic efficacy of Cassia alata (C. alata), Cassia(C. angustifolia) and Cassia occidentalis (C. occidentalis). angustifolia Methods: Crude ethanol extract from leaves of the three plants were prepared in rotary evaporator and different concentrations (10, 20 and 40 mg/mL) of leaf extracts were used for treatment on different representatives of helminthes (Heterakis gallinarum, Raillietina tetragona and Catatropis sp.) from domestic fowl (Gallus gallus domesticus). Loss of motility and death were monitored frequently.Results: C. alata showed early paralysis in all worms treated followed by C. angustifolia. C. occidentalis in combination with C. alata together caused early paralysis in all treated worms than the combination of C. alata with C. angustfolia. While Heterakis gallinarum in control survived for (81.33±2.07) h, treated worms lost their motility at (5.71±0.10) h, (6.60±0.86) h and (13.95±0.43) h with C. angustifolia, C. alata and C. occidentalis respectively at a concentration of 40 mg/mL which showed better efficacy than albendazole. Catatropis sp. survival period was (26.49±1.38) h in control, but with plant treatment, it lost its motility in just (0.57±0.08) h, (1.00±0.12) h and (1.47±0.40) h at 40 mg/mL concentration of C. alata, C. angustifolia and C. occidentalis respectively.Raillietina tetragona on the other hand became paralysed at (1.68±0.27) h, (2.95±0.29) h and (4.13±0.31) h with above concentrations treated with three plants respectively, however in control it survived up to (81.93±4.71) h.Conclusions:This present study indicated broad spectrum vermifugal activity of all plants tested.

  18. Microlensing of Quasar Broad Emission Lines: Constraints on Broad Line Region Size

    CERN Document Server

    Guerras, E; Jimenez-Vicente, J; Kochanek, C S; Muñoz, J A; Falco, E; Motta, V

    2012-01-01

    We measure the differential microlensing of the broad emission lines between 18 quasar image pairs in 16 gravitational lenses. We find that high ionization lines such as CIV are more strongly microlensed than low ionization lines, indicating that the high ionization line emission regions are more compact. If we statistically model the distribution of microlensing magnifications, we obtain estimates for the broad line region radius of 24 (-15/+22) and 55 (-35/+150) light-days (90% confidence) for the high and low ionization lines, respectively. When the sample is divided attending to quasar luminosity, we find that the line emission regions of more luminous quasars are larger, with a slope consistent with the expected scaling from photoionization models. Our estimates also agree well with the results from local reveberation mapping studies.

  19. Symmetric limb overgrowth following anterior cruciate ligament reconstruction in a skeletally immature patient.

    Science.gov (United States)

    Zimmerman, Lance J; Jauregui, Julio J; Riis, Jacob F; Tuten, Hans Robert

    2015-11-01

    This report describes a case of symmetric femoral and tibial overgrowth of 2.8 cm in a 13-year-old patient after undergoing reconstruction surgery for his torn right anterior cruciate ligament. A literature review of previous cases is also provided. Following a pediatric anterior cruciate ligament tear, delaying surgery until the patient approaches skeletal maturity may avoid long-term growth disturbances, however, delaying this procedure may increase the probability of further joint damage. This growth disturbance was managed with a percutaneous epiphysiodesis that corrected the limb length deformity. PMID:25919804

  20. MR imaging of the knee following cruciate ligament reconstruction and meniscal surgery

    International Nuclear Information System (INIS)

    Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications. (orig.)