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Pruneski JA, Heyworth BE, Kocher MS, Tavabi N, Milewski MD, Kramer DE, Christino MA, Yen YM, Micheli LJ, Murray MM, Gilreath L, Kim A, Murray J, Kiapour AM. Prevalence and Predictors of Concomitant Meniscal and Ligamentous Injuries Associated With ACL Surgery: An Analysis of 20 Years of ACL Reconstruction at a Tertiary Care Children's Hospital. Am J Sports Med 2024; 52:77-86. [PMID: 38164668 DOI: 10.1177/03635465231205556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. HYPOTHESIS There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). RESULTS Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). CONCLUSION These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.
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Affiliation(s)
- James A Pruneski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nazgol Tavabi
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Christino
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha M Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leah Gilreath
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Kim
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Nusia J, Xu JC, Knälmann J, Sjöblom R, Kleiven S. Injury risk functions for the four primary knee ligaments. Front Bioeng Biotechnol 2023; 11:1228922. [PMID: 37860626 PMCID: PMC10582698 DOI: 10.3389/fbioe.2023.1228922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/21/2023] Open
Abstract
The purpose of this study was to develop injury risk functions (IRFs) for the anterior and posterior cruciate ligaments (ACL and PCL, respectively) and the medial and lateral collateral ligaments (MCL and LCL, respectively) in the knee joint. The IRFs were based on post-mortem human subjects (PMHSs). Available specimen-specific failure strains were supplemented with statistically generated failure strains (virtual values) to accommodate for unprovided detailed experimental data in the literature. The virtual values were derived from the reported mean and standard deviation in the experimental studies. All virtual and specimen-specific values were thereafter categorized into groups of static and dynamic rates, respectively, and tested for the best fitting theoretical distribution to derive a ligament-specific IRF. A total of 10 IRFs were derived (three for ACL, two for PCL, two for MCL, and three for LCL). ACL, MCL, and LCL received IRFs in both dynamic and static tensile rates, while a sufficient dataset was achieved only for dynamic rates of the PCL. The log-logistic and Weibull distributions had the best fit (p-values: >0.9, RMSE: 2.3%-4.7%) to the empirical datasets for all the ligaments. These IRFs are, to the best of the authors' knowledge, the first attempt to generate injury prediction tools based on PMHS data for the four knee ligaments. The study has summarized all the relevant literature on PHMS experimental tensile tests on the knee ligaments and utilized the available empirical data to create the IRFs. Future improvements require upcoming experiments to provide comparable testing and strain measurements. Furthermore, emphasis on a clear definition of failure and transparent reporting of each specimen-specific result is necessary.
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Affiliation(s)
- Jiota Nusia
- Department of Traffic Safety and Traffic Systems, The Swedish National Road and Transport Research Institute (VTI), Stockholm, Sweden
| | - Jia-Cheng Xu
- Department of Traffic Safety and Traffic Systems, The Swedish National Road and Transport Research Institute (VTI), Stockholm, Sweden
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Johan Knälmann
- Department of Strength and Crash Analysis, Scania CV AB, Södertälje, Sweden
| | - Reimert Sjöblom
- Department of Strength and Crash Analysis, Scania CV AB, Södertälje, Sweden
| | - Svein Kleiven
- Division of Neuronic Engineering, KTH Royal Institute of Technology, Stockholm, Sweden
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Knisely B, Noland SS, Melville DM. Ultrasound versus MRI in the evaluation of the thumb metacarpophalangeal joint. J Ultrason 2023; 23:e214-e222. [PMID: 38020517 PMCID: PMC10668926 DOI: 10.15557/jou.2023.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 12/01/2023] Open
Abstract
An intricate and unique combination of ligamentous, fibrocartilaginous, and osseous structures stabilize the thumb metacarpophalangeal joint. Both ultrasound and high-resolution magnetic resonance imaging are extremely useful in evaluating these critical structures. This article reviews common injuries of the thumb metacarpophalangeal joint, while highlighting the merits, limitations, and pitfalls of the two imaging modalities. A clear appreciation of each method, paired with anatomic knowledge, will lend greater confidence and accuracy to diagnosing impactful injuries and guiding intervention.
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Levy KH, Kurtzman JS, Horowitz EH, Dar QA, Hayes WT, Koehler SM. Proximal Interphalangeal Joint Congruity: A Biomechanical Study. Hand (N Y) 2023; 18:938-944. [PMID: 35156413 PMCID: PMC10470231 DOI: 10.1177/15589447211060419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity. METHODS Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA). RESULTS Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion. CONCLUSIONS Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.
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Holderread BM, Jafarnia J, Phelps B, Perrin M, Jack RA, Harris JD, Liberman SR. Return to Sport and Performance After Thumb Metacarpophalangeal Joint Collateral Ligament Surgery in the National Basketball Association. Cureus 2023; 15:e42499. [PMID: 37637654 PMCID: PMC10456974 DOI: 10.7759/cureus.42499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Basketball players are at increased risk of thumb collateral ligament injury (ulnar collateral ligament (UCL) and radial collateral ligament (RCL)). Methods The National Basketball Association (NBA) players with thumb collateral ligament surgery were identified using publicly available data. Performance statistics, ligament injuries (UCL or RCL), return to sport (RTS) time, laterality, and injury dates were recorded. Cases were matched 1:1 with controls based on age (±1 year), body mass index (BMI), NBA experience (±1 year), and performance statistics prior to the index date. RTS was defined as playing in one NBA game postoperatively. Career longevity was evaluated. Summary statistics were calculated, and Student's t-tests (ɑ = 0.001) were performed. Results All 47 players identified with thumb collateral ligament surgeries returned to sport. Thirty-three players (age: 26.9 ± 3.0) had one year of postoperative NBA experience for performance analysis. Career length (case: 9.6 ± 4.1, control: 9.4 ± 4.3, p > 0.001) was not significantly different from controls (p > 0.001). The same season time to RTS (n = 20) was 7.1 ± 2.4 weeks. Off-season or season-ending surgery (n = 13) RTS time was 28.4 ± 18.7 weeks. Neither thumb collateral ligament (UCL, n = 7; RCL, n = 10; unknown, n = 16) had an identifiable difference between the groups when evaluating career length. Career length, games/season, and performance were not different for players who underwent surgery on their dominant thumb (63.6%, 21/33) compared to controls (p > 0.001). Conclusion RTS rate is high in NBA athletes undergoing thumb collateral ligament surgery. Players do not experience decreased performance or career length due to thumb collateral ligament surgery, regardless of a dominant or non-dominant thumb injury.
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Affiliation(s)
| | - Jordan Jafarnia
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Brian Phelps
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Mark Perrin
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Robert A Jack
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Joshua D Harris
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
| | - Shari R Liberman
- Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, USA
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Smith TA, Bueno B, Phelan JV, Anand D, Kirschenbaum D, Katt BM. Stener-Like Lesions in the Hand: A Qualitative Review. Hand (N Y) 2023:15589447231171655. [PMID: 37212201 DOI: 10.1177/15589447231171655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A Stener-like lesion is defined as the interposition of the sagittal band between the torn collateral ligament of the metacarpophalangeal (MCP) joint of a finger and its origin or insertion. Owing to the rarity of this injury, standardized protocols on the diagnosis and care of these injuries are not currently available. PubMed Central and Google Scholar were searched for published studies from 1962 to 2022. Inclusion criteria admitted any injury of the MCP joints of any nonthumb fingers involving a torn collateral ligament with sagittal band injury that trapped the collateral ligament. Eight studies were ultimately included in our analysis and contained 11 cases of Stener-like lesions. Eight of the 11 cases presented radial collateral ligament injury to the ring and little fingers. All 11 cases presented showed that detailed physical examination was a primary step in diagnosis of these lesions. Metacarpophalangeal joint laxity was present in all cases reported. Imaging-aided diagnosis was used in majority of the cases presented and included arthrography, ultrasound, or magnetic resonance imaging. All cases presented in this review were managed surgically. Following surgical repair, a majority of authors opted to use immobilization techniques immediately postoperatively. As awareness of this injury pattern increases, a standardized treatment algorithm may develop.
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Affiliation(s)
- Tiffany A Smith
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian Bueno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Joseph V Phelan
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Divya Anand
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Brian M Katt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Mallory A, Kender A, Valek A, Badman B, Stammen J. Knee ligament injuries in U.S. pedestrian crashes. Traffic Inj Prev 2022; 23:452-457. [PMID: 35793173 DOI: 10.1080/15389588.2022.2086978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Projectile legform tests are used to evaluate pedestrian lower extremity injury risk, including risk of injury to the cruciate and collateral ligaments. However, it has been suggested that cruciate ligament injuries rarely occur without collateral ligament injuries, making a cruciate ligament injury requirement unnecessary in pedestrian test procedures. Therefore, the current study examines cruciate ligament injuries among U.S. pedestrians with and without other injuries that are evaluated in pedestrian test procedures. METHODS Injury data for pedestrians treated in U.S. trauma centers from 2007 to 2017 were drawn from the National Trauma Data Bank (NTDB) Research Data Set (RDS) and from its successor, the Trauma Quality Program (TQP) Participant User Files (PUF). Crash and demographic details for individual cases with documented knee ligament injuries were obtained from the Pedestrian Crash Data Study (PCDS). RESULTS Among pedestrians aged 16 and older with knee ligament injuries, 38% had only collateral injuries, 31% had only cruciate injuries and 31% were documented with injuries to both. Younger pedestrians also sustained cruciate injuries without collateral injuries, with 36% of the 0-15 year-old pedestrians diagnosed with knee ligament injuries having isolated cruciate injuries. Given that injuries to the left and right knee could not be distinguished in NTDB cases, these estimates of isolated ligament injuries are likely conservative, so that at least 31% of pedestrians aged 16 and older and at least 36% of younger pedestrians sustained cruciate ligament injuries without collateral ligament injuries in the same knee. A PCDS case study illustrated how cruciate injury can occur without collateral injury in a lateral bumper impact below the knee. CONCLUSIONS Cruciate ligament injuries can occur in pedestrian crashes, with or without other injuries that are evaluated in pedestrian test procedures. Isolated cruciate injuries may be more likely in impacts above or below the knee and in impacts with a component of anterior-posterior loading. The frequency of cruciate injury in the absence of collateral injury in lateral and non-lateral impact supports inclusion of injury measures correlating to cruciate injury risk in pedestrian legform test procedures.
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Affiliation(s)
- A Mallory
- Transportation Research Center Inc, East Liberty, Ohio
| | - A Kender
- Transportation Research Center Inc, East Liberty, Ohio
| | - A Valek
- Transportation Research Center Inc, East Liberty, Ohio
- College of Public Health, The Ohio State University, Columbus, Ohio
| | - B Badman
- Transportation Research Center Inc, East Liberty, Ohio
- College of Public Health, The Ohio State University, Columbus, Ohio
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Arrigoni P, Cucchi D, Luceri F, Menon A, Zaolino C, Zagarella A, Catapano M, Radici M, Migliaccio N, Polli D, Randelli PS. Lateral Elbow Laxity Is Affected by the Integrity of the Radial Band of the Lateral Collateral Ligament Complex: A Cadaveric Model With Sequential Releases and Varus Stress Simulating Everyday Activities. Am J Sports Med 2021; 49:2332-2340. [PMID: 34115528 DOI: 10.1177/03635465211018208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An elongation of the radial lateral collateral complex (R-LCL) can provoke symptomatic minor instability of the lateral elbow leading to lateral elbow pain. Biomechanical models investigating the effects of elongation and partial or complete lesions of the R-LCL on lateral elbow stability are lacking. PURPOSE To evaluate how partial and complete R-LCL release affects radiocapitellar joint stability in a setting of controlled varus load and progressive soft tissue release. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen cadaveric specimens were obtained and mounted on a custom-made support to control elbow flexion and extension and to allow for controlled varus loading. Stress tests were performed on all intact specimens under gravity load alone, a 0.5-kg load applied to the hand, and a 1-kg load applied to the hand. After load application, anteroposterior radiographs were obtained. The following release sequence was applied to all specimens: release of the anterior half of the common extensor origin, pie crusting of the R-LCL, and R-LCL release. After each release, stress tests and radiographs were performed. The varus joint angulation of the elbow (α) was measured by 2 examiners as the main outcome parameter. RESULTS Significant changes in α from the initial condition occurred after each release, and a significant effect of varus load on α was documented for all release steps. A significant effect of the releases on α could be documented for all identical varus load conditions. A linear regression model was generated to describe the effect of varus load on α. CONCLUSION Varus loads simulating everyday activities produce changes in the varus joint angulation of the elbow already in the intact specimen, which are linearly dependent on the applied moment and persist after release of the lateral stabilizing structures. With progressive load, a pie crusting of the R-LCL is the minimal procedure able to provoke a significant change in the varus joint angulation, and a complete R-LCL release produces additional increase in the varus joint angulation in all testing conditions. CLINICAL RELEVANCE These findings confirm the role of the R-LCL as static lateral stabilizer, supporting a pathological model based on its insufficiency and culminating with a symptomatic minor instability of the lateral elbow.
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Affiliation(s)
- Paolo Arrigoni
- UOC 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Francesco Luceri
- UOC 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Alessandra Menon
- UOC 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Zaolino
- UOC 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Andrea Zagarella
- UOC Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Michele Catapano
- UOC Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | | | | | - Dario Polli
- Physics Department, Politecnico di Milano, Milan, Italy
| | - Pietro S Randelli
- UOC 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Research Center for Adult and Pediatric Rheumatic Diseases, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Cho BK, Woo KJ. Lateral Collateral Ligament Reconstruction Using Suture-tape for Chronic Varus Metatarsophalangeal Instability of The Hallux. J Foot Ankle Surg 2021; 59:1062-1065. [PMID: 32571727 DOI: 10.1053/j.jfas.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/15/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
Chronic varus instability or recurrent subluxation following isolated metatarsophalangeal dislocation of the hallux is a rare injury. A young Judo athlete with a history of repetitive sport injuries complained of recurrent medial dislocation of the hallux for 3 years. For prior injuries, he underwent manual reduction under local anesthesia and recovered with splint immobilization. Physical examination and fluoroscopic radiograph demonstrated the reducible but unstable first metatarsophalangeal joint to slight varus stress, and magnetic resonance imaging revealed an insufficient remnant of the lateral collateral ligament. For patients with the failed conservative treatment, no consensus has been reached regarding the best joint-salvage procedure to achieve a restoration of metatarsophalangeal stability and a fast return to sport activity. We report a case who achieved satisfactory clinical outcome through the collateral ligament reconstruction using a suture-tape.
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Affiliation(s)
- Byung-Ki Cho
- Professor, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea; Surgeon, Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Korea.
| | - Kyung-Jei Woo
- Researcher, Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
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Midtgaard KS, Nolte PC, Miles JW, Tanghe KK, Peebles LA, Provencher MT, Adolfsson L. Biomechanical significance of the collateral ligaments in transolecranon fracture-dislocations. J Shoulder Elbow Surg 2021; 30:1245-1250. [PMID: 33010439 DOI: 10.1016/j.jse.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/29/2020] [Accepted: 09/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is widely accepted that transolecranon fracture-dislocations are not associated with collateral ligament disruption. The aim of the present study was to investigate the significance of the collateral ligaments in transolecranon fractures. METHODS Twenty cadaveric elbows with a mean age of 46.3 years were used. All soft tissue was dissected to the level of the capsule, leaving the anterior band of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) intact. A standardized, oblique osteotomy starting from the distal margin of the cartilage bare area of the ulna was made. The elbows were loaded with an inferiorly directed force of 5 and 10 N in the intact, MCL cut, LCL cut, and both ligaments cut states. All measurements were recorded on lateral calibrated radiographs. RESULTS The mean inferior translation with intact ligaments (n = 20) when the humerus was loaded with 5 and 10 N was 1.52 mm (95% confidence interval [CI], 1.02-2.02) and 2.23 mm (95% CI, 1.61-2.85), respectively. When the LCL was cut first (n = 10), the inferior translation with 5 and 10 N load was 4.11 mm (95% CI, 0.95-7.26) and 4.82 mm (95% CI, 1.91-7.72), respectively. When the MCL was cut first (n = 10), the inferior translation when loaded with 5 and 10 N was 3.94 mm (95% CI, 0.796-7.08) and 5.68 mm (95% CI, 3.03-8.33), respectively. The inferior translation when loaded with 5 and 10 N and both ligaments cut was 15.65 mm (95% CI, 12.59-18.79) and 17.50 mm (95% CI, 14.86-20.13), respectively. There was a statistical difference between the intact and MCL cut first at 10 N and when both ligaments were cut at 5 and 10 N. CONCLUSIONS The findings suggest that collateral ligament disruption is a prerequisite for a transolecranon fracture-dislocation. An inferior translation of more than 3 mm suggests that at least one of the collateral ligaments is disrupted, and more than 7.5 mm indicates that both collateral ligaments are disrupted.
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Affiliation(s)
- Kaare S Midtgaard
- Institute of Military Medicine and Epidemiology, Norwegian Armed Forces Joint Medical Services, Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA.
| | - Philip-Christian Nolte
- Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA; Department of Trauma and Orthopedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | - Jon W Miles
- Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA
| | - Kira K Tanghe
- Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA
| | - Liam A Peebles
- Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA
| | - Matthew T Provencher
- Department of Biomedical Engineering, The Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | - Lars Adolfsson
- Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
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Abstract
PRACTICAL RELEVANCE Traumatic stifle joint luxation is an uncommon but severe injury. There is usually rupture of several stabilising structures of the joint including the cruciate ligaments, collateral ligaments, joint capsule and menisci. Successful management of this condition requires good anatomical knowledge and repair or replacement of all damaged structures to achieve adequate joint reduction and stability. Better understanding of the treatment options available will aid clinical decision-making. CLINICAL CHALLENGES Due to the significant joint instability associated with these injuries, surgical repair is challenging. The use of a temporary transarticular pin to hold the stifle joint in anatomic reduction greatly aids ligament repair or replacement. Postoperative joint immobilisation has traditionally been recommended to protect the primary repair and aid periarticular fibrosis, but prolonged immobilisation can have deleterious long-term effects on the joint. Thus recommendations for the duration of postoperative immobilisation vary between 2 and 6 weeks. Also, due to their independent, outdoor lifestyle, affected cats may have been involved in a significant trauma with important concurrent injuries that need to be addressed prior to the orthopaedic repair. EVIDENCE BASE Published data is limited, with reports including only a small number of cats. The information and recommendations in this article have therefore been drawn from the available literature, the authors' experience and preliminary data from an ongoing multicentre retrospective study (unpublished). AIMS The aims of this article are to give the reader as thorough a summary as possible of the diagnosis, treatment, outcome and complications of traumatic stifle luxation.
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Affiliation(s)
- Elena Addison
- University of Glasgow Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary & Life Sciences, 464 Bearsden Road, Glasgow G61 1QH, UK
| | - Alessandro Conte
- University of Glasgow Small Animal Hospital, School of Veterinary Medicine, College of Medical, Veterinary & Life Sciences, 464 Bearsden Road, Glasgow G61 1QH, UK
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12
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Smith R, Parsons J, Dixon J. Risk of intra-articular injection with longitudinal ultrasound-guided injection of collateral ligaments of the equine distal interphalangeal joint. Vet Radiol Ultrasound 2019; 61:67-76. [PMID: 31574572 DOI: 10.1111/vru.12811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Abstract
Desmopathy of the collateral ligaments of the distal interphalangeal joint is a common cause of equine foot lameness and carries a poor prognosis with conservative management. Intralesional injections may improve healing, although accuracy of radiographically guided injections is significantly less than when guided by MRI, which requires special needles. Longitudinal ultrasound-guided injection of the distal collateral ligament has not been evaluated objectively. In this prospective, anatomic study, seven equine cadaver limbs (14 collateral ligaments) were injected with methylene blue dye and radiographic contrast medium using ultrasound to guide the needle longitudinally into the collateral ligaments until contacting bone. The insertion site of the needle proximal to the coronary band was measured on the limb and the needles left in place for radiography and CT to evaluate the needle angulation, location of the contrast medium, and whether the contrast entered the distal interphalangeal joint. The limbs were frozen and sectioned with a band saw to identify the location of the dye. Fifty percentage of injections were in or around the collateral ligaments. However, the percentage of "successful" injections, defined as in the collateral ligament but not in the joint, was only 36%. All legs had dye and contrast in the joint after both ligaments had been injected. There were no significant differences between the needle angle and entry site for "successful" and "unsuccessful" injections. Findings from this study indicates that the success rate is low for injecting the distal portions of the distal interphalangeal joint collateral ligaments using ultrasound guidance alone.
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Affiliation(s)
- Roger Smith
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK
| | - Jennifer Parsons
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK
| | - Jonathon Dixon
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK
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Kirkpatrick CJ, Ernst NS, Trumble TN. Palmar/plantar approach for radiographic-guided injection of the equine distal interphalangeal joint collateral ligament insertion. Vet Rec 2019; 184:527. [PMID: 30842259 DOI: 10.1136/vr.105027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/26/2018] [Accepted: 01/28/2019] [Indexed: 11/03/2022]
Abstract
There are limited radiographic-guided injection techniques of the insertion of the distal interphalangeal joint (DIPJ) collateral ligaments. The objective of this study was to develop and evaluate a palmar/plantar radiographic-guided injection of the collateral ligament insertion in cadavers. Fifty limbs were used to develop the technique and 24 additional limbs were used to evaluate accuracy. An 18 G, 9 cm spinal needle was placed in the depression between the palmar digital neurovascular bundle and arch of the ungular cartilage with dorsodistal advancement towards the distal phalanx collateral fossa. Radiographs verified ideal needle location on the proximal border of the distal phalanx at the collateral fossa. Dye was injected. Hoof walls were partially removed and collateral ligaments were dissected with needles in place to determine needle and dye location. Accuracy of needle placement into the insertion of the DIPJ collateral ligament was 41/48 (85 per cent), with lower accuracy of dye within the ligament (34/48; 71 per cent). Dye entered the DIPJ in 2/48 injections, but dye entered periligamentous structures in 22/48 (46 per cent) injections. A palmar/plantar radiographic-guided injection of the insertion of the DIPJ collateral ligament had high accuracy rate with low injection rate of the DIPJ in cadavers.
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Affiliation(s)
- C Jordan Kirkpatrick
- Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine, St Paul, Minnesota, USA
| | - Nicolas S Ernst
- Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine, St Paul, Minnesota, USA
| | - Troy N Trumble
- Veterinary Population Medicine, University of Minnesota College of Veterinary Medicine, St Paul, Minnesota, USA
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Rausch V, Wegmann S, Hackl M, Leschinger T, Neiss WF, Scaal M, Müller LP, Wegmann K. Insertional anatomy of the anterior medial collateral ligament on the sublime tubercle of the elbow. J Shoulder Elbow Surg 2019; 28:555-560. [PMID: 30391185 DOI: 10.1016/j.jse.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute injuries to the anterior medial collateral ligament (AMCL) can occur due to valgus trauma or during other dislocating events to the elbow. AMCL lesions are often associated with bony lesions, such as radial head fractures or fractures of the coronoid process. We analyzed the insertion of the AMCL on the sublime tubercle in relation to surrounding osseous structures. We aimed to increase the understanding of the involvement of the AMCL in bony lesions to the sublime tubercle. METHODS We investigated 86 elbows from 43 embalmed human specimens. We measured the most ventral extensions of the AMCL at the sublime tubercle in relation to a clearly defined and reproducible landmark. We used as our landmark a horizontal line (baseline) originating on the lesser sigmoid notch in a right angle to the ulnar ridge. RESULTS The mean distance of the coronoid process tip to the baseline was 4.0 mm (standard deviation [SD], 1.3 mm; range, 1.4-6.7 mm). The mean distance of the ventral extension of the AMCL to the horizontal line was 3.7 mm (SD, 2.6 mm; range: 9.4-2.2 mm). The mean horizontal distance between the ventral aspect of the AMCL and the coronoid tip was 13.7 mm (SD, 2.5 mm; range, 7.7-20.5 mm). CONCLUSIONS We present a detailed description of the insertional anatomy of the AMCL at the sublime tubercle. These values could be helpful for classifications of coronoid fractures and to estimate the involvement of the AMCL in fractures of the sublime tubercle.
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Affiliation(s)
- Valentin Rausch
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Department of Anatomy I, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Sebastian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
| | - Michael Hackl
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
| | - Tim Leschinger
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
| | - Wolfram F Neiss
- Department of Anatomy I, Medical Faculty, University of Cologne, Cologne, Germany
| | - Martin Scaal
- Department of Anatomy II, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany
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15
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Hoshika S, Nimura A, Yamaguchi R, Nasu H, Yamaguchi K, Sugaya H, Akita K. Medial elbow anatomy: A paradigm shift for UCL injury prevention and management. Clin Anat 2019; 32:379-389. [PMID: 30521139 PMCID: PMC6850211 DOI: 10.1002/ca.23322] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 12/19/2022]
Abstract
To improve the management outcomes and diagnostic accuracy of the ulnar collateral ligament (UCL) injury, the anatomy of the medial side of the elbow joint is necessary to be understood in terms of the periarticular surroundings rather than the specific ligaments. The aim of this study was to anatomically clarify the medial side of the elbow joint in terms of the tendinous structures and joint capsule. We conducted a descriptive anatomical study of 23 embalmed cadaveric elbows. We macroscopically analyzed the relationship between the flexor pronator muscles (FPMs) and the joint capsule in 10 elbows, histologically analyzed in 6 elbows, and observed the bone morphology through micro computed tomography in 7 elbows. The two tendinous septa (TS) were found: between the pronator teres (PT) and flexor digitorum superficial (FDS) muscles, and between the FDS and flexor carpi ulnaris (FCU) muscles. These two TS are connected to the medial part of the brachialis tendon, deep aponeurosis of the FDS, and FCU to form the tendinous complex, which linked the humeroulnar joint and could not be histologically separated from each other. Moreover, the capsule of the humeroulnar joint under the tendinous complex had attachment on the ST of 7 mm width. The two TS, the brachialis tendon, the deep FDS and FCU aponeuroses, and the joint capsule linked the humeroulnar joint. These anatomical findings could lead to a paradigm shift in the prevention, diagnosis, and treatment of UCL injuries in baseball players. Clin. Anat. 32:379–389, 2019. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.
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Affiliation(s)
- Shota Hoshika
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan.,Shoulder & Elbow Service, Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Reiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisayo Nasu
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroyuki Sugaya
- Shoulder & Elbow Service, Funabashi Orthopaedic Sports Medicine & Joint Center, Funabashi, Chiba, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Reiman MP, Walker MD, Peters S, Kilborn E, Thigpen CA, Garrigues GE. Risk factors for ulnar collateral ligament injury in professional and amateur baseball players: a systematic review with meta-analysis. J Shoulder Elbow Surg 2019; 28:186-195. [PMID: 30392938 DOI: 10.1016/j.jse.2018.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/08/2018] [Accepted: 08/11/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Risk factors for ulnar collateral ligament injury (UCLI) are unclear despite increasing injury rates. We sought to summarize UCLI risk factors in baseball players. METHODS A computer-assisted search of 4 databases was performed using keywords related to UCLI risk factors. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for study methodology. Odds ratios and 95% confidence intervals were calculated for dichotomous outcomes, and mean differences and 95% confidence intervals were calculated for continuous outcomes using a random-effects model. RESULTS Thirteen studies qualified for inclusion. A greater nondominant (ND) shoulder internal rotation (IR) range of motion (ROM) at 90° abduction arm demonstrated strong evidence as a significant risk factor for UCLI (P < .001) compared with a control group. Mean overall velocity (P < .001), fastball velocity (P < .001), changeup velocity (P = .03), and curveball velocity (P = .01), as well as fewer years of player experience (P < .001), less humeral retrotorsion in the ND arm (P < .001), and greater absolute side-to-side differences in retrotorsion (P = .006) were all moderate-evidence risk factors compared with control groups. Strong evidence suggests total ROM arc at 90° abduction in the dominant arm was not a risk factor for UCLI (P = .81). CONCLUSIONS Greater ND shoulder IR ROM and less humeral retrotorsion (in professional and amateur players) as well as pitching velocity (in professional players) demonstrated strong to moderate evidence as risk factors for UCLI. Dominant arm total arc of motion, external, or IR ROM were not risk factors for UCLI. Standardized collection and reporting of risk factors is recommended to more clearly elucidate definitive risk factors for UCLI.
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Affiliation(s)
- Michael P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Merritt D Walker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Scott Peters
- Toronto Blue Jays Baseball Club, Toronto, ON, Canada
| | - Elizabeth Kilborn
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Charles A Thigpen
- Program in Observational Clinical Research in Orthopedics, Center for Effectiveness in Orthopedic Research, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
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Abstract
OBJECTIVE We conducted ultrasonography (US) examination for asymptomatic elbow injuries in judo athletes to confirm availability of US screening for elbow. MATERIALS AND METHODS One hundred and thirty-two black belts in judo (85 males and 47 females; mean age, 20.0 ± 1.6 years) participated in this screening. Forty-eight participants had a history of elbow injury (elbow-injury group), and 84 did not (no-elbow-injury group). All participants completed a survey in the form of a questionnaire. Subsequently, US scanning of both elbows was performed. RESULTS The maximal thickness of the medial collateral ligament of both elbows was significantly larger in the elbow-injury group than in the no-elbow-injury group. The width of the joint space was significantly larger in the right radiohumeral joint in the elbow-injury group than in the no-elbow-injury group. Combination injuries involving ligament and bone and those involving both the medial and lateral collateral ligaments were most commonly seen in both elbows in the elbow-injury group; however, these combined lesions of both elbows were also found in the no-elbow-injury group. CONCLUSIONS Because US screening can reveal abnormalities of the asymptomatic elbow, US is recommended as a complementary imaging modality that is useful for evaluation of elbow injuries in athletes.
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Affiliation(s)
- Tatsunori Takahashi
- Department of Tokyo-Judo Therapy, Faculty of the Medical Sciences, Teikyo University of Science, 2-2-1 Senju Sakuragi, Adachi-ku, Tokyo, Japan
| | - Soichiro Itoh
- Department of Inorganic Materials, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda, Tokyo, Japan
| | - Masakazu Kida
- Department of Orthopedic Surgery, Kawakita General Hospital, 1-7-3 Asagaya-kita, Suginami, Tokyo, Japan
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18
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Lee RJ, Margalit A, Nduaguba A, Gunderson MA, Ganley TJ. Risk Factors for Concomitant Collateral Ligament Injuries in Children and Adolescents With Anterior Cruciate Ligament Tears. Orthop J Sports Med 2018; 6:2325967118810389. [PMID: 30480025 PMCID: PMC6249661 DOI: 10.1177/2325967118810389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Risk factors for concomitant ligament injuries (CLIs) of the lateral collateral ligament (LCL) and medial collateral ligament (MCL) in children and adolescents with anterior cruciate ligament (ACL) tears are unknown. Purpose: To determine whether body mass index (BMI), sex, age, and injury mechanism are associated with CLIs in children and adolescents with ACL tears and whether CLIs are associated with meniscal and chondral injuries and a delay to surgery. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the records of patients aged ≤18 years with ACL tears from 2009 through 2013 for sex, age, height, weight, CLI, injury mechanism, intra-articular injury, and time to surgery. Patients were assigned to groups according to the presence of a CLI (CLI group) compared with the presence of an isolated ACL tear (ACL group). BMI was categorized as underweight, normal weight, or overweight/obese. The older group was defined as age ≥14 years for girls and ≥16 years for boys. Logistic regression, Mann-Whitney U tests, and chi-square tests were performed (alpha = 0.05). Results: We included 509 patients (267 girls) with a mean age of 15 years (range, 6-18 years) at the time of injury. There were 396 patients (78%) in the ACL group and 113 patients (22%) in the CLI group (90 with MCL, 11 with LCL, and 12 with both MCL and LCL injuries). Groups had similar proportions of overweight/obese patients (P = .619) and girls (P = .104). Older age (odds ratio [OR], 2.0 [95% CI, 1.3-3.3]) and contact injuries (OR, 2.2 [95% CI, 1.4-3.4]) were associated with CLIs. The CLI group had a higher proportion of chondral injuries (P = .001) but not meniscal injuries (P = .295) and presented to surgery earlier than the ACL group (P = .002). Conclusion: Older age and contact injuries were associated with CLIs in children and adolescents with ACL tears, whereas BMI category and sex were not. CLIs were associated with a higher proportion of chondral injuries but not meniscal injuries and were not associated with a delay to surgery.
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Affiliation(s)
- R Jay Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam Margalit
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Afamefuna Nduaguba
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Melissa A Gunderson
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Investigation performed at the Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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19
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Draghi F, Gitto S, Bianchi S. Injuries to the Collateral Ligaments of the Metacarpophalangeal and Interphalangeal Joints: Sonographic Appearance. J Ultrasound Med 2018; 37:2117-2133. [PMID: 29480577 DOI: 10.1002/jum.14575] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/04/2017] [Accepted: 12/09/2017] [Indexed: 06/08/2023]
Abstract
Injuries to the collateral ligaments of the metacarpophalangeal (MCP) and interphalangeal (IP) joints are commonly encountered in both athletes and nonathletes. They require prompt evaluation to ensure proper management and prevent loss of joint motion and permanent disability. Imaging is often required to confirm the diagnosis and assess injury severity. This review article aims to provide physicians with guidelines for sonographic assessment of the collateral ligaments of the MCP and IP and related injuries. Sonographic features of ligament injuries ranging from sprains and partial-thickness tears to full-thickness tears are described. Specific lesions of the ulnar collateral ligament of the thumb MCP joint, such as gamekeeper's thumb, skier's thumb, and Stener lesions, are also included. In conclusion, sonography is effective in evaluating the collateral ligaments of the MCP and IP joints and related injuries and represents a valuable tool for diagnosis.
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Affiliation(s)
- Ferdinando Draghi
- Radiology Institute, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Università Degli Studi di Pavia, Pavia, Italy
| | - Salvatore Gitto
- Postgraduate School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
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Shekarchi B, Mokhdanzadeh Dashti M, Shahrezaei M, Karimi E. The Accuracy of Ultrasonography in Detection of Ulnar Collateral Ligament of Thumb Injuries; a Cross-Sectional Study. Emerg (Tehran) 2018; 6:e15. [PMID: 29503840 PMCID: PMC5827047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Timely diagnosis and treatment of traumatic injury to ulnar collateral ligament (UCL) of thumb is of special importance for preserving the full function of the hand. Therefore, the present study has been designed with the aim of evaluating the accuracy of ultrasonography in detection of these injuries. METHODS The present diagnostic accuracy study was performed on trauma patients over 15 years old who had clinical evidence of injury to UCL of thumb and were admitted to the emergency department. All patients were evaluated regarding injury to the mentioned ligament via ultrasonography and MRI and finally, the accuracy of ultrasonography in this regard was measured considering MRI as the reference test. RESULTS 20 individuals with the mean age of 38.60 ± 13.45 (16 - 64) years were evaluated (60% male). Based on ultrasonography and MRI findings 7 (35%) individuals and 7 (35%), respectively had complete ligament rupture (kappa: 0.560 (95% CI: 0.179 - 0.942)). Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio of ultrasonography in detecting injuries of the mentioned ligament were 71.42 (30.25 - 94.88), 84.61 (53.66 - 97.28), 71.42 (30.25 - 94.88), 84.61 (53.66 - 97.28), 2.5 (0.71 - 8.82), and 0.18 (0.04 - 0.67), respectively. CONCLUSION Based on the findings of the present study, performance of ultrasonography by a radiologist in the emergency department has 80% accuracy in detecting traumatic injuries of UCL of the thumb.
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Affiliation(s)
- Babak Shekarchi
- Radiology Department, Imam Reza Hospital, AJA University of Medical Sciences, Faculty of Medicine, Tehran, Iran
| | | | - Mostafa Shahrezaei
- Orthopedics Department, Imam Reza Hospital, AJA University of Medical Sciences, Faculty of Medicine, Tehran, Iran
| | - Ebrahim Karimi
- Emergency Department, Be’sat Hospital, AJA University of Medical Sciences, Faculty of Medicine, Tehran, Iran.,Corresponding author: Ebrahim Karimi; Emergency Department, Be’sat Hospital, Afsariyeh Highway, Hejrat Boulevard, Tehran, Iran.
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Abstract
We investigated the in vivo length changes of the collateral ligaments of metacarpophalangeal joint during flexion. We obtained computed tomography scans of index, middle, ring and little fingers at 0°, 30°, 60° and 90° of joint flexion from six hands of six healthy adult volunteers. Three of them had their dominant right hand studied, and the other three had their non-dominant left hand studied. We measured and analysed the radial and ulnar collateral ligaments of each metacarpophalangeal joint from the reconstructed images. We found that the dorsal and middle portions of the both radial and ulnar collateral ligament lengthened progressively during digital flexion and reached the maximum at 90° flexion. The length of the volar portion increased from 0° to 30° flexion and then decreased from 30° to 60° flexion, reaching the minimum at 90°. In conclusion, three portions of collateral ligaments on both sides of the metacarpophalangeal joint have variable length changes during flexion, which act to stabilize the joint through its flexion arc.
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Affiliation(s)
- Y C Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - X M Sheng
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - J Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - Z W Qian
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
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Jin ZW, Jin Y, Yamamoto M, Abe H, Murakami G, Yan TF. Oblique cord (chorda obliqua) of the forearm and muscle-associated fibrous tissues at and around the elbow joint: a study of human foetal specimens. Folia Morphol (Warsz) 2016; 75:493-502. [PMID: 27830875 DOI: 10.5603/fm.a2016.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/13/2016] [Indexed: 11/25/2022]
Abstract
In adults, the oblique cord or chorda obliqua separates the origins of the flexor pollicis longus (FPL) and flexor digitorum profundus (FDP) muscles from the supinator muscle and elbow joint. This study examined the topographic anatomy of the oblique cord and related muscles in foetuses. Semiserial sections of five mid-term foetuses of gestational age (GA) 14-16 weeks and 12 late-stage foetuses of GA 28-30 weeks were histologically examined and three forearms at GA 30 weeks were macroscopically evaluated. Late-stage foetuses showed a fascial structure between the supinator and FDP muscles. The latter extended proximally to the elbow joint and the muscle origin thickened the distal, ulnar part of the capsule. The FPL origin also extended proximally but did not reach the joint capsule. These morphologies were consistent with macroscopic examinations. The brachialis muscle was widely inserted into the proximal, anterior part of the capsule. In addition, the medial collateral ligament was not covered by the pronator-flexor muscles but by the triceps brachii muscle. The oblique cord apparently did not form prenatally. After birth, the proximal parts of the FDP and FPL muscles were likely replaced by collagenous tissues, providing a specific type of intermuscular septum i.e., the oblique cord. This type of muscle-ligament transition was observed in the annular ligament of the radius. The foetal elbow joint was characterised by strong support by the FDP, brachialis and triceps brachii muscles. Therefore, the foetal elbow is not a miniature version of the adult elbow.
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Affiliation(s)
- Z W Jin
- Department of Anatomy, Histology and Embryology, Yanbian University Medical College, China.
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23
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Kluczynski MA, Kang JV, Marzo JM, Bisson LJ. Magnetic Resonance Imaging and Intra-articular Findings After Anterior Cruciate Ligament Injuries in Ice Hockey Versus Other Sports. Orthop J Sports Med 2016; 4:2325967116646534. [PMID: 27294167 PMCID: PMC4887880 DOI: 10.1177/2325967116646534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of comorbid knee pathology has been examined for sports-related anterior cruciate ligament (ACL) injuries, but it has not been examined in ice hockey players. PURPOSE To compare concomitant bone bruising, collateral ligament injuries, and intra-articular injuries in ACL injuries suffered during ice hockey versus other sports. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 20 patients with ACL injuries sustained during ice hockey were identified from a prospective registry, of which 95% were male and 90% had a contact mechanism of injury (MOI). Thirteen cases and 46 controls who sustained ACL injuries from ice hockey and other sports, respectively, were included. Inclusion criteria for cases and controls were male sex, contact MOI, no prior knee surgery, magnetic resonance imaging (MRI) within 6 weeks of injury, and surgery within 3 months of injury. Age, body mass index (BMI), MRI findings (bone bruising, medial and lateral collateral ligament [MCL, LCL] injuries), and arthroscopic findings (meniscus tears, chondral injuries) were compared for cases versus controls using t tests or exact chi-square tests. RESULTS Age (22.9 ± 8.8 vs 23.4 ± 10.4 years, P = .88) and BMI ≥25 kg/m(2) (50% vs 65.9%, P = .66) did not differ between cases and controls. Cases had less lateral bone bruising (lateral femoral condyle: 54.6% vs 93%, P = .01; lateral tibial plateau: 72.7% vs 93%, P = .09) and no medial bone bruising (medial femoral condyle: 0% vs 7%, P = .06; medial tibial plateau: 0% vs 32.6%, P = .05) compared with controls. Cases had less frequent lateral meniscus tears than controls (23.1% vs 58.5%, P = .05). There were no significant differences in MCL (40% vs 31.2%, P = .77), LCL (0% vs 3.9%, P > .999), medial meniscus tears (7.7% vs 37%, P = .08), and chondral injuries (10% vs 9.4%, P > .999) for cases versus controls. CONCLUSION Male ice hockey players with ACL injuries had less lateral femoral condyle and medial tibial plateau bone bruising compared with other sports injuries. They also had fewer lateral meniscus tears, and there was a trend toward fewer medial meniscus tears. These differences may reflect different MOIs, or the ability to dissipate energy, for contact ACL injuries that occur during ice hockey versus other sports.
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Affiliation(s)
- Melissa A. Kluczynski
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Jeansol V. Kang
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - John M. Marzo
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
| | - Leslie J. Bisson
- University at Buffalo, The State University of New York at Buffalo, Buffalo, New York, USA
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Chen J, Tan J, Zhang AX. In Vivo length changes of the proximal interphalangeal joint proper and accessory collateral ligaments during flexion. J Hand Surg Am 2015; 40:1130-7. [PMID: 25703864 DOI: 10.1016/j.jhsa.2014.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the length changes in proper collateral ligament (PCL) and accessory collateral ligament (ACL) during flexion of the proximal interphalangeal (PIP) joint in vivo and how portions of the PCL and ACL stabilize the PIP joint. METHODS We obtained computed tomography scans of the index, middle, and ring fingers of one hand from 6 volunteers at 0°, 30°, 60°, 90°, and full flexion of the PIP joint. Radial and ulnar PCL and ACL were measured and analyzed with computer modeling. RESULTS The data showed that during flexion the average length of the dorsal portion of the radial and ulnar PCL increased significantly and reached a maximum at 90°. The volar portion of the radial and ulnar PCL and the distal portion of the radial and ulnar ACL shortened continuously from extension to full flexion. CONCLUSIONS The proximal and middle portions of each ACL are nearly isometric, the dorsal portion of each PCL becomes taut only in flexion, and the volar portion of PCL and the distal portion of ACL become taut only in extension. The current findings indicate that the dorsal portion of PCL is the most stabilizing structure during flexion of the PIP joint, and that the volar portion of PCL and the distal portion of ACL provide the crucial lateral stability to the joint at extension. CLINICAL RELEVANCE The results may provide information relevant to the ligaments of PIP joint reconstruction and rehabilitation.
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Affiliation(s)
- Jing Chen
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Jun Tan
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ai Xian Zhang
- Department of Internal Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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25
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Kwon DG, Sung KH, Chung CY, Park MS, Kim TW, Lee SH, Lee KM. Associations between MRI findings and symptoms in patients with chronic ankle sprain. J Foot Ankle Surg 2014; 53:411-4. [PMID: 24717520 DOI: 10.1053/j.jfas.2014.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging (MRI) provides an accurate method of observing and diagnosing injuries of the ligament complex of the ankle. However, the association between ankle symptoms and MRI findings has been unclear. The purpose of the present study was to evaluate the relationship between ankle pain and MRI findings. This prospective study included 40 patients with ankle pain after inversion injury and 10 healthy volunteers. Correlations among the ankle symptoms (tenderness on the anterior talofibular ligament, pain during varus stress in a neutral and plantarflexed ankle), and MRI findings were analyzed. A complete tear of the anterior talofibular ligament correlated with ankle pain during varus stress in the neutral position (r = 0.365, p = .031) and tenderness at the anterior talofibular ligament (r = 0.362, p = .032). The results of our study suggest that a complete tear of the anterior talofibular ligament will correlate with lateral ankle pain.
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Affiliation(s)
- Dae Gyu Kwon
- Department of Orthopaedic Surgery, In-Ha University Hospital, Incheon, Korea
| | - Ki Hyuk Sung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Tae Won Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea
| | - Sang Hyeong Lee
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, Kyungki, Korea
| | - Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Kyungki, Korea.
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Prasitdumrong I, Rungprai C, Reeboonlarb N, Poonpracha T, Phisitkul P. Severe degeneration of the medial collateral ligament in hallux valgus: a histopathologic study in 12 consecutive patients. Iowa Orthop J 2013; 33:54-7. [PMID: 24027461 PMCID: PMC3748892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine the degree and location of degenerative changes of the medial collateral ligament of the first metatarsophalangeal joint, using the lateral collateral ligament as a control, in patients undergoing hallux valgus correction. MATERIALS AND METHODS A strip of medial and lateral collateral ligaments were biopsied from 12 consecutive patients (age 45 ± 4.8 years) with symptomatic hallux valgus. A blinded analysis of histopathology was performed by an experienced pathologist. RESULTS The medial collateral ligament was significantly more degenerated compared to the lateral collateral ligament (x(2) = 23.41, DF = 2, p < 0.0001). There was no significant difference in degeneration between different parts of each ligament. CONCLUSION Our study found generalized severe degeneration in the medial collateral ligament without proximal-distal predilection. This information may have implications in the management of medial soft tissue repair in hallux valgus correction. The Authors received no financial support for this study.
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Affiliation(s)
- Ittipol Prasitdumrong
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chamnanni Rungprai
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Nitit Reeboonlarb
- Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Tara Poonpracha
- Department of Anatomical Pathology Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Phinit Phisitkul
- Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Dennison DG. A complete radial collateral ligament avulsion of the small finger metacarpophalangeal joint with displacement through the radial sagittal band. Hand (N Y) 2008; 3:220-3. [PMID: 18780099 PMCID: PMC2525884 DOI: 10.1007/s11552-008-9087-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 02/08/2008] [Indexed: 11/30/2022]
Abstract
A displaced complete radial collateral ligament avulsion with associated injury to the sagittal band of the metacarpophalangeal joint of the small finger, if left untreated, may result in chronic pain, instability, weakness, and deformity. A case of a displaced radial collateral ligament that ruptured through the radial sagittal band of the small finger, with resultant injury to the extensor mechanism, is described and discussed with a review of the literature. Proper identification of this injury by physical exam and imaging studies along with surgical repair is associated with good outcome.
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Affiliation(s)
- David G. Dennison
- Department Of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 1st Street SW, Gonda 14th Flr, Rochester, MN 55905 USA
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