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Boccolari P, Pantaleoni F, Tedeschi R, Donati D. The mechanics of the collateral ligaments in the metacarpophalangeal joints: A scoping review. Morphologie 2024; 108:100770. [PMID: 38428155 DOI: 10.1016/j.morpho.2024.100770] [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: 11/30/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The metacarpophalangeal (MCP) joint's collateral ligaments have been extensively debated, with no clear consensus on their mechanics. Understanding their function is crucial for comprehending joint movement and stability. METHODS A thorough search was conducted across databases, including PubMed, Scopus, Cochrane library and grey literature. A total of 59 articles were identified, and after rigorous evaluation, six articles were included in the review. RESULTS The analysis underscores two principal findings. Firstly, the principal and accessory collateral ligaments exhibit consistent tension influenced by the MCP joint's position. This tension varies across different sections of the ligaments. Secondly, the ligaments' interaction with the joint structure plays a pivotal role in defining the range of motion of the joint. CONCLUSION Preliminary findings from this review indicate that MCP joint collateral ligament tension varies with joint position. Increased tension in the principal collateral ligament during flexion and isometric behavior of its volar portion in extension are observed. The accessory ligament may tighten during extension. The shape of the metacarpal head appears to influence this tension. These insights, while informative, call for further detailed research to deepen our understanding of MCP joint mechanics.
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Affiliation(s)
- P Boccolari
- Azienda Ospedaliero - Universitaria di Modena Policlinico, Modena, Italy
| | - F Pantaleoni
- Azienda Ospedaliero - Universitaria di Modena Policlinico, Modena, Italy
| | - R Tedeschi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - D Donati
- Physical Therapy and Rehabilitation Unit, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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Zou D, Ling Z, Tan J, Zheng N, Dimitriou D, Chen Y, Tsai TY. Medial stability and lateral flexibility of the collateral ligaments during mid-range flexion in medial-pivot total knee arthroplasty patients demonstrates favorable postoperative outcomes. Knee Surg Sports Traumatol Arthrosc 2023; 31:3734-3744. [PMID: 36670261 DOI: 10.1007/s00167-023-07307-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/26/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE The objectives of the present study were to investigate the length change in different bundles of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) during lunge, and to evaluate their association with Knee Society Score (KSS) following medial-pivot total knee arthroplasty (MP-TKA). METHODS Patients with unilateral MP-TKA knees performed a bilateral single-leg lunge under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The contralateral non-operated knees were used as the control group. The attachment sites of the sMCL and LCL were marked to calculate the 3D wrapping length. The sMCL and LCL were divided into anterior, intermediate, and posterior portions (aMCL, iMCL, pMCL, aLCL, iLCL, pLCL). Correlations between lengths/elongation rate of ligament bundles from full extension to 100° flexion and the KSS were examined. RESULTS The sMCL and LCL demonstrated relative stability in length at low flexion, but sMCL length decreased whereas LCL increased with further flexion on operated knees. The sMCL length increased at low flexion and remained stable with further flexion, while the LCL length decreased with flexion on the contralateral non-operated knees. The lengths of aMCL, iMCL, and pMCL showed moderate (0.5 < r < 0.7, p < 0.05) negative correlations with the KSS, and the lengths of aLCL, iLCL, and pLCL were positively correlated with the KSS at mid flexion on operated knees (p < 0.05). The elongation rates of aLCL, iLCL, and pLCL were negatively correlated with the KSS at high flexion on operated knees (p < 0.05). However, no significant correlations between the length of different bundles of sMCL or LCL with KSS were found on contralateral non-operated knees. CONCLUSIONS The elongation pattern of sMCL/LCL on MP-TKA knees showed differences with contralateral non-operated knees. The sMCL is tense at low to middle flexion and relaxed at high flexion, while LCL is relaxed at low to middle flexion and tense at high flexion following MP-TKA. Medial stability and proper lateral flexibility during mid flexion were associated with favorable postoperative outcomes in MP-TKA patients. In contrast, lateral relaxation at deep flexion should be avoided when applying soft-tissue balancing in MP-TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi Ling
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Tan
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, CH-8008, Zürich, Switzerland.
| | - Yunsu Chen
- Department of Orthopedics, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Chen PH, Chen CY. Rupture of finger distal interphalangeal collateral ligament treated with a mini soft anchor. Injury 2023:S0020-1383(23)00250-4. [PMID: 36977618 DOI: 10.1016/j.injury.2023.03.007] [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: 02/11/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ruptured finger distal interphalangeal (DIP) collateral ligament is a rare injury, with controversial treatment until the present. Our case series aimed to demonstrate feasible surgical intervention using a mini anchor. METHODS The present study includes four patients with ruptured finger DIP collateral ligaments who received primary repair in a single institute. They have suffered from joint instability due to ligament loss caused by infection, motorcycle accidents, and work-related accidents. All patients were operated on similarly using a 1.0 mm mini anchor for ligament reattachment. RESULTS The finger DIP joint range of motion (ROM) was documented in all patients during follow-up. Joint ROM recovered to almost normal degrees, and the pinch strength recovered to > 90% compared to the contralateral side in all patients. Additionally, collateral ligament re-rupture, DIP joint subluxation or re-dislocation, and infection were not noted during follow-up. CONCLUSIONS Ruptured finger DIP joint ligament requiring surgery is usually based on a combination with other soft tissue injuries and defects. However, repair with a 1.0 mm mini anchor is a feasible surgical intervention to reattach the ligament with minimal complication.
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Affiliation(s)
- Po-Hsiang Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Extn: 3051, Kaohsiung city, Taiwan, ROC; Department of Medical education and research, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung city, Taiwan, ROC
| | - Chun-Yu Chen
- Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Extn: 3051, Kaohsiung city, Taiwan, ROC; Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung city, Taiwan, ROC; Department of Biomedical Engineering, I-Shou University, Kaohsiung city, Taiwan, ROC.
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Prusa G, Bauer L, Santos I, Thorwächter C, Woiczinski M, Kistler M. Strain evaluation of axially loaded collateral ligaments: a comparison of digital image correlation and strain gauges. Biomed Eng Online 2023; 22:13. [PMID: 36774524 PMCID: PMC9922447 DOI: 10.1186/s12938-023-01077-z] [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: 08/12/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
The response of soft tissue to loading can be obtained by strain assessment. Typically, strain can be measured using electrical resistance with strain gauges (SG), or optical sensors based on the digital image correlation (DIC), among others. These sensor systems are already established in other areas of technology. However, sensors have a limited range of applications in medical technology due to various challenges in handling human soft materials. The aim of this study was to compare directly attached foil-type SG and 3D-DIC to determine the strain of axially loaded human ligament structures. Therefore, the medial (MCL) and lateral (LCL) collateral ligaments of 18 human knee joints underwent cyclic displacement-controlled loading at a rate of 20 mm/min in two test trials. In the first trial, strain was recorded with the 3D-DIC system and the reference strain of the testing machine. In the second trial, strain was additionally measured with a directly attached SG. The results of the strain measurement with the 3D-DIC system did not differ significantly from the reference strain in the first trial. The strains assessed in the second trial between reference and SG, as well as between reference and 3D-DIC showed significant differences. This suggests that using an optical system based on the DIC with a given unrestricted view is an effective method to measure the superficial strain of human ligaments. In contrast, directly attached SGs provide only qualitative comparable results. Therefore, their scope on human ligaments is limited to the evaluation of changes under different conditions.
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Affiliation(s)
- Gwendolin Prusa
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Leandra Bauer
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Inês Santos
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Christoph Thorwächter
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Matthias Woiczinski
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Manuel Kistler
- grid.5252.00000 0004 1936 973XDepartment of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
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Aydoğmuş S, Mete BD, Aydoğmuş H, Uluç ME, Tosun Ö, Çetinoğlu YK. Investigation of ligament, bone, synovial and plica pathologies accompanied by common extensor tendon in patients with lateral overuse syndrome of the elbow using magnetic resonance imaging. Acta Radiol 2022; 63:214-221. [PMID: 33631940 DOI: 10.1177/0284185121990797] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tendinosis in the common extensor tendon and accompanying ligament, bone, and plica abnormalities can be observed on magnetic resonance imaging (MRI). PURPOSE To determine whether there is a difference between accompanying abnormalities according to the degree of common extensor tendon injury. MATERIAL AND METHODS Patients who underwent 1.5-T MRI tests with a prediagnosis of lateral overuse syndrome were retrospectively reviewed, and 56 patients who had an injury in the common extensor tendon (CET) were included. The degree of tendon and ligament injury, muscle signal change, bone marrow signal change, presence of joint effusion, and morphological features in the presence of plica were evaluated via MRI examinations of the elbow. RESULTS Overall, 32, 16, and eight patients had mild, moderate, and severe CET damage, respectively. As the severity of CET damage increased, the presence of joint effusion, and the presence and degree of damage to the lateral ulnar collateral ligament (LUCL) and radial collateral ligament (RCL) increased. The radiohumeral (RH) plica area was significantly larger in the group with mild CET damage. There was no statistically significant correlation between the severity of CET damage and the end of RH plica with a blind-end, coverage of one-third or more of the radius, its signal, thickness, and presence of olecranon fold. CONCLUSION As the severity of CET injury increases, damage to the LUCL, RCL, and the presence of effusion in the joint increases. RH plica should be evaluated in terms of concomitant pathology in patients with mild CET injuries on MRI.
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Affiliation(s)
- Sinem Aydoğmuş
- Department of Radiology, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Berna Dirim Mete
- Department of Radiology, Izmir Democracy University Faculty of Medicine, Izmir, Turkey
| | - Hüseyin Aydoğmuş
- Department of Physical Medicine and Rehabilitation, Mugla Sitki Kocman University Training and Research Hospital, Mugla, Turkey
| | - Muhsin Engin Uluç
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Özgür Tosun
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
| | - Yusuf Kenan Çetinoğlu
- Department of Radiology, Izmir Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey
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Bui D, Jenkins M, Schick B, Sivakumar BS. Outcomes of Acute Operative Repair of Complete Digital Proximal Interphalangeal Joint Collateral Ligament Ruptures: A Systematic Review. J Hand Surg Asian Pac Vol 2021; 26:644-653. [PMID: 34789094 DOI: 10.1142/s2424835521500624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: No consensus exists regarding the management of complete collateral ligament injuries of the proximal interphalangeal joint (PIPJ) of fingers. Methods: We aimed to systematically review the outcomes of Acute (< 1 month) surgical repairs of these injuries. Outcomes assessed included Stability, Pain, Range-of-Motion and Return to Function. The Modified Coleman Methodology Score (MCMS) was utilised in critical appraisal. Results: 70 patients with complete collateral ligament injuries of the PIPJ were identified in 5 studies. 49 were managed operatively and 21 non-operatively. All trials were methodologically flawed with a mean MCMS of 50.4, corresponding to a "Poor" Level of evidence. Conclusions: Whilst acute surgical repair of complete collateral ligament injuries of finger PIPJs are a described viable management option with promising results, there is insufficient high-quality evidence to inform current practice. Based on the current literature, no evidence-based conclusions can be made regarding superiority of acute surgical repair over conservative management or one method of surgical repair over another. Further high level studies are required.
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Affiliation(s)
- David Bui
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Michael Jenkins
- Department of Orthopaedic Surgery, Macquarie University Hospital, Macquarie University, NSW, Australia
| | - Bernard Schick
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Brahman Shankar Sivakumar
- Department of Hand Surgery and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
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Afshar A, Tabrizi A, Taleb H, Safari M. Results of fracture-dislocation of interphalangeal treatment with volar buttressing hook plating techniques. Orthop Traumatol Surg Res 2020; 106:765-769. [PMID: 32360557 DOI: 10.1016/j.otsr.2020.02.012] [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: 11/09/2019] [Revised: 12/10/2019] [Accepted: 02/12/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Proximal interphalangeal joint (PIP) is one of the joints exposed to upper limb injury. The dorsal fracture-dislocations of the PIP is a common injury. Treatment of cases with small avulsed bone fragments is challenging. Stable fixation with rapid recovery is important in these patients. HYPOTHESIS Volar buttress plating a new technique in treatment of the dorsal proximal interphalangeal joint fracture dislocations but the results of it is unknown. METHODS In this case series, 21 patients with dorsal fracture-dislocations of the proximal interphalangeal were studied. We used a volar hook plate buttressing technique so that fixation was done by low-profile 2-mm stainless steel hook plate with a 1.5-mm screw. Range of motion movements, power and grip strength were measured after 3 months. At end of follow-up period, functional outcome was determined by the visual analogue scale, Quick Disabilities of the Arm, Shoulder, and Hand. RESULTS After three-month follow-up a union of fractures occurred in all of the patients. There were no complications, such as infection, digital nerve injuries or flexor tendon rupture. The joints range of motion were stable and had no restrictions. Postoperative range of motion outcome in 19 (90.5%) patients was 85.7±13.2 degree which was not significantly different from opposite side on other hand (p=0.1). In two patients range of motion was 65.5±5.4 degree and painful. Postoperative pain in 19 patients was 2.5±0.8 so that there was no pain in 17(76.2%) patients, three (14.1%) patients had mild pain and two (9.5%) patients had moderate pain (5.4±1.2). Two patients complained of plate irritation of especially at end of proximal intrphalangeal flexion. CONCLUSION Clinical application of hook plate buttressing technique induced stable fixation and rapid recovery. Because of maintaining articular congruity and restoring anatomically, this technique associated with good outcomes. LEVEL OF EVIDENCE IV, Therapeutic study.
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Affiliation(s)
- Ahmadreza Afshar
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ali Tabrizi
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
| | - Hassan Taleb
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Milad Safari
- Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Cho BK, Park JK, Choi SM, SooHoo NF. Revision with suture-tape augmentation after failed collateral ligament reconstruction for chronic interphalangeal instability of the hallux. Foot Ankle Surg 2017; 23:e31-4. [PMID: 29203000 DOI: 10.1016/j.fas.2017.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 02/04/2023]
Abstract
Chronic varus instability or recurrent subluxation following isolated interphalangeal dislocation of the hallux is a rare injury. No consensus has been reached regarding the best joint-salvage procedure for patients with the failed collateral ligament reconstruction using tendon graft. We report a case who achieved satisfactory clinical outcome through a modified surgical procedure (revision collateral ligament reconstruction augmented with suture-tape).
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Lin KJ, Wei HW, Huang CH, Liu YL, Chen WC, McClean CJ, Cheng CK. Change in collateral ligament length and tibiofemoral movement following joint line variation in TKA. Knee Surg Sports Traumatol Arthrosc 2016; 24:2498-505. [PMID: 25354558 DOI: 10.1007/s00167-014-3400-z] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/21/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE The primary intent of total knee arthroplasty is the restoration of normal knee kinematics, with ligamentous constraint being a key influential factor. Displacement of the joint line may lead to alterations in ligament attachment sites relative to knee flexion axis and variance of ligamentous constraints on tibiofemoral movement. This study aimed to investigate collaterals strains and tibiofemoral kinematics with different joint line levels. METHODS A previously validated knee model was employed to analyse the change in length of the collateral ligaments and tibiofemoral motion during knee flexion. The models shifted the joint line by 3 and 5 mm both proximally and distally from the anatomical level. The data were captured from full extension to flexion 135°. RESULTS The elevated joint line revealed a relative increase in distance between ligament attachments for both collateral ligaments in comparison with the anatomical model. Also, tibiofemoral movement decreased with an elevation in the joint line. Conversely, lowering the joint line led to a significant decrease in distance between ligament attachments, but greater tibiofemoral motion. CONCLUSION Elevation of the joint line would strengthen the capacity of collateral ligaments for knee motion constraint, whereas a distally shifted joint line might have the advantage of improving tibiofemoral movement by slackening the collaterals. It implies that surgeons can appropriately change the joint line position in accordance with patient's requirement or collateral tensions. A lowered joint line level may improve knee kinematics, whereas joint line elevation could be useful to maintain knee stability. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Kun-Jhih Lin
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Chungli City, Taiwan
| | - Hung-Wen Wei
- Technology Translation Center for Medical Device, Chung Yuan Christian University, Chungli City, Taiwan
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Chang-Hung Huang
- Biomechanics Research Laboratory, Department of Biomedical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | | | - Wen-Chuan Chen
- Orthopaedic Device Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Colin Joseph McClean
- Orthopaedic Biomechanics Laboratory, Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Shih-Pai, Taipei, 11221, Taiwan
| | - Cheng-Kung Cheng
- Orthopaedic Biomechanics Laboratory, Institute of Biomedical Engineering, National Yang-Ming University, No. 155, Sec. 2, Li-Nung St., Shih-Pai, Taipei, 11221, Taiwan.
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Ziegler C, Neshkova I, Schmidt K, Meffert R, Jakubietz M, Jakubietz R. [Surgical treatment of ulnar collateral ligament injuries of the thumb metacarpophalangeal joint]. Oper Orthop Traumatol 2016; 28:111-26; quiz 127. [PMID: 26769008 DOI: 10.1007/s00064-015-0436-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 08/22/2014] [Revised: 10/08/2015] [Accepted: 10/10/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Reconstruction of the ruptured ulnar collateral ligament of the metacarpophalangeal (MP) joint of the thumb. INDICATIONS Ruptured ulnar collateral ligament of the thumb MP joint with instability: joint opening of more than 30° in flexion and more than 20° in extension, Stener lesion, displaced avulsion fractures. CONTRAINDICATIONS Abrasions, wound-healing disturbance, skin disease, osteoarthritis. SURGICAL TECHNIQUE Curved skin incision dorsoulnar above the thumb MP joint. Protection of the branches of the superficial radial nerve. Incision of the adductor aponeurosis. Exposing the ulnar collateral ligament; opening and examination of the joint. Depending on the injury, primary suture repair, transosseous suture, repair with a bone anchor, osteosynthesis with K-wires or small screws in avulsion fracture, ligament reconstruction in chronic instability or older injury. POSTOPERATIVE TREATMENT Cast splint of the MP joint until swelling subsides; cast immobilization for 6 weeks; range-of-motion exercises, avoiding forced radial deviation of the MP joint for 3 months. RESULTS Complete joint stability 3 months postoperatively in all 34 patients with rupture of the ulnar collateral ligament.
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Affiliation(s)
- C Ziegler
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - I Neshkova
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - K Schmidt
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - R Meffert
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - M Jakubietz
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - R Jakubietz
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Universität Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
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Carlo J, Dell PC, Matthias R, Wright TW. Collateral Ligament Reconstruction of the Proximal Interphalangeal Joint. J Hand Surg Am 2016; 41:129-32. [PMID: 26614593 DOI: 10.1016/j.jhsa.2015.10.007] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/31/2015] [Accepted: 10/15/2015] [Indexed: 02/02/2023]
Abstract
Proximal interphalangeal joint collateral ligament injuries are common; however, chronic instability of this joint is rare. In such cases, however, there is no consensus on optimal management. Various repairs and reconstructions have been devised, although the literature on outcomes remains scant. We present a method of reconstruction of the proximal interphalangeal joint collateral ligament using a distally based slip of the flexor digitorum superficialis tendon.
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Affiliation(s)
- Julian Carlo
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Paul C Dell
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Rob Matthias
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL
| | - Thomas W Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL.
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Parkes R, Newton R, Dyson S. Is there an association between clinical features, response to diagnostic analgesia and radiological findings in horses with a magnetic resonance imaging diagnosis of navicular disease or other injuries of the podotrochlear apparatus? Vet J 2015; 204:40-6. [PMID: 25724857 DOI: 10.1016/j.tvjl.2014.12.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 11/20/2022]
Abstract
Previous descriptions of the clinical features of navicular disease occurred before the widespread use of magnetic resonance imaging (MRI) allowed a more definitive diagnosis of foot pain. The objective of this study was to compare the clinical features of horses with lesions of the podotrochlear apparatus with those with other causes of foot pain. It was hypothesised that primary navicular bone disease would be associated with more advanced radiological findings than other diagnoses. A retrospective study was performed of all horses examined at a referral centre with a definitive diagnosis of foot pain based on MRI ± post-mortem examination. Clinical examination findings, response to diagnostic analgesia and radiological grading of the navicular bone were compared among five diagnosis groups: (1) primary navicular bone pathology (NB); (2) lesions of the collateral sesamoidean ligament and/or distal sesamoidean impar ligament (CSL + DSIL); (3) primary deep digital flexor tendon injury (DDFT); (4) navicular bone pathology and other lesions of the podotrochlear apparatus ± DDFT (PTA) and (5) Other. There were 702 horses (NB, 62; CSL + DSIL, 180; DDFT, 69; PTA, 92; Other, 299). Horses with PTA injuries were more frequently unilaterally lame than other groups (P = 0.04). Horses with DDFT injury were more likely to exhibit pain on turning than other groups (P <0.01). There were no associations between response to diagnostic analgesia and diagnostic group, and no association between radiological grade and diagnostic group. Clinical examination findings generally did not discriminate between diseases of the PTA and other causes of foot pain. Overall radiological scores of the navicular bone did not accurately predict navicular bone pathology.
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Park KK, Hosseini A, Tsai TY, Kwon YM, Li G. Elongation of the collateral ligaments after cruciate retaining total knee arthroplasty and the maximum flexion of the knee. J Biomech 2014; 48:418-24. [PMID: 25555307 DOI: 10.1016/j.jbiomech.2014.12.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 07/28/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
The mechanisms that affect knee flexion after total knee arthroplasty (TKA) are still debatable. This study investigated the elongation of the superficial medial (sMCL) and lateral collateral ligaments (LCL) before and after a posterior cruciate retaining (CR) TKA. We hypothesized that overstretching of the collateral ligaments in high flexion after TKA could reduce maximal flexion of the knee. Three-dimensional models of 11 osteoarthritic knees of 11 patients including the insertions of the collateral ligaments were created using MR images. Each ligament was divided into three equal portions: anterior, middle and posterior portions. The shortest 3D wrapping length of each ligament portion was determined before and after the TKA surgery along a weight-bearing, single leg flexion path. The relationship between the changes of ligament elongation and the changes of the maximal knee flexion after TKAs was quantitatively analyzed. The sMCL showed significant increases in length only at low flexion after TKA; the LCL showed decreases in length at full extension, but increases with further flexion after TKA. The amount of increases of the maximum flexion angle after TKA was negatively correlated with the increases of the elongations of the anterior portion (p=0.010, r=0.733) and middle portion (p=0.049, r=0.604) of the sMCL as well as the anterior portion (p=0.010, r=0.733) of the LCL at maximal flexion of the knee. The results indicated that the increases of the length of the collateral ligaments at maximal flexion after TKA were associated with the decreases of the maximal flexion of the knee. Our data suggest that collateral ligament management should also be evaluated at higher knee flexion angles in order to optimize maximal flexion of the knee after TKAs.
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Affiliation(s)
- Kwan Kyu Park
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Orthopedic Surgery, Yonsei University, College of Medicine, Seoul, Korea.
| | - Ali Hosseini
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Wong JC, Lutsky KF, Beredjiklian PK. Outcomes after repair of subacute-to-chronic grade III metacarpophalangeal joint collateral ligament injuries in fingers are suboptimal. Hand (N Y) 2014; 9:322-8. [PMID: 25191162 PMCID: PMC4152438 DOI: 10.1007/s11552-013-9588-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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: 11/30/2022]
Abstract
PURPOSE Although injury to the collateral ligaments of the metacarpophalangeal joint (MPJ) of the fingers is less common than corresponding injuries in the thumb, similar disability may result from chronic untreated injuries. We evaluated injury characteristics and the outcome after primary repair of subacute to chronic grade III collateral ligament injuries of the MPJs of the fingers. METHODS We retrospectively reviewed all patients who underwent primary repair of a finger MPJ collateral ligament over a 3-year period. Twenty-five digits in 23 patients with subacute to chronic injuries were identified, all of which had complete MPJ collateral ligament tear. Postoperatively, we assessed disability using DASH scores and evaluated joint stability, range of motion, and grip strength. These measures were compared to preoperative data to assess results. Post hoc analysis was used to compare the level of disability between index and small radial collateral ligaments and other finger CL injuries. RESULTS Intraoperative findings revealed complete tears in all cases and all ligaments were of sufficient quality to permit primary repair using a suture anchor. The average preoperative DASH score was 40 (range 17-77) in 7 patients (nine fingers) where this was available. Postoperative DASH scores were available in 19 patients (21 fingers). The average postoperative DASH score was 19 (range 0-65). In the subgroup of patients with preoperative and postoperative DASH scores, there was no statistically significant difference after surgery (preop DASH 39.1 vs. postop DASH 23.8, p = 0.17). The average grip strength as a percentage of the contralateral hand was 68 % (range 32-100 %). The average postoperative MPJ arc of motion was 75° (range 50-90°). Post hoc analysis showed statistically significant higher postoperative DASH scores among small finger RCL repairs compared to other finger CL repairs (p = 0.007). DISCUSSION Primary repair of complete MPJ collateral ligament injuries of the fingers may be performed in the subacute to chronic setting. Although joint stability was restored, patients continued to have decreased grip strength and residual disability.
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Affiliation(s)
- Justin C. Wong
- />Department of Orthopedic Surgery, Thomas Jefferson University, 1020 Walnut Street, College Building Rm 516, Philadelphia, PA 19107 USA
| | - Kevin F. Lutsky
- />Rothman Institute, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA USA
| | - Pedro K. Beredjiklian
- />Rothman Institute, Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA USA
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Abstract
BACKGROUND Differentiating chronic from acute injuries of the collateral ligament of the metacarpophalangeal joint (MCPJ) of the thumb can be difficult in the absence of a conclusive history and examination. We aimed to establish the presence of a radiological sign in patients with a chronic injury and the reliability of the sign in differentiating chronic from acute ligament injury. METHODS Consecutive patients undergoing surgical treatment for chronic (n = 14) or acute (n = 8) ligament injury of the MCPJ of the thumb were identified retrospectively. Six upper limb orthopedic surgeons and four musculoskeletal radiologists were recruited from three regional centers. Observers judged the presence or absence of the sign, an exostosis at the level of the neck of the thumb metacarpal, on radiographs presented on a computer program. The radiographs were then observed in a different random order. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the radiological sign were evaluated for each observer and the intra- and interobserver error was calculated. RESULTS The mean observer specificity and sensitivity for the sign were 84 and 54 %, respectively. The PPV and NPV were 89 and 52 %, respectively. The kappa statistic for intraobserver error was 0.69 and interobserver error 0.34. CONCLUSIONS A radiological sign associated with chronic collateral ligament injuries of the MCPJ of the thumb is established. The presence of the sign can increase the confidence of the clinician in differentiating chronic from acute collateral ligament injuries, when history and examination are inconclusive in this respect.
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Affiliation(s)
- Alistair R. Hunter
- />Upper Limb Unit, Department of Orthopedic Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD UK
- />Department of Orthopedics, Chase Farm Hospital, The Ridgeway, Enfield, Middlesex, EN2 8JL UK
| | - Rosamond J. Tansey
- />Upper Limb Unit, Department of Orthopedic Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD UK
| | - Lindsay T. Muir
- />Upper Limb Unit, Department of Orthopedic Surgery, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD UK
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Krkovic M, Costa ML. Stabilisation of the elbow in cases of severe disruption of the lateral collateral complex. Eur J Trauma Emerg Surg 2010; 36:587-91. [PMID: 26816315 DOI: 10.1007/s00068-010-0037-6] [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: 01/05/2010] [Accepted: 06/26/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rupture of the lateral collateral ligamentous complex of the elbow is a serious injury. If direct repair of the ligamentous complex is not possible, then an alternative method must be found to stabilise the elbow. MATERIALS AND METHODS We describe a novel method of maintaining stability while allowing early movement in a severe injury to the elbow. CONCLUSION This technique is a viable alternative to hinged external fixation in patients with severe lateral instability of the elbow joint.
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Affiliation(s)
- M Krkovic
- Department of Trauma and Orthopaedics, University Hospitals of Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - M L Costa
- Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry, CV2 2DX, UK
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