Sex-Based Differences of Medial Collateral Ligament and Anterior Cruciate Ligament Strains With Cadaveric Impact Simulations.

PubMed

Schilaty, Nathan D; Bates, Nathaniel A; Nagelli, Christopher V; Krych, Aaron J; Hewett, Timothy E

2018-04-01

Female patients sustain noncontact knee ligament injuries at a greater rate compared with their male counterparts. The cause of these differences in the injury rate and the movements that load the ligaments until failure are still under dispute in the literature. This study was designed to determine differences in anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strains between male and female cadaveric specimens during a simulated athletic task. The primary hypothesis tested was that female limbs would demonstrate significantly greater ACL strain compared with male limbs under similar loading conditions. A secondary hypothesis was that MCL strain would not differ between sexes. Controlled laboratory study. Motion analysis of 67 athletes performing a drop vertical jump was conducted. Kinetic data were used to categorize injury risk according to tertiles, and these values were input into a cadaveric impact simulator to assess ligamentous strain during a simulated landing task. Uniaxial and multiaxial load cells and differential variable reluctance transducer strain sensors were utilized to collect mechanical data for analysis. Conditions of external loads applied to the cadaveric limbs (knee abduction moment, anterior tibial shear, and internal tibial rotation) were varied and randomized. Data were analyzed using 1-way analysis of variance (ANOVA), 2-way repeated-measures ANOVA, and the Fisher exact test. There were no significant differences ( P = .184) in maximum ACL strain between male (13.2% ± 8.1%) and female (16.7% ± 8.3%) specimens. Two-way ANOVA demonstrated that across all controlled external load conditions, female specimens consistently attained at least 3.5% increased maximum ACL strain compared with male specimens ( F 1,100 = 4.188, P = .043); however, when normalized to initial contact, no significant difference was found. There were no significant differences in MCL strain between sexes for similar parameters. When compared with

Instrument-assisted cross fiber massage increases tissue perfusion and alters microvascular morphology in the vicinity of healing knee ligaments

PubMed Central

2013-01-01

Background Ligament injuries are common clinical problems for which there are few established interventions. Instrument-assisted cross fiber massage (IACFM) was recently shown to accelerate the restoration of biomechanical properties in injured rodent knee medial collateral ligaments (MCL). The current study aimed to investigate the influence of IACFM on regional perfusion and vascularity in the vicinity of healing rodent knee MCL injuries. Methods Bilateral knee MCL injuries were induced in female Sprague–Dawley rats. Commencing 1 week post-injury, 1 minute of IACFM was introduced unilaterally 3 times/week for 3 weeks. The contralateral injured MCL served as an internal control. Regional tissue perfusion was assessed in vivo throughout healing using laser Doppler imaging, whereas regional microvascular morphology was assessed ex vivo via micro-computed tomography of vessels filled with contrast. Results IACFM had no effect on tissue perfusion when assessed immediately, or at 5, 10, 15 or 20 min following intervention (all p > 0.05). However, IACFM-treated hindlimbs had enhanced tissue perfusion when assessed 1 day following the 4th and 9th (last) treatment sessions (all p < 0.05). IACFM-treated hindlimbs also had greater perfusion when assessed 1 wk following the final treatment session (32 days post-injury) (p < 0.05). Subsequent investigation of microvascular morphology found IACFM to increase the proportion of arteriole-sized blood vessels (5.9 to <41.2 μm) in the tibial third of the ligament (p < 0.05). Conclusions These findings suggest IACFM alters regional perfusion and vascularity in the vicinity of healing rodent knee MCL injuries. This effect may contribute to the beneficial effect of IACFM observed on the recovery of knee ligament biomechanical properties following injury. PMID:24073942

Influence of Ligament Properties on Knee Mechanics in Walking

PubMed Central

Smith, Colin R.; Lenhart, Rachel L.; Kaiser, Jarred; Vignos, Mike; Thelen, Darryl G.

2016-01-01

Computational knee models provide a powerful platform to investigate the effects of injury and surgery on functional knee behavior. The objective of this study was to use a multibody knee model to investigate the influence of ligament properties on tibiofemoral kinematics and cartilage contact pressures in the stance phase of walking. The knee model included 14 ligament bundles and articular cartilage contact acting across the tibiofemoral and patellofemoral joints. The knee was incorporated into a lower extremity musculoskeletal model and used to simulate knee mechanics during the stance phase of normal walking. A Monte Carlo approach was employed to assess the influence ligament stiffness and reference strains on knee mechanics. The ACL, MCL and posterior capsule properties exhibited significant influence on anterior tibial translation at heel strike, with the ACL acting as the primary restraint to anterior translation in mid-stance. The MCL and LCL exhibited the greatest influence on tibial rotation from heel strike through mid-stance. Simulated tibial plateau contact location was dependent on the ACL, MCL and LCL properties, while pressure magnitudes were most dependent on the ACL. A decrease in ACL stiffness or reference strain significantly increased average contact pressure in mid-stance, with the pressure migrating posteriorly on the medial tibial plateau. These ligament-dependent shifts in tibiofemoral cartilage contact during walking are potentially relevant to consider when investigating the causes of early onset osteoarthritis following knee ligament injury and surgical treatment. PMID:26408997

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

PubMed

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

2013-01-01

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

Surgical Techniques for the Reconstruction of Medial Collateral Ligament and Posteromedial Corner Injuries of the Knee: A Systematic Review.

PubMed

DeLong, Jeffrey M; Waterman, Brian R

2015-11-01

To systematically review reconstruction techniques of the medial collateral ligament (MCL) and associated medial structures of the knee (e.g., posterior oblique ligament). A systematic review of Medline/PubMed Database (1966 to November 2013), reference list scanning and citation searches of included articles, and manual searches of high-impact journals (2000 to July 2013) and conference proceedings (2009 to July 2013) were performed to identify publications describing MCL reconstruction techniques of the knee. Exclusion criteria included (1) MCL primary repair techniques or advancement procedures, (2) lack of clear description of MCL reconstruction technique, (3) animal models, (4) nonrelevant study design, (5) and foreign language articles without available translation. After review of 4,600 references, 25 publications with 359 of 388 patients (92.5%) were isolated for analysis, including 18 single-bundle MCL and 10 double-bundle reconstruction techniques. Only 2 techniques were classified as anatomic reconstructions, and clinical and objective outcomes (n = 28; 100% <3 mm side-to-side difference [SSD]) were superior to those with nonanatomic reconstruction (n = 182; 79.1% <3 mm SSD) and tendon transfer techniques (n = 114; 52.6% <3 mm SSD). This systematic review demonstrated that numerous medial reconstruction techniques have been used in the treatment of isolated and combined medial knee injuries in the existent literature. Many variations exist among reconstruction techniques and may differ by graft choices, method of fixation, number of bundles, tensioning protocol, and degree of anatomic restoration of medial and posteromedial corner knee restraints. Further studies are required to better ascertain the comparative clinical outcomes with anatomic, non-anatomic, and tendon transfer techniques for medial knee reconstruction. Level IV, systematic review of level IV studies and surgical techniques. Published by Elsevier Inc.

Ankle ligament injuries.

PubMed

Abbassian, Ali; Thomas, Rhidian

2008-06-01

Ankle ligament injuries in the presence or in the absence of fractures are common. They often present a diagnostic challenge, and their management is poorly understood and subject to debate. This article reviews and discusses the current literature on the management and diagnosis of these injuries.

Functional tissue engineering of ligament healing

PubMed Central

2010-01-01

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

Tendon and ligament injuries: the genetic component

PubMed Central

September, Alison V; Schwellnus, Martin P; Collins, Malcolm

2007-01-01

Tendons and ligaments within the upper and lower limbs are some of the more common sites of musculoskeletal injuries during physical activity. Several extrinsic and intrinsic factors have been shown to be associated with these injuries. More recently, studies have suggested that there is also, at least in part, a genetic component to the Achilles tendon, rotator cuff and anterior cruciate ligament injuries. However, specific genes have not been suggested to be associated with rotator cuff or anterior cruciate ligament injuries. Sequence variants of the tenascin C (TNC) gene, on the other hand, have been shown to be associated with Achilles tendinopathies and Achilles tendon ruptures, whereas a variant of the collagen V α 1 (COL5A1) gene has also been shown to be associated with Achilles tendinopathies. Both genes encode for important structural components of tendons and ligaments. The COL5A1 gene encodes for a component of type V collagen, which has an important role in regulating collagen fibre assembly and fibre diameters. The TNC gene, on the other hand, encodes for TNC, which regulates the tissue's response to mechanical load. To date, only variants in two genes have been shown to be associated with Achilles tendon injuries. In addition, although specific genes have not been identified, investigators have suggested that there is also a genetic component to both rotator cuff and anterior cruciate ligament injuries. In future, specific genotypes associated with increased risk of injury to specific tendons and ligaments can prevent these injuries by identifying individuals at higher risk. PMID:17261551

Causes of anterior cruciate ligament injuries.

PubMed

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

2010-01-01

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

Physical Examination of Knee Ligament Injuries.

PubMed

Bronstein, Robert D; Schaffer, Joseph C

2017-04-01

The knee is one of the most commonly injured joints in the body. A thorough history and physical examination of the knee facilitates accurate diagnosis of ligament injury. Several examination techniques for the knee ligaments that were developed before advanced imaging remain as accurate or more accurate than these newer imaging modalities. Proper use of these examination techniques requires an understanding of the anatomy and pathophysiology of knee ligament injuries. Advanced imaging can be used to augment a history and examination when necessary, but should not replace a thorough history and physical examination.

[Prevention and repair of patellar ligament injury in total knee arthroplasty].

PubMed

Bian, Yanyan; Weng, Xisheng

2013-09-01

To review the progress in the prevention and repair of patellar ligament injury in total knee Recent literature about the prevention and repair of patellar ligament injury in total knee arthroplasty arthroplasty. was reviewed and analyzed. Increased exposure can prevent the patellar ligament injury, and treatments of acute patellar ligament rupture can be obtained by simple repair, reconstruction with allograft materials or artificial materials, and auxiliary strengthening. Patellar ligament injury in total knee arthroplasty should not be ignored. Active prevention and repair of patellar ligament injury can obtain better function of knee joint.

MR imaging of knees having isolated and combined ligament injuries.

PubMed

Rubin, D A; Kettering, J M; Towers, J D; Britton, C A

1998-05-01

Although clinical evaluation and MR imaging both accurately reveal injuries in knees with isolated ligament tears, physical examination becomes progressively less reliable when multiple lesions exist. We investigated the accuracy of MR imaging of knees having varying degrees and numbers of ligament injuries. We prospectively interpreted the MR images of 340 consecutive injured knees and compared these interpretations with the results of subsequent arthroscopy or open surgery, which served as the gold standard. Our interpretations of MR images focused on five soft-tissue supporting structures (the two cruciate ligaments, the two collateral ligaments, and the patellar tendon) and the two menisci. Patients were divided into three groups: no ligament injuries, single ligament injuries, and multiple ligament injuries. Using MR imaging, we found overall sensitivity and specificity for diagnosing ligament tears to be 94% and 99%, respectively, when no or one ligament was torn and 88% and 84%, respectively, when two or more supporting structures were torn. The difference in specificity was statistically significant (p < .0001). Sensitivity for diagnosing meniscal tears decreased as the number of injured structures increased, but the relationship achieved statistical significance (p = .001) only for the medial meniscus. For all categories of injury, MR imaging was more accurate than clinical evaluation, statistics for which were taken from the orthopedic literature. In knees with multiple ligament injuries, the diagnostic specificity of MR imaging for ligament tears decreases, as does the sensitivity for medial meniscal tears.

Medial collateral ligament injuries and subsequent load on the anterior cruciate ligament: a biomechanical evaluation in a cadaveric model.

PubMed

Battaglia, Michael J; Lenhoff, Mark W; Ehteshami, John R; Lyman, Stephen; Provencher, Matthew T; Wickiewicz, Thomas L; Warren, Russell F

2009-02-01

Numerous studies have documented the effect of complete medial collateral ligament injury on anterior cruciate ligament loads; few have addressed how partial medial collateral ligament disruption affects knee kinematics. To determine knee kinematics and subsequent change in anterior cruciate ligament load in a partial and complete medial collateral ligament injury model. Controlled laboratory study. Ten human cadaveric knees were sequentially tested by a robot with the medial collateral ligament intact, in a partial injury model, and in a complete injury model with a universal force-moment sensor measuring system. Tibial translation, rotation, and anterior cruciate ligament load were measured under 3 conditions: anterior load (125 N), valgus load (10 N x m), and internal-external rotation torque (4 N x m; all at 0 degrees and 30 degrees of flexion). Anterior and posterior translation did not statistically increase with a partial or complete medial collateral ligament injury at 0 degrees and 30 degrees of flexion. In response to a 125 N anterior load, at 0 degrees , the anterior cruciate ligament load increased 8.7% (from 99.5 to 108.2 N; P = .006) in the partial injury and 18.3% (117.7 N; P < .001) in the complete injury; at 30 degrees , anterior cruciate ligament load was increased 12.3% (from 101.7 to 114.2 N; P = .001) in the partial injury and 20.6% (122.7 N; P < .001) in the complete injury. In response to valgus torque (10 N x m) at 30 degrees , anterior cruciate ligament load was increased 55.3% (30.4 to 47.2 N; P = .044) in the partial injury model and 185% (86.8 N; P = .001) in the complete injury model. In response to internal rotation torque (4 N.m) at 30 degrees , anterior cruciate ligament load was increased 29.3% (27.6 to 35.7 N; P = .001) in the partial injury model and 65.2% (45.6 N; P < .001) in the complete injury model. The amount of internal rotation at 30 degrees of flexion was significantly increased in the complete injury model (22.8 degrees

Pentadecapeptide BPC 157 (PL 14736) improves ligament healing in the rat.

PubMed

Cerovecki, Tomislav; Bojanic, Ivan; Brcic, Luka; Radic, Bozo; Vukoja, Ivan; Seiwerth, Sven; Sikiric, Predrag

2010-09-01

We improved medial collateral ligament (MCL) healing throughout 90 days after surgical transection. We introduced intraperitoneal, per-oral (in drinking water) and topical (thin cream layer) peptide therapy always given alone, without a carrier. Previously, as an effective peptide therapy, stable gastric pentadecapeptide BPC 157 (GEPPPGKPADDAGLV, an anti-ulcer peptide effective in inflammatory bowel disease therapy (PL 14736)) particularly improved healing of transected tendon and muscle and wound healing effect including the expression of the early growth response 1 (egr-1) gene. After MCL transection BPC 157 was effective in rats when given once daily intraperitoneally (10 microg or 10 ng/kg) or locally as a thin layer (1.0 microg dissolved in distilled water/g commercial neutral cream) at the site of injury, first application 30 min after surgery and the final application 24 h before sacrifice. Likewise, BPC 157 was effective given per-orally (0.16 microg/ml in the drinking water (12 ml/day/rat)) until sacrifice. Commonly, BPC 157 microg-ng-rats exhibited consistent functional, biomechanical, macroscopic and histological healing improvements. Thus, we suggest BPC 157 improved healing of acute ligament injuries in further ligament therapy. (c) 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Optimal management of ulnar collateral ligament injury in baseball pitchers

PubMed Central

Hibberd, Elizabeth E; Brown, J Rodney; Hoffer, Joseph T

2015-01-01

The ulnar collateral ligament stabilizes the elbow joint from valgus stress associated with the throwing motion. During baseball pitching, this ligament is subjected to tremendous stress and injury if the force on the ulnar collateral ligament during pitching exceeds the physiological limits of the ligament. Injuries to the throwing elbow in baseball pitchers result in significant time loss and typically surgical intervention. The purpose of this paper is to provide a review of current information to sports medicine clinicians on injury epidemiology, injury mechanics, injury risk factors, injury prevention, surgical interventions, nonsurgical interventions, rehabilitation, and return to play outcomes in baseball pitchers of all levels. PMID:26635490

[Acute injuries of lateral ankle joint ligaments].

PubMed

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

2010-08-01

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

Injuries to the Collateral Ligaments of the Metacarpophalangeal Joint of the Thumb, Including Simultaneous Combined Thumb Ulnar and Radial Collateral Ligament Injuries, in National Football League Athletes.

PubMed

Werner, Brian C; Belkin, Nicole S; Kennelly, Steve; Weiss, Leigh; Barnes, Ronnie P; Rodeo, Scott A; Warren, Russell F; Hotchkiss, Robert N

2017-01-01

Thumb collateral ligament injuries occur frequently in the National Football League (NFL). In the general population or in recreational athletes, pure metacarpophalangeal (MCP) abduction or adduction mechanisms yield isolated ulnar collateral ligament (UCL) and radial collateral ligament (RCL) tears, respectively, while NFL athletes may sustain combined mechanism injury patterns. To evaluate the incidence of simultaneous combined thumb UCL and RCL tears among all thumb MCP collateral ligament injuries in NFL athletes on a single team. Case series; Level of evidence, 4. A retrospective review of all thumb injuries on a single NFL team from 1991 to 2014 was performed. All players with a thumb MCP collateral ligament injury were included. Collateral ligament injuries were confirmed by review of both physical examination findings and magnetic resonance imaging. Player demographics, surgical details, and return-to-play data were obtained from the team electronic medical record and surgeons' records. A total of 36 thumbs in 32 NFL players were included in the study, yielding an incidence of 1.6 thumb MCP collateral ligament injuries per year on a single NFL team. Of these, 9 thumbs (25%) had a simultaneous combined UCL and RCL tear injury pattern confirmed on both physical examination and MRI. The remaining 27 thumbs (75%) were isolated UCL injuries. All combined UCL/RCL injuries required surgery due to dysfunction from instability; 63.0% of isolated UCL injuries required surgical repair ( P = .032) due to continued pain and dysfunction from instability. Repair, when required, was delayed until the end of the season. All players with combined UCL/RCL injuries and isolated UCL injuries returned to play professional football the following season. Simultaneous combined thumb UCL and RCL tear is a previously undescribed injury pattern that occurred in 25% of thumb MCP collateral ligament injuries on a single NFL team over a 23-year period. All players with combined thumb UCL

[Ligamentous injuries to the ankle joint].

PubMed

Rammelt, S; Schneiders, W; Grass, R; Rein, S; Zwipp, H

2011-10-01

Injuries to the lateral ankle ligaments are the most common sports injuries. Determination of their severity and exclusion of relevant accompanying injuries requires a subtle clinical and a focussed radiological assessment. Treatment is non-operative and functional in the majority of cases. Consequent application of orthoses limiting supination and proprioceptive training are essential to avoid chronic instability. With recurrent ankle sprains one has to distinguish between functional and mechanical instability. The latter can be treated successfully with anatomic reconstruction and ligamentoplasty in more than 80 % of cases. Extraanatomic tenodeses should be reserved for cases of combined ankle and subtalar instability. Isolated injuries to the medial collateral ligaments are rare. Therefore, osseous injuries or underlying deformities have to be excluded. Isolated deltoid ligament ruptures may be treated non-operatively. Unstable injuries to the distal tibiofibular syndesmosis resulting in a manifest or latent diastasis are treated with open reduction and fixation with two tibiofibular set screws. Anatomic reduction of the distal fibula into the tibial groove is of utmost prognostic relevance and therefore should be reliably proved with either intraoperative 3D fluoroscopy or postoperative CT scanning. For chronic syndesmotic instability an anatomic ligamentoplasty using half the peroneus longus tendon is recommended. © Georg Thieme Verlag KG Stuttgart · New York.

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

PubMed

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

2017-12-21

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

Varying whole body vibration amplitude differentially affects tendon and ligament structural and material properties

PubMed Central

Keller, Benjamin V.; Davis, Matthew L.; Thompson, William R.; Dahners, Laurence E.; Weinhold, Paul S.

2014-01-01

Whole Body Vibration (WBV) is becoming increasingly popular for helping to maintain bone mass and strengthening muscle. Vibration regimens optimized for bone maintenance often operate at hypogravity levels (<1 G) and regimens for muscle strengthening often employ hypergravity (>1 G) vibrations. The effect of vibratory loads on tendon and ligament properties is unclear though excessive vibrations may be injurious. Our objective was to evaluate how tendon gene expression and the mechanical/histological properties of tendon and ligament were affected in response to WBV in the following groups: no vibration, low vibration (0.3 G peak-to-peak), and high vibration (2 G peak-to-peak). Rats were vibrated for 20 min a day, 5 days a week, for 5 weeks. Upon sacrifice, the medial collateral ligament (MCL), patellar tendon (PT), and the Achilles Tendon (AT) were isolated with insertion sites intact. All tissues were tensile tested to determine structural and material properties or used for histology. Patellar tendon was also subjected to quantitative RT-PCR to evaluate expression of anabolic and catabolic genes. No differences in biomechanical data between the control and the low vibration groups were found. There was evidence of significant weakness in the MCL with high vibration, but no significant effect on the PT or AT. Histology of the MCL and PT showed a hypercellular tissue response and some fiber disorganization with high vibration. High vibration caused an increase in collagen expression and a trend for an increase in IGF-1 expression suggesting a potential anabolic response to prevent tendon overuse injury. PMID:23623311

MRI of injury to the lateral collateral ligamentous complex of the ankle.

PubMed

Cardone, B W; Erickson, S J; Den Hartog, B D; Carrera, G F

1993-01-01

We retrospectively evaluated the lateral collateral ligamentous complex of 43 patients who had complained of ankle pain following ankle sprain. The MR signs of ligamentous abnormality included discontinuity or absence, increased signal within the ligament, and ligamentous irregularity or waviness with normal thickness and signal intensity. Using these criteria, 30 anterior talofibular, 20 calcaneofibular, and no posterior talofibular ligament injuries were diagnosed. Compared with surgery (nine patients), MRI demonstrated six of seven anterior talofibular ligament injuries and six of six calcaneofibular ligament injuries. Magnetic resonance showed ligamentous abnormalities in 12 of 23 cases with normal stress radiography. Magnetic resonance imaging provides useful information for the evaluation of patients presenting with chronic pain after ankle sprain.

The injury of the calcaneocuboid ligaments.

PubMed

Andermahr, J; Helling, H J; Maintz, D; Mönig, S; Koebke, J; Rehm, K E

2000-05-01

The selective rupture of the calcaneocuboid ligament is extremely rare and frequently misdiagnosed. This study tries to clarify the mechanism, classification and treatment of this entity. The necessity of radiographs with varus stress and in certain cases of computer tomography (CT) and magnetic resonance imaging (MRI), beside the routine antero-posterior and lateral views, is emphasized. Thirteen cases out of five-hundred-twenty-one sprain injuries of the ankle are described, classified and the therapy discussed: If on varus stress radiographs, there is a calcaneocuboid angle <10 degrees without a bony flake (type 1) strapping for six weeks is indicated. A calcaneocuboid angle >10 degrees with or without a small bony flake of the ligament insertion (type 2) should primarily be treated with a shoe cast for 6 weeks; if there are persistent symptoms a secondary peroneus brevis tendon graft is recommended. A calcaneocuboid angle >10 degrees with a big flake (type 3) should be treated by open reduction and refixation of the ligament. Complex injuries (type 4) are characterised by cuboid compression fracture and ligament rupture.

Understanding acute ankle ligamentous sprain injury in sports

PubMed Central

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

2009-01-01

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

Analysis of change in gait in the ovine stifle: normal, injured, and anterior cruciate ligament reconstructed.

PubMed

Heard, B J; Beveridge, J E; Atarod, M; O'Brien, E J; Rolian, C; Frank, C B; Hart, D A; Shrive, N G

2017-05-23

Many patients who undergo anterior cruciate ligament (ACL) reconstructive surgery develop post-traumatic osteoarthritis (PTOA). ACL reconstructive surgery may not fully restore pre-injury joint biomechanics, thereby resulting in further joint damage and contributing to the development of PTOA. In an ovine model of idealized ACL reconstruction (ACL-R), it has been shown that signs of PTOA develop within surgical joints by 20 weeks post-surgery. The aim of the present study was to investigate whether altered kinematics contribute to early PTOA development within ACL-R joints of the ovine injury model by comparing the gait of these surgical animals to the gait of a stable normal control group, and an unstable injury group in which the ACL and medial collateral ligament (MCL) had been transected. Fifteen skeletally mature female sheep were allocated evenly into 3 treatment groups: normal control, ACL-R, and ACL/MCL Tx (each group n = 5). Each animal's gait was recorded at baseline, 4 weeks post injury, and 20 weeks post injury. Principal component analysis (PCA) was used to identify the kinematic patterns that may be discriminant between treatment groups. Results from previous studies were referenced to present the amount of gross PTOA-like changes that occurred in the joints. ACL-R and ACL/MCL transected (Tx) animals developed a similar amount of early PTOA-like changes within the surgical joints, but differed significantly in the amount of kinematic change present at 20 weeks post-surgery. We showed that the stifle joint kinematics of ACL/MCL Tx differed significantly from those of CTRL and the majority of ACL-R animals, while no significant differences in joint kinematic changes were found between ACL-R and CTRL animals. These results suggest that the early PTOA-like changes reported in the ACL-R model cannot be attributed exclusively to post-surgical kinematic changes, and therefore biologic components in the post-injury environment must be contributing

Surgical Treatment and Rehabilitation of Combined Complex Ligament Injuries

PubMed Central

Romeyn, Richard L.; Jennings, Jason

2008-01-01

This article is a description of the surgical treatment and rehabilitation of combined complex ligament injuries. A background will be provided, and information on the combined complex knee injuries, selected aspects of surgical treatments, and rehabilitation strategies will be presented. Combined complex ligament injuries are devastating injuries and are not very common compared to other knee injuries. No meta-analysis or systematic review studies exist regarding the best treatments for these patients. This article's emphasis is on the stages in the rehabilitation program with documentation of the scientific and clinical rationale for the treatment techniques in each stage. Treatment interventions are described and documented with the limited evidence available in treating these patients. Guidelines for treatment, surgery, and a clinical protocol for treating patients with combined complex ligament injuries are provided for the practicing clinician to use as a template for treating these complicated patients. PMID:21509123

Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries.

PubMed

Van Dyck, Pieter; Clockaerts, Stefan; Vanhoenacker, Filip M; Lambrecht, Valérie; Wouters, Kristien; De Smet, Eline; Gielen, Jan L; Parizel, Paul M

2016-10-01

To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. • ALL injuries are fairly common in patients with acute ACL rupture. • ALL injuries are highly associated with lateral meniscal and osseous injuries. • MRI assessment of ACL-injured knees should include evaluation of the ALL.

Low-Magnitude, High-Frequency Vibration Fails to Accelerate Ligament Healing but Stimulates Collagen Synthesis in the Achilles Tendon.

PubMed

Thompson, William R; Keller, Benjamin V; Davis, Matthew L; Dahners, Laurence E; Weinhold, Paul S

2015-05-01

Low-magnitude, high-frequency vibration accelerates fracture and wound healing and prevents disuse atrophy in musculoskeletal tissues. To investigate the role of low-magnitude, high-frequency vibration as a treatment to accelerate healing of an acute ligament injury and to examine gene expression in the intact Achilles tendon of the injured limb after low-magnitude, high-frequency vibration. Controlled laboratory study. Complete surgical transection of the medial collateral ligament (MCL) was performed in 32 Sprague-Dawley rats, divided into control and low-magnitude, high-frequency vibration groups. Low-magnitude, high-frequency vibration started on postoperative day 2, and rats received vibration for 30 minutes a day for 12 days. All rats were sacrificed 2 weeks after the operation, and their intact and injured MCLs were biomechanically tested or used for histological analysis. Intact Achilles tendons from the injured limb were evaluated for differences in gene expression. Mechanical testing revealed no differences in the ultimate tensile load or the structural stiffness between the control and vibration groups for either the injured or intact MCL. Vibration exposure increased gene expression of collagen 1 alpha (3-fold), interleukin 6 (7-fold), cyclooxygenase 2 (5-fold), and bone morphogenetic protein 12 (4-fold) in the intact Achilles tendon when compared with control tendons ( P < .05). While no differences were observed in the mechanical or histological properties of the fully transected MCL after low-magnitude, high-frequency vibration treatment, significant enhancements in gene expression were observed in the intact Achilles tendon. These included collagen, several inflammatory cytokines, and growth factors critical for tendons. As low-magnitude, high-frequency vibration had no negative effects on ligament healing, vibration therapy may be a useful tool to accelerate healing of other tissues (bone) in multitrauma injuries without inhibiting ligament healing

Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases.

PubMed

Abdel-Hamid, Mohamed Zaki; Chang, Chung-Hsun; Chan, Yi-Sheng; Lo, Yang-Pin; Huang, Jau-Wen; Hsu, Kuo-Yao; Wang, Ching-Jen

2006-06-01

This investigation arthroscopically assesses the frequency of soft tissue injury in tibial plateau fracture according to the severity of fracture patterns. We hypothesized that use of arthroscopy to evaluate soft tissue injury in tibial plateau fractures would reveal a greater number of associated injuries than have previously been reported. From March 1996 to December 2003, 98 patients with closed tibial plateau fractures were treated with arthroscopically assisted reduction and osteosynthesis, with precise diagnosis and management of associated soft tissue injuries. Arthroscopic findings for associated soft tissue injuries were recorded, and the relationship between fracture type and soft tissue injury was then analyzed. The frequency of associated soft tissue injury in this series was 71% (70 of 98). The menisci were injured in 57% of subjects (56 in 98), the anterior cruciate ligament (ACL) in 25% (24 of 98), the posterior cruciate ligament (PCL) in 5% (5 of 98), the lateral collateral ligament (LCL) in 3% (3 of 98), the medial collateral ligament (MCL) in 3% (3 of 98), and the peroneal nerve in 1% (1 of 98); none of the 98 patients exhibited injury to the arteries. No significant association was noted between fracture type and incidence of meniscus, PCL, LCL, MCL, artery, and nerve injury. However, significantly higher injury rates for the ACL were observed in type IV and VI fractures. Soft tissue injury was associated with all types of tibial plateau fracture. Menisci (peripheral tear) and ACL (bony avulsion) were the most commonly injured sites. A variety of soft tissue injuries are common with tibial plateau fracture; these can be diagnosed with the use of an arthroscope. Level III, diagnostic study.

In vivo Length Change Patterns of the Medial and Lateral Collateral Ligaments along the Flexion Path of the Knee

PubMed Central

Hosseini, Ali; Qi, Wei; Tsai, Tsung-Yuan; Liu, Yujie; Rubash, Harry; Li, Guoan

2014-01-01

Purpose The knowledge of the function of the collateral ligaments – i.e., superficial medial collateral ligament (sMCL), deep medial collateral ligament (dMCL) and lateral collateral ligament (LCL) – in the entire range of knee flexion is important for soft tissue balance during total knee arthroplasty. The objective of this study was to investigate the length changes of different portions (anterior, middle and posterior) of the sMCL, dMCL and LCL during in vivo weightbearing flexion from full extension to maximal knee flexion. Methods Using a dual fluoroscopic imaging system eight healthy knees were imaged while performing a lunge from full extension to maximal flexion. The length changes of each portion of the collateral ligaments were measured along the flexion path of the knee. Results All anterior portions of the collateral ligaments were shown to have increasing length with flexion except that of the sMCL which showed a reduction in length at high flexion. The middle portions showed minimal change in lengths except that of the sMCL which showed a consistent reduction in length with flexion. All posterior portions showed reduction in lengths with flexion. Conclusions These data indicated that every portion of the ligaments may play important roles in knee stability at different knee flexion range. The soft tissue releasing during TKA may need to consider the function of the ligament portions along the entire flexion path including maximum flexion. PMID:25239504

The effects of plasma rich in growth factors (PRGF-Endoret) on healing of medial collateral ligament of the knee.

PubMed

Yoshioka, Tomokazu; Kanamori, Akihiro; Washio, Toshikatsu; Aoto, Katsuya; Uemura, Kenta; Sakane, Masataka; Ochiai, Naoyuki

2013-08-01

Platelet-rich plasma (PRP) has been increasingly used in sports-related injuries for therapeutic applications. However, there are numerous manufacturing procedures and treatment protocols of PRP use, which make difficult to assess its real efficacy for tissue healing. This study addressed to evaluate the therapeutic effects of locally delivered plasma rich in growth factors (PRGF-Endoret) on the early healing of medial collateral ligament (MCL) in rabbit knees. Thirty-one Japanese white rabbits were subjected to a mop-end tear in the MCL of the left knee. PRGF-Endoret was prepared using Anitua's technique. Two groups were set up. In 17 knees, prepared 1.0 ml of PRGF-Endoret after clotting was applied on the tear site, while in 14 knees the tear site was untreated serving as a control. Quantitative aspects of PRGF-Endoret, the concentration of platelets, leukocytes and erythrocytes and therapeutic growth factors such as PDGF-BB and TGF-β1 were measured. Rabbits were sacrificed at 3 and 6 weeks after the operation and histological and biomechanical evaluation were performed. No leukocytes were measured and certain amount of growth factors such as PDGF-BB and TGF-β1 were confirmed in the PRGF-Endoret. PRGF-Endoret stimulated proliferation of fibroblasts and neovascularization, and induced statistically better structural properties in repaired MCL. Our findings provide evidence that local administration of PRGF-Endoret promotes early steps in ligament healing and the repair of structural properties in a rabbit model. PRGF-Endoret would be a useful product in clinical treatment of ligament injuries.

Anatomy of the collateral ligaments of the feline elbow joint: functional implications.

PubMed

Engelke, E; Pfarrer, C; Waibl, H

2011-04-01

Cats show a higher capability to supinate their forearms than dogs. This suggests a special arrangement of the collateral ligaments of the feline elbow joint. Therefore, the course of the ligaments was examined in 13 adult cats. The size of the ligaments was measured, and effects of passive joint movements were studied. Ligaments of five additional cats were examined histologically. The lateral collateral ligament (LCL) had a superficial and deep part, both originating from the humerus. The free humeral portion of the LCL was short and contained fibrous cartilage. Fibre bundles of the deep part inserted into the annular ligament, while the remaining deep fibres and the superficial part inserted with a long antebrachial portion on the radius. The medial collateral ligament (MCL) originated from the humeral epicondyle and divided into cranial and caudal parts. The caudal part inserted medioproximally on the ulna, while the cranial part attached primarily with a long thin part to the caudal aspect of the radius. During supination, the MCL loosened thus allowing medial widening of the joint space, up to 2 mm. A specific feature of the feline elbow is the long thin part of the MCL. Its course through a special furrow distal to the medial coronoid causes the tightening of the feline MCL during pronation. Apart from that, the feline collateral ligaments combine the features of both human and canine cubital anatomy. This explains the range of supination in cats, which is intermediate between humans and dogs. © 2010 Blackwell Verlag GmbH.

Investigating the relationship between internal tibial torsion and medial collateral ligament injury in patients undergoing knee arthroscopy due to tears in the posterior one third of the medial meniscus.

PubMed

Guler, Olcay; Isyar, Mehmet; Karataş, Dilek; Ormeci, Tugrul; Cerci, Halis; Mahirogulları, Mahir

2016-08-01

To evaluate the relationship between medial collateral ligament (MCL) injury and degree of internal tibial torsion in patients who had undergone arthroscopic resection due to tears in the posterior one third of the medial meniscus. Seventy-one patients were allocated into two groups with respect to foot femur angle (FFA) and transmalleolar angle (TMA) (Group 1 31 patients with FFA<8° and Group 2 40 patients with FFA≥8°). The groups were compared in terms of valgus instability, Lysholm score, magnetic resonance view, FFA, and TMA, both before and after the operation. Lysholm scores were higher in Group 2 at both postoperative week 1 (p<0.001) and month 1 (p=0.045) relative to Group 1. Preoperative cartilage injury was encountered more frequently in Group 1 (p=0.037) than in Group 2. MCL injury was detected more frequently in Group 1 compared to Group 2 postoperatively at week 1 (p=0.001). We conclude that FFA and TFA, indicators of internal tibial torsion, may serve as markers for foreseeing clinical improvement and complications following arthroscopic surgery. level III retrospective comparative study. Copyright © 2015 Elsevier B.V. All rights reserved.

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

PubMed Central

Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

2016-01-01

Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task

Biomechanical analysis of ankle ligamentous sprain injury cases from televised basketball games: Understanding when, how and why ligament failure occurs.

PubMed

Panagiotakis, Emmanouil; Mok, Kam-Ming; Fong, Daniel Tik-Pui; Bull, Anthony M J

2017-12-01

Ankle sprains due to landing on an opponent's foot are common in basketball. There is no analysis to date that provides a quantification of this injury mechanism. The aim of this study was to quantify the kinematics of this specific injury mechanism and relate this to lateral ankle ligament biomechanics. Case series. The model-based image-matching technique was used to quantify calcaneo-fibular-talar kinematics during four ankle inversion sprain injury incidents in televised NBA basketball games. The four incidents follow the same injury pattern in which the players of interest step onto an opponent's foot with significant inversion and a diagnosed ankle injury. A geometric analysis was performed to calculate the in vivo ligament strains and strain rates for the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). Despite the controlled selection of cases, the results show that there are two distinct injury mechanisms: sudden inversion and internal rotation with low levels of plantarflexion; and a similar mechanism without internal rotation. The first of these mechanisms results in high ATFL and CFL strains, whereas the second of these strains the CFL in isolation. The injury mechanism combined with measures of the ligament injury in terms of percentage of strain to failure correlate directly with the severity of the injury quantified by return-to-sport. The opportunity to control excessive internal rotation through proprioceptive training and/or prophylactic footwear or bracing could be utilised to reduce the severity of common ankle injuries in basketball. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Sports Injury-Related Fingers and Thumb Deformity Due to Tendon or Ligament Rupture.

PubMed

Bai, Rong-Jie; Zhang, Hui-Bo; Zhan, Hui-Li; Qian, Zhan-Hua; Wang, Nai-Li; Liu, Yue; Li, Wen-Ting; Yin, Yu-Ming

2018-05-05

Hand injuries are very common in sports, such as skiing and ball sports. One of the major reasons causing hand and finger deformity is due to ligament and tendon injury. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) can demonstrate the complex anatomy of the fingers and thumb, especially the tendons and ligaments, and provide the accurate diagnosis of clinically important fingers and thumbs deformity due to ligamentous and tendinous injuries during sport activities. Sixteen fresh un-embalmed cadaveric hands were harvested from eight cadavers. A total of 20 healthy volunteers' hands and 44 patients with fingers or thumb deformity due to sports-related injuries were included in this study. All subjects had MR examination with T1-weighted images and proton density-weighted imaging with fat suppression (PD FS) in axial, coronal, and sagittal plane, respectively. Subsequently, all 16 cadaveric hands were sliced into 2-mm thick slab with a band saw (six in coronal plane, six in sagittal plane, and four in axial plane). The correlation of anatomic sections and the MRI characteristics of tendons of fingers and the ulnar collateral ligament (UCL) at the metacarpal phalangeal joint (MCPJ) of thumb between 20 healthy volunteers and 44 patients (confirmed by surgery) were analyzed. The normal ligaments and tendons in 16 cadaveric hands and 20 volunteers' hands showed uniform low-signal intensity on all the sequences of the MRI. Among 44 patients with tendinous and ligamentous injuries in the fingers or thumb, 12 cases with UCL injury at MCPJ of the thumb (Stener lesion = 8 and non-Stener lesion = 4), 6 cases with the central slip injury, 12 cases with terminal tendon injury, and 14 cases with flexor digitorum profundus injury. The ligaments and tendons disruption manifested as increased signal intensity and poor definition, discontinuity, and heterogeneous signal intensity of the involved ligaments and tendons. Sports

Comparison of complete distal release of the medial collateral ligament and medial epicondylar osteotomy during ligament balancing in varus knee total knee arthroplasty.

PubMed

Sim, Jae Ang; Lee, Yong Seuk; Kwak, Ji Hoon; Yang, Sang Hoon; Kim, Kwang Hui; Lee, Beom Koo

2013-12-01

During ligament balancing for severe medial contracture in varus knee total knee arthroplasty (TKA), complete distal release of the medial collateral ligament (MCL) or a medial epicondylar osteotomy can be necessary if a large amount of correction is needed. This study retrospectively reviewed 9 cases of complete distal release of the MCL and 11 cases of medial epicondylar osteotomy which were used to correct severe medial contracture. The mean follow-up periods were 46.5 months (range, 36 to 78 months) and 39.8 months (range, 32 to 65 months), respectively. There were no significant differences in the clinical results between the two groups. However, the valgus stress radiograph revealed significant differences in medial instability. In complete distal release of the MCL, some stability was obtained by repair and bracing but the medial instability could not be removed completely. Medial epicondylar osteotomy for a varus deformity in TKA could provide constant medial stability and be a useful ligament balancing technique.

Viability of ligaments after freezing: an experimental study in a rabbit model.

PubMed

Frank, C; Edwards, P; McDonald, D; Bodie, D; Sabiston, P

1988-01-01

Our purpose in this study was to assess ligament fibroblast viability after freezing by quantifying the subsequent ability of fibroblasts to synthesize collagen in vitro. Both medial collateral ligament (MCL) complexes from 40 adolescent rabbits were studied. Collagen production was determined by in vitro incubation of ligaments in 3H-proline (a collagen precursor) and subsequent analysis of 3H-hydroxyproline (a marker of newly synthesized collagen). Autoradiographs determined the distributions of ligament cell activity. All right MCL complexes served as fresh controls, providing a baseline of collagen production. Each left MCL was assigned to an experimental group and was either incubated fresh (10 animals); "killed" by drying, multiple freeze thawing, or cycloheximide (six animals); or slowly frozen at -70 degrees C without cryoprotection (24 animals). Collagen production of rapidly thawed ligaments was studied by proline incubation at 1 day, 9 days, or 6 weeks after freezing and was compared with that of contralateral fresh controls. Results demonstrate that some cells in the substance of these rabbit ligaments retained the ability to synthesize collagen in vitro after being frozen for up to 6 weeks. Mean collagen production of frozen ligaments was decreased, but tests of mean and median values as well as ratios were statistically similar to fresh contralateral ligaments in all animals. This postfreezing ligament cell survival and collagen production after -70 degrees C storage may have implications for ligament transplantation.

Surgical treatment of subacute and chronic valgus instability in multiligament-injured knees with superficial medial collateral ligament reconstruction using Achilles allografts: a quantitative analysis with a minimum 2-year follow-up.

PubMed

Liu, Xin; Feng, Hua; Zhang, Hui; Hong, Lei; Wang, Xue Song; Zhang, Jin; Shen, Jie Wei

2013-05-01

Symptomatic medial collateral ligament (MCL) instability is rare, and it is frequently associated with multiligament injuries. Most clinical investigations have failed to clearly define the specific objective outcome measures assessing the stability of the MCL quantitatively before and after the reconstruction procedure. To quantitatively evaluate the early clinical outcomes of patients with valgus instability of knee joints who had undergone superficial MCL reconstruction using Achilles tendon allografts. Case series; Level of evidence, 4. From August 2005 to December 2010, 19 consecutive patients with MCL injuries were included in this study. The inclusion criteria were (1) a subacute or chronic MCL injury, with a time from initial injury to surgery of longer than 3 weeks, and (2) valgus laxity graded C or D according to the International Knee Documentation Committee (IKDC). All patients underwent superficial MCL reconstruction using Achilles tendon allografts. To evaluate the laxity of the MCL preoperatively and postoperatively, valgus stress radiographs using a Telos device were used. Other assessments included the IKDC subjective functional evaluation and Lysholm score estimation. Sixteen of the 19 patients (12 men and 4 women) were available for final follow-up. The median age of the patients was 37 years (range, 19-53 years); mean body mass index (BMI) was 26.4 (range, 21.7-29.4). The mean time from injury to surgery was 15.9 months (range, 24 days to 84 months), and median follow-up period was 34 months (range, 24-67 months). The mean medial knee laxity (side-to-side difference) was 8.9 ± 3.2 mm (range, 6-15.9 mm) preoperatively and 1.1 ± 0.9 mm (range, -1.1 to 3.2 mm) postoperatively (P < .001). The preoperative mean IKDC subjective knee functional score was 49.8 ± 6.9 (range, 31-57.5), while the postoperative functional score was 84.3 ± 6.0 (range, 71.3-93.1) (P < .001). The mean Lysholm score was 69.3 ± 5.9 (range, 55-78) preoperatively and 88.6 �

Subfailure injury of the rabbit anterior cruciate ligament.

PubMed

Panjabi, M M; Yoldas, E; Oxland, T R; Crisco, J J

1996-03-01

Ligamentous injuries range in severity from a simple sprain to a complete rupture. Although sprains occur more frequently than complete failures, only a few studies have investigated the phenomena of these subfailure injuries. The purpose of our study was to document the changes in the load-deformation curve until the failure point, after the ligament has been subjected to an 80% subfailure stretch. Thirteen paired fresh rabbit bone-anterior cruciate ligament-bone preparations were used. One of the pairs (control) was stretched until failure; the other (experimental) was first stretched to 80% of the failure deformation of the control and then stretched to failure. Comparisons were made between the load-deformation curves of the experimental and control specimens. The nonlinear load-deformation curves were characterized by eight parameters: failure load (Ffail), failure deformation (Dfail), energy until failure (Efail), deformations measured at 5, 10, 25, and 50% of the failure load (D5, D10, D25, and D50, respectively), and stiffness measured at 50% of the failure force (K50). There were no significant differences in the values for Ffail, Dfail, and Efail between the experimental and control ligaments (p > 0.33). In contrast, the deformation values were all larger for the experimental than the control ligaments (p > 0.01). The deformations D5, D10, D25, and D50 (mean +/- SD) for the control were 0.36 +/- 0.13, 0.49 +/- 0.23, 0.81 +/- 0.35, and 1.23 +/- 0.41 mm. The corresponding deformations for the experimental ligaments were, respectively, 209, 186, 153, and 130% of the control values. K50 was also greater for the experimental ligament (125.0 +/- 41.7 N/mm compared with 108.7 +/- 31.4 N/mm, p < 0.03). These findings indicate that even though the strength of the ligament did not change due to a subfailure injury, the shape of the load-displacement curve, especially at low loads, was significantly altered. Under the dynamic in vivo loading conditions of daily

Anterior longitudinal ligament injuries in whiplash may lead to cervical instability.

PubMed

Stemper, Brian D; Yoganandan, Narayan; Pintar, Frank A; Rao, Raj D

2006-07-01

Although whiplash injuries account for a significant annual cost to society, the exact mechanism of injury and affected tissues remain unknown. Previous investigations documented injuries to the cervical anterior longitudinal ligament in whiplash. The present investigation implemented a comprehensively validated computational model to quantify level-dependent distraction magnitudes of this structure in whiplash. Maximum ligament distractions approached failure levels, particularly in middle to lower cervical levels, and occurred during the initial phase of head-neck kinematics. In particular, the C5-C6 anterior longitudinal ligament sustained distraction magnitudes as high as 2.6mm during the retraction phase, corresponding to 56% of distraction necessary to result in ligament failure. Present results demonstrated that anterior structures in the lower cervical spine may be susceptible to injury through excess distraction during the retraction phase of whiplash, which likely occurs prior to head restraint contact. Susceptibility of these structures is likely due to non-physiologic loading placed on the cervical spinal column as the head translates posteriorly relative to the thorax. Injury to anterior spinal structures can result in clinical indications including cervical instability in extension, axial rotation, and lateral bending modes. Mitigation of whiplash injury may be achieved by minimizing head retraction during initial stages of whiplash.

Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

PubMed

Davis, Bryan A; Hiller, Lucas P; Imbesi, Steven G; Chang, Eric Y

2015-08-01

We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.

Nonoperative Management of Craniocervical Ligamentous Distraction Injury: Literature Review.

PubMed

Kaplan, Nathan B; Molinari, Christine; Molinari, Robert W

2015-12-01

Study Design Literature review and case report. Objective Review the existing literature and report the successful nonoperative management of a two-level craniocervical ligamentous distraction injury. Methods A PubMed and Medline review revealed only three limited reports involving the nonoperative management of patients with craniocervical distraction injury. This article reviews the existing literature and reports the case of a 27-year-old man who was involved in a motorcycle accident and sustained multiple systemic injuries and ligamentous distraction injuries to both occipitocervical joints and both C1-C2 joints. The patient's traumatic brain injury and bilateral pulmonary contusions precluded safe operative management of the two-level craniocervical distraction injury. Therefore, the patient was placed in a halo immobilization device. Results The literature remains unclear as to the specific indications for nonoperative management of ligamentous craniocervical injuries. Nonoperative management was associated with poor outcomes in the majority of reported patients. We report a patient who was managed for 6 months in a halo device. Posttreatment computed tomography and flexion-extension radiographs demonstrated stable occipitocervical and C1-C2 joints bilaterally. The patient reported minimal neck pain and had excellent functional outcome with a Neck Disability Index score of 2 points at 41 months postoperatively. He returned to preinjury level of employment without restriction. Conclusions Further study is needed to determine which craniocervical injuries may be managed successfully with nonoperative measures.

Nonoperative Management of Craniocervical Ligamentous Distraction Injury: Literature Review

PubMed Central

Kaplan, Nathan B.; Molinari, Christine; Molinari, Robert W.

2015-01-01

Study Design Literature review and case report. Objective Review the existing literature and report the successful nonoperative management of a two-level craniocervical ligamentous distraction injury. Methods A PubMed and Medline review revealed only three limited reports involving the nonoperative management of patients with craniocervical distraction injury. This article reviews the existing literature and reports the case of a 27-year-old man who was involved in a motorcycle accident and sustained multiple systemic injuries and ligamentous distraction injuries to both occipitocervical joints and both C1–C2 joints. The patient's traumatic brain injury and bilateral pulmonary contusions precluded safe operative management of the two-level craniocervical distraction injury. Therefore, the patient was placed in a halo immobilization device. Results The literature remains unclear as to the specific indications for nonoperative management of ligamentous craniocervical injuries. Nonoperative management was associated with poor outcomes in the majority of reported patients. We report a patient who was managed for 6 months in a halo device. Posttreatment computed tomography and flexion–extension radiographs demonstrated stable occipitocervical and C1–C2 joints bilaterally. The patient reported minimal neck pain and had excellent functional outcome with a Neck Disability Index score of 2 points at 41 months postoperatively. He returned to preinjury level of employment without restriction. Conclusions Further study is needed to determine which craniocervical injuries may be managed successfully with nonoperative measures. PMID:26682101

A new surgical technique for medial collateral ligament balancing: multiple needle puncturing.

PubMed

Bellemans, Johan; Vandenneucker, Hilde; Van Lauwe, Johan; Victor, Jan

2010-10-01

In this article, we present our experience with a new technique for medial soft tissue balancing, where we make multiple punctures in the medial collateral ligament (MCL) using a 19-gauge needle, to progressively stretch the MCL until a correct ligament balance is achieved. Ligament status was evaluated both before and after the procedure using computer navigation and mediolateral stress testing. The procedure was considered successful when 2 to 4-mm mediolateral joint line opening was obtained in extension and 2 to 6 mm in flexion. In 34 of 35 cases, a progressive correction of medial tightness was achieved according to the above described criteria. One case was considered overreleased in extension. Needle puncturing is a new, effective, and safe technique for progressive correction of MCL tightness in the varus knee. Copyright © 2010 Elsevier Inc. All rights reserved.

Surgical techniques for the treatment of carpal ligament injury in the athlete.

PubMed

Paci, Gabrielle M; Yao, Jeffrey

2015-01-01

Treatment of intercarpal ligament injuries in the athlete requires special attention due to several practical and biomechanical considerations. Optimally, the athlete will maintain as much function and range of motion as possible with return to high-impact and load-bearing activity in a timely fashion. Several cutting-edge techniques have arisen in treatment. This article discusses injury patterns in the athlete with scapholunate injury, lunotriquetral injury, scaphotrapezial-trapezoidal injury, and extrinsic ligamentous injury, and the various approaches to addressing these injuries, with a review of the classic as well as newer, innovative techniques. Copyright © 2015 Elsevier Inc. All rights reserved.

Does a balance deficit persist in Australian Football players with previous lower limb ligament injury?

PubMed

Hrysomallis, C; McLaughlin, P; Goodman, C

2005-03-01

A history of lower limb ligament injury is a commonly-cited risk factor for another similar injury. During the acute phase of injury, there is a balancing skill deficit in the injured limb. It has been unclear as to whether this deficit persists in the medium-to-long term for previously injured Australian footballers, contributing to the risk of re-injury. This study compared the balance ability of footballers with and without previous lower limb ligament injury and, for previously injured players, the balance ability of the previously injured limb to the opposite uninjured limb. A total of 216 players from 6 teams from the Australian Football League were tested. The balance task comprised stepping on to a foam mat on top of a force plate and maintaining one-legged balance. The subjects were divided into 4 groups based on their injury history: all ankle injuries to only one limb, recent ankle injuries to only one limb (within the last 12 months), knee ligament injury only to one limb, and no previous ankle or knee ligament injury. Statistical analysis revealed that there was no significant difference between the balance scores of any of the previously injured players and those with no previous lower limb ligament injury. There was no significant difference between the balance score of the previously injured limb with the opposite uninjured limb. It appears that a balance deficit does not persist in Australian Football players with previous lower limb ligament injury.

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

PubMed Central

Jung, Ho-Joong; Fisher, Matthew B; Woo, Savio L-Y

2009-01-01

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

Treatment of chronic deltoid ligament injury using suture anchors.

PubMed

Wang, Xu; Ma, Xin; Zhang, Chao; Wang, Chen; Huang, Jia-zhang

2014-08-01

To explore the efficacy of overlapping suture-anchor fixation for treatment of chronic deltoid ligament injury. Seventeen patients (11 men, 6 women of mean age 32.1 years [range, 18-58 years]) who had undergone surgery for chronic deltoid ligament injury from January 2007 to December 2011 were retrospectively analyzed. Preoperatively, they had undergone bilateral weight-bearing posterior-anterior radiographs, (MRI) and ultrasound examinations of the ankle. Ankle arthroscopy was performed to confirm the diagnosis, followed by surgery to clear intra-articular proliferating synovial tissues and remove cartilage debris and scar tissue. The deep layer of the deltoid ligament was sutured onto the tip of the medial malleolus and its superficial layer sutured onto its periosteum and fixed with suture anchors. American Orthopedic Foot and Ankle Society (AOFAS) scoring system for the ankle-hindfoot was used to evaluate the ankles pre- and post-operatively. The 17 patients were followed up for 12-34 months (mean 20.1 months). The angle between the long axes of the talus and first metatarsal and the hindfoot angle measured in a hindfoot alignment view (as described by Saltzman) were reduced from 5.4° ± 1.8° and 8.2° ± 2.6° preoperatively to 4.0° ± 0.9° and 5.3° ± 1.3° postoperatively, respectively. The mean AOFAS ankle-hindfoot score was 76.8 ± 7.0 preoperatively and 94.1 ± 3.3 at the last follow-up visit. Ten patients were scored as excellent, six as good, and one as fair. Pain was relieved in all patients and no patients had recurrent deltoid ligament injury. Using suture anchors to treat chronic deltoid ligament injury has relatively satisfactory outcomes. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Evaluation of Transsyndesmotic Fixation and Primary Deltoid Ligament Repair in Ankle Fractures With Suspected Combined Deltoid Ligament Injury.

PubMed

Wu, Kai; Lin, Jian; Huang, Jianhua; Wang, Qiugen

2018-04-13

The present prospective study examined the utility of the intraoperative tap test/technique for distal tibiofibular syndesmosis in the diagnosis of deltoid ligament rupture and compared the outcomes of transsyndesmotic fixation to deltoid ligament repair with suture anchor. This diagnostic technique was performed in 59 ankle fractures with suspected deltoid ligament injury. The width of the medial clear space of 59 cases was evaluated to assess the sensitivity and specificity. Those with deltoid ligament rupture were randomly assigned to 2 groups and treated with deltoid ligament repair with a suture anchor or with syndesmosis screw fixation. All the patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, short-form 36-item questionnaire (SF-36), and visual analog scale (VAS). The tap test was positive in 53 cases. However, surgical exploration demonstrated that 51 cases (86.4%) had a combined deltoid ligament injury and fracture. The sensitivity and specificity of the tap test was 100.0% and 75.0%, respectively. Finally, 26 cases (96.3%) in the syndesmosis screw group and 22 (91.7%) in the deltoid repair group were followed up. No statistically significant differences were found in the AOFAS ankle-hindfoot scale score, SF-36 score, or VAS score between the 2 groups. The malreduction rate in the syndesmosis screw group was 34.6% and that in the deltoid repair group was 9.09%. The tap test is an intraoperative diagnostic method to use to evaluate for deltoid ligament injury. Deltoid ligament repair with a suture anchor had good functional and radiologic outcomes comparable to those with syndesmotic screw fixation but has a lower malreduction rate. We did not encounter the issue of internal fixation failure or implant removal. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Return to National Basketball Association Competition Following Anterior Cruciate Ligament and Fibular Collateral Ligament Injuries: A Case Report.

PubMed

LaPrade, Robert F; O'Brien, Luke; Kennedy, Nicholas I; Cinque, Mark E; Chahla, Jorge

2017-01-01

Numerous outcome studies regarding anterior cruciate ligament (ACL) reconstruction demonstrate the ability of athletes to return to a high level of play. However, to our knowledge, there is limited literature regarding return to play following injury to both the ACL and the fibular collateral ligament (FCL). We describe the case of a National Basketball Association (NBA) player who sustained a combined ACL and FCL knee injury and subsequently underwent surgical reconstruction of both affected ligaments. He was able to return to a preinjury level of competition at 9 months postoperatively. It is possible for athletes to return to competitive basketball and maintain a high production level following a single-staged reconstruction of both the ACL and the FCL.

Knee Ligament Injury and the Clinical Application of Tissue Engineering Techniques: A Systematic Review.

PubMed

Riley, Thomas C; Mafi, Reza; Mafi, Pouya; Khan, Wasim S

2018-02-23

The incidence of knee ligament injury is increasing and represents a significant cost to healthcare providers. Current interventions include tissue grafts, suture repair and non-surgical management. These techniques have demonstrated good patient outcomes but have been associated graft rejection, infection, long term immobilization and reduced joint function. The limitations of traditional management strategies have prompted research into tissue engineering of knee ligaments. This paper aims to evaluate whether tissue engineering of knee ligaments offers a viable alternative in the clinical management of knee ligament injuries. A search of existing literature was performed using OVID Medline, Embase, AMED, PubMed and Google Scholar, and a manual review of citations identified within these papers. Silk, polymer and extracellular matrix based scaffolds can all improve graft healing and collagen production. Fibroblasts and stem cells demonstrate compatibility with scaffolds, and have been shown to increase organized collagen production. These effects can be augmented using growth factors and extracellular matrix derivatives. Animal studies have shown tissue engineered ligaments can provide the biomechanical characteristics required for effective treatment of knee ligament injuries. There is a growing clinical demand for a tissue engineered alternative to traditional management strategies. Currently, there is limited consensus regarding material selection for use in tissue engineered ligaments. Further research is required to optimize tissue engineered ligament production before clinical application. Controlled clinical trials comparing the use of tissue engineered ligaments and traditional management in patients with knee ligament injury could determine whether they can provide a cost-effective alternative. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Shoulder Acromioclavicular and Coracoclavicular Ligament Injuries: Common Problems and Solutions.

PubMed

Wylie, James D; Johnson, Jeremiah D; DiVenere, Jessica; Mazzocca, Augustus D

2018-04-01

Injuries to the acromioclavicular joint and coracoclavicular ligaments are common. Many of these injuries heal with nonoperative management. However, more severe injuries may lead to continued pain and shoulder dysfunction. In these patients, surgical techniques have been described to reconstruct the function of the coracoclavicular ligaments to provide stable relationship between the clavicle and scapula. These surgeries have been fraught with high complication rates including clavicle and coracoid fractures, infection, loss of reduction and fixation, hardware migration, and osteolysis. This article reviews common acromioclavicular and coracoclavicular repair and reconstruction techniques and associated complications, and provides recommendations for prevention and management. Copyright © 2018 Elsevier Inc. All rights reserved.

Conservative treatment of injury to the fibular ligaments of the ankle.

PubMed Central

Cetti, R.

1982-01-01

Fifty-one patients with fibular ligamentous injury of the ankle are presented. The treatment consisted of complete non-weight-bearing of the affected foot by use of elbow crutches for three weeks. All patients were seen at follow-up eighteen months after the accident. The results are discussed in the light of previous literature on conservative and operative treatment of lateral ligament injuries. Images p47-a PMID:6802213

Knee pain

MedlinePlus

... the kneecap. Torn ligament. An anterior cruciate ligament (ACL) injury, or medial collateral ligament (MCL) injury may ... need surgery. Alternative Names Pain - knee Patient Instructions ACL reconstruction - discharge Hip or knee replacement - after - what ...

Ligamentous Injuries and the Risk of Associated Tissue Damage in Acute Ankle Sprains in Athletes: A Cross-sectional MRI Study.

PubMed

Roemer, Frank W; Jomaah, Nabil; Niu, Jingbo; Almusa, Emad; Roger, Bernard; D'Hooghe, Pieter; Geertsema, Celeste; Tol, Johannes L; Khan, Karim; Guermazi, Ali

2014-07-01

Ankle joint injuries are extremely common sports injuries, with the anterior talofibular ligament involved in the majority of ankle sprains. There have been only a few large magnetic resonance imaging (MRI) studies on associated structural injuries after ankle sprains. To describe the injury pattern in athletes who were referred to MRI for the assessment of an acute ankle sprain and to assess the risk of associated traumatic tissue damage including lateral and syndesmotic ligament involvement. Cross-sectional study; Level of evidence, 3. A total of 261 ankle MRI scans of athletes with acute ankle sprains were evaluated for: lateral and syndesmotic ligament injury; concomitant injuries to the deltoid and spring ligaments and sinus tarsi; peroneal, flexor, and extensor retinacula and tendons; traumatic and nontraumatic osteochondral and osseous changes; and joint effusion. Patients were on average 22.5 years old, and the average time from injury to MRI was 5.7 days. Six exclusive injury patterns were defined based on lateral and syndesmotic ligament involvement. The risk for associated injuries was assessed by logistic regression using ankles with no or only low-grade lateral ligament injuries and no syndesmotic ligament damage as the reference. With regard to the injury pattern, there were 103 ankles (39.5%) with complete anterior talofibular ligament disruption and no syndesmotic injury, and 53 ankles (20.3%) had a syndesmotic injury with or without lateral ligament damage. Acute osteochondral lesions of the lateral talar dome were seen in 20 ankles (7.7%). The percentage of chronic lateral osteochondral lesions was 1.1%. The risk for talar bone contusions increased more than 3-fold for ankles with complete lateral ligament ruptures (adjusted odds ratio [aOR], 3.43; 95% CI, 1.72-6.85) but not for ankles with syndesmotic involvement. The risk for associated deltoid ligament injuries increased for ankles with complete lateral ligament injuries (aOR, 4.04; 95% CI, 1

How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard.

PubMed

Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J; Hewett, Timothy E

2017-01-01

Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury - a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms.

How Anterior Cruciate Ligament Injury was averted during Knee Collapse in a NBA Point Guard

PubMed Central

Schilaty, Nathan D; Bates, Nathaniel A; Krych, Aaron J; Hewett, Timothy E

2017-01-01

Summary Non-contact anterior cruciate ligament (ACL) injuries occur with rapid decelerations and pivoting. A recent injury to a high-level National Basketball Association (NBA) player demonstrated neuromuscular control and injury-sparing mechanisms that resulted in only minor ligament injury to the medial collateral ligament. We analyzed biomechanical mechanisms via publically available orthogonal 2-D video to demonstrate how this potential ACL injury was averted. Analysis of the knee injury mechanism demonstrated that the NBA player experienced low ground reaction force, high sagittal plane flexion, and maintenance of frontal plane stability with neuromuscular control. The outcome of these factors inhibited dynamic valgus collapse of the knee throughout the fall, avoiding ACL injury – a potentially career-altering injury. Many athletes, professional and recreational, will be subjected to similar mechanisms of injury and will have improved outcomes if they can successfully utilize preventive strategies of neuromuscular control to limit injury mechanisms. PMID:28603786

Do Tibial Plateau Fractures Worsen Outcomes of Knee Ligament Injuries? A Matched Cohort Analysis

PubMed Central

Cinque, Mark E.; Godin, Jonathan A.; Moatshe, Gilbert; Chahla, Jorge; Kruckeberg, Bradley M.; Pogorzelski, Jonas; LaPrade, Robert F.

2017-01-01

Background: Tibial plateau fractures account for a small portion of all fractures; however, these fractures can pose a surgical challenge when occurring concomitantly with ligament injuries. Purpose/Hypothesis: The purpose of this study was to compare 2-year outcomes of soft tissue reconstruction with or without a concomitant tibial plateau fracture and open reduction internal fixation. We hypothesized that patients with a concomitant tibial plateau fracture at the time of soft tissue surgery would have inferior outcomes compared with patients without an associated tibial plateau fracture. Study Design: Cohort study; Level of evidence, 3. Methods: Forty patients were included in this study: 8 in the fracture group and 32 in the matched control group. Inclusion criteria for the fracture group included patients who were at least 18 years old at the time of surgery and sustained a tibial plateau fracture and a concomitant injury of the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, or fibular collateral ligament in isolation or any combination of cruciate or collateral ligaments and who subsequently underwent isolated or combined ligament reconstruction. Patients were excluded if they underwent prior ipsilateral knee surgery, sustained additional bony injuries, or sustained an isolated extra-articular ligament injury at the time of injury. Each patient with a fracture was matched with 4 patients from a control group who had no evidence of a tibial plateau fracture but underwent the same soft tissue reconstruction procedure. Results: Patients in the fracture group improved significantly from preoperatively to postoperatively with respect to Short Form–12 (P < .05) and Western Ontario and McMaster Universities Osteoarthritis Index total scores (P < .05). The Lysholm (P = .075) and Tegner scores (P = .086) also improved, although this was not statistically significant. Patients in the control group improved significantly from

[Cruciate ligament injuries under gender aspects].

PubMed

Grabau, D E; Vitzthum, K; Mache, S; Groneberg, D A; Quarcoo, D

2011-12-01

An injury of cruciate ligament is one the most common knee injuries. This accident happens mostly without external impact and towards the end of training and competition sessions. Women, especially athletes playing team sports ball games such as soccer or disciplines such as tennis, are affected 2 to 8 times more often than men. Anatomic, biomechanical and endocrinological differences are currently discussed as potential risk factors. In terms of prevention, biomechanical impact is of greatest importance given its influenceability through various training opportunities. Training programs including endurance aspects, strengthening knee musculature, balance as well as plyometric trainings were most effective. Further studies should focus more on concomitants of course of injuries. © Georg Thieme Verlag KG Stuttgart · New York.

Acute torn meniscus combined with acute cruciate ligament injury. Second look arthroscopy after 3-month conservative treatment.

PubMed

Ihara, H; Miwa, M; Takayanagi, K; Nakayama, A

1994-10-01

The purpose of this study was to evaluate arthroscopically the natural healing of an acute torn meniscus combined with an acute cruciate ligament injury treated nonoperatively. There were 30 lateral and 10 medial meniscus tears associated with 25 acute anterior cruciate ligament and 7 posterior cruciate ligament injuries in 32 patients. There was more than 1 tear on some menisci for a total of 51 tear sites. Injuries to the menisci and ligaments were allowed to heal without surgery, but were given protective mobilization immediately in order to stimulate stress oriented healing of injured collagen fibers and promote circulation of synovial fluid to the meniscus and ligament. A Kyuro knee brace with a coil spring traction system was used to add adequate but not excessive stress to the associated injured cruciate ligament. All knees were examined and arthroscoped before and after a 3-month treatment period. Results indicated that 69% of the lateral menisci healed completely and 18% healed partially, whereas 58% of the medial menisci healed completely and none healed partially. Twenty of 25 anterior cruciate ligaments and 3 of 7 posterior cruciate ligaments healed satisfactorily. This study indicated that acute tears of the meniscus, even when they occur in association with a cruciate ligament injury, can heal morphologically with nonsurgical treatment.

Acute posterior cruciate ligament injuries: effect of location, severity, and associated injuries on surgical management.

PubMed

Anderson, Mark A; Simeone, F Joseph; Palmer, William E; Chang, Connie Y

2018-06-01

To correlate MRI findings of patients with posterior cruciate ligament (PCL) injury and surgical management. A retrospective search yielded 79 acute PCL injuries (36 ± 16 years old, 21 F, 58 M). Two independent readers graded PCL tear location (proximal, middle, or distal third) and severity (low-grade or high-grade partial/complete) and evaluated injury of other knee structures. When available, operative reports were examined and the performed surgical procedure was compared with injury grade, location, and presence of associated injuries. The most commonly injured knee structures in acute PCL tears were posterolateral corner (58/79, 73%) and anterior cruciate ligament (ACL) (48/79, 61%). Of the 64 patients with treatment information, 31/64 (48%) were managed surgically: 12/31 (39%) had PCL reconstruction, 13/31 (42%) had ACL reconstruction, 10/31 (32%) had posterolateral corner reconstruction, 9/31 (29%) had LCL reconstruction, 8/31 (26%) had meniscectomy, and 8/31 (26%) had fixation of a fracture. Proximal third PCL tear and multiligamentous injury were more commonly associated with surgical management (P < 0.05). Posterolateral and posteromedial corner, ACL, collateral ligament, meniscus, patellar retinaculum, and gastrocnemius muscle injury, and fracture were more likely to result in surgical management (P < 0.05). Patients with high-grade partial/complete PCL tear were more likely to have PCL reconstruction as a portion of surgical management (P < 0.05). Location of PCL tear and presence of other knee injuries were associated with surgical management while high-grade/complete PCL tear grade was associated with PCL reconstruction. MRI reporting of PCL tear location, severity, and of other knee structure injuries is important for guiding clinical management.

Assessment of Knee Proprioception in the Anterior Cruciate Ligament Injury Risk Position in Healthy Subjects: A Cross-sectional Study.

PubMed

Mir, Seyed Mohsen; Talebian, Saeed; Naseri, Nasrin; Hadian, Mohammad-Reza

2014-10-01

[Purpose] Knee joint proprioception combines sensory input from a variety of afferent receptors that encompasses the sensations of joint position and motion. Poor proprioception is one of the risk factors of anterior cruciate ligament injury. Most studies have favored testing knee joint position sense in the sagittal plane and non-weight-bearing position. One of the most common mechanisms of noncontact anterior cruciate ligament injury is dynamic knee valgus. No study has measured joint position sense in a manner relevant to the mechanism of injury. Therefore, the aim of this study was to measure knee joint position sense in the noncontact anterior cruciate ligament injury risk position and normal condition. [Subjects and Methods] Thirty healthy male athletes participated in the study. Joint position sense was evaluated by active reproduction of the anterior cruciate ligament injury risk position and normal condition. The dominant knees of subjects were tested. [Results] The results showed less accurate knee joint position sense in the noncontact anterior cruciate ligament injury risk position rather than the normal condition. [Conclusion] The poorer joint position sense in non-contact anterior cruciate ligament injury risk position compared with the normal condition may contribute to the increased incidence of anterior cruciate ligament injury.

Posterior root tear of the medial meniscus in multiple knee ligament injuries.

PubMed

Kim, Young Jae; Kim, Jin Goo; Chang, Seok Hwan; Shim, Jae Chan; Kim, Sang Bum; Lee, Mi Young

2010-10-01

The purposes of the present study were to examine the frequency and characteristics of root tears of the medial meniscus associated with ligament injuries of the knee and to evaluate the effectiveness of pull-out repair for restoring meniscus function. We retrospectively analyzed the 9 patients (10 knees) with posterior root tears of the medial meniscus and ligament injuries of the knee treated between August 2004 and February 2007. All the patients were male, with average age of 29.8 years, and the mean follow-up period was 29.7 months. The pull-out suture technique was used to repair the root tears. Clinical outcomes were evaluated using the Lysholm, IKDC, and Tegner scores, as well as the McMurray and Apley tests. The mean follow-up period was 41.1 months (range, 30 to 63 months). The incidence of root tears of the medial meniscus with ligament injuries was 2.74% (10 cases in 365 ligament surgeries). All clinical results showed significant improvement. At the final follow-up, McMurray test showed one positive and nine negative cases, and the Apley test revealed two positive and eight negative cases. There were no positive findings in anterior drawer test, posterior drawer test, valgus and varus stress test, and posterolateral instability test. Healing of the root tear was confirmed by arthroscopy in five patients and by MR in four patients. Root tears of the medial meniscus may occur in multiple knee ligament injuries. It is important not to miss them. Our results indicate that pull-out repair provides satisfactory results and evidence of healing. Copyright 2009 Elsevier B.V. All rights reserved.

Laxity after complete release of the medial collateral ligament in primary total knee arthroplasty.

PubMed

Cho, Woo-Shin; Byun, Seong-Eun; Lee, Sang-Jun; Yoon, Jaeyoun

2015-06-01

Medial collateral ligament (MCL) release is one of the essential steps toward the achievement of ligament balancing during the total knee arthroplasty (TKA) in patients with varus deformity. When the varus deformity is severe, complete release of the MCL until balanced is often required. However, it is believed that complete MCL release may lead to catastrophic laxity. The purpose of this prospective study is to compare the medial joint gap opening in postoperative valgus stress radiograph in patients with complete MCL release against patients with partial release. Out of 209 primary TKAs performed for degenerative osteoarthritis, complete MCL release was required in 33 cases (group I) by sub-periosteal detachment at proximal tibia using periosteal elevator. For the remaining 176 knees (group II), partial release of MCL was done. At postoperative 6 months and 1 year, both groups were evaluated for comparing the joint gap on valgus stress radiographs using modified Telos device in 0°, 45°, and 90° of flexion. Additional parameters which were analyzed included preoperative varus and valgus stress radiographs in full extension and pre- and postoperative mechanical alignment in each group. The knee range of motion (ROM) and clinical scores were evaluated at 1-year follow-up. The mean values of the joint opening on the postoperative valgus stress test with the knee joint extended, and in the 45° and 90° flexed states at 6 months and at 1 year postoperatively in group I were not statistically significantly different from those of group II. The clinical scores also did not show a statistically significant difference between two groups. There was a statistically significant difference in ROM between two groups, pre- and postoperatively and the difference was 5°, respectively. This study suggests that complete MCL release for ligament balancing is a safe procedure and does not lead to postoperative laxity.

Incidence of elbow injuries in adolescent baseball players: screening by a low field magnetic resonance imaging system specialized for small joints.

PubMed

Okamoto, Yoshikazu; Maehara, Kiyoshi; Kanahori, Tetsuya; Hiyama, Takashi; Kawamura, Takashi; Minami, Manabu

2016-04-01

The aim of this preliminary study was to examine the capability of screening for elbow injuries induced by baseball using a low field small joint MRI system. Sixty-two players in the 4th-6th elementary school grades, with ages ranging from 9 to 12 years, participated in this study. Screening for elbow injuries was performed using a low-magnetic-field (0.2-T) magnetic resonance imaging (MRI) system designed for examinations of small joints of the extremities. Gradient-echo coronal, sagittal, and short-tau inversion recovery (STIR) coronal images of the dominant arm used for pitching were obtained to identify medial collateral ligament (MCL) injuries with or without avulsion fracture and osteochondritis dissecans. All 62 examinations were performed successfully, with 26 players (41.9 %) showing positive findings, all being confined to the MCL. No child showed bone damage. All criteria in the MRI evaluation of injuries showed high agreement rates and kappa values between two radiologists. Screening for early detection of elbow injuries in junior Japanese baseball players can be successfully performed using a low-field MRI system specialized for small joints. The percentage of MCL injury without avulsion fracture was unexpectedly high (41.9 %).

Life- threatening hemothorax due to the inferior pulmonary ligament injury without obvious organ injuries: a case report.

PubMed

Kim, Jae Jun; Kim, Yong Hwan; Choi, Si Young; Jeong, Seong Cheol; Moon, Seok Whan

2015-03-21

Traumatic hemothorax is usually associated with obvious organ injuries, such as rib fractures, pulmonary injuries, and other mediastinal injuries. We present a rare case in which a 42-year- old Korean man who fell off of a roof, approximately 3 meters in height, resulting in a life-threatening hemothorax without obvious injuries to the thoracic organs. Chest CT showed a large amount of hemothorax in the right side of the thoracic cavity, and an active bleeding, presumably from the posterior intercostal or the phrenic artery, with a focal aneurysmal change. The emergency thoracotomy was performed to bring the active bleeding under control. The operative findings showed there were only the inferior pulmonary ligament tears, and the active bleeding from it. The postoperative course was uneventful and the patient was discharged without any complications. We should consider the inferior pulmonary ligamental injury as one of causes for traumatic hemothorax.

The developmental morphology of a "periosteal" ligament insertion: growth and maturation of the tibial insertion of the rabbit medial collateral ligament.

PubMed

Matyas, J R; Bodie, D; Andersen, M; Frank, C B

1990-05-01

The structural properties of ligament insertions change dramatically during growth and maturation, but little is known about their developmental anatomy. This study describes and quantifies changes in the gross and microscopic anatomy of the tibial insertion of the rabbit medial collateral ligament (MCL) during development and at skeletal maturity. Eighty animals were used for growth and descriptive studies. From this group, 27 animals, ranging in age from 1 to 24 months, were injected with fluorescent bone markers and their tibial insertions were processed undecalcified for histology. Sections were examined by polarized light and fluorescence microscopy to identify matrix and cells and to quantify mineral formation. Results showed that animals achieved histological skeletal maturity between 9 and 12 months of age. Body weights were a poor index of skeletal maturity. The tibial insertion was composed of five tissue layers, which changed proportions during growth and maturation. In immature animals, MCL fibers entered the periosteum; in older animals, MCL fibers were cemented to the tibia by advancing mineral. The tibial attachment of the MCL was thus transferred from the periosteum to the cortex during growth, suggesting that the term "periosteal insertion" is imprecise in adults. The hypothesis is put forward that these structural changes account for the reported increase in tensile failure of this insertion near skeletal maturity.

Prevention of anterior cruciate ligament injury in the female athlete

PubMed Central

Silvers, Holly Jacinda; Mandelbaum, Bert R

2007-01-01

The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury are pivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism of ACL injury and the most effective intervention for decreasing ACL injuries in this high‐risk population. PMID:17609222

[In situ suture repair procedure of knee dislocation with multiple-ligament injury at acute stage].

PubMed

Ye, Jingbing; Luo, Dahui; Fu, Weili; He, Xin; Li, Jian

2009-09-01

To investigate the method and the short term clinical effectiveness of in situ suture repair procedure of knee dislocation with multiple-ligament injury at acute stage. From February 2006 to November 2007, 9 patients suffering from single knee closed dislocation with multiple-ligament injury underwent open in situ suture repair procedure with non-absorbable thread and managements of other combined injuries simultaneously. Nine patients included 6 males and 3 females, aged 34-52 years old. The injured knees were left side in 4 cases and right side in 5 cases. Injuries were caused by traffic accident in 8 cases and heavy-weight crushing in 1 case. EMRI and arthroscopic examination showed that all patients suffered from the avulsion injuries of anterior cruciate ligament and posterior cruciate ligament. The time from injury to operation was 4 to 7 days with an average of 5.1 days. No bacterial arthritis occurred after operation. Subcutaneous ligated fat occurred and cured after symptomatic treatment in 2 cases, other incisions healed by first intension. All patients were followed up 12 months. At 12 months postoperatively, 2 patients' flexion range of the suffering knees lost 10 degrees when to compared with normal knees, and the range of motion was from 0 to 125 degrees. The Lysholm knee scores were 83-92 (average 86.3), the results were excellent in 3 cases and good in 6 cases. The posterior drawer test and anterior drawer test were one-degree positive in 3 cases respectively; the Lachman tests were one-degree positive in 5 cases, lateral stress tests were negative in all cases. In situ suture repair procedure of knee dislocation with multiple-ligament injury at acute stage has the advantages such as reliable fixation, simultaneous management of other combined injuries and satisfactory short term effect.

Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament.

PubMed

Forthman, Christopher; Henket, Marjolijn; Ring, David C

2007-10-01

To determine the effectiveness of a protocol for the treatment of fracture-dislocations of the elbow based on the concept that, if dislocation of the elbow with associated fractures can be made to resemble a simple elbow dislocation by repairing or reconstructing the fractured structures, repair of the medial collateral ligament (MCL) will not be necessary. Over a 5-year period, a single surgeon operated on 34 patients with a posterior dislocation of the elbow associated with one or more intra-articular fractures. The mean age of these 19 men and 15 women was 48 years. Associated fractures included the capitellum, trochlea, and lateral epicondyle in 3 patients; the olecranon in 1 patient; and the radial head in 30 patients (with concomitant fracture of the coronoid process-the so-called "terrible triad" of the elbow-in 22 patients, and concomitant fracture of the coronoid and olecranon in 1 patient). Operative treatment consisted of open reduction internal fixation (ORIF) or prosthetic replacement of all fractures and reattachment of the origin of the lateral collateral ligament (LCL) complex to the lateral epicondyle. The MCL was not repaired. Two patients (1 with a terrible triad injury and 1 with fracture of the capitellum and trochlea) had postoperative instability related to noncompliance, had reconstructive procedures, and were considered failures. An average of 32 months after injury, the remaining 32 patients regained an average of 120 degrees ulnohumeral motion and 142 degrees forearm rotation. Twenty-five of 34 patients (74%) had good or excellent results according to the system of Broberg and Morrey. Patients with terrible triad injuries had an average of 117 degrees ulnohumeral motion and 137 degrees forearm rotation, and 17 of 22 patients (77%) had good or excellent results. MCL repair is unnecessary in the treatment of dislocation of the elbow with associated intra-articular fractures, provided that the articular fractures and the LCL are repaired or

Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

PubMed Central

Oshima, Takeshi; Nakase, Junsuke; Numata, Hitoaki; Takata, Yasushi

2015-01-01

A multiple-ligament knee injury that includes posterolateral corner (PLC) disruption often causes palsy of the common peroneal nerve (CPN), which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury. PMID:26064740

Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?

PubMed

Mui, Leonora W; Engelsohn, Eliyahu; Umans, Hilary

2007-02-01

(1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury.

Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings.

PubMed

Park, H-J; Cha, S-D; Kim, S S; Rho, M-H; Kwag, H-J; Park, N-H; Lee, S-Y

2012-04-01

To evaluate the accuracy of magnetic resonance imaging (MRI) findings in chronic lateral ankle ligament injury in comparison with that of surgical findings. Forty-eight cases (25 men, 23 women, mean age 36 years) of clinically suspected chronic ankle ligament injury underwent MRI studies and surgery. Sagittal, coronal, and axial, T1-weighted, spin-echo, proton density and T2-weighted, fast spin-echo images with fat saturation were obtained in all patients. MRI examinations were read in consensus by two fellowship-trained academic musculoskeletal radiologists who evaluated the lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) without clinical information. The results of the MRI studies were then compared with the surgical findings. The MRI findings of ATFL injury showed a sensitivity of detection of complete tears of 75% and specificity of 86%. The sensitivity of detection of partial tears was 75% and the specificity was 78%. The sensitivity of detection of sprains was 44% and the specificity was 88%. Regarding the MRI findings of CFL injury, the sensitivity of detection of complete tears was 50% and the specificity was 98%. The sensitivity of detection of partial tear was 83% and the specificity was 93%. The sensitivity of detection of sprains was 100% and the specificity was 90%. Regarding the ATFL, the accuracies of detection were 88, 58, 77, and 85% for no injury, sprain, partial tear, and complete tear, respectively, and for the CFL the accuracies of detection were 90, 90, 92, and 96% for no injury, sprain, partial tear, and complete tear, respectively. The diagnosis of a complete tear of the ATFL on MRI is more sensitive than the diagnosis of a complete tear of the CFL. MRI findings of CFL injury are diagnostically specific but are not sensitive. However, only normal findings and complete tears were statistically significant between ATFL and CFL (p < 0.001). Copyright © 2011 The Royal College of

Case report - calcification of the medial collateral ligament of the knee with simultaneous calcifying tendinitis of the rotator cuff.

PubMed

Kamawal, Yama; Steinert, Andre F; Holzapfel, Boris M; Rudert, Maximilian; Barthel, Thomas

2016-07-13

Calcification of the medial collateral ligament (MCL) of the knee is a very rare disease. We report on a case of a patient with a calcifying lesion within the MCL and simultaneous calcifying tendinitis of the rotator cuff in both shoulders. Calcification of the MCL was diagnosed both via x-ray and magnetic resonance imaging (MRI) and was successfully treated surgically. Calcifying tendinitis of the rotator cuff was successfully treated applying conservative methods. This is the first case report of a patient suffering from both a calcifying lesion within the medial collateral ligament and calcifying tendinitis of the rotator cuff in both shoulders. Clinical symptoms, radio-morphological characteristics and macroscopic features were very similar and therefore it can be postulated that the underlying pathophysiology is the same in both diseases. Our experience suggests that magnetic resonance imaging and x-ray are invaluable tools for the diagnosis of this inflammatory calcifying disease of the ligament, and that surgical repair provides a good outcome if conservative treatment fails. It seems that calcification of the MCL is more likely to require surgery than calcifying tendinitis of the rotator cuff. However, the exact reason for this remains unclear to date.

Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament☆

PubMed Central

e Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

2015-01-01

Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up. PMID:27218089

Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players

PubMed Central

Read, Paul J.; Oliver, Jon L.; De Ste Croix, Mark B. A.; Myer, Gregory D.; Lloyd, Rhodri S.

2017-01-01

Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury. PMID:26856339

Neuromuscular Risk Factors for Knee and Ankle Ligament Injuries in Male Youth Soccer Players.

PubMed

Read, Paul J; Oliver, Jon L; De Ste Croix, Mark B A; Myer, Gregory D; Lloyd, Rhodri S

2016-08-01

Injuries reported in male youth soccer players most commonly occur in the lower extremities, and include a high proportion of ligament sprains at the ankle and knee with a lower proportion of overuse injuries. There is currently a paucity of available literature that examines age- and sex-specific injury risk factors for such injuries within youth soccer players. Epidemiological data have reported movements that lead to non-contact ligament injury include running, twisting and turning, over-reaching and landing. Altered neuromuscular control during these actions has been suggested as a key mechanism in females and adult populations; however, data available in male soccer players is sparse. The focus of this article is to review the available literature and elucidate prevalent risk factors pertaining to male youth soccer players which may contribute to their relative risk of injury.

Development of a subject-specific model to predict the forces in the knee ligaments at high flexion angles.

PubMed

Yang, Zhaochun; Wickwire, Alexis C; Debski, Richard E

2010-11-01

Recent clinical evidence has suggested that tasks performed in kneeling or squatting postures place the knee at a higher risk for injury because loads across the knee might overload the ligaments. The objective of this study was to develop a subject-specific model of the knee that is kinematically driven to predict the forces in the major ligaments at high flexion angles. The geometry of the femur, tibia, and fibula and the load-elongation curves representing the structural properties of the ACL, PCL, LCL, and MCL served as inputs to the model, which represented each ligament as a nonlinear elastic spring. To drive the model, kinematic data was obtained while loads were applied to the same cadaveric knee at four flexion angles. The force in each ligament during the recorded kinematic data allowed an optimization procedure to determine the location of the ligament attachment sites on each bone and their reference lengths. The optimization procedure could successfully minimize the differences between the experimental and predicted forces only when the kinematics at 90°, 120°, and 140° of flexion were utilized. This finding suggests that the ligaments at the knee function differently at high-flexion angles compared to low flexion angles and separate models must be used to examine each range of motion. In the future, the novel experimental and computational methodology will be used to construct additional models and additional knee kinematics will be input to help elucidate mechanisms of injury during tasks performed in kneeling or squatting postures.

Regenerative Medicine and Rehabilitation for Tendinous and Ligamentous Injuries in Sport Horses.

PubMed

Ortved, Kyla F

2018-05-23

Tendon and ligament injuries are a common source of lameness in the athletic horse. Although tendons and ligaments have the ability to spontaneously heal, lesions tend to fill with biomechanically inferior fibrous tissue such that the horse is prone to reinjury. Regenerative medicine is used to improve quality of repair tissue and prevent reinjury. Platelet-rich plasma, stem cells, and autologous conditioned serum are the most commonly used orthobiologics in the horse. A tailored rehabilitation program is key to returning horses to athleticism following injury. The specifics of regenerative medicine and rehabilitation for tendonitis and desmitis in the horse are discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

Estimation of ligament strains and joint moments in the ankle during a supination sprain injury.

PubMed

Wei, Feng; Fong, Daniel Tik-Pui; Chan, Kai-Ming; Haut, Roger C

2015-01-01

This study presents the ankle ligament strains and ankle joint moments during an accidental injury event diagnosed as a grade I anterior talofibular ligament (ATaFL) sprain. A male athlete accidentally sprained his ankle while performing a cutting motion in a laboratory setting. The kinematic data were input to a three-dimensional rigid-body foot model for simulation analyses. Maximum strains in 20 ligaments were evaluated in simulations that investigated various combinations of the reported ankle joint motions. Temporal strains in the ATaFL and the calcaneofibular ligament (CaFL) were then compared and the three-dimensional ankle joint moments were evaluated from the model. The ATaFL and CaFL were highly strained when the inversion motion was simulated (10% for ATaFL and 12% for CaFL). These ligament strains were increased significantly when either or both plantarflexion and internal rotation motions were added in a temporal fashion (up to 20% for ATaFL and 16% for CaFL). Interestingly, at the time strain peaked in the ATaFL, the plantarflexion angle was not large but apparently important. This computational simulation study suggested that an inversion moment of approximately 23 N m plus an internal rotation moment of approximately 11 N m and a small plantarflexion moment may have generated a strain of 15-20% in the ATaFL to produce a grade I ligament injury in the athlete's ankle. This injury simulation study exhibited the potentially important roles of plantarflexion and internal rotation, when combined with a large inversion motion, to produce a grade I ATaFL injury in the ankle of this athlete.

Radiographic landmarks for locating the femoral origin of the superficial medial collateral ligament.

PubMed

Hartshorn, Timothy; Otarodifard, Karimdad; White, Eric A; Hatch, George F Rick

2013-11-01

Little has been written about the use of radiographic landmarks for locating the origin of the superficial medial collateral ligament (sMCL). A standardized radiographic landmark for the sMCL origin using intraoperative fluoroscopic imaging may be of value in aiding the surgeon in accurate femoral tunnel placement in the setting of extensive soft tissue disruption and bony attrition. To determine a reproducible radiographic landmark that will assist in correct femoral tunnel placement in sMCL repair and reconstruction. Descriptive laboratory study. Ten fresh-frozen unmatched human cadaveric knees were dissected, and the origin of the sMCL was exposed. A 2-mm metallic marker was then placed at the center of the femoral origin of the sMCL. True lateral fluoroscopically assisted digital radiographs were obtained of the knee with the posterior and distal femoral condyles overlapping in a standardized fashion. With the use of computer software, reference lines were drawn on the images, creating 4 quadrants. Two independent examiners performed quantitative measurements of the sMCL origin in relation to this axis and to the Blumensaat line. Mean measurements showed the sMCL origin to be closely related to the intersection point of the Blumensaat line and a line drawn distally from the posterior femoral cortex on a true lateral radiograph. The sMCL origin was found at a mean point 1.6 ± 4.3 mm posterior and 4.9 ± 2.1 mm proximal to the intersection of a line paralleling the posterior femoral cortex and a line drawn perpendicular to the posterior femoral cortical line, where it intersects the Blumensaat line. In 5 of 10 specimens, the center of the sMCL origin fell precisely on the Blumensaat line. The remaining specimens had sMCL origins anterior to the Blumensaat line. The femoral origin of the sMCL was found in the proximal and posterior quadrants in 8 of 10 specimens. With a relatively small amount of deviation, the sMCL origin can be consistently identified on a true

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury.

PubMed

Wellsandt, E; Zeni, J A; Axe, M J; Snyder-Mackler, L

2017-12-01

Anterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. Nineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. Five of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. The current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

PubMed Central

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

2015-01-01

Objective: The objective of this study was to investigate the clinical curative effect of stage I repair of acute injuries of the lateral ligament complex of the ankle by the application of suture anchors. Methods: We retrospectively analyzed 18 cases of III degree acute injuries of the lateral ligament complex of the ankle. Results: There were statistically significant differences in preoperative and last follow-up VAS pain scores and AOFAS ankle hind-foot function scores. The X-ray talus displacement values in the anterior drawer test and pressure anteroposterior X-ray talar tilt in the ankle talar tilt test also showed statistically significant differences. Complications occurred in 2 patients, incision surface infection in one, and postoperative lateral dorsal skin numbness in one. All these cases were cured after symptomatic treatment. At the last follow-up all patients’ ankle joint activity recovered to their preinjury function levels. Conclusion: The application of suture anchors for small incision stage I repair of the lateral collateral ligament of ankle joint degree III injury, can effectively restored the stability of ankle joint, and prevent the occurrence of chronic ankle instability complications. It is effective and feasible for the treatment of ankle joint lateral collateral ligament injuries. PMID:26885144

Should the Ipsilateral Hamstrings Be Used for Anterior Cruciate Ligament Reconstruction in the Case of Medial Collateral Ligament Insufficiency? Biomechanical Investigation Regarding Dynamic Stabilization of the Medial Compartment by the Hamstring Muscles.

PubMed

Herbort, Mirco; Michel, Philipp; Raschke, Michael J; Vogel, Nils; Schulze, Martin; Zoll, Alexander; Fink, Christian; Petersen, Wolf; Domnick, Christoph

2017-03-01

Semitendinosus and gracilis muscles are frequently harvested for autologous tendon grafts for cruciate ligament reconstruction. This study investigated the joint-stabilizing effects of these hamstring muscles in cases of insufficiency of the medial collateral ligament (MCL). First, both the semitendinosus and gracilis muscles can actively stabilize the joint against valgus moments in the MCL-deficient knee. Second, the stabilizing influence of these muscles decreases with an increasing knee flexion angle. Controlled laboratory study. The kinematics was examined in 10 fresh-frozen human cadaveric knees using a robotic/universal force moment sensor system and an optical tracking system. The knee kinematics under 5- and 10-N·m valgus moments were determined in the different flexion angles of the (1) MCL-intact and (2) MCL-deficient knee using the following simulated muscle loads: (1) 0-N (idle) load, (2) 200-N semitendinosus (ST) load, and (3) 280-N (200/80-N) combined semitendinosus/gracilis (STGT) load. Cutting the MCL increased the valgus angle under all tested conditions and angles compared with the MCL-intact knee by 4.3° to 8.1° for the 5-N·m valgus moment and 6.5° to 11.9° for the 10-N·m valgus moment ( P < .01). The applied 200-N simulated ST load reduced the valgus angle significantly at 0°, 10°, 20°, and 30° of flexion under 5- and 10-N·m valgus moments ( P < .05). At 0°, 10°, and 20° of flexion, these values were close to those for the MCL-intact joint under the respective moments (both P > .05). The combined 280-N simulated STGT load significantly reduced the valgus angle in 0°, 10°, and 20° of flexion under 5- and 10-N·m valgus moments ( P < .05) to values near those for the intact joint (5 N·m: 0°, 10°; 10 N·m: 0°, 10°, 20°; P > .05). In 60° and 90° of flexion, ST and STGT loads did not decrease the resulting valgus angle of the MCL-deficient knee without hamstring loads ( P > .05 vs deficient; P = .0001 vs intact). In this

Mechanisms for anterior cruciate ligament injuries in badminton.

PubMed

Kimura, Yuka; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Tsukada, Harehiko; Toh, Satoshi

2010-12-01

A high incidence of anterior cruciate ligament (ACL) injuries related to sports activities has been reported; however, the injury situation of ACL injury in badminton has not been elucidated. This study investigated the mechanism of ACL injury in badminton using a questionnaire. Information on injury mechanism was gathered from interviews with six male and 15 female badminton players who received a non-contact ACL injury playing badminton and underwent ACL reconstruction. The most common injury mechanism (10 of 21 injuries) was single-leg landing after overhead stroke. Nine of 10 players had injured the knee opposite to the racket-hand side. The second most frequent injury mechanism (eight of 21 injuries) was plant-and-cut while side-stepping or backward stepping. All eight players injured the knee of the racket-hand side. Eleven injuries occurred in the rear court, and six of the 11 injuries occurred during single-leg landing after an overhead stroke. The knee opposite to the racket-hand side tended to sustain the ACL injuries during single-leg landing after a backhand overhead stroke, whereas the knee of the racket-hand side tended to be injured by plant-and-cut during side or backward stepping. These injury patterns appear to be due to specific movements during badminton.

Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings.

PubMed

Cheng, Y; Cai, Y; Wang, Y

2014-01-01

The aim of this study was to assess the accuracy of ultrasonography in the diagnosis of chronic lateral ankle ligament injury. A total of 120 ankles in 120 patients with a clinical suspicion of chronic ankle ligament injury were examined by ultrasonography by using a 5- to 17-MHz linear array transducer before surgery. The results of ultrasonography were compared with the operative findings. There were 18 sprains and 24 partial and 52 complete tears of the anterior talofibular ligament (ATFL); 26 sprains, 27 partial and 12 complete tears of the calcaneofibular ligament (CFL); and 1 complete tear of the posterior talofibular ligament (PTFL) at arthroscopy and operation. Compared with operative findings, the sensitivity, specificity and accuracy of ultrasonography were 98.9%, 96.2% and 84.2%, respectively, for injury of the ATFL and 93.8%, 90.9% and 83.3%, respectively, for injury of the CFL. The PTFL tear was identified by ultrasonography. The accuracy of identification between acute-on-chronic and subacute-chronic patients did not differ. The accuracies of diagnosing three grades of ATFL injuries were almost the same as those of diagnosing CFL injuries. Ultrasonography provides useful information for the evaluation of patients presenting with chronic pain after ankle sprain. Intraoperative findings are the reference standard. We demonstrated that ultrasonography was highly sensitive and specific in detecting chronic lateral ligments injury of the ankle joint.

Rupture of the meniscofibular ligament

PubMed Central

2010-01-01

The meniscofibular ligament is an anatomically defined ligament of the knee in humans. However, there are no data regarding the prognosis following injury to this ligament. Our case was a 42-year-old man who presented at our clinic with pain of the lateral side of his left knee. MRI of his left knee revealed the rupture of the meniscofibular ligament. The mechanism of injury was consistent with anatomical and mechanical studies of the meniscofibular ligament. The patient was treated conservatively for 1 year, but his pain did not resolve completely. A case series of patients with the same injury is required to establish an effective treatment for this rare injury. PMID:20478075

Low Prevalence of Anterior and Posterior Cruciate Ligament Injuries in Patients With Achondroplasia.

PubMed

Brooks, Jaysson T; Ramji, Alim F; Lyapustina, Tatyana A; Yost, Mary T; Ain, Michael C

2017-01-01

Anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) injuries and their subsequent reconstructions are common in the general population, but there has been no research regarding ACL or PCL injuries in patients with achondroplasia, the most common skeletal dysplasia. Our goals were to (1) evaluate the prevalence of ACL and PCL injuries in adolescents and adults with achondroplasia, (2) compare this prevalence with that reported for the general population, (3) determine how many patients with ACL or PCL injuries underwent ligament reconstruction as treatment, and (4) determine patient activity levels as they relate to the rate of ACL/PCL injuries and reconstructions. We reviewed medical records of 430 patients with achondroplasia seen in the senior author's clinic from 2002 through 2014. Demographic data were reviewed, as well as any documentation of ACL or PCL injury or reconstruction. We called all 430 patients by telephone, and 148 agreed to participate in our survey, whereas 1 declined. We asked these patients about their history of ACL or PCL injury or reconstruction, as well as current and past physical activity levels. No ACL or PCL injuries were found on chart review. One patient reached by telephone reported an ACL injury that did not require reconstruction. This yielded a theoretical prevalence of 3/430 (0.7%). Of the 148 patients surveyed, 43 (29%) reported low physical activity, 75 (51%) reported moderate physical activity, and 26 (17%) reported high physical activity. There was no significant difference in the rate of ACL injury when stratified by physical activity level (P=0.102). ACL and PCL injuries and reconstructions are extremely rare in patients with achondroplasia, which cannot be completely ascribed to a low level of physical activity. One possible explanation is that patients with achondroplasia, on an average, have a more anterior tibial slope compared with those without achondroplasia, which decreases the force generated

The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries.

PubMed

Musahl, Volker; Rahnemai-Azar, Ata A; Costello, Joanna; Arner, Justin W; Fu, Freddie H; Hoshino, Yuichi; Lopomo, Nicola; Samuelsson, Kristian; Irrgang, James J

2016-12-01

The role of the anterolateral capsule (ALC) as a secondary restraint to quantitative rotatory laxity of patients with an anterior cruciate ligament (ACL) injury is currently debated. The purpose was to determine the influence of concomitant ALC injuries as well as injuries to other soft tissue structures on rotatory knee laxity in patients with an ACL injury. It was hypothesized that a concomitant ALC injury would be associated with increased rotatory knee laxity as measured during a quantitative pivot-shift test. Cross-sectional study; Level of evidence, 3. Forty-one patients with an ACL injury (average age, 23 ± 6.9 years) were enrolled. Two blinded musculoskeletal radiologists reviewed magnetic resonance imaging (MRI) scans for the presence of ACL injuries and concomitant soft tissue injuries including the ALC, medial collateral ligament, lateral collateral ligament, posterolateral corner, medial meniscus, and lateral meniscus. A standardized pivot-shift test was performed under anesthesia, and rotatory laxity was quantified according to anterior translation of the lateral tibial compartment during the pivot-shift maneuver. The Student t test was used to analyze the data. Statistical significance was set at P < .05. A complete ACL rupture was confirmed in all of the patients. MRI evidence of an ALC injury was observed in 21 (51%) of the patients. Patients with MRI evidence of an ALC injury had significantly higher rotatory knee laxity (3.6 ± 1.5 mm) compared with those without an ALC injury (2.7 ± 1.5 mm; P = .04). Lateral and medial meniscus injuries were detected in 17 (41%) and 19 (46%) patients, respectively. Patients with MRI evidence of either a medial meniscus injury or lateral meniscus injury had significantly higher rotatory knee laxity compared with patients without these injuries (medial meniscus: 3.7 ± 1.4 mm vs 2.7 ± 1.6 mm, respectively; lateral meniscus: 3.7 ± 1.7 mm vs 2.7 ± 1.3 mm, respectively) (P = .03 for both). MRI evidence of a

Elongation of the collateral ligaments after cruciate retaining total knee arthroplasty and the maximum flexion of the knee.

PubMed

Park, Kwan Kyu; Hosseini, Ali; Tsai, Tsung-Yuan; Kwon, Young-Min; Li, Guoan

2015-02-05

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

Value of ultrasonography for detecting chronic injury of the lateral ligaments of the ankle joint compared with ultrasonography findings

PubMed Central

Cheng, Y; Cai, Y

2014-01-01

Objective: The aim of this study was to assess the accuracy of ultrasonography in the diagnosis of chronic lateral ankle ligament injury. Methods: A total of 120 ankles in 120 patients with a clinical suspicion of chronic ankle ligament injury were examined by ultrasonography by using a 5- to 17-MHz linear array transducer before surgery. The results of ultrasonography were compared with the operative findings. Results: There were 18 sprains and 24 partial and 52 complete tears of the anterior talofibular ligament (ATFL); 26 sprains, 27 partial and 12 complete tears of the calcaneofibular ligament (CFL); and 1 complete tear of the posterior talofibular ligament (PTFL) at arthroscopy and operation. Compared with operative findings, the sensitivity, specificity and accuracy of ultrasonography were 98.9%, 96.2% and 84.2%, respectively, for injury of the ATFL and 93.8%, 90.9% and 83.3%, respectively, for injury of the CFL. The PTFL tear was identified by ultrasonography. The accuracy of identification between acute-on-chronic and subacute–chronic patients did not differ. The accuracies of diagnosing three grades of ATFL injuries were almost the same as those of diagnosing CFL injuries. Conclusion: Ultrasonography provides useful information for the evaluation of patients presenting with chronic pain after ankle sprain. Advances in knowledge: Intraoperative findings are the reference standard. We demonstrated that ultrasonography was highly sensitive and specific in detecting chronic lateral ligments injury of the ankle joint. PMID:24352708

[Operative treatment and curative effects of the deltoid ligament injuries of the ankle joint].

PubMed

Cong, Pei-Jun; Liu, Bai-Hong; Wang, Ji-Ping; Qiao, Yong-Ping

2009-12-01

To explore the operative methods and curative effects of the deltoid ligament injuries. From 2002 to 2008, all 61 patients with ankle fractures complicated with deltoid ligament injuries were treated with open reduction and firm internal fixation. Among the patients, 39 patients were male and 22 patients were female, ranging in age from 14 to 71 years, with an average of 41 years. During the operation, the deltoid ligament was reconstructed to restore the medial and lateral stability of ankle joint. All the patients were followed up ranged from 5 to 30 months, with an average of 17 months. Fifty-nine patients had incision healed at the first stage; 2 patients had superficial infections at lateral malleolus, and healed at the 3rd week after changing dressings. The incisions at the internal medial malleolus were all healed at the first stage. According to Qi evaluation criteria, 35 patients got an excellent result, 13 good and 13 fair. The deltoid ligament should be treated properly in the treatment of ankle joint fractures when open reduction and firm internal fixation were emphasized.

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes.

PubMed

Clark, Nicholas J; Desai, Vishal S; Dines, Joshua D; Morrey, Mark E; Camp, Christopher L

2018-03-01

This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

[Injury to the Scapholunate Ligament in Distal Radius Fractures: Peri-Operative Diagnosis and Treatment Results].

PubMed

Gajdoš, R; Pilný, J; Pokorná, A

2016-01-01

PURPOSE OF THE STUDY Injury to the scapholunate ligament is frequently associated with a fracture of the distal radius. At present neither a unified concept of treatment nor a standard method of diagnosis in these concomitant injuries is available. The aim of the study was to evaluate a group of surgically treated patients with distal radius fractures in order to assess a contribution of combined conventional X-ray and intra-operative fluoroscopic examinations to the diagnosis of associated lesions and to compare short-term functional outcomes of sugically treated patients with those of patients treated conservatively. MATERIAL AND METHODS A group of patients undergoiong surgery for distal radius fractures using plate osteosynthesis was evaluated retrospectively. The peri-operative diagnosis of associated injury to the scapholunate ligament was based on pre-operative standard X-ray views and intra-operative fluoroscopy. The latter consisted of images of maximum radial and ulnar deviation as well as an image of the forearm in traction exerted manually along the long axis. All views were in postero-anterior projection. Results were read directly on the monitor of a fluoroscopic device after its calibration or were obtained by comparing the thickness of an attached Kirschner wire with the distance to be measured. Subsequently, pixels were converted to millimetres. When a scapholunate ligament injury was found and confirmed by examination of the contralateral wrist, the finding was verified by open reduction or arthroscopy. Both static and dynamic instabilities were treated together with the distal radius fracture at one-stage surgery. After surgery, the patients without ligament injury had the wrist immobilised for 4 weeks, then rehabilitation followed. In the patients with a damaged ligament, immobilisation in a short brace lasted until transarticular wires were removed. All patients were followed up for a year at least. At follow-up, the injured wrist was examined

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery.

PubMed

Lamo-Espinosa, J M; Llombart Blanco, R; Valentí, J R

2012-01-01

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries.

Cost-effectiveness of MRI to assess for posttraumatic ligamentous cervical spine injury.

PubMed

Murphy, Joshua M; Park, Paul; Patel, Rakesh D

2014-02-01

Magnetic resonance imaging (MRI) has been shown to be sensitive in identifying ligamentous injury to the cervical spine. The major drawbacks to its routine use are cost and availability. The purpose of this study was to compare the cost of using MRI to rule out ligamentous injury of the cervical spine with the cost of immobilization in a cervical collar and outpatient follow-up. Neurologically intact and nonobtunded patients with neck pain and normal findings on radiographs evaluated for ligamentous injury of the cervical spine were studied. Patients were either evaluated with MRI or immobilized in a cervical collar and followed up for repeat clinical and radiographic evaluation as outpatients. The authors gathered year 2011 fees from their institution and 2011 Medicare reimbursement data and compared the costs of MRI with the costs of cervical collar and outpatient follow-up. In addition, the median income of the local community was used to estimate opportunity costs associated with cervical collar immobilization. After 7 days of lost wages at the median local income, MRI became a less costly option when comparing hospital fees. Alternatively, when considering Medicare reimbursement, MRI became less costly after only 2 days of lost wages at the median local income. On the basis of these findings, MRI of the cervical spine is less costly than other current management strategies when opportunity costs are considered. Copyright 2014, SLACK Incorporated.

Finite Element Model of the Knee for Investigation of Injury Mechanisms: Development and Validation

PubMed Central

Kiapour, Ali; Kiapour, Ata M.; Kaul, Vikas; Quatman, Carmen E.; Wordeman, Samuel C.; Hewett, Timothy E.; Demetropoulos, Constantine K.; Goel, Vijay K.

2014-01-01

Multiple computational models have been developed to study knee biomechanics. However, the majority of these models are mainly validated against a limited range of loading conditions and/or do not include sufficient details of the critical anatomical structures within the joint. Due to the multifactorial dynamic nature of knee injuries, anatomic finite element (FE) models validated against multiple factors under a broad range of loading conditions are necessary. This study presents a validated FE model of the lower extremity with an anatomically accurate representation of the knee joint. The model was validated against tibiofemoral kinematics, ligaments strain/force, and articular cartilage pressure data measured directly from static, quasi-static, and dynamic cadaveric experiments. Strong correlations were observed between model predictions and experimental data (r > 0.8 and p < 0.0005 for all comparisons). FE predictions showed low deviations (root-mean-square (RMS) error) from average experimental data under all modes of static and quasi-static loading, falling within 2.5 deg of tibiofemoral rotation, 1% of anterior cruciate ligament (ACL) and medial collateral ligament (MCL) strains, 17 N of ACL load, and 1 mm of tibiofemoral center of pressure. Similarly, the FE model was able to accurately predict tibiofemoral kinematics and ACL and MCL strains during simulated bipedal landings (dynamic loading). In addition to minimal deviation from direct cadaveric measurements, all model predictions fell within 95% confidence intervals of the average experimental data. Agreement between model predictions and experimental data demonstrates the ability of the developed model to predict the kinematics of the human knee joint as well as the complex, nonuniform stress and strain fields that occur in biological soft tissue. Such a model will facilitate the in-depth understanding of a multitude of potential knee injury mechanisms with special emphasis on ACL injury

The association between lower extremity energy absorption and biomechanical factors related to anterior cruciate ligament injury.

PubMed

Norcross, Marc F; Blackburn, J Troy; Goerger, Benjamin M; Padua, Darin A

2010-12-01

Greater total energy absorption by the lower extremity musculature during landing may reduce stresses placed on capsuloligamentous tissues with differences in joint contributions to energy absorption potentially affecting anterior cruciate ligament injury risk. However, the relationships between energy absorption and prospectively identified biomechanical factors associated with non-contact anterior cruciate ligament injury have yet to be demonstrated. Sagittal plane total, hip, knee and ankle energy absorption, and peak vertical ground reaction force, anterior tibial shear force, knee flexion and knee valgus angles, and internal hip extension and knee varus moments were measured in 27 individuals (14 females, 13 males) performing double leg jump landings. Correlation coefficients assessed the relationships between energy absorption during three time intervals (initial impact phase, terminal phase, and total landing) and biomechanical factors related to anterior cruciate ligament injury. More favorable values of biomechanical factors related to non-contact anterior cruciate ligament injury were associated with: 1) Lesser total (R(2)=0.178-0.558), hip (R(2)=0.229-0.651) and ankle (R(2)=0.280), but greater knee (R(2)=0.147) energy absorption during the initial impact phase; 2) Greater total (R(2)=0.170-0.845), hip (R(2)=0.599), knee (R(2)=0.236-0.834), and ankle (R(2)=0.276) energy absorption during the terminal phase of landing; and 3) Greater knee (R(2)=0.158-0.709), but lesser hip (R(2)=0.309) and ankle (R(2)=0.210-0.319) energy absorption during the total landing period. These results suggest that biomechanical factors related to anterior cruciate ligament injury are influenced by both the magnitude and timing of lower extremity energy absorption during landing. Copyright © 2010 Elsevier Ltd. All rights reserved.

Evaluation of the Morphology and Function of Medial Collateral Ligament afterTotal Knee Arthroplasty with High-frequency Ultrasound.

PubMed

Jiang, Ling; Liu, Yan-Qing; Cui, Li-Gang; Meng, Ying; Tian, Hua; Zhang, Ke; Wang, Jin-Rui

2016-10-10

Objective To explore the feasibility and clinical value of ultrasonography in evaluating the morphology and function of medial collateral ligaments (MCL) after total knee arthroplasty (TKA). Methods Totally 38 patients undergoing routine KTA (group A) and 22 patients undergoing constrained condylar knee arthroplasty KTA with MCL injury (group B) were included. Long axis views of MCL were taken and the MCL thickness was measured on femur side and tibial side 1 cm away from the joint line, respectively. The thicknesses were compared between the two groups. Subsequently, the gap between the metal part of the femoral prosthesis and the spacer after dynamic valgus stress was measured. The distribution and composition of the gap between the two groups were compared. Results High-frequency ultrasound clearly showed the prosthesis and MCL after TKA. MCL fiber structures of both groups were intact. The MCL thickness on the tibial side in group B was (0.25±0.06)cm, which was significantly thinner than group A [(0.32±0.14)cm] (t=2.12, P=0.040).For the femur side, there was no significant difference (t=1.65, P=0.110) between these two groups [(0.37±0.09) cm in group B versus (0.42±0.12)cm in group A]. Under the condition of valgus stress, the gaps between the metal part of the femoral prosthesis and the spacer could be found in 11 cases in group B but only in 1 case in group A. The proportion of gaps in group B was significantly higher than that in group A (Fisher's exact test, P=0.000). Conclusions High-frequency ultrasound can clearly show the prosthesis and MCL after TKA. The injured MCL can be well joined but the thickness is thinner. Under the condition of valgus stress of the knee, the stability of the TKA can be evaluated according to the gap between the prosthesis and the spacer.

The fifty highest cited papers in anterior cruciate ligament injury.

PubMed

Vielgut, Ines; Dauwe, Jan; Leithner, Andreas; Holzer, Lukas A

2017-07-01

The anterior cruciate ligament (ACL) is one of the most common injured knee ligaments and at the same time, one of the most frequent injuries seen in the sport orthopaedic practice. Due to the clinical relevance of ACL injuries, numerous papers focussing on this topic including biomechanical-, basic science-, clinical- or animal studies, were published. The purpose of this study was to determine the most frequently cited scientific articles which address this subject, establish a ranking of the 50 highest cited papers and analyse them according to their characteristics. The 50 highest cited articles related to Anterior Cruciate Ligament Injury were searched in Thomson ISI Web of Science® by the use of defined search terms. All types of scientific papers with reference to our topic were ranked according to the absolute number of citations and analyzed for the following characteristics: journal title, year of publication, number of citations, citation density, geographic origin, article type and level of evidence. The 50 highest cited articles had up to 1624 citations. The top ten papers on this topic were cited 600 times at least. Most papers were published in the American Journal of Sports Medicine. The publication years spanned from 1941 to 2007, with the 1990s and 2000s accounting for half of the articles (n = 25). Seven countries contributed to the top 50 list, with the USA having by far the most contribution (n = 40). The majority of articles could be attributed to the category "Clinical Science & Outcome". Most of them represent a high level of evidence. Scientific articles in the field of ACL injury are highly cited. The majority of these articles are clinical studies that have a high level of evidence. Although most of the articles were published between 1990 and 2007, the highest cited articles in absolute and relative numbers were published in the early 1980s. These articles contain well established scoring- or classification systems. The

Inferior Lateral Genicular Artery Injury during Anterior Cruciate Ligament Reconstruction Surgery

PubMed Central

Lamo-Espinosa, J. M.; Llombart Blanco, R.; Valentí, J. R.

2012-01-01

We report a case of inferior lateral genicular artery (ILG) injury during anterior cruciate ligament (ACL) reconstruction surgery with lateral partial meniscectomy. This is a rare arthroscopy complication. A review of the literature has been made with the aim to define the anatomy of ILG across the lateral articular line and the risk of lesion during knee arthroscopy. We propose embolization as a good treatment option for this type of injuries. PMID:22957293

Utility of flexion-extension radiography for the detection of ligamentous cervical spine injury and its current role in the clearance of the cervical spine.

PubMed

Oh, Jason Jaeseong; Asha, Stephen Edward

2016-04-01

Detecting the presence of injuries to the cervical spine is an important component of the initial assessment of patients sustaining blunt trauma. A small proportion of cervical spine injuries consists of ligamentous disruption. Accurate detection of ligamentous injury is essential as it may result in sequelae including radiculopathy, quadriplegia and death. Flexion-extension (FE) radiography has traditionally been utilised for the detection of ligamentous injury in patients who have been cleared of bony injury. There are controversies surrounding the use of FE for alert patients with neck pain. There are studies that call into question the diagnostic accuracy of FE, the high proportion of inadequate FE images due to muscle spasm and the adverse effects of prolonged cervical collar immobilisation while awaiting FE. Other literature indicates that FE provides no additional diagnostic information following a multi-detector helical computed tomography. This review evaluates the literature on the utility of FE for the detection of ligamentous injury and explores alternate strategies for clearing the cervical spine of ligamentous injury. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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

PubMed

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

2014-06-01

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

Guideline on anterior cruciate ligament injury

PubMed Central

2012-01-01

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

Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport.

PubMed

Paterno, Mark V; Kiefer, Adam W; Bonnette, Scott; Riley, Michael A; Schmitt, Laura C; Ford, Kevin R; Myer, Gregory D; Shockley, Kevin; Hewett, Timothy E

2015-12-01

Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. Sixty-one female athletes who were cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify differences. A main effect of group (P = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (P = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], P = 0.03. Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at risk. Copyright © 2015 Elsevier Ltd. All rights reserved.

Prospectively Identified Deficits in Sagittal Plane Hip-Ankle Coordination in Female Athletes who Sustain a Second Anterior Cruciate Ligament Injury after Anterior Cruciate Ligament Reconstruction and Return to Sport

PubMed Central

Paterno, Mark V.; Kiefer, Adam W.; Bonnette, Scott; Riley, Michael A.; Schmitt, Laura C.; Ford, Kevin R.; Myer, Gregory D.; Shockley, Kevin; Hewett, Timothy E.

2015-01-01

Background Athletes who return to sport after anterior cruciate ligament reconstruction are at increased risk of future ACL injury. Altered coordination of lower extremity motion may increase this risk. The purpose of this study was to prospectively determine if altered lower extremity coordination patterns exist in athletes who go on to sustain a 2nd anterior cruciate ligament injury. Methods Sixty-one female athletes who were medically cleared to return to sport after anterior cruciate ligament reconstruction were included. Hip-ankle coordination was assessed prior to return to sport with a dynamic postural coordination task. Within 12 months, 14 patients sustained a 2nd ACL injury. Fourteen matched subjects were selected for comparative analysis. Cross-recurrence quantification analysis characterized hip-ankle coordination patterns. A group × target speed (slow vs. fast) × leg (involved vs. uninvolved) analysis of variance was used to identify coordination differences. Findings A main effect of group (p = 0.02) indicated that the single injury group exhibited more stable hip-ankle coordination [166.2 (18.9)] compared to the 2nd injury group [108.4 (10.1)]. A leg × group interaction was also observed (p = .04). The affected leg of the single injury group exhibited more stable coordination [M = 187.1 (23.3)] compared to the affected leg of the 2nd injury group [M = 110.13 (9.8)], p = 0.03. Interpretation Hip-ankle coordination was altered in female athletes who sustained a 2nd anterior cruciate ligament injury after return to sport. Failure to coordinate lower extremity movement in the absence of normal knee proprioception may place the knee at high-risk. PMID:26416200

[Internal fixation with one-hole microplate for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture].

PubMed

Wang, Xi-Xun; Sun, De-Tao; Chen, Xu-Hui; Li, Jun; Cui, Yan; Hu, Ji-Chao; Shu, Zheng-Hua; He, Jian; Ding, Chao-Qi; Chen, Bo

2015-03-01

To study clinical effects of one-hole microplate internal fixation for the treatment of collateral ligament injuries of the metacarpophalangeal joint of the thumb combined with fracture. Twenty-two patients (16 males, 6 females) with collateral ligament injuries of the metacarpophalangeal joint of the thumb combined fracture were treated with one-hole microplate internal fixation. The age of the patients ranged from 18 to 53 years old with a mean age of 28.5 years old. The duration from injury to surgery ranged from 2 hours to 2 months, and the mean time was 6 days. All the patients had collateral ligament injuries combined with fracture of the metacarpophalangeal joint of the thumb. Thirteen patients had injuries in the right hand and 9 patients had injuries in the left hand. There were 18 cases of closed wound and 4 cases of open wound. Eighteen patients had fresh injuries (< 2 weeks) and 4 had old injuries (> 2 weeks). Sixteen patients had injuries in the ulnar collateral ligament of the thumb combined with fracture, 6 patients had radial collateral ligament injuries of the thumb combined with fracture, 4 cases of which were complicated with injuries of abductor pollicis brevis and the end of the flexor pollicis brevis tender. The size of the avulsed fragment was about 3.0 mm x 4.0 mm to 6.0 mm x 7.0 mm. The incisions of 22 patients healed by first intention. The follow-up periods ranged from 6 months to 5 years old,with an average of 2.5 years old. The thumb function was evaluated by Saetta and other evaluation criteria, and 20 patients got an excellent result and 2 good. The application of one-hole microplate internal fixation in treating collateral ligament injuries with fracture of the metacarpophalangeal joint of the thumb is an effective method.

Ligament-induced sacral fractures of the pelvis are possible.

PubMed

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

2014-07-01

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

Semi-automated detection of anterior cruciate ligament injury from MRI.

PubMed

Štajduhar, Ivan; Mamula, Mihaela; Miletić, Damir; Ünal, Gözde

2017-03-01

A radiologist's work in detecting various injuries or pathologies from radiological scans can be tiresome, time consuming and prone to errors. The field of computer-aided diagnosis aims to reduce these factors by introducing a level of automation in the process. In this paper, we deal with the problem of detecting the presence of anterior cruciate ligament (ACL) injury in a human knee. We examine the possibility of aiding the diagnosis process by building a decision-support model for detecting the presence of milder ACL injuries (not requiring operative treatment) and complete ACL ruptures (requiring operative treatment) from sagittal plane magnetic resonance (MR) volumes of human knees. Histogram of oriented gradient (HOG) descriptors and gist descriptors are extracted from manually selected rectangular regions of interest enveloping the wider cruciate ligament area. Performance of two machine-learning models is explored, coupled with both feature extraction methods: support vector machine (SVM) and random forests model. Model generalisation properties were determined by performing multiple iterations of stratified 10-fold cross validation whilst observing the area under the curve (AUC) score. Sagittal plane knee joint MR data was retrospectively gathered at the Clinical Hospital Centre Rijeka, Croatia, from 2007 until 2014. Type of ACL injury was established in a double-blind fashion by comparing the retrospectively set diagnosis against the prospective opinion of another radiologist. After clean up, the resulting dataset consisted of 917 usable labelled exam sequences of left or right knees. Experimental results suggest that a linear-kernel SVM learned from HOG descriptors has the best generalisation properties among the experimental models compared, having an area under the curve of 0.894 for the injury-detection problem and 0.943 for the complete-rupture-detection problem. Although the problem of performing semi-automated ACL-injury diagnosis by observing knee

The Effects of Generalized Joint Laxity on Risk of Anterior Cruciate Ligament Injury in Young Female Athletes

PubMed Central

Myer, Gregory D.; Ford, Kevin R.; Paterno, Mark V.; Nick, Todd G.; Hewett, Timothy E.

2012-01-01

Background Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men. Purpose To prospectively determine if female athletes with decreased passive knee joint restraint (greater joint laxity) and greater side-to-side differences in knee laxity would be at increased risk of anterior cruciate ligament injury. Study Design Case control study; Level of evidence, 3. Methods From 1558 female soccer and basketball players who were prospectively screened, 19 went on to tear their anterior cruciate ligaments. Four height- and mass-matched control subjects were selected from the uninjured screened athletes for comparison with each of the 19 injured subjects, making a total of 95 subjects (19 injured; 76 uninjured). Generalized joint-laxity tests and anterior-posterior tibiofemoral translation were quantified using the CompuKT knee arthrometer. A multivariable logistic regression model was constructed to determine predictors of anterior cruciate ligament injury status from recorded laxity measures. Results A multivariable logistic regression model (chi-square = 18.6; P = .002) used the independent variables laxity measures of knee hyperextension (P = .02), wrist and thumb to forearm opposition (P = .80), fifth-finger hyperextension >90° (P = .71), side-to-side differences in anterior-posterior tibiofemoral translation (P = .002), and prior knee injury (P = .22) to predict anterior cruciate ligament–injury status. The validated C statistic, or validated area under the receiver operating characteristic curve, was 0.72. For every 1.3-mm increase in side-to-side differences in anterior-posterior knee displacement, the odds of anterior cruciate ligament–injured status increased 4-fold (95% confidence interval, 1.68–9.69). A positive measure of knee hyperextension increased the odds of anterior cruciate ligament–injured status 5-fold (95% confidence interval, 1.24–18.44). Conclusion The current results

Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes?

PubMed Central

Redler, Lauren H; Degen, Ryan M; McDonald, Lucas S; Altchek, David W; Dines, Joshua S

2016-01-01

Injury to the ulnar collateral ligament (UCL) most commonly occurs in the overhead throwing athlete. Knowledge surrounding UCL injury pathomechanics continues to improve, leading to better preventative treatment strategies and rehabilitation programs. Conservative treatment strategies for partial injuries, improved operative techniques for reconstruction in complete tears, adjunctive treatments, as well as structured sport specific rehabilitation programs including resistive exercises for the entire upper extremity kinetic chain are all important factors in allowing for a return to throwing in competitive environments. In this review, we explore each of these factors and provide recommendations based on the available literature to improve outcomes in UCL injuries in athletes. PMID:27114930

Reference Values for the Marx Activity Rating Scale in a Young Athletic Population: History of Knee Ligament Injury Is Associated With Higher Scores.

PubMed

Cameron, Kenneth L; Peck, Karen Y; Thompson, Brandon S; Svoboda, Steven J; Owens, Brett D; Marshall, Stephen W

2015-01-01

Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited. To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex. Cross-sectional study. Level 2. All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest. The median MARS score was significantly higher for men when compared with women (χ(2) = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ(2) = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ(2) = 9.06, df = 1, P = 0.003). Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex. © 2015 The Author(s).

Association of polymorphisms rs1800012 in COL1A1 with sports-related tendon and ligament injuries: a meta-analysis

PubMed Central

Wang, Chunguang; Li, Hao; Chen, Kang; Wu, Bing; Liu, Haifeng

2017-01-01

It has been reported that the single nucleotide polymorphism (SNP) rs1800012 in COL1A1 might be associated with the susceptibility to sports-related tendon and ligament injuries such as ACL injuries, Achilles tendon injuries, shoulder dislocations and tennis elbow. But the data from different studies have been conflicting. Here we attempted to systematically summarize and clarify the association between the SNP and sports-related tendon and ligament injuries risk. Six eligible studies including 933 cases and 1,381 controls were acquired from PubMed, Web Of Science and Cochrane library databases. Significant association was identified in homozygote model (TT versus GG: OR=0.17, 95%CI 0.08-0.35, PH=0.00) and recessive model (TT versus GT/GG: OR=0.21, 95%CI 0.10-0.44, PH=0.00). Our results indicated that COL1A1 rs1800012 polymorphism may be associated with the reduced risk of sports-related tendon or ligament injuries, especially in ACL injuries, and that rare TT may played as a protective role. PMID:28206959

Anterior Cruciate Ligament Injury, Reconstruction, and the Optimization of Outcome

PubMed Central

Bliss, James Philip

2017-01-01

Anterior cruciate ligament reconstruction (ACLR) provides an established surgical intervention to control pathological tibiofemoral translational and rotational movement. ACLR is a safe and reproducible intervention, but there remains an underlying rate of failure to return to preinjury sporting activity levels. Postoperative pathological laxity and graft reinjury remain concerns. Previously, unrecognized meniscal lesions, disruption of the lateral capsule, and extracapsular structures offer potential avenues to treat and to therefore improve kinematic outcome and functional results, following reconstruction. Addressing laterally based injuries may also improve the durability of intraarticular ACLR. Improving the anterior cruciate ligament (ACL) graft replication of the normal ACL attachment points on the femur and the tibia, using either double bundle or anatomical single bundle techniques, improves kinematics, which may benefit outcome and functionality, following reconstruction. PMID:28966384

Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI.

PubMed

Ringler, Michael D; Shotts, Ezekiel E; Collins, Mark S; Howe, B Matthew

2016-12-01

Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee.

An unusual mechanism for injury of the anterior cruciate ligament in figure skating.

PubMed

Wilson, Eugene K; Lahurd, Alexandra P; Wilckens, John H

2012-03-01

A 20-year-old competitive figure skater presented with an acute disabling knee injury that occurred in the overhead, non-weight-bearing knee during the performance of a Biellmann spin. Examination and magnetic resonance imaging confirmed the diagnosis of a complete anterior cruciate ligament (ACL) tear. To our knowledge, no previous cases of acute injury of the ACL sustained during the execution of a Biellmann spin have been reported. The ACL injury we report is unique because it occurred without the blade contacting the ice. The mechanism of injury has some features that are similar to those of other noncontact ACL injuries, with the addition of centrifugal force as a potential contributor to the injury.

Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review.

PubMed

Michaelidis, Michael; Koumantakis, George A

2014-08-01

Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports. To analyze the effects of ACL injury prevention programs on injury rates in female athletes between different sports. A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: 'anterior cruciate ligament', 'ACL', 'knee joint', 'knee injuries', 'female', 'athletes', 'neuromuscular', 'training', 'prevention'. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete-exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes. 13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results. Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery. Copyright © 2013 Elsevier Ltd. All rights reserved.

Management of Anterior Cruciate Ligament Injury: What's In and What's Out?

PubMed Central

Raines, Benjamin Todd; Naclerio, Emily; Sherman, Seth L

2017-01-01

Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears. PMID:28966380

Treatment of Medial Malleolus or Pure Deltoid Ligament Injury in Patients with Supination-External Rotation Type IV Ankle Fractures.

PubMed

Wang, Xu; Zhang, Chao; Yin, Jian-Wen; Wang, Chen; Huang, Jia-Zhang; Ma, Xin; Wang, Cheng-Wei; Wang, Xue

2017-02-01

To investigate the effect of internal fixation on postoperative ankle function in patients with supination-external rotation type IV ankle fractures, including medial malleolus fractures and deltoid ligament injury. Between January 2012 and June 2014, patients with medial structure injuries were enrolled in this study and assigned to the medial malleolus fracture group or the deltoid ligament group. The surgical procedures for the two groups were documented. The follow-up endpoint was the time point when the steel plate or screw was removed from the lateral ankle. The Olerud-Molander ankle scoring system was used to assess ankle function. A total of 84 patients with supination-external rotation type IV ankle fractures had complete medical records and were included in this study. The average age of the patients was 44.16 years (range, 15-75). The patient sample included 39 males and 45 females. Overall, 49 patients (19 males and 30 females) suffered a medial malleolus fracture. The average age of these patients was 40.20 years (range, 15-75). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 81.6% (40 patients) of these patients. Overall, 35 patients (20 males and 15 females) experienced a deltoid ligament injury. The average age of these patients was 44.21 years (range, 17-73). Patients with a posterior malleolar fracture fragment >25% of the articular surface accounted for 11.5% (four patients) of these patients. Open reduction was performed in patients with medial malleolus fractures, and two 4.0-mm cannulated screws were used to fixate the posterior malleolus and the medial malleolus. The suture-anchor technique was used to repair the ligaments in patients with deltoid ligament injuries. The follow-up endpoint was the time point when the steel plate and screws were removed from the lateral ankle in patients. The average follow-up period was 13.4 months (range, 11-17). The Olerud-Molander ankle scoring system was

Basic science of anterior cruciate ligament injury and repair

PubMed Central

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

2014-01-01

Injury to the anterior cruciate ligament (ACL) is one of the most devastating and frequent injuries of the knee. Surgical reconstruction is the current standard of care for treatment of ACL injuries in active patients. The widespread adoption of ACL reconstruction over primary repair was based on early perception of the limited healing capacity of the ACL. Although the majority of ACL reconstruction surgeries successfully restore gross joint stability, post-traumatic osteoarthritis is commonplace following these injuries, even with ACL reconstruction. The development of new techniques to limit the long-term clinical sequelae associated with ACL reconstruction has been the main focus of research over the past decades. The improved knowledge of healing, along with recent advances in tissue engineering and regenerative medicine, has resulted in the discovery of novel biologically augmented ACL-repair techniques that have satisfactory outcomes in preclinical studies. This instructional review provides a summary of the latest advances made in ACL repair. Cite this article: Bone Joint Res 2014;3:20–31. PMID:24497504

ANTERIOR CRUCIATE LIGAMENT INJURY: TREATMENT AND REHABILITATION. CURRENT PERSPECTIVES AND TRENDS

PubMed Central

Arliani, Gustavo Gonçalves; Astur, Diego da Costa; Kanas, Michel; Kaleka, Camila Cohen; Cohen, Moises

2015-01-01

Objective: The aim of this study was to evaluate the procedures used by knee surgeons in Brazil for treating and rehabilitating anterior cruciate ligament injuries. Methods: A questionnaire consisting of 21 closed questions was developed, addressing topics relating to treatment and rehabilitation after anterior cruciate ligament reconstruction. The questionnaire was applied to Brazilian knee surgeons during the three days of the 42nd Brazilian Congress of Orthopedics and Traumatology in 2010. Results: A total of 226 surgeons filled out the questionnaire completely. The most commonly used types of graft were hamstrings tendons and the central third of the ipsilateral patellar tendon, which were used by 82.3% and 53.5% of the sample, respectively. The technique of reconstruction with a single transtibial band was the first preference and was used by 66.4% of the participants. A period of 1 to 4 weeks between injury and surgical procedure was considered ideal by most participants (52.65%). Complaints from patients that the knee was ‘giving way’ or unstable and presence of a positive pivot shift maneuver were the most decisive factors considered in making the decision to operate the patient. Patient satisfaction and absence of complaints of instability during the postoperative period were the criteria deemed to be most important for the surgery to be considered a success. Conclusions: There are clearly evolving trends in treating and rehabilitating the anterior cruciate ligament in Brazil. However, more prospective controlled studies are needed in order to evaluate the clinical and scientific benefits of these trends. PMID:27042620

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

PubMed Central

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

2015-01-01

Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

Expression of modulators of extracellular matrix structure after anterior cruciate ligament injury.

PubMed

Haslauer, Carla M; Proffen, Benedikt L; Johnson, Victor M; Murray, Martha M

2014-01-01

The ability of the anterior cruciate ligament (ACL) to heal after injury declines within the first 2 weeks after ACL rupture. To begin to explore the mechanism behind this finding, we quantified the expression of genes for collagen I and III, decorin, tenascin-C, and alpha smooth muscle actin, as well as matrix metalloproteinase (MMP)-1 and -13 gene expression within multiple tissues of the knee joint after ACL injury in a large animal model over a 2-week postinjury period. Gene expression of collagen I and III, decorin, and MMP-1 was highest in the synovium, whereas the highest MMP-13 gene expression levels were found in the ACL. The gene expression for collagen and decorin increased over the 2 weeks to levels approaching that in the ligament and synovium; however, no significant increase in either of the MMPs was found in the provisional scaffold. This suggests that although the ACL and synovium up-regulate both anabolic and catabolic factors, the provisional scaffold is primarily anabolic in function. The relative lack of provisional scaffold formation within the joint environment may thus be one of the key reasons for ACL degradation after injury. © 2014 by the Wound Healing Society.

Video Analysis of Anterior Cruciate Ligament (ACL) Injuries

PubMed Central

Carlson, Victor R.; Sheehan, Frances T.; Boden, Barry P.

2016-01-01

Background: As the most viable method for investigating in vivo anterior cruciate ligament (ACL) rupture, video analysis is critical for understanding ACL injury mechanisms and advancing preventative training programs. Despite the limited number of published studies involving video analysis, much has been gained through evaluating actual injury scenarios. Methods: Studies meeting criteria for this systematic review were collected by performing a broad search of the ACL literature with use of variations and combinations of video recordings and ACL injuries. Both descriptive and analytical studies were included. Results: Descriptive studies have identified specific conditions that increase the likelihood of an ACL injury. These conditions include close proximity to opposing players or other perturbations, high shoe-surface friction, and landing on the heel or the flat portion of the foot. Analytical studies have identified high-risk joint angles on landing, such as a combination of decreased ankle plantar flexion, decreased knee flexion, and increased hip flexion. Conclusions: The high-risk landing position appears to influence the likelihood of ACL injury to a much greater extent than inherent risk factors. As such, on the basis of the results of video analysis, preventative training should be applied broadly. Kinematic data from video analysis have provided insights into the dominant forces that are responsible for the injury (i.e., axial compression with potential contributions from quadriceps contraction and valgus loading). With the advances in video technology currently underway, video analysis will likely lead to enhanced understanding of non-contact ACL injury. PMID:27922985

Addition of lateral bending range of motion measurement to standard sagittal measurement to improve diagnosis sensitivity of ligamentous injury in the human lower cervical spine.

PubMed

Leahy, P Devin; Puttlitz, Christian M

2016-01-01

This study examined the cervical spine range of motion (ROM) resulting from whiplash-type hyperextension and hyperflexion type ligamentous injuries, and sought to improve the accuracy of specific diagnosis of these injuries. The study was accomplished by measurement of ROM throughout axial rotation, lateral bending, and flexion and extension, using a validated finite element model of the cervical spine that was modified to simulate hyperextension and/or hyperflexion injuries. It was found that the kinematic difference between hyperextension and hyperflexion injuries was minimal throughout the combined flexion and extension ROM measurement that is commonly used for clinical diagnosis of cervical ligamentous injury. However, the two injuries demonstrated substantially different ROM under axial rotation and lateral bending. It is recommended that other bending axes beyond flexion and extension are incorporated into clinical diagnosis of cervical ligamentous injury.

Anterior Cruciate Ligament Injuries in Baseball Players.

PubMed

Dugas, Jeffrey R; Bedford, Benjamin B; Andrachuk, John S; Scillia, Anthony J; Aune, Kyle T; Cain, E Lyle; Andrews, James R; Fleisig, Glenn S

2016-11-01

To determine common mechanisms of anterior cruciate ligament (ACL) injury in baseball players and to quantify the rate of return to play after primary surgical reconstruction and review intermediate clinical outcomes. Surgical injuries involving the ACL in youth, high school, collegiate, and professional baseball players were queried for an 11-year period (2001 to 2011). Over the study period, 42 baseball players were identified who had undergone arthroscopically assisted primary ACL reconstruction by 1 of 3 attending surgeons. Retrospective chart review was performed for all 42 patients to evaluate variables of age, level of competition, position, mechanism of injury, graft choice, and associated meniscal injuries. Twenty-six patients were reached for telephone survey and International Knee Documentation Committee questionnaire and they answered questions about their original injury and playing history. The most common mechanism of injury was fielding, followed by base running. Infielders and outfielders (32% each) were the most commonly injured position, followed by pitchers (29%). Among the 32 players for whom it could be determined, 30 (94%) were able to return to playing baseball at a mean follow-up of 4.2 years (range 1.0 to 9.9 years). The mean International Knee Documentation Committee score was 84.0 (range 63 to 91). Among the 26 patients contacted for telephone interview, no one required revision ACL surgery, but 3 required a subsequent procedure for meniscal tear. Twenty-five patients (96%) denied any episodes of instability in the knee after reconstruction. The overwhelming majority of baseball players that sustain ACL injuries do so while fielding or base running. Outfielders are significantly more likely than infielders to suffer ACL injuries while fielding versus base running. The results with respect to return to play are promising, as nearly all patients were able to return to baseball and none required a revision ACL surgery at a mean follow

Interleukin Expression after Injury and the Effects of Interleukin-1 Receptor Antagonist

PubMed Central

Chamberlain, Connie S.; Leiferman, Ellen M.; Frisch, Kayt E.; Brickson, Stacey L.; Murphy, William L.; Baer, Geoffrey S.; Vanderby, Ray

2013-01-01

Ligament healing follows a series of complex coordinated events involving various cell types, cytokines, as well as other factors, producing a mechanically inferior tissue more scar-like than native tissue. Macrophages provide an ongoing source of cytokines to modulate inflammatory cell adhesion and migration as well as fibroblast proliferation. Studying interleukins inherent to ligament healing during peak macrophage activation and angiogenesis may elucidate inflammatory mediators involved in subsequent scar formation. Herein, we used a rat healing model assayed after surgical transection of their medial collateral ligaments (MCLs). On days 3 and 7 post-injury, ligaments were collected and used for microarray analysis. Of the 12 significantly modified interleukins, components of the interleukin-1 family were significantly up-regulated. We therefore examined the influence of interleukin-1 receptor antagonist (IL-1Ra) on MCL healing. Transected rat MCLs received PBS or IL-1Ra at the time of surgery. Inhibition of IL-1 activation decreased pro-inflammatory cytokines (IL-1α, IL-1β, IL-12, IL-2, and IFN-γ), myofibroblasts, and proliferating cells, as well as increased anti-inflammatory cytokines (IL-10), endothelial cells/blood vessel lumen, M2 macrophages, and granulation tissue size without compromising the mechanical properties. These results support the concept that IL-1Ra modulates MCL-localized granulation tissue components and cytokine production to create a transient environment that is less inflammatory. Overall, IL-1Ra may have therapeutic potential early in the healing cascade by stimulating the M2 macrophages and altering the granulation tissue components. However, the single dose of IL-1Ra used in this study was insufficient to maintain the more regenerative early response. Due to the transient influence on most of the healing components tested, IL-1Ra may have greater therapeutic potential with sustained delivery. PMID:23936523

Joint stability characteristics of the ankle complex after lateral ligamentous injury, part I: a laboratory comparison using arthrometric measurement.

PubMed

Kovaleski, John E; Heitman, Robert J; Gurchiek, Larry R; Hollis, J M; Liu, Wei; Pearsall, Albert W

2014-01-01

The mechanical property of stiffness may be important to investigating how lateral ankle ligament injury affects the behavior of the viscoelastic properties of the ankle complex. A better understanding of injury effects on tissue elastic characteristics in relation to joint laxity could be obtained from cadaveric study. To biomechanically determine the laxity and stiffness characteristics of the cadaver ankle complex before and after simulated injury to the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) during anterior drawer and inversion loading. Cross-sectional study. University research laboratory. Seven fresh-frozen cadaver ankle specimens. All ankles underwent loading before and after simulated lateral ankle injury using an ankle arthrometer. The dependent variables were anterior displacement, anterior end-range stiffness, inversion rotation, and inversion end-range stiffness. Isolated ATFL and combined ATFL and CFL sectioning resulted in increased anterior displacement but not end-range stiffness when compared with the intact ankle. With inversion loading, combined ATFL and CFL sectioning resulted in increased range of motion and decreased end-range stiffness when compared with the intact and ATFL-sectioned ankles. The absence of change in anterior end-range stiffness between the intact and ligament-deficient ankles indicated bony and other soft tissues functioned to maintain stiffness after pathologic joint displacement, whereas inversion loading of the CFL-deficient ankle after pathologic joint displacement indicated the ankle complex was less stiff when supported only by the secondary joint structures.

Ligament reconstruction with single bone tunnel technique for chronic symptomatic subtle injury of the Lisfranc joint in athletes.

PubMed

Miyamoto, Wataru; Takao, Masato; Innami, Ken; Miki, Shinya; Matsushita, Takashi

2015-08-01

Only few procedures for Lisfranc ligaments reconstruction to treat subtle injury of the Lisfranc joint have been reported. We have developed a novel technique for Lisfranc ligaments reconstruction, which was applied to treat chronic symptomatic subtle injuries that had failed to respond to initial treatment or were misdiagnosed. This article describes the technique and its operative outcome in a small case series. Between April 2011 and October 2013, 5 (4 male and 1 female) athletes with a mean age of 19.4 (range 17-21) years were diagnosed with chronic subtle injury of the Lisfranc joint and underwent our novel reconstructive operation. In this technique, only a bone tunnel between the medial cuneiform and the second metatarsal bone is needed for near-anatomical reconstruction of the dorsal and interosseous ligaments. All patients were evaluated before and at 1 year after surgery using the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle-midfoot. In addition, the interval between surgery and return to athletic activity, defined as return to near pre-injury performance level, was investigated. Mean duration of postoperative follow-up was 18.8 (range 12-26) months. Mean AOFAS score improved significantly from 74.6 ± 2.5 (range 71-77) preoperatively to 96.0 ± 5.5 (range 90-100) at 1 year after the operation (p < 0.01). All patients were able to return to their previous athletic activities and the interval between surgery and return to athletic activity was 16.8 ± 1.1 (range 15-18) weeks. There was no complication related to the operation. The results of this study suggest that our technique of Lisfranc ligaments reconstruction using autologous graft is effective for athletes with chronic subtle injury. Level IV, retrospective case series.

Computer aided analysis of gait patterns in patients with acute anterior cruciate ligament injury.

PubMed

Christian, Josef; Kröll, Josef; Strutzenberger, Gerda; Alexander, Nathalie; Ofner, Michael; Schwameder, Hermann

2016-03-01

Gait analysis is a useful tool to evaluate the functional status of patients with anterior cruciate ligament injury. Pattern recognition methods can be used to automatically assess walking patterns and objectively support clinical decisions. This study aimed to test a pattern recognition system for analyzing kinematic gait patterns of recently anterior cruciate ligament injured patients and for evaluating the effects of a therapeutic treatment. Gait kinematics of seven male patients with an acute unilateral anterior cruciate ligament rupture and seven healthy males were recorded. A support vector machine was trained to distinguish the groups. Principal component analysis and recursive feature elimination were used to extract features from 3D marker trajectories. A Classifier Oriented Gait Score was defined as a measure of gait quality. Visualizations were used to allow functional interpretations of characteristic group differences. The injured group was evaluated by the system after a therapeutic treatment. The results were compared against a clinical rating of the patients' gait. Cross validation yielded 100% accuracy. After the treatment the score improved significantly (P<0.01) as well as the clinical rating (P<0.05). The visualizations revealed characteristic kinematic features, which differentiated between the groups. The results show that gait alterations in the early phase after anterior cruciate ligament injury can be detected automatically. The results of the automatic analysis are comparable with the clinical rating and support the validity of the system. The visualizations allow interpretations on discriminatory features and can facilitate the integration of the results into the diagnostic process. Copyright © 2016 Elsevier Ltd. All rights reserved.

Anterior Cruciate Ligament Injuries in the National Hockey League: Epidemiology and Performance Impact.

PubMed

Longstaffe, Robert; Leiter, Jeff; MacDonald, Peter

2018-03-27

To determine the incidence of anterior cruciate ligament (ACL) injuries in the National Hockey League (NHL) and to examine the effects of this injury on return-to-play status and performance. Case series; level of evidence, 4. This was a 2-phase study. Phase I used the NHL electronic injury surveillance system and Athlete Health Management System to collect data on ACL injuries and man games lost over 10 seasons (2006/2007-2015/2016). Data collected in phase I were received in deidentified form. Phase II examined the performance impact of an ACL injury. Players were identified through publically available sources, and performance-related statistics were analyzed. Data collected in phase II were not linked to data collected in phase I. A paired t test was used to determine any difference in the matching variables between controls and cases in the preinjury time period. A General linear model (mixed) was used to determine the performance impact. Phase I: 67 ACL injuries occurred over 10 seasons. The incidence for all players was 0.42/1000 player game hours (forward, 0.61; defenseman, 0.32, goalie, 0.08) and by game exposure was 0.2/1000 player game exposures (forward, 0.33; defenseman, 0.11; goalie, 0.07). Forwards had a greater incidence rate of ACL tears with both game hours and game exposures when compared with defensemen and goalies (P < 0.001, <0.001; P = 0.008, <0.001, respectively). Phase II: 70 ACL tears (60 players) were identified. Compared with controls, players who suffered an ACL tear demonstrated a decrease in goals/season (P < 0.04), goals/game (P < 0.015), points/season (0.007), and points/game (0.001). Number of games and seasons played after an ACL injury did not differ compared with controls (P = 0.068, 0.122, respectively). Anterior cruciate ligament injuries occur infrequently, as it relates to other hockey injuries. Despite a high return to play, the performance after an ACL injury demonstrated a decrease in points and goals per game and per

Kinematics analysis of ankle inversion ligamentous sprain injuries in sports: five cases from televised tennis competitions.

PubMed

Fong, Daniel Tik-Pui; Ha, Sophia Chui-Wai; Mok, Kam-Ming; Chan, Christie Wing-Long; Chan, Kai-Ming

2012-11-01

Ankle ligamentous sprain is common in sports. The most direct way to study the mechanism quantitatively is to study real injury cases; however, it is unethical and impractical to produce an injury in the laboratory. A recently developed, model-based image-matching motion analysis technique allows quantitative analysis of real injury incidents captured in televised events and gives important knowledge for the development of injury prevention protocols and equipment. To date, there have been only 4 reported cases, and there is a need to conduct more studies for a better understanding of the mechanism of ankle ligamentous sprain injury. This study presents 5 cases in tennis and a comparison with 4 previous cases for a better understanding of the mechanism of ankle ligamentous sprain injury. Case series; level of evidence, 4. Five sets of videos showing ankle sprain injuries in televised tennis competition with 2 camera views were collected. The videos were transformed, synchronized, and rendered to a 3-dimensional animation software. The dimensions of the tennis court in each case were obtained to build a virtual environment, and a skeleton model scaled to the injured athlete's height was used for the skeleton matching. Foot strike was determined visually, and the profiles of the ankle joint kinematics were individually presented. There was a pattern of sudden inversion and internal rotation at the ankle joint, with the peak values ranging from 48°-126° and 35°-99°, respectively. In the sagittal plane, the ankle joint fluctuated between plantar flexion and dorsiflexion within the first 0.50 seconds after foot strike. The peak inversion velocity ranged from 509 to 1488 deg/sec. Internal rotation at the ankle joint could be one of the causes of ankle inversion sprain injury, with a slightly inverted ankle joint orientation at landing as the inciting event. To prevent the foot from rolling over the edge to cause a sprain injury, tennis players who do lots of sideward

An improved OpenSim gait model with multiple degrees of freedom knee joint and knee ligaments.

PubMed

Xu, Hang; Bloswick, Donald; Merryweather, Andrew

2015-08-01

Musculoskeletal models are widely used to investigate joint kinematics and predict muscle force during gait. However, the knee is usually simplified as a one degree of freedom joint and knee ligaments are neglected. The aim of this study was to develop an OpenSim gait model with enhanced knee structures. The knee joint in this study included three rotations and three translations. The three knee rotations and mediolateral translation were independent, with proximodistal and anteroposterior translations occurring as a function of knee flexion/extension. Ten elastic elements described the geometrical and mechanical properties of the anterior and posterior cruciate ligaments (ACL and PCL), and the medial and lateral collateral ligaments (MCL and LCL). The three independent knee rotations were evaluated using OpenSim to observe ligament function. The results showed that the anterior and posterior bundles of ACL and PCL (aACL, pACL and aPCL, pPCL) intersected during knee flexion. The aACL and pACL mainly provided force during knee flexion and adduction, respectively. The aPCL was slack throughout the range of three knee rotations; however, the pPCL was utilised for knee abduction and internal rotation. The LCL was employed for knee adduction and rotation, but was slack beyond 20° of knee flexion. The MCL bundles were mainly used during knee adduction and external rotation. All these results suggest that the functions of knee ligaments in this model approximated the behaviour of the physical knee and the enhanced knee structures can improve the ability to investigate knee joint biomechanics during various gait activities.

Anterior cruciate ligament injury in female and male athletes: the relationship between foot structure and injury.

PubMed

Jenkins, Walter L; Killian, Clyde B; Williams, D S; Loudon, Janice; Raedeke, Suzanne G

2007-01-01

It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players. One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n=89) and an ACL-injured group (n=16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A chi2 analysis determined whether the prevalence of ACL injury was independent of sport. No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players. Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players.

Fear of re-injury in people who have returned to sport following anterior cruciate ligament reconstruction surgery.

PubMed

Ardern, Clare L; Taylor, Nicholas F; Feller, Julian A; Webster, Kate E

2012-11-01

To examine fear of re-injury in athletes who had returned to regular sports participation following anterior cruciate ligament reconstruction surgery. Cross-sectional case series. A self-report questionnaire was used to collect data 2-7 years following surgery. Key inclusion criteria were regular participation in sport prior to injury and participation in sport at the time of the study. A sample of 209 (88 females, 121 males) at a mean of 39.6 ± 13.8 months post surgery participated. Overall, participants did not express fear of re-injury, scoring >6/10 (where 10 was the most positive response) on all questions. In terms of the total score and for six out of eight questions, participants who returned to their pre-injury sports level had significantly less fear of re-injury than those who had not returned to their pre-injury level. Females had significantly more concern than males about the environmental conditions experienced while playing (mean 6.1 compared to 7.5). On three out of eight questions, individuals who had surgery more than 3 months after injury had a greater fear of re-injury than those who had their surgery closer to the time of injury. Athletes participating in sport 2-7 years following their anterior cruciate ligament reconstruction generally appear to do so without fear of re-injury. However, gender, the timing of surgery following injury and the level of sport the athletes returned to may be associated with fear of re-injury following surgery. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Anterior cruciate ligament injury: A persistently difficult diagnosis.

PubMed

Parwaiz, Hammad; Teo, Alex Q A; Servant, Christopher

2016-01-01

Historically anterior cruciate ligament (ACL) injuries have been diagnosed poorly. A paper published in Injury in 1996 showed that less than 10% of patients with an ACL injury had the diagnosis made by the first physician to see them and that the average delay from first presentation to diagnosis was 21 months. The aim of our study was to investigate whether an improvement has been made over the last two decades in diagnosing ACL injuries. We identified 160 patients who had an ACL reconstruction performed by a single surgeon between October 2004 and December 2011 and for whom a complete data set was available. Data was extracted retrospectively from the hospital notes and a dedicated patient database. We performed a sub-group analysis comparing patients seen prior to the introduction of an acute knee injury clinic in April 2007 and patients seen after the introduction of the clinic. 75.1% (120/160) of patients presented first to an emergency department (ED) or to their general practitioner (GP), but only 14.4% (23/160) were diagnosed on initial presentation. The median number of healthcare professionals a patient saw prior to a diagnosis of ACL injury was 3. The median delay from injury to presentation was 0 weeks (range 0-885), injury to diagnosis 13 weeks (0-926), presentation to diagnosis 10 weeks (0-924), presentation to a specialist knee clinic 24 weeks (0-1006), and specialist knee clinic to surgery 13 weeks (0-102). The median total time from injury to surgery was 42 weeks (0-1047). Following the implementation of an acute knee injury clinic in 2007, the median delay from presentation to surgery dropped from 59 weeks to 36 weeks (p = 0.050) and there was a significant decrease in the median delay from specialist knee clinic to surgery from 23 to 11 weeks (p=0.002). Over the past two decades there appears to have been little improvement in the early diagnosis of ACL injuries, with only 14.4% of patients being diagnosed correctly at initial presentation. We

Incidence of anterior cruciate ligament injuries among elite ballet and modern dancers: a 5-year prospective study.

PubMed

Liederbach, Marijeanne; Dilgen, Faye E; Rose, Donald J

2008-09-01

Ballet and modern dance are jump-intensive activities, but little is known about the incidence of anterior cruciate ligament (ACL) injuries among dancers. Rigorous jump and balance training has been shown in some prospective studies to significantly reduce ACL injury rates among athletes. Dancers advance to the professional level only after having achieved virtuosic jump and balance technique. Therefore, dancers on the elite level may be at relatively low risk for ACL injury. Descriptive epidemiology study. Dance exposure, injuries, and injury conditions were systematically recorded at 4 dance organizations over 5 years. Select neuromuscular and psychometric variables were compared between and within ACL-injured and noninjured dancers. Of 298 dancers, 12 experienced an ACL injury over the 5-year period. The incidence of ACL injury was 0.009 per 1000 exposures. Landing from a jump onto 1 leg was the mechanism of injury in 92% of cases. Incidence was not statistically different between gender or dance groups, although women modern dancers had a 3 to 5 times greater relative risk than women ballet dancers and men dancers. No difference between ACL-injured and noninjured dancers emerged with regard to race, oral contraceptive use, or select musculoskeletal measures. Dancers suffer considerably fewer ACL injuries than athletes participating in team ball sports. The training dancers undertake to perfect lower extremity alignment, jump, and balance skills may serve to protect them against ACL injury. Anterior cruciate ligament injuries happened most often late in the day and season, suggesting an effect of fatigue.

Intrinsic healing response of the human anterior cruciate ligament: an histological study of reattached ACL remnants.

PubMed

Nguyen, Duy Tan; Ramwadhdoebe, Tamara H; van der Hart, Cor P; Blankevoort, Leendert; Tak, Paul Peter; van Dijk, Cornelis Niek

2014-02-01

A reattachment of the tibial remnant of the torn anterior cruciate ligament (ACL) to the posterior cruciate ligament is sometimes observed during surgery and apparently implies that the human ACL does have a healing response. The aim of this study was to investigate whether this reattachment tissue has similar histological characteristics of a healing response as the medial collateral ligament (MCL), which can heal spontaneously. Standard histology and immunostaining of α-smooth muscle actin and collagen type 3 was performed. The results shows that the reattached tissue has typical characteristics of a healing response: there attached ACL remnant could not be released by forceful traction; microscopy showed that the collagen fibers of the reattached tissue were disorganized with no preferred direction; increased neovascularization; the presence of lipid vacuoles; the mean number of cells within the biopsy tissue was 631±269 cells per mm2; and 68±20% was expressing α-SMA; semi-quantitative analysis of collagen type 3 expression showed that collagen type 3 had an high expression with an average score of 3. In conclusion, this study shows that the human proximal 1/3 ACL has an intrinsic healing response with typical histological characteristics similar to the MCL. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Tendon and ligament imaging

PubMed Central

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

2012-01-01

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

Posterior Cruciate Ligament Injury

MedlinePlus

... tear. Contact sports. Athletes in sports such as football and soccer can tear their posterior cruciate ligament ... vehicle accident and participating in sports such as football and soccer are the most common risk factors ...

Clinical study on the arthroscopic refreshing treatment of anterior cruciate ligament injury combined with stable medial meniscus ramp injury

PubMed Central

Yang, J.; Guan, K.; Wang, J.Z.

2017-01-01

This study sought to investigate the clinical efficacy of arthroscopic refreshing treatment of anterior cruciate ligament (ACL) injury combined with stable medial meniscus ramp injury. Sixty-eight patients treated between January 2010 and January 2014 were included, and their clinical data were retrospectively analyzed. All patients, after being treated using ACL reconstruction, were divided into 2 groups according to meniscus injury treatment method. The observation group (31 cases) was treated by arthroscopic refreshing, which removed the tissue on both sides of the tear edge using a cutting knife, while the control group (37 cases) was treated using Fast-fix sutures. All patients were followed up for at least 24 months. Surgical duration, postoperative function recovery time, and hospital stay for patients in the observation group were significantly shorter than for those of the control group (P<0.05). Both groups showed significant post-operative improvement for Lysholm scores, IKDC scores, and average knee range of motion at 12 and 24 months post-operation (P<0.05), but no significant differences between groups were observed (P>0.05). Regarding the difference in movement range between the healthy and injured sides, both groups showed significant decrease post-operation (P<0.05). Ultimately, there was no significant difference in the recovery of ramp damage and objective symptoms between the two groups (P>0.05). Arthroscopic refreshing treatment of patients with anterior cruciate ligament injury combined with stable ramp lesion can achieve similar clinical curative effects as the Fast-fix suture, thereby providing a simple alternative for patient treatment worth popularizing. PMID:28574418

The role of the deep medial collateral ligament in controlling rotational stability of the knee.

PubMed

Cavaignac, Etienne; Carpentier, Karel; Pailhé, Regis; Luyckx, Thomas; Bellemans, Johan

2015-10-01

The tibial insertion of the deep medial collateral ligament (dMCL) is frequently sacrificed when the proximal tibial cut is performed during total knee arthroplasty. The role of the dMCL in controlling the knee's rotational stability is still controversial. The aim of this study was to quantify the rotational laxity induced by an isolated lesion of the dMCL as it occurs during tibial preparation for knee arthroplasty. An isolated resection of the deep MCL was performed in 10 fresh-frozen cadaver knees. Rotational laxity was measured during application of a standard 5.0 N.m rotational torque. Maximal tibial rotation was measured at different knee flexion angles using an image-guided navigation system (Medivision Surgetics system, Praxim, Grenoble, France) before and after dMCL resection. In all cases, internal and external tibial rotation increased after dMCL resection. Total rotational laxity increased significantly for all knee flexion angles, with an average difference of +7.8° (SD 5.7) with the knee in extension, +8.9° (SD 1.9) in 30° flexion, +7° (SD 2.9) in 60° flexion and +5.3° (SD 2.8) in 90° flexion. Sacrificing the tibial insertion of the deep MCL increases rotational laxity of the knee by 5°-9°, depending on the knee flexion angle. Based on our findings, new surgical techniques and implants that preserve the dMCL insertion such as tibial inlay components should be developed. Further clinical evaluations are necessary.

Does a conservative tibial cut in conventional total knee arthroplasty violate the deep medial collateral ligament?

PubMed

Maes, Michael; Luyckx, Thomas; Bellemans, Johan

2014-11-01

Based on the anatomy of the deep medial collateral ligament (MCL), it was hypothesized that at least part of its cross-sectional insertion area is jeopardized while performing a standard tibial cut in conventional total knee arthroplasty (TKA). The aim of this study was to determine whether it is anatomically possible to preserve the tibial deep MCL insertion during conventional TKA. Thirty-three unpaired cadaveric knee specimens were used for this study. Knees with severe varus/valgus deformity or damage to the medial structures of the knee were excluded. In the first part of the study, the dimensions of the tibial insertion of the deep MCL and its relationship to the joint line were recorded. Next, the cross-sectional area of the deep MCL insertion was determined using calibrated digital photographic analysis. In the second part, the effect of a standard 9-mm 3° sloped tibial cut on the structural integrity of the deep MCL cross-sectional insertion area was determined using conventional instrumentation. The proximal border of the deep MCL insertion site on the tibia was located on average 4.7 ± 1.2 mm distally to the joint line. After performing a standard 9-mm 3° sloped tibial cut, on average 54% of the deep MCL insertion area was resected. In 29% of the cases, the deep MCL insertion area was completely excised. The deep MCL cannot routinely be preserved in conventional TKA. The deep MCL insertion is at risk and may be jeopardized in case of a tibial cut 9 mm below the native joint line. As the deep MCL is a distinct medial stabilizer and plays an important role in rotational stability, this may have implications in future designs of both unicondylar and total knee arthroplasty, but further research is necessary.

[Conservative treatment using plasma rich in growth factors (PRGF) for injury to the ligamentous complex of the ankle].

PubMed

Frei, R; Biosca, F E; Handl, M; Trc, T

2008-02-01

The authors describe the therapeutic utilization of separated/isolated autologous growth factors in semiconservative treatment of type III injury to the ankle ligamentous complex. Between October 2004 and March 2005 a group of 11 patients, two women and nine men, aged 18 to 41 (average, 25.09) years with acute injury to the lateral ligamentous complex of the ankle were treated by plasma rich in growth factors (PRGF) infiltration. On functional radiographic examination, the post-traumatic lateral opening of the tibiotalar intraarticular space was 17.45 degrees (range, 12.0-30.0; s = 5.68). The injured patients were clinically examined and standard forced inversion radiographs were made using topical anesthesia. Autologous PRGF activated with calcium chloride was used to infiltrate the injured tissues. The treatment was followed by immobilization of the joint and its subsequent rehabilitation. Clinical examination of injured tissues was carried out at 4 and 6 weeks of follow-up, using stability assessment tests and functional radiography of the ankle. Physical therapy included standard procedures, but faster regeneration of the soft tissues allowed for more exercises. The average time of healing was 5.18 weeks. Five patients showed no signs of instability at 4 weeks after therapy and could return to their previous sports activities. One patient had lateral ankle instability at 5 weeks and therefore the therapy continued with prolonged immobilization and then rehabilitation at a slower pace. The average lateral opening of the tibiotalar intra-articular space at 4 or 6 follow-up weeks was 4.73 degrees (range, 3.0 - 7.0; s = 1.19). At 6 weeks after therapy, 90.9% of the patients resumed their full sports activities. Ankle distortion with swelling, hematoma and pain, but with no radiographic findings of ligament lesions, is usually treated conservatively by ankle immobilization and early rehabilitation. When an injury to the fibular ankle ligaments occurs (i.e., opening

Limb Symmetry Indexes Can Overestimate Knee Function After Anterior Cruciate Ligament Injury.

PubMed

Wellsandt, Elizabeth; Failla, Mathew J; Snyder-Mackler, Lynn

2017-05-01

Study Design Prospective cohort. Background The high risk of second anterior cruciate ligament (ACL) injuries after return to sport highlights the importance of return-to-sport decision making. Objective return-to-sport criteria frequently use limb symmetry indexes (LSIs) to quantify quadriceps strength and hop scores. Whether using the uninvolved limb in LSIs is optimal is unknown. Objectives To evaluate the uninvolved limb as a reference standard for LSIs utilized in return-to-sport testing and its relationship with second ACL injury rates. Methods Seventy athletes completed quadriceps strength and 4 single-leg hop tests before anterior cruciate ligament reconstruction (ACLR) and 6 months after ACLR. Limb symmetry indexes for each test compared involved-limb measures at 6 months to uninvolved-limb measures at 6 months. Estimated preinjury capacity (EPIC) levels for each test compared involved-limb measures at 6 months to uninvolved-limb measures before ACLR. Second ACL injuries were tracked for a minimum follow-up of 2 years after ACLR. Results Forty (57.1%) patients achieved 90% LSIs for quadriceps strength and all hop tests. Only 20 (28.6%) patients met 90% EPIC levels (comparing the involved limb at 6 months after ACLR to the uninvolved limb before ACLR) for quadriceps strength and all hop tests. Twenty-four (34.3%) patients who achieved 90% LSIs for all measures 6 months after ACLR did not achieve 90% EPIC levels for all measures. Estimated preinjury capacity levels were more sensitive than LSIs in predicting second ACL injuries (LSIs, 0.273; 95% confidence interval [CI]: 0.010, 0.566 and EPIC, 0.818; 95% CI: 0.523, 0.949). Conclusion Limb symmetry indexes frequently overestimate knee function after ACLR and may be related to second ACL injury risk. These findings raise concern about whether the variable ACL return-to-sport criteria utilized in current clinical practice are stringent enough to achieve safe and successful return to sport. Level of Evidence

Phosphorylation alters Bim-mediated Mcl-1 stabilization and priming.

PubMed

Conage-Pough, Jason E; Boise, Lawrence H

2018-05-18

Mcl-1 is a highly labile protein, subject to extensive post-translational regulation. This distinguishes Mcl-1 from other antiapoptotic proteins and necessitates further study to better understand how interactions with proapoptotic Bcl-2 proteins affect its regulation. One such protein, Bim, is known to stabilize Mcl-1, and Bim phosphorylation has been associated with increased Mcl-1 binding. Consequently, we investigated the potential impact of Bim phosphorylation on Mcl-1 stability. We found that Bim stabilizes and primes Mcl-1 in RPCI-WM1 cells and is constitutively phosphorylated. Additionally, introduction of several phospho-mimetic and unphosphosphorylateable Bim mutations resulted in altered Mcl-1 stability and distinct Bim binding to antiapoptotic proteins. These findings suggest Bim phosphorylation not only regulates Mcl-1 stability but also is a potential mechanism for enforcing Mcl-1 dependence. © 2018 Federation of European Biochemical Societies.

Anatomy of the ankle ligaments: a pictorial essay.

PubMed

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

2016-04-01

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

Physiotherapists' experiences of the management of anterior cruciate ligament injuries.

PubMed

von Aesch, Arlene V; Perry, Meredith; Sole, Gisela

2016-05-01

While extensive research has been reported for management of anterior cruciate ligament (ACL) injuries, variation in treatment by physiotherapists is evident. To explore physiotherapists' experiences regarding ACL injury rehabilitation and factors that influenced physiotherapists' decision making for ACL rehabilitation, and to elicit what research physiotherapists perceived would support their management of these patients. Qualitative study. Fifteen physiotherapists from six private clinics in New Zealand participated in semi-structured interviews. The interviews were recorded, transcribed verbatim and the general inductive approach was used to develop key themes. Participant's management strengths were evident by their intent and commitment to provide expert rehabilitation, using a biopsychosocial approach and evidence-informed practice. The lengthy management process (including prolonged rehabilitation and referral processes) and interprofessional disconnect concerned participants. Translational research was needed for clear directions for exercise prescription and milestones for return to sports and occupation following ACL injury. Participants provided a biopsychosocial and evidence-based approach to ACL injury management. Potential areas of improvement include simplifying the referral process and enhancing communication between physiotherapists and other health professionals. Future research should focus on clarifying areas of ACL rehabilitation uncertainty, or collating results in an accessible and usable format for clinical practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

CONSERVATIVE MANAGEMENT OF AN ISOLATED GRADE III LATERAL COLLATERAL LIGAMENT INJURY IN AN ADOLESCENT MULTI-SPORT ATHLETE: A CASE REPORT

PubMed Central

Haddad, M. Alex; Budich, Justin M.; Eckenrode, Brian J.

2016-01-01

ABSTRACT Study design Case report Background Isolated, grade III lateral collateral ligament knee injuries are an uncommon traumatic injury with little guidance available in the literature for conservative management and prognosis for return to sport. The purpose of this case report is to describe the clinical decision-making in both differential diagnosis and physical therapy management of an isolated grade III lateral collateral ligament sprain in an adolescent multi-sport high school athlete. Case Description A 16 year-old male, high school, multi-sport athlete (cross country, wrestling, track and field) sustained a traumatic knee injury during a wrestling match when his involved lower extremity was forcefully externally rotated by his opponent. Initial clinical presentation revealed pain and increased laxity with varus stress testing of the left knee, which was subsequently identified via MRI as a complete lateral collateral ligament rupture (grade III). A conservative physical therapy program was developed targeting the active and neuromuscular subsystems, theorized to compensate for the lack of an intact lateral collateral ligament. Outcomes The subject attended 18 visits of physical therapy over a period of 12 weeks. His rehabilitation program focused on functional strengthening of the posterolateral corner, enhancement of neuromuscular control, and graded progression to sports specific drills. Return to play decisions were based on a combination of lower extremity functional performance measures, condition specific outcome measures and subjective performance on sports specific tasks. At discharge from physical therapy, he reported 0/10 pain, scored a 76/80 on the Lower Extremity Functional Scale, and was able to return to competitive track and field events. Discussion Few descriptions in the literature exist for the conservative management of isolated, grade III lateral collateral ligament injuries. A program of selective functional strengthening

Mcl-1 and Bcl-xL Cooperatively Maintain Integrity of Hepatocytes in Developing and Adult Murine Liver

PubMed Central

Hikita, Hayato; Takehara, Tetsuo; Shimizu, Satoshi; Kodama, Takahiro; Li, Wei; Miyagi, Takuya; Hosui, Atsushi; Ishida, Hisashi; Ohkawa, Kazuyoshi; Kanto, Tatsuya; Hiramatsu, Naoki; Yin, Xiao-Ming; Hennighausen, Lothar; Tatsumi, Tomohide; Hayashi, Norio

2013-01-01

Anti-apoptotic members of the Bcl-2 family, including Bcl-2, Bcl-xL, Mcl-1, Bcl-w and Bfl-1, inhibit the mitochondrial pathway of apoptosis. Bcl-xL and Mcl-1 are constitutively expressed in the liver. Although previous research established Bcl-xL as a critical apoptosis antagonist in differentiated hepatocytes, the significance of Mcl-1 in the liver, especially in conjunction with Bcl-xL, has not been clear. To examine this question, we generated hepatocyte-specific Mcl-1– deficient mice by crossing mcl-1flox/flox mice and AlbCre mice and further crossed them with bcl-xflox/flox mice, giving Mcl-1/Bcl-xL– deficient mice. The mcl-1flox/flox AlbCre mice showed spontaneous apoptosis of hepatocytes after birth, as evidenced by elevated levels of serum alanine aminotransferase (ALT) and caspase-3/7 activity and an increased number of terminal deoxynucleotidyl transferase-mediated 2′-deoxyuridine 5′-triphosphate nick-end labeling (TUNEL)-positive cells in the liver; these phenotypes were very close to those previously found in hepatocyte-specific Bcl-xL– deficient mice. Although mcl-1flox/+ AlbCre mice did not display apoptosis, their susceptibility to Fas-mediated liver injury significantly increased. Further crossing of Mcl-1 mice with Bcl-xL mice showed that bcl-xflox/+ mcl-1flox/+ AlbCre mice also showed spontaneous hepatocyte apoptosis similar to Bcl-xL– deficient or Mcl-1– deficient mice. In contrast, bcl-xflox/flox mcl-1flox/+ AlbCre, bcl-xflox/+ mcl-1flox/flox AlbCre, and bcl-xflox/flox mcl-1flox/flox AlbCre mice displayed a decreased number of hepatocytes and a reduced volume of the liver on day 18.5 of embryogenesis and rapidly died within 1 day after birth, developing hepatic failure evidenced by increased levels of blood ammonia and bilirubin. Conclusion: Mcl-1 is critical for blocking apoptosis in adult liver and, in the absence of Bcl-xL, is essential for normal liver development. Mcl-1 and Bcl-xL are two major anti-apoptotic Bcl-2 family

An analysis of specific lower extremity injury rates on grass and FieldTurf playing surfaces in National Football League Games: 2000-2009 seasons.

PubMed

Hershman, Elliott B; Anderson, Robert; Bergfeld, John A; Bradley, James P; Coughlin, Michael J; Johnson, Robert J; Spindler, Kurt P; Wojtys, Edward; Powell, John W

2012-10-01

Players in the National Football League (NFL) sustain injuries every season as the result of their participation. One factor associated with the rate of injury is the type of playing surface on which the players participate. There is no difference in the rate of knee sprains and ankle sprains during NFL games when comparing rates of those injuries during games played on natural grass surfaces with rates of those injuries during games played on the artificial surface FieldTurf. Descriptive epidemiology study. The NFL records injury and exposure (ie, game) data as part of its injury surveillance system. During the 2000-2009 NFL seasons, there were 2680 games (5360 team games) played on grass or artificial surfaces. Specifically, 1356 team games were played on FieldTurf and 4004 team games were played on grass. We examined the 2000-2009 game-related injury data from those games as recorded by the injury surveillance system. The data included the injury diagnosis, the date of injury, and the surface at the time of injury. The injury data showed that 1528 knee sprains and 1503 ankle sprains occurred during those games. We calculated injury rates for knee sprains and ankle sprains-specifically, medial collateral ligament (MCL) sprains, anterior cruciate ligament (ACL) sprains, eversion ankle sprains, and inversion ankle sprains-using incidence density ratios (IDRs). We used a Poisson model and logistic regression odds ratios to validate the IDR analysis. A multivariate logistic regression model was used to adjust the odds ratio for weather conditions. The observed injury rate of knee sprains on FieldTurf was 22% (IDR = 1.22, 95% confidence interval [CI], 1.09-1.36) higher than on grass, and the injury rate of ankle sprains on FieldTurf was 22% (IDR = 1.22, 95% CI, 1.09-1.36) higher than on grass. These differences are statistically significant. Specifically, the observed injury rates of ACL sprains and eversion ankle sprains on FieldTurf surfaces were 67% (P < .001) and

Anatomy of the ankle ligaments: a pictorial essay

PubMed Central

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

2010-01-01

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

Single-stage in situ suture repair of multiple-ligament knee injury: a retrospective study of 17 patients (18 knees).

PubMed

Hua, Xingyi; Tao, Hui; Fang, Wang; Tang, Jian

2016-01-22

Multiple-ligament injured knee (MLIK) is a rare but severe injury. Although the principles of MLIK management have progressed over the past 40 years, there is a paucity of high-quality evidence upon which to base the management of MLIK. Treatment strategies for MLIK are challenging for most orthopedic surgeons, and the optimal treatment remains controversial, especially with regard to repair vs. reconstruction of the ligaments. The aim of the present study was to observe clinical outcomes of single-stage in situ suture repair of knee dislocation with multiple-ligament injury using nonabsorbable suture material. Consecutive patients with MLIK between 2002 and 2010 were included, for a total of 25 patients with knee dislocation. 17 patients (18 knees) with closed knee dislocation with a mean follow-up of 4.8 ± 1.3 years were retrospective analyzed. All patients were treated surgically with single-stage in situ suture repair for all injured ligaments and followed a standardized postoperative rehabilitation protocol. The VAS score, satisfactory score, total SF-36 score, Lysholm score, Tegner score, the Meyers functional rating and the ranges of motion and knee stability were used to evaluate outcomes. At final follow-up, mean visual analog scale score was 2.4 ± 0.9, patient satisfaction score was 8.0 ± 1.1, 36-item Short-Form Health Survey total score was 85.5 ± 10.4, and mean Lysholm score was 87.5 ± 7.7. There were significant differences between mean preinjury and postoperative Tegner activity scores (5.6 ± 1.4 and 3.4 ± 1.7, respectively; P < 0.01) and in mean range of motion between the injured and contralateral knees (112.5 ± 8.4° and 129.6 ± 10.3°, respectively; P < 0.01). At final follow-up, no patient demonstrated obvious ligamentous laxity, and only one patient was unable to return to work. Three patients had knee joint stiffness, two had wound problems (infection or fat liquefaction), and two had

Reconstruction of Bile Duct Injury and Defect with the Round Ligament.

PubMed

Dokmak, Safi; Aussilhou, Béatrice; Ragot, Emilia; Tantardini, Camille; Cauchy, François; Ponsot, Philippe; Belghiti, Jacques; Sauvanet, Alain; Soubrane, Olivier

2017-09-01

Lateral injury of the bile duct can occur after cholecystectomy, bile duct dissection, or exploration. If direct repair is not possible, conversion to bilioenteric anastomosis can be needed with the risk of long-term bile duct infections and associated complications. We developed a new surgical technique which consist of reconstructing the bile duct with the round ligament. The vascularized round ligament is completely mobilized until its origin and used for lateral reconstruction of the bile duct to cover the defect. T tube was inserted and removed after few months. Patency of the bile duct was assessed by cholangiography, the liver function test and magnetic resonance imaging (MRI). Two patients aged 33 and 59 years old underwent lateral reconstruction of the bile duct for defects secondary to choledocotomy for stone extraction or during dissection for Mirizzi syndrome. The defects measured 2 and 3 cm and occupied half of the bile duct circumference. The postoperative course was marked by low output biliary fistula resolved spontaneously. In one patient, the T tube was removed at 3 months after surgery and MRI at 9 months showed strictly normal aspect of the bile duct with normal liver function test. The second patient is going very well 2 months after surgery and the T tube is closed. Lateral reconstruction of the bile duct can be safely achieved with the vascularized round ligament. We will extend our indications to tubular reconstruction.

Rate and Risk of Anterior Cruciate Ligament Injury Among Sportswomen in Slovenia

PubMed Central

Vauhnik, Renata; Morrissey, Matthew C.; Rutherford, Olga M.; Turk, Zmago; Pilih, Iztok A.; Perme, Maja Pohar

2011-01-01

Abstract Context: Anterior cruciate ligament (ACL)-injury rate is greater among female athletes than among male athletes. Objective: To investigate the rate and risk of ACL injury among Slovenian sportswomen playing professional basketball, team handball, or volleyball. Design: Prospective cohort study. Setting: The Slovenian National Organizations of basketball, team handball, and volleyball. Patients or Other Participants: During the 2003–2004 season, we prospectively followed 585 Slovenian sportswomen registered in the Slovenian National Organizations of basketball, team handball, and volleyball. Main Outcome Measure(s): We asked sportswomen and coaches to document the occurrence of every significant traumatic knee injury requiring medical attention. Injury rate and injury risk were calculated for sportswomen in each sport group. To calculate injury rate, we estimated the average exposure of each sportswoman during the research period. Results: During the 2003–2004 season, 585 Slovenian sportswomen sustained 12 ACL injuries. The ACL-injury risk was different in athletes participating in the various sports, with basketball players having the greatest ACL-injury risk and volleyball players having the lowest ACL-injury risk (P  =  .04). The risk of ACL injury among Slovenian sportswomen was 2.1 per 100 athletes (95% confidence interval  =  0.9, 3.2), whereas the rate of ACL injury was 0.037 per 1000 exposure hours (95% confidence interval  =  0.016, 0.06). Conclusions: Overall differences in injury risk were found among sports, but no differences were noted among divisions within sports. No differences for injury rate were observed between or within sports. The rate and risk of ACL injury among Slovenian sportswomen are high, with basketball players having the greatest ACL-injury risk. PMID:21214356

AMP-activated protein kinase (AMPK)-induced preconditioning in primary cortical neurons involves activation of MCL-1.

PubMed

Anilkumar, Ujval; Weisová, Petronela; Düssmann, Heiko; Concannon, Caoimhín G; König, Hans-Georg; Prehn, Jochen H M

2013-03-01

Neuronal preconditioning is a phenomenon where a previous exposure to a sub-lethal stress stimulus increases the resistance of neurons towards a second, normally lethal stress stimulus. Activation of the energy stress sensor, AMP-activated protein kinase (AMPK) has been shown to contribute to the protective effects of ischaemic and mitochondrial uncoupling-induced preconditioning in neurons, however, the molecular basis of AMPK-mediated preconditioning has been less well characterized. We investigated the effect of AMPK preconditioning using 5-aminoimidazole-4-carboxamide riboside (AICAR) in a model of NMDA-mediated excitotoxic injury in primary mouse cortical neurons. Activation of AMPK with low concentrations of AICAR (0.1 mM for 2 h) induced a transient increase in AMPK phosphorylation, protecting neurons against NMDA-induced excitotoxicity. Analysing potential targets of AMPK activation, demonstrated a marked increase in mRNA expression and protein levels of the anti-apoptotic BCL-2 family protein myeloid cell leukaemia sequence 1 (MCL-1) in AICAR-preconditioned neurons. Interestingly, over-expression of MCL-1 protected neurons against NMDA-induced excitotoxicity while MCL-1 gene silencing abolished the effect of AICAR preconditioning. Monitored intracellular Ca²⁺ levels during NMDA excitation revealed that MCL-1 over-expressing neurons exhibited improved bioenergetics and markedly reduced Ca²⁺ elevations, suggesting a potential mechanism through which MCL-1 confers neuroprotection. This study identifies MCL-1 as a key effector of AMPK-induced preconditioning in neurons. © 2012 International Society for Neurochemistry.

MCL-CAw: a refinement of MCL for detecting yeast complexes from weighted PPI networks by incorporating core-attachment structure

PubMed Central

2010-01-01

Background The reconstruction of protein complexes from the physical interactome of organisms serves as a building block towards understanding the higher level organization of the cell. Over the past few years, several independent high-throughput experiments have helped to catalogue enormous amount of physical protein interaction data from organisms such as yeast. However, these individual datasets show lack of correlation with each other and also contain substantial number of false positives (noise). Over these years, several affinity scoring schemes have also been devised to improve the qualities of these datasets. Therefore, the challenge now is to detect meaningful as well as novel complexes from protein interaction (PPI) networks derived by combining datasets from multiple sources and by making use of these affinity scoring schemes. In the attempt towards tackling this challenge, the Markov Clustering algorithm (MCL) has proved to be a popular and reasonably successful method, mainly due to its scalability, robustness, and ability to work on scored (weighted) networks. However, MCL produces many noisy clusters, which either do not match known complexes or have additional proteins that reduce the accuracies of correctly predicted complexes. Results Inspired by recent experimental observations by Gavin and colleagues on the modularity structure in yeast complexes and the distinctive properties of "core" and "attachment" proteins, we develop a core-attachment based refinement method coupled to MCL for reconstruction of yeast complexes from scored (weighted) PPI networks. We combine physical interactions from two recent "pull-down" experiments to generate an unscored PPI network. We then score this network using available affinity scoring schemes to generate multiple scored PPI networks. The evaluation of our method (called MCL-CAw) on these networks shows that: (i) MCL-CAw derives larger number of yeast complexes and with better accuracies than MCL, particularly

Diagnostic Tools for Acute Anterior Cruciate Ligament Injury: GNRB, Lachman Test, and Telos.

PubMed

Ryu, Seung Min; Na, Ho Dong; Shon, Oog Jin

2018-06-01

The purpose of this study is to compare the accuracy of the GNRB arthrometer (Genourob), Lachman test, and Telos device (GmbH) in acute anterior cruciate ligament (ACL) injuries and to evaluate the accuracy of each diagnostic tool according to the length of time from injury to examination. From September 2015 to September 2016, 40 cases of complete ACL rupture were reviewed. We divided the time from injury to examination into three periods of 10 days each and analyzed the diagnostic tools according to the time frame. An analysis of the area under the curve (AUC) of a receiver operating characteristic curve showed that all diagnostic tools were fairly informative. The GNRB showed a higher AUC than other diagnostic tools. In 10 cases assessed within 10 days after injury, the GNRB showed statistically significant side-to-side difference in laxity (p＜0.001), whereas the Telos test and Lachman test did not show significantly different laxity (p=0.541 and p=0.413, respectively). All diagnostic values of the GNRB were better than other diagnostic tools in acute ACL injuries. The GNRB was more effective in acute ACL injuries examined within 10 days of injury. The GNRB arthrometer can be a useful diagnostic tool for acute ACL injuries.

Fiber-based modeling of in situ ankle ligaments with consideration of progressive failure.

PubMed

Nie, Bingbing; Forman, Jason L; Panzer, Matthew B; Mait, Alexander R; Donlon, John-Paul; Kent, Richard W

2017-08-16

Ligament sprains account for a majority of injuries to the foot and ankle complex among athletic populations. The infeasibility of measuring the in situ response and load paths of individual ligaments has precluded a complete characterization of their mechanical behavior via experiment. In the present study a fiber-based modeling approach of in situ ankle ligaments was developed and validated for determining the heterogeneous force-elongation characteristics and the consequent injury patterns. Nine major ankle ligaments were modeled as bundles of discrete elements, corresponding functionally to the structure of collagen fibers. To incorporate the progressive nature of ligamentous injury, the limit strain at the occurrence of fiber failure was described by a distribution function ranging from 12% to 18% along the width of the insertion site. The model was validated by comparing the structural kinetic and kinematic response obtained experimentally and computationally under well-controlled foot rotations. The simulation results replicated the 6 degree-of-freedom bony motion and ligamentous injuries and, by implication, the in situ deformations of the ligaments. Gross stiffness of the whole ligament derived from the fibers was comparable to existing experimental data. The present modeling approach provides a biomechanically realistic, interpretable and computationally efficient way to characterize the in situ ligament slack, sequential and heterogeneous uncrimping of collagen fascicles and failure propagation as the external load is applied. Applications of this model include functional ankle joint mechanics, injury prevention and countermeasure design for athletes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Opening the medial tibiofemoral compartment by pie-crusting the superficial medial collateral ligament at its tibial insertion: a cadaver study.

PubMed

Roussignol, X; Gauthe, R; Rahali, S; Mandereau, C; Courage, O; Duparc, F

2015-09-01

Arthroscopic treatment of tears in the middle and posterior parts of the medial meniscus can be difficult when the medial tibiofemoral compartment is tight. Passage of the instruments may damage the cartilage. The primary objective of this cadaver study was to perform an arthroscopic evaluation of medial tibiofemoral compartment opening after pie-crusting release (PCR) of the superficial medial collateral ligament (sMCL) at its distal insertion on the tibia. The secondary objective was to describe the anatomic relationships at the site of PCR (saphenous nerve, medial saphenous vein). We studied 10 cadaver knees with no history of invasive procedures. The femur was held in a vise with the knee flexed at 45°, and the medial aspect of the knee was dissected. PCR of the sMCL was performed under arthroscopic vision, in the anteroposterior direction, at the distal tibial insertion of the sMCL, along the lower edge of the tibial insertion of the semi-tendinosus tendon. Continuous 300-N valgus stress was applied to the ankle. Opening of the medial tibiofemoral compartment was measured arthroscopically using graduated palpation hooks after sequential PCR of the sMCL. The compartment opened by 1mm after release of the anterior third, 2.3mm after release of the anterior two-thirds, and 3.9mm after subtotal release. A femoral fracture occurred in 1 case, after completion of all measurements. Both the saphenous nerve and the medial saphenous vein were located at a distance from the PCR site in all 10 knees. PCR of the sMCL is chiefly described as a ligament-balancing method during total knee arthroplasty. This procedure is usually performed at the joint line, where it opens the compartment by 4-6mm at the most, with some degree of unpredictability. PCR of the sMCL at its distal tibial insertion provides gradual opening of the compartment, to a maximum value similar to that obtained with PCR at the joint space. The lower edge of the semi-tendinosus tendon is a valuable landmark

Risk Factors for Anterior Cruciate Ligament Injury in Competitive Adolescent Alpine Skiers

PubMed Central

Westin, Maria; Harringe, Marita L.; Engström, Björn; Alricsson, Marie; Werner, Suzanne

2018-01-01

Background: There is a high risk for anterior cruciate ligament (ACL) injuries in alpine skiers. To reduce or try to prevent these injuries, intrinsic and extrinsic risk factors need to be identified. Purpose: To identify possible intrinsic and extrinsic ACL injury risk factors among competitive adolescent alpine skiers. Study Design: Case-control study; Level of evidence, 3. Methods: Between 2006 and 2009, a cohort of 339 alpine ski students (176 male, 163 female) from Swedish ski high schools were prospectively observed in terms of ACL injuries. First-time ACL injuries were recorded. In September, prior to each ski season, the skiers were clinically examined according to a specific knee protocol. Results: Overall, 11 male and 14 female skiers sustained a total of 25 first-episode ACL injuries. The majority of injuries occurred in the left knee (P < .05). Skiers who had participated in alpine skiing for >13 years (hazard ratio, 0.83; 95% CI, 0.68-1.00; P < .05) had a reduced risk of sustaining an ACL injury. Eighteen ACL injuries occurred during training, 12 in the technical discipline of giant slalom, and 8 in slalom. Fourteen skiers reported not to be fatigued at all at the time of injury, and 8 skiers reported that they were somewhat fatigued. Conclusion: ACL injuries occurred more often in the left knee than the right. This should be taken into consideration in the design of ACL injury prevention programs. Those who reported a higher number of active years in alpine skiing showed a reduced risk of sustaining an ACL injury. No other factor among those studied could be identified as an independent risk factor for ACL injury. PMID:29780835

The common mechanisms of anterior cruciate ligament injuries in judo: a retrospective analysis.

PubMed

Koshida, S; Deguchi, T; Miyashita, K; Iwai, K; Urabe, Y

2010-09-01

Although high prevalence of anterior cruciate ligament injuries (ACL) in judokas has been reported, there has been very little research concerning events preceding the injury. To determine the common situations and mechanisms of ACL injury in judo. A total of 43 cases of ACL injuries that had occurred during judo competition or practice were investigated, using questionnaires with interviews conducted by a single certified athletic trainer who has 20 years of judo experience to obtain information regarding the situation and mechanism in which the ACL injury occurred. The number of ACL injuries when the participant's grip style was different from the style of the opponent (ie, kenka-yotsu style) (28 cases) was significantly greater than when the participant's grip style was the same as that of the opponent (ie, ai-yotsu style) (15 cases; p<0.001). The number of ACL injuries was significantly higher when the participant was attacked by the opponent than when counterattacked or when attempting the attack (p<0.001). In addition, being attacked with osoto-gari was revealed as the leading cause of ACL injury incidence among the participants (16.8%). Grip style may be associated with ACL injury occurrence in judo. In addition, direct contact due to the opponent's attack may be a common mechanism for ACL injuries in judo.

Open dislocation of the proximal interphalangeal joint of the little finger subsequent to chronic radial collateral ligament injury: a case report of primary ligament reconstruction with a half-slip of the flexor digitorum superficialis: Case Report.

PubMed

Wada, Kazuma; Hibino, Naohito; Kondo, Kenji; Yoshioka, Shinji; Terai, Tomoya; Henmi, Tatsuhiko; Sairyo, Koichi

2015-01-01

Open dislocation of the proximal interphalangeal (PIP) joint is relatively rare. We report a case of a 32-year-old man who had open dislocation of the PIP joint of the little finger while playing American football. He had a history of chronic radial collateral ligament injury. We reconstructed the radial collateral ligament with a half-slip of the flexor digitorum superficialis tendon.

Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction.

PubMed

Webster, Kate E; Feller, Julian A; Leigh, Warren B; Richmond, Anneka K

2014-03-01

Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive. To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these. Case-control study; Level of evidence, 3. A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter. Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury. Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.

Scapholunate Interosseous Ligament Anatomy and Biomechanics.

PubMed

Rajan, Prashant V; Day, Charles S

2015-08-01

Injury to the scapholunate interosseous ligament is one of the most common causes of carpal instability and can impart considerable compromise to the patient's hand function. However, the management of scapholunate ligament injuries remains a dynamic concept, especially with regard to the multitude of options and techniques that exist for its surgical treatment. We present a thorough review of scapholunate anatomy and morphology, and the role of the scapholunate articulations in the kinetics and pathomechanics of wrist instability. We also review the current literature on the biomechanical properties of the scapholunate ligament and its subcomponents. A sound understanding of the anatomy and biomechanics of the scapholunate ligament can clarify its instability and may better orient current reconstructive procedures or pioneer better future techniques. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Malleolar fractures and their ligamentous injury equivalents have similar outcomes in supination-external rotation type IV fractures of the ankle treated by anatomical internal fixation.

PubMed

Berkes, M B; Little, M T M; Lazaro, L E; Sculco, P K; Cymerman, R M; Daigl, M; Helfet, D L; Lorich, D G

2012-11-01

It has previously been suggested that among unstable ankle fractures, the presence of a malleolar fracture is associated with a worse outcome than a corresponding ligamentous injury. However, previous studies have included heterogeneous groups of injury. The purpose of this study was to determine whether any specific pattern of bony and/or ligamentous injury among a series of supination-external rotation type IV (SER IV) ankle fractures treated with anatomical fixation was associated with a worse outcome. We analysed a prospective cohort of 108 SER IV ankle fractures with a follow-up of one year. Pre-operative radiographs and MRIs were undertaken to characterise precisely the pattern of injury. Operative treatment included fixation of all malleolar fractures. Post-operative CT was used to assess reduction. The primary and secondary outcome measures were the Foot and Ankle Outcome Score (FAOS) and the range of movement of the ankle. There were no clinically relevant differences between the four possible SER IV fracture pattern groups with regard to the FAOS or range of movement. In this population of strictly defined SER IV ankle injuries, the presence of a malleolar fracture was not associated with a significantly worse clinical outcome than its ligamentous injury counterpart. Other factors inherent to the injury and treatment may play a more important role in predicting outcome.

Motives for sports participation as predictions of self-reported outcomes after anterior cruciate ligament injury of the knee.

PubMed

Roessler, K K; Andersen, T E; Lohmander, S; Roos, E M

2015-06-01

Aim of the study was to access how individual's motives for participation in sports impact on self-reported outcomes 2 years after an anterior cruciate ligament injury. Based on a longitudinal cohort study, this secondary analysis present data from the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study, a randomized controlled trial. At baseline, 121 patients recorded in an initial questionnaire that their motives for sports participation fell into four categories: achievement, health, social integration, or fun and well-being. These four categories were used as variables in the analyses. All 121 subjects completed the 2-year follow-up. The largest improvement was seen in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale sports and recreation function, with an effect size of 2.43. KOOS sports and recreation function was also the subscale score best predicted by the motives for sports participation. Baseline motives achievement and fun and well-being predicted worse levels of pain and function 2 years after the injury, even after adjusting for age, gender, treatment and baseline scores. Psychological aspects, such as motives for participation in sport, can be factors in predicting of patient-reported outcomes 2 years after injury. Evaluating motives for sports participation may help predict the outcome 2 years after ACL injury. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Modulation of Mcl-1 expression reduces age-related cochlear degeneration

PubMed Central

Yang, Wei Ping; Xu, Yang; Guo, Wei Wei; Liu, Hui Zhan; Hu, Bo Hua

2013-01-01

Mcl-1 is an anti-apoptotic member of the Bcl-2 family that modulates apoptosis-related signaling pathways and promotes cell survival. We have previously demonstrated a reduction of Mcl-1 expression in aging cochleae. To investigate whether restoring Mcl-1 expression would reduce aging-related cochlear degeneration, we developed a rat model of Mcl-1 overexpression. A plasmid encoding human Mcl-1/enhanced green fluorescent protein was applied to the round window of the cochlea. This in vivo treatment transfected both the sensory and supporting cells of the cochlear sensory epithelium and enhanced Mcl-1 expression at both the mRNA and the protein level. The upregulation of Mcl-1 expression reduced the progression of age-related cochlear dysfunction and sensory cell death. Furthermore, the transfection of Mcl-1 exerted its protective effect by suppressing cochlear apoptosis at the mitochondrial level. This study demonstrates that the genetic modulation of Mcl-1 expression reduces the progression of age-related cochlear degeneration. PMID:23790646

Electron microscopic quantification of collagen fibril diameters in the rabbit medial collateral ligament: a baseline for comparison.

PubMed

Frank, C; Bray, D; Rademaker, A; Chrusch, C; Sabiston, P; Bodie, D; Rangayyan, R

1989-01-01

To establish a normal baseline for comparison, thirty-one thousand collagen fibril diameters were measured in calibrated transmission electron (TEM) photomicrographs of normal rabbit medial collateral ligaments (MCL's). A new automated method of quantitation was used to compare statistically fibril minimum diameter distributions in one midsubstance location in both MCL's from six animals at 3 months of age (immature) and three animals at 10 months of age (mature). Pooled results demonstrate that rabbit MCL's have statistically different (p less than 0.001) mean minimum diameters at these two ages. Interanimal differences in mean fibril minimum diameters were also significant (p less than 0.001) and varied by 20% to 25% in both mature and immature animals. Finally, there were significant differences (p less than 0.001) in mean diameters and distributions from side-to-side in all animals. These mean left-to-right differences were less than 10% in all mature animals but as much as 62% in some immature animals. Statistical analysis of these data demonstrate that animal-to-animal comparisons using these protocols require a large number of animals with appropriate numbers of fibrils being measured to detect small intergroup differences. With experiments which compare left to right ligaments, far fewer animals are required to detect similarly small differences. These results demonstrate the necessity for rigorous control of sampling, an extensive normal baseline and statistically confirmed experimental designs in any TEM comparisons of collagen fibril diameters.

Anterior cruciate ligament injury/reinjury in alpine ski racing: a narrative review

PubMed Central

Jordan, Matthew J; Aagaard, Per; Herzog, Walter

2017-01-01

The purpose of the present review was to: 1) provide an overview of the current understanding on the epidemiology, etiology, risk factors, and prevention methods for anterior cruciate ligament (ACL) injury in alpine ski racing; and 2) provide an overview of what is known pertaining to ACL reinjury and return to sport after ACL injury in alpine ski racing. Given that most of the scientific studies on ACL injuries in alpine ski racing have been descriptive, and that very few studies contributed higher level scientific evidence, a nonsystematic narrative review was employed. Three scholarly databases were searched for articles on ACL injury or knee injury in alpine ski racing. Studies were classified according to their relevance in relation to epidemiology, etiology, risk factors, and return to sport/reinjury prevention. Alpine ski racers (skiers) were found to be at high risk for knee injuries, and ACL tears were the most frequent diagnosis. Three primary ACL injury mechanism were identified that involved tibial internal rotation and anteriorly directed shear forces from ski equipment and the environment. While trunk muscle strength imbalance and genetics were found to be predictive of ACL injuries in development-level skiers, there was limited scientific data on ACL injury risk factors among elite skiers. Based on expert opinion, research on injury risk factors should focus on equipment design, course settings/speed, and athlete factors (eg, fitness). While skiers seem to make a successful recovery following ACL injury, there may be persistent neuromuscular deficits. Future research efforts should be directed toward prospective studies on ACL injury/reinjury prevention in both male and female skiers and toward the effects of knee injury on long-term health outcomes, such as the early development of osteoarthritis. International collaborations may be necessary to generate sufficient statistical power for ACL injury/reinjury prevention research in alpine ski racing

Application of cell and biomaterial-based tissue engineering methods in the treatment of cartilage, menisci and ligament injuries.

PubMed

Trzeciak, Tomasz; Richter, Magdalena; Suchorska, Wiktoria; Augustyniak, Ewelina; Lach, Michał; Kaczmarek, Małgorzata; Kaczmarczyk, Jacek

2016-03-01

Over 20 years ago it was realized that the traditional methods of the treatment of injuries to joint components: cartilage, menisci and ligaments, did not give satisfactory results and so there is a need of employing novel, more effective therapeutic techniques. Recent advances in molecular biology, biotechnology and polymer science have led to both the experimental and clinical application of various cell types, adapting their culture conditions in order to ensure a directed differentiation of the cells into a desired cell type, and employing non-toxic and non-immunogenic biomaterial in the treatment of knee joint injuries. In the present review the current state of knowledge regarding novel cell sources, in vitro conditions of cell culture and major important biomaterials, both natural and synthetic, used in cartilage, meniscus and ligament repair by tissue engineering techniques are described, and the assets and drawbacks of their clinical application are critically evaluated.

Bioreactor design for tendon/ligament engineering.

PubMed

Wang, Tao; Gardiner, Bruce S; Lin, Zhen; Rubenson, Jonas; Kirk, Thomas B; Wang, Allan; Xu, Jiake; Smith, David W; Lloyd, David G; Zheng, Ming H

2013-04-01

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

Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function

PubMed Central

L Loizou, Constantinos; Allen, Georgina M; Wilson, David J; Athanasou, Nick; Uchihara, Yoshinobu; Cooke, Paul; Cosker, Thomas

2017-01-01

Objective: To assess the prevalence of injury of the talonavicular ligament (TNL) in ankle sprains, its anatomy and the stability of the talonavicular joint (TNJ) before and after dividing the TNL in a cadaver. Methods: During a prospective study of 100 patients to assess the outcome of ankle injuries, we noted high incidence of TNL injuries; we will discuss here the TNL findings. Each patient had undergone ultrasound and cone beam CT examination of the ankle. Six TNLs were dissected off fresh-frozen cadaveric feet for histological analysis. In further six cadaveric feet, the stability of the TNJ was assessed by mechanical stress before and after division of the TNL; movement at the joint was assessed by measuring the distance between the talus and navicular bone [talonavicular distance (TD)] using ultrasound. The TD was measured on ten randomly selected ultrasound images by three independent observers and repeated twice by a single observer to determine the inter- and intraobserver reliability. Results: 21% of the patients had an injury to the TNL. Histological examination demonstrated a dense connective tissue composed of bundles of collagen in parallel arrangement along the ligament length. The interobserver and intraobserver reliability of the TD showed almost perfect agreement. Displacement at the TNJ after stress with the TNL intact measured 0.18 ± 0.08 cm and 0.29 ± 0.07 cm (p < 0.005) when divided. Conclusion: The TNL is surprisingly commonly injured in ankle sprains. Its anatomy and histology suggest a role in tensile force transmission during the windlass mechanism in gait. Advances in knowledge: Injury to the TNL is common and has not been described. Its anatomy suggests resistance to tensile forces and its injury allows excessive movement at the TNJ. PMID:27993094

A method to characterize average cervical spine ligament response based on raw data sets for implementation into injury biomechanics models.

PubMed

Mattucci, Stephen F E; Cronin, Duane S

2015-01-01

Experimental testing on cervical spine ligaments provides important data for advanced numerical modeling and injury prediction; however, accurate characterization of individual ligament response and determination of average mechanical properties for specific ligaments has not been adequately addressed in the literature. Existing methods are limited by a number of arbitrary choices made during the curve fits that often misrepresent the characteristic shape response of the ligaments, which is important for incorporation into numerical models to produce a biofidelic response. A method was developed to represent the mechanical properties of individual ligaments using a piece-wise curve fit with first derivative continuity between adjacent regions. The method was applied to published data for cervical spine ligaments and preserved the shape response (toe, linear, and traumatic regions) up to failure, for strain rates of 0.5s(-1), 20s(-1), and 150-250s(-1), to determine the average force-displacement curves. Individual ligament coefficients of determination were 0.989 to 1.000 demonstrating excellent fit. This study produced a novel method in which a set of experimental ligament material property data exhibiting scatter was fit using a characteristic curve approach with a toe, linear, and traumatic region, as often observed in ligaments and tendons, and could be applied to other biological material data with a similar characteristic shape. The resultant average cervical spine ligament curves provide an accurate representation of the raw test data and the expected material property effects corresponding to varying deformation rates. Copyright © 2014 Elsevier Ltd. All rights reserved.

Posterior Cruciate Ligament Injuries Associated With Military Survival Swim Training.

PubMed

Crowell, Michael S; Mason, John S; Posner, Matthew A; Haley, Chad A

2017-07-01

Posterior cruciate ligament (PCL) injuries are relatively common injuries associated with athletic activities and high-energy trauma. Posterolateral corner (PLC) injuries frequently accompany injury to the PCL. Diagnosis can be challenging and requires a comprehensive history and physical examination. Patients frequently report vague, nonspecific symptoms and the mechanism of injury is often useful in localizing injured structures. Two of the more common mechanisms for PCL injury include a direct blow to the proximal anterior tibia with the knee flexed, as well as a significant knee hyperextension injury. With a PCL tear, patients rarely describe an audible "pop" that is commonly reported in ACL injuries. On physical exam, a frequent finding in PCL tears is a loss of 10 to 20° of knee flexion. Although the most common clinical tests for PCL tears include the posterior drawer test, the posterior sag sign, and the quadriceps active test, there is a lack of high-quality diagnostic accuracy studies. Two cases of U.S. Military Academy Cadets who sustained PCL injuries while removing combat boots during military survival swim training are presented. The results of the clinical examination are accompanied by magnetic resonance imaging results and intraoperative arthroscopic images to highlight key findings. Both patients were evaluated and diagnosed with PCL injures within 10 days of their injuries. Each reported feeling/hearing a "pop," which is atypical in PCL tears. Both patients demonstrated a lack of active and passive knee flexion, which is a commonly reported impairment. One patient was managed nonsurgically with physical therapy and eventually returned to full duty without limitations 9 months after his injury. The other patient, who sustained a combined PCL-PLC injury, underwent a PCL reconstruction and PLC repair and reconstruction 8 weeks after his injury. He returned all training, with the exception of contact/collision sports, 9 months after surgery. Both

Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures

PubMed Central

Hewett, T E; Lynch, T R; Myer, G D; Ford, K R; Gwin, R C; Heidt, R S

2014-01-01

Objective A multifactorial combination of predictors may increase anterior cruciate ligament (ACL) injury risk in athletes. The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury. Methods Female twins in high-risk sports were prospectively measured prior to an injury for neuromuscular control using three-dimensional motion analysis during landing, hamstrings and quadriceps muscular strength on a dynamometer and joint laxity using a modified Beighton–Horan index and a Compu-KT arthrometer. Intraoperative measures of femoral intercondylar notch width were recorded during ACL reconstruction. Results Abduction angles were increased at one knee in both of the twin sister athletes relative to uninjured controls at initial contact and at maximum displacement during landing. The twin female athletes that went on to ACL injury also demonstrated decreased peak knee flexion motion at both knees than uninjured females during landing. The twin athletes also had increased joint laxity and decreased hamstrings to quadriceps (H/Q) torque ratios compared to controls. Femoral intercondylar notch widths were also below the control mean in the twin siblings. Conclusions Prescreened mature female twins that subsequently experienced ACL injury demonstrated multiple potential risk factors including: increased knee abduction angles, decreased knee flexion angles, increased general joint laxity, decreased H/Q ratios and femoral intercondylar notch width. PMID:19158132

Bioreactor Design for Tendon/Ligament Engineering

PubMed Central

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

2013-01-01

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

Rationale and Clinical Techniques for Anterior Cruciate Ligament Injury Prevention Among Female Athletes

PubMed Central

Myer, Gregory D; Ford, Kevin R; Hewett, Timothy E

2004-01-01

Objective: To present the rationale and detailed techniques for the application of exercises targeted to prevent anterior cruciate ligament (ACL) injury in high-risk female athletes. Background: Female athletes have a 4- to 6-fold increased risk for ACL injury compared with their male counterparts playing at similar levels in the same sports. The increased ACL injury risk coupled with greater sports participation by young women over the last 30 years (9-fold increase in high school and 5-fold increase in collegiate sports) has generated public awareness and fueled several sex-related mechanistic and interventional investigations. These investigations provide the groundwork for the development of neuromuscular training aimed at targeting identified neuromuscular imbalances to decrease ACL injury risk. Description: After the onset of puberty, female athletes may not have a neuromuscular spurt to match their similar, rapid increase in growth and development. The lack of a natural neuromuscular adaptation may facilitate the development of neuromuscular imbalances that increase the risk for ACL injury. Dynamic neuromuscular analysis training provides the methodologic approach for identifying high-risk individuals and the basis of using interventions targeted to their specific needs. Clinical Advantages: Dynamic neuromuscular training applied to the high-risk population may decrease ACL injury risk and help more female athletes enjoy the benefits of sports participation without the long-term disabilities associated with injury. PMID:15592608

Ultrasound-guided percutaneous lavage of calcific bursitis of the medial collateral ligament of the knee: a case report and review of the literature.

PubMed

Del Castillo-González, Federico; Ramos-Álvarez, Juan José; González-Pérez, José; Jiménez-Herranz, Elena; Rodríguez-Fabián, Guillermo

2016-10-01

Calcification of the medial collateral ligament (MCL) of the knee is rare. The literature reports no positive outcomes when conservative treatment has been followed. This paper reports a case of such calcification and its treatment using ultrasound-guided percutaneous lavage (UGPL). A 66-year-old patient presented with medial knee pain. X-ray, ultrasound, and magnetic resonance (MR) examinations revealed calcific bursitis of the MCL, which was treated by UGPL. One month after treatment the patient was asymptomatic. X-ray, ultrasound, and MR examinations confirmed the almost complete disappearance of the calcification; only very tiny fragments remained. Calcific bursitis of the MCL of the knee is very uncommon, but should be taken into account in differential diagnoses for medial knee pain. UGPL is proposed as a treatment for this condition.

Knee injuries in women collegiate rugby players.

PubMed

Levy, A S; Wetzler, M J; Lewars, M; Laughlin, W

1997-01-01

We evaluated the prevalence and patterns of knee injuries in 810 women collegiate rugby players. Injuries that resulted in players missing at least one game were recorded and a questionnaire was used to delineate players' rugby and knee injury history. There were 76 total knee injuries in 58,296 exposures. This resulted in a 1.3 knee injury rate per 1000 exposures. Twenty-one anterior cruciate ligament tears were reported for a 0.36 incidence per 1000 exposures. Other injuries included meniscal tears (25), medical collateral ligament sprains (23), patellar dislocations (5), and posterior cruciate ligament tears (2). Sixty-one percent of the medial collateral ligament sprains occurred in rugby forwards and 67% of anterior cruciate ligament tears occurred in rugby backs. All other injuries occurred with equal frequency in backs and forwards. This study demonstrates that knee injury rates in women's collegiate rugby are similar to those reported for other women's collegiate sports. The overall rate of anterior cruciate ligament injury in women's rugby, however, is slightly higher than that reported for women soccer and basketball players.

[Application of silk-based tissue engineering scaffold for tendon / ligament regeneration].

PubMed

Hu, Yejun; Le, Huihui; Jin, Zhangchu; Chen, Xiao; Yin, Zi; Shen, Weiliang; Ouyang, Hongwei

2016-03-01

Tendon/ligament injury is one of the most common impairments in sports medicine. The traditional treatments of damaged tissue repair are unsatisfactory, especially for athletes, due to lack of donor and immune rejection. The strategy of tissue engineering may break through these limitations, and bring new hopes to tendon/ligament repair, even regeneration. Silk is a kind of natural biomaterials, which has good biocompatibility, wide range of mechanical properties and tunable physical structures; so it could be applied as tendon/ligament tissue engineering scaffolds. The silk-based scaffold has robust mechanical properties; combined with other biological ingredients, it could increase the surface area, promote more cell adhesion and improve the biocompatibility. The potential clinical application of silk-based scaffold has been confirmed by in vivo studies on tendon/ligament repairing, such as anterior cruciate ligament, medial collateral ligament, achilles tendon and rotator cuff. To develop novel biomechanically stable and host integrated tissue engineered tendon/ligament needs more further micro and macro studies, combined with product development and clinical application, which will give new hope to patients with tendon/ligament injury.

Mcl-1 dynamics influence mitotic slippage and death in mitosis.

PubMed

Sloss, Olivia; Topham, Caroline; Diez, Maria; Taylor, Stephen

2016-02-02

Microtubule-binding drugs such as taxol are frontline treatments for a variety of cancers but exactly how they yield patient benefit is unclear. In cell culture, inhibiting microtubule dynamics prevents spindle assembly, leading to mitotic arrest followed by either apoptosis in mitosis or slippage, whereby a cell returns to interphase without dividing. Myeloid cell leukaemia-1 (Mcl-1), a pro-survival member of the Bcl-2 family central to the intrinsic apoptosis pathway, is degraded during a prolonged mitotic arrest and may therefore act as a mitotic death timer. Consistently, we show that blocking proteasome-mediated degradation inhibits taxol-induced mitotic apoptosis in a Mcl-1-dependent manner. However, this degradation does not require the activity of either APC/C-Cdc20, FBW7 or MULE, three separate E3 ubiquitin ligases implicated in targeting Mcl-1 for degradation. This therefore challenges the notion that Mcl-1 undergoes regulated degradation during mitosis. We also show that Mcl-1 is continuously synthesized during mitosis and that blocking protein synthesis accelerates taxol induced death-in-mitosis. Modulating Mcl-1 levels also influences slippage; overexpressing Mcl-1 extends the time from mitotic entry to mitotic exit in the presence of taxol, while inhibiting Mcl-1 accelerates it. We suggest that Mcl-1 competes with Cyclin B1 for binding to components of the proteolysis machinery, thereby slowing down the slow degradation of Cyclin B1 responsible for slippage. Thus, modulating Mcl-1 dynamics influences both death-in-mitosis and slippage. However, because mitotic degradation of Mcl-1 appears not to be under the control of an E3 ligase, we suggest that the notion of network crosstalk is used with caution.

Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children

PubMed Central

Lang, Pamela J; Sugimoto, Dai; Micheli, Lyle J

2017-01-01

As more children and adolescents participate in competitive organized sports, there has been an increase in the reported incidence of anterior cruciate ligament (ACL) injuries in these age groups. ACL injuries in skeletally immature athletes present a challenge, as reconstruction must preserve the physis of the distal femur and of the proximal tibia to avoid growth disturbances. Historically, a skeletally immature athlete with an ACL injury was treated with a brace and activity modification until skeletal maturity, with ACL reconstruction being performed at that time in the “non-copers” who experienced instability. More recently, evidence has shown that delayed reconstruction may lead to increased damage to the meniscus and articular cartilage. As a result, early reconstruction is favored to protect the meniscus and allow continued physical activity. While adolescents at or those near skeletal maturity may be treated with standard reconstruction techniques, they may result in growth disturbances in younger athletes with significant growth remaining. In response to the growing need for ACL reconstruction techniques in skeletally immature individuals, physeal-sparing and physeal-respecting reconstruction techniques have been developed. In addition to the advancements in surgical technique, ACL injury prevention has also gained attention. This growing interest in ACL prevention is in part related to the high risk of ACL re-tear, either of the ACL graft or of the contralateral ACL, in children and adolescents. Recent reports indicate that well-designed neuromuscular training programs may reduce the risk of primary and subsequent ACL injuries. PMID:28652828

A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities.

PubMed

Izadpanah, Kaywan; Winterer, Jan; Vicari, Marco; Jaeger, Martin; Maier, Dirk; Eisebraun, Leonie; Ute Will, Jutta; Kotter, Elmar; Langer, Mathias; Südkamp, Norbert P; Hennig, Jürgen; Weigel, Mathias

2013-06-01

To show the feasibility of a stress magnetic resonance imaging (MRI) as a new method for simultaneous evaluation of the morphology and the functional integrity of the acromioclavicular joint (ACJ) ligamentous stabilizers. MRI of four volunteers, 10 patients with acute, and six with chronic ACJ injuries was performed using a 0.25 T open MRI scanner. A 2D-proton-density and a 3D-gradient-echo sequence at rest and under 6.5 kg shoulder traction were performed. Comparative measurements of the coracoclavicular and the acromioclavicular distance were performed. Additionally, the conoid and trapezoid ligament lengths were measured with multiplanar reconstructions. MRI at rest correctly identified tears of the coracoclavicular and the acromioclavicular ligaments in eight patients suffering acute ACJ injuries. Stress application helped to distinguish between partial and complete coracoclavicular ligament tears in two cases. Insufficiency of the ACJ ligaments was present in all acute and chronic ACJ injuries. Stress application in chronic ACJ ligaments revealed isolated insufficiency of the conoid ligament in three cases and of the trapezoid ligament in one case. Combined insufficiency was present in two cases. Stress MRI facilitates simultaneous acquisition of morphologic and functional information of the ACJ stabilizers. In acute ACJ injuries it helps to distinguish between partial and complete ligament tears. In chronic ACJ injuries it provides functional information of the ligament regrinds. Copyright © 2012 Wiley Periodicals, Inc.

Tissue Engineering Strategies for the Tendon/ligament-to-bone insertion

PubMed Central

Smith, Lester; Xia, Younan; Galatz, Leesa M.; Genin, Guy M.; Thomopoulos, Stavros

2012-01-01

Injuries to connective tissues are painful and disabling and result in costly medical expenses. These injuries often require re-attachment of an unmineralized connective tissue to bone. The uninjured tendon/ligament-to-bone insertion (enthesis) is a functionally graded material that exhibits a gradual transition from soft tissue (i.e., tendon or ligament) to hard tissue (i.e., mineralized bone) through a fibrocartilaginous transition region. This transition is believed to facilitate force transmission between the two dissimilar tissues by ameliorating potentially damaging interfacial stress concentrations. The transition region is impaired or lost upon tendon/ligament injury and is not regenerated following surgical repair or natural healing, exposing the tissue to risk of re-injury. The need to regenerate a robust tendon-to-bone insertion has led a number of tissue engineering repair strategies. This review treats the tendon-to-bone insertion site as a tissue structure whose primary role is mechanical and discusses current and emerging strategies for engineering the tendon/ligament-to-bone insertion in this context. The focus lies on strategies for producing mechanical structures that can guide and subsequently sustain a graded tissue structure and the associated cell populations. PMID:22185608

A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries.

PubMed

Taylor, Drew W; Petrera, Massimo; Hendry, Mike; Theodoropoulos, John S

2011-07-01

To evaluate, through a systematic review of the current literature, the evidence-based outcomes of the use of platelet-rich plasma (PRP) for the treatment of tendon and ligament injuries. A search of English-language articles was performed in PubMed and EMBASE using keywords "PRP," "platelet plasma," and "platelet concentrate" combined with "tendon" and then "ligament" independently. The search was conducted through September 2010. Search was limited to in vivo studies. Nonhuman studies were excluded. Tissue engineering strategies, which included a combination of PRP with additional cell types (bone marrow), were also excluded. Articles with all levels of evidence were included. Thirteen of 32 retrieved articles respected the inclusion criteria. The authors reviewed and tabulated data according to the year of study and journal, study type and level of evidence, patient demographics, method of PRP preparation, site of application, and outcomes. The selected studies focused on the application of PRP in the treatment of patellar and elbow tendinosis, Achilles tendon injuries, rotator cuff repair, and anterior cruciate ligament (ACL) reconstruction. Seven studies demonstrated favorable outcomes in tendinopathies in terms of improved pain and functional scores. In 3 studies on the use of PRP in ACL reconstruction, no statistically significant differences were seen with regard to clinical outcomes, tunnel widening, and graft integration. One study examined the systemic effects after the local PRP application for patellar and elbow tendinosis. Presently, PRP use in tendon and ligament injuries has several potential advantages, including faster recovery and, possibly, a reduction in recurrence, with no adverse reactions described. However, only 3 randomized clinical trials have been conducted.

Does C₁ fracture displacement correlate with transverse ligament integrity?

PubMed

Radcliff, Kristen E; Sonagli, Marcos A; Rodrigues, Luciano M; Sidhu, Gursukhman S; Albert, Todd J; Vaccaro, Alexander R

2013-05-01

The Rule of Spence states that displacement of the C₁ lateral masses by >6.9-8.1 mm suggests loss of transverse ligament integrity. The purpose of this study was to establish the thresholds of C₁ displacement on CT scans that correspond to transverse ligament disruption. Over four years, consecutive patients with acute C₁ fractures with at least three fracture lines were analyzed. CT measurements and MRI were assessed by blinded observers for bony displacement in the axial (internal and external lateral mass separation), coronal and sagittal planes and transverse ligament integrity. Eighteen patients were studied. Mean CT bony measurements were as follows: internal border lateral mass separation (ILM) 23.3 ± 3.4 mm, external border lateral mass separation (ELM) 50.3 ± 4.3 mm, total C₁ lateral mass overhang over the C₂ superior process (LMO) 5.4 ± 1.3 mm. Twelve patients were identified as having intact transverse ligament and six had transverse ligament disruption. There was no difference in mean normalized ILM, ELM, or LMO between patients with or without transverse ligament integrity (P > 0.05). There was no correlation between bony displacement and transverse ligament integrity. CT scans post-injury may not show the position of maximal displacement. If there is clinical concern about a possible transverse ligament injury, MRI should be performed. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Anterior cruciate ligament injury: Identifying information sources and risk factor awareness among the general population.

PubMed

Nagano, Yasuharu; Yako-Suketomo, Hiroko; Natsui, Hiroaki

2018-01-01

Raising awareness on a disorder is important for its prevention and for promoting public health. However, for sports injuries like the anterior cruciate ligament (ACL) injury no studies have investigated the awareness on risk factors for injury and possible preventative measures in the general population. The sources of information among the population are also unclear. The purpose of the present study was to identify these aspects of public awareness about the ACL injury. A questionnaire was randomly distributed among the general population registered with a web based questionnaire supplier, to recruit 900 participants who were aware about the ACL injury. The questionnaire consisted of two parts: Question 1 asked them about their sources of information regarding the ACL injury; Question 2 asked them about the risk factors for ACL injury. Multivariate logistic regression was used to determine the information sources that provide a good understanding of the risk factors. The leading source of information for ACL injury was television (57.0%). However, the results of logistic regression analysis revealed that television was not an effective medium to create awareness about the risk factors, among the general population. Instead "Lecture by a coach", "Classroom session on Health", and "Newspaper" were significantly more effective in creating a good awareness of the risk factors (p < 0.001).

Ulnar Collateral Ligament Reconstruction

PubMed Central

Erickson, Brandon J.; Harris, Joshua D.; Chalmers, Peter N.; Bach, Bernard R.; Verma, Nikhil N.; Bush-Joseph, Charles A.; Romeo, Anthony A.

2015-01-01

Context: Ulnar collateral ligament (UCL) injuries lead to pain and loss of performance in the thrower’s elbow. Ulnar collateral ligament reconstruction (UCLR) is a reliable treatment option for the symptomatic, deficient UCL. Injury to the UCL usually occurs because of chronic accumulation of microtrauma, although acute ruptures occur and an acute-on-chronic presentation is also common. Evidence Acquisition: Computerized databases, references from pertinent articles, and research institutions were searched for all studies using the search terms ulnar collateral ligament from 1970 until 2015. Study Design: Clinical review. Level of Evidence: Level 5. Results: All studies reporting outcomes for UCLR are level 4. Most modern fixation methodologies appear to be biomechanically and clinically equivalent. Viable graft choices include ipsilateral palmaris longus tendon autograft, gracilis or semitendinosus autograft, and allograft. Clinical studies report excellent outcomes of UCLR for both recreational and elite level athletes with regard to return to sport and postoperative performance. Complications, although rare, include graft rerupture or attenuation, ulnar nerve symptoms, stiffness, pain, and/or weakness leading to decreased performance. Conclusion: Injuries to the UCL have become commonplace among pitchers. Nonoperative treatment should be attempted, but the limited studies have not shown promising results. Operative treatment can be performed with several techniques, with retrospective studies showing promising results. Complications include ulnar neuropathy as well as failure to return to sport. Detailed preoperative planning, meticulous surgical technique, and a comprehensive rehabilitation program are essential components to achieving a satisfactory result. PMID:26502444

Ankle ligament healing after an acute ankle sprain: an evidence-based approach.

PubMed

Hubbard, Tricia J; Hicks-Little, Charlie A

2008-01-01

To perform a systematic review to determine the healing time of the lateral ankle ligaments after an acute ankle sprain. We identified English-language research studies from 1964 to 2007 by searching MEDLINE, Physiotherapy Evidence Database (PEDro), SportDiscus, and CINAHL using the terms ankle sprain, ankle rehabilitation, ankle injury, ligament healing, and immobilization. We selected studies that described randomized, controlled clinical trials measuring ligament laxity either objectively or subjectively immediately after injury and at least 1 more time after injury. Two reviewers independently scored the 7 studies that met the inclusion criteria. Because of differences in study designs, a meta-analysis could not be performed. Effect sizes and confidence intervals could be calculated only for 1 study. The percentages of subjective and objective instability were calculated for the remaining studies. Ankle laxity improved over a period of 6 weeks to 1 year. One author showed stress talar tilt values of 16.10 +/- 8.8 degrees immediately after injury and 3.4 +/- 3.6 degrees at 3 months after injury. In 2 articles, the authors reported that positive anterior drawer tests were still present in 3% to 31% of participants at 6 months after injury. Additionally, feelings of instability affected 7% to 42% of participants up to 1 year after injury. In the studies that we examined, it took at least 6 weeks to 3 months before ligament healing occurred. However, at 6 weeks to 1 year after injury, a large percentage of participants still had objective mechanical laxity and subjective ankle instability. Direct comparison among articles is difficult because of differences in methods. More research focusing on more reliable methods of measuring ankle laxity is needed so that clinicians can know how long ligament healing takes after injury. This knowledge will help clinicians to make better decisions during rehabilitation and for return to play.

Restricted Hip Rotation Is Correlated With an Increased Risk for Anterior Cruciate Ligament Injury.

PubMed

VandenBerg, Curtis; Crawford, Eileen A; Sibilsky Enselman, Elizabeth; Robbins, Christopher B; Wojtys, Edward M; Bedi, Asheesh

2017-02-01

The primary purpose was to compare ipsilateral hip internal rotation (IR) in male and female athletes with or without an anterior cruciate ligament (ACL) tear. A secondary purpose was to compare radiographic markers of femoroacetabular impingement (FAI) in patients with or without an ACL tear. In this prospective case-control study, based on a power analysis, a convenience sample of 25 ACL-injured and 25 control patients matched by age and gender were examined over 14 months. The ACL injury group included preoperative patients 12-40 years old with an ACL rupture within the previous 3 months with no prior lower extremity injuries, ligamentous laxity, or arthralgias. Controls included patients presenting with an upper extremity complaint with no history of knee injury. In the outpatient clinic, hip axial rotation range of motion was measured with a goniometer on physical examination and hip radiographs were evaluated for morphologic variations consistent with FAI. Univariate analysis of variance was used to examine differences between groups. Each group had 13 males and 12 females, average ages of 22.8 ± 7.2 years (ACL group) versus 24.5 ± 7.9 years (controls; P = .439). The average sum of hip rotation (internal plus external) in patients with an ACL tear was 60.3 ± 12.4° compared with 72.6 ± 17.2° in controls (P = .006). ACL-injured patients had decreased hip IR compared with controls, with respective mean measurements of 23.4 ± 7.6° versus 30.4 ± 10.4° (P = .009). For every 10° increase in hip IR, the odds of having an ACL tear decreased by a factor of 0.419 (P = .015). Risk of ACL injury is associated with restricted hip IR, and as hip IR increases, the odds of having an ACL tear decreases. In addition, ACL injury is associated with FAI in a generalized population of male and female athletes, although causality cannot be determined and most ACL-injured patients do not exhibit hip complaints. Level II, prognostic, prospective cohort study

miR-193b Regulates Mcl-1 in Melanoma

PubMed Central

Chen, Jiamin; Zhang, Xiao; Lentz, Cindy; Abi-Daoud, Marie; Paré, Geneviève C.; Yang, Xiaolong; Feilotter, Harriet E.; Tron, Victor A.

2011-01-01

MicroRNAs play important roles in gene regulation, and their expression is frequently dysregulated in cancer cells. In a previous study, we reported that miR-193b represses cell proliferation and regulates cyclin D1 in melanoma cells, suggesting that miR-193b could act as a tumor suppressor. Herein, we demonstrate that miR-193b also down-regulates myeloid cell leukemia sequence 1 (Mcl-1) in melanoma cells. MicroRNA microarray profiling revealed that miR-193b is expressed at a significantly lower level in malignant melanoma than in benign nevi. Consistent with this, Mcl-1 is detected at a higher level in malignant melanoma than in benign nevi. In a survey of melanoma samples, the level of Mcl-1 is inversely correlated with the level of miR-193b. Overexpression of miR-193b in melanoma cells represses Mcl-1 expression. Previous studies showed that Mcl-1 knockdown cells are hypersensitive to ABT-737, a small-molecule inhibitor of Bcl-2, Bcl-XL, and Bcl-w. Similarly, overexpression of miR-193b restores ABT-737 sensitivity to ABT-737–resistant cells. Furthermore, the effect of miR-193b on the expression of Mcl-1 seems to be mediated by direct interaction between miR-193b and seed and seedless pairing sequences in the 3′ untranslated region of Mcl-1 mRNA. Thus, this study provides evidence that miR-193b directly regulates Mcl-1 and that down-regulation of miR-193b in vivo could be an early event in melanoma progression. PMID:21893020

Anterior cruciate ligament repair - past, present and future.

PubMed

Mahapatra, Piyush; Horriat, Saman; Anand, Bobby S

2018-06-15

This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing. The poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries. The history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed. There has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur. In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair. In addition, biological supplementation is being investigated as an adjunct and we will

Neck ligament strength is decreased following whiplash trauma

PubMed Central

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

2006-01-01

Background Previous clinical studies have documented successful neck pain relief in whiplash patients using nerve block and radiofrequency ablation of facet joint afferents, including capsular ligament nerves. No previous study has documented injuries to the neck ligaments as determined by altered dynamic mechanical properties due to whiplash. The goal of the present study was to determine the dynamic mechanical properties of whiplash-exposed human cervical spine ligaments. Additionally, the present data were compared to previously reported control data. The ligaments included the anterior and posterior longitudinal, capsular, and interspinous and supraspinous ligaments, middle-third disc, and ligamentum flavum. Methods A total of 98 bone-ligament-bone specimens (C2–C3 to C7-T1) were prepared from six cervical spines following 3.5, 5, 6.5, and 8 g rear impacts and pre- and post-impact flexibility testing. The specimens were elongated to failure at a peak rate of 725 (SD 95) mm/s. Failure force, elongation, and energy absorbed, as well as stiffness were determined. The mechanical properties were statistically compared among ligaments, and to the control data (significance level: P < 0.05; trend: P < 0.1). The average physiological ligament elongation was determined using a mathematical model. Results For all whiplash-exposed ligaments, the average failure elongation exceeded the average physiological elongation. The highest average failure force of 204.6 N was observed in the ligamentum flavum, significantly greater than in middle-third disc and interspinous and supraspinous ligaments. The highest average failure elongation of 4.9 mm was observed in the interspinous and supraspinous ligaments, significantly greater than in the anterior longitudinal ligament, middle-third disc, and ligamentum flavum. The average energy absorbed ranged from 0.04 J by the middle-third disc to 0.44 J by the capsular ligament. The ligamentum flavum was the stiffest ligament, while the

Prospective analysis of magnetic resonance imaging accuracy in diagnosing traumatic injuries of the posterior ligamentous complex of the thoracolumbar spine.

PubMed

Pizones, Javier; Sánchez-Mariscal, Felisa; Zúñiga, Lorenzo; Álvarez, Patricia; Izquierdo, Enrique

2013-04-20

Prospective cohort study. To study magnetic resonance imaging (MRI) accuracy in diagnosing posterior ligamentous complex (PLC) damage, when applying the new dichotomic instability criteria in a prospective cohort of patients with vertebral fracture. Recent studies dispute MRI accuracy to diagnose PLC injuries. They analyze the complex based on 3 categories (intact/indeterminate/rupture), including the indeterminate in the ruptured group (measurement bias) in the accuracy analysis. Moreover, fractures with conservative treatment (selection bias) are not included. Both facts reduce the specificity. A recent study has proposed new criteria where posterior instability is determined with supraspinous ligament (SSL) rupture. Prospective study of patients with acute thoracolumbar fracture, using radiography and MRI (FS-T2-w/short-tau inversion-recovery sequences). 1. The integrity (ruptured/unruptured) of each isolated component of the PLC (facet capsules, interspinous ligament, SSL, and ligamentum flavum) was assessed via MRI and surgical findings. 2. PLC integrity as a whole was assessed, adopting the new dichotomic stability criteria from previous studies. In the MR images, PLC is considered ruptured when the SSL is found discontinued, and intact when not (this excludes the "indeterminate" category). In surgically treated fractures, PLC stability as a whole was assessed dynamically (ruptured/unruptured). In conservative fractures, PLC stability was assessed according to change in vertebral kyphosis measured with the local kyphotic angle at 2-year follow-up (ruptured if difference is > 5°/unruptured if difference is < 5°).3. Comparative analysis among findings provided MRI accuracy in diagnosing PLC damage. Fifty-eight vertebral fractures were studied (38 surgical, 20 conservative), of which 50% were in males; average age, 40.4 years. MRI sensitivity for injury diagnosis of each isolated PLC component varied between 92.3% (interspinous ligament) and 100% (ligamentum

miR-193b Regulates Mcl-1 in Melanoma.

PubMed

Chen, Jiamin; Zhang, Xiao; Lentz, Cindy; Abi-Daoud, Marie; Paré, Geneviève C; Yang, Xiaolong; Feilotter, Harriet E; Tron, Victor A

2011-11-01

MicroRNAs play important roles in gene regulation, and their expression is frequently dysregulated in cancer cells. In a previous study, we reported that miR-193b represses cell proliferation and regulates cyclin D1 in melanoma cells, suggesting that miR-193b could act as a tumor suppressor. Herein, we demonstrate that miR-193b also down-regulates myeloid cell leukemia sequence 1 (Mcl-1) in melanoma cells. MicroRNA microarray profiling revealed that miR-193b is expressed at a significantly lower level in malignant melanoma than in benign nevi. Consistent with this, Mcl-1 is detected at a higher level in malignant melanoma than in benign nevi. In a survey of melanoma samples, the level of Mcl-1 is inversely correlated with the level of miR-193b. Overexpression of miR-193b in melanoma cells represses Mcl-1 expression. Previous studies showed that Mcl-1 knockdown cells are hypersensitive to ABT-737, a small-molecule inhibitor of Bcl-2, Bcl-X(L), and Bcl-w. Similarly, overexpression of miR-193b restores ABT-737 sensitivity to ABT-737-resistant cells. Furthermore, the effect of miR-193b on the expression of Mcl-1 seems to be mediated by direct interaction between miR-193b and seed and seedless pairing sequences in the 3' untranslated region of Mcl-1 mRNA. Thus, this study provides evidence that miR-193b directly regulates Mcl-1 and that down-regulation of miR-193b in vivo could be an early event in melanoma progression. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Usefulness of oblique axial scan in magnetic resonance imaging evaluation of anterior talofibular ligament in ankle sprain.

PubMed

Kim, Jin-su; Moon, Yong-ju; Choi, Yun Sun; Park, Young Uk; Park, Seung Min; Lee, Kyung Tai

2012-01-01

The purpose of the present study was to clarify the usefulness of the oblique axial scan parallel to the course of the anterior talofibular ligament in magnetic resonance imaging of the anterior talofibular ligament in patients with chronic ankle instability. We evaluated this anterior talofibular ligament view and routine axial magnetic resonance imaging planes of 115 ankles. We diagnosed the grade of the anterior talofibular ligament injury and confirmed full-length views of the anterior talofibular ligament. Associated lesions were also checked. The subjective diagnostic convenience of associated problems was determined. The full-length view of the anterior talofibular ligament was checked in 85 (73.9%) patients in the routine axial view and 112 (97.4%) patients in the anterior talofibular ligament view. The grade of injury increased in the anterior talofibular ligament view in 26 (22.6%) patients compared with the routine axial view. There were 64 associated injuries. The anterior inferior tibiofibular ligament, posterior inferior tibiofibular ligament, and posterior tibialis tendinitis were more easily diagnosed on the routine axial view than on the anterior talofibular ligament view. An additional anterior talofibular ligament view is useful in the evaluation of the anterior talofibular ligament in patients with chronic ankle instability. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Owner Evaluation of a CORA-Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs.

PubMed

Kishi, Erin N; Hulse, Don

2016-05-01

To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs. Retrospective case series. Dogs (n=70). Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dog's function after surgery. Based on owner responses, clinical outcomes were established. CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related. The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function. © Copyright 2016 by The American College of Veterinary Surgeons.

Compliance With Neuromuscular Training and Anterior Cruciate Ligament Injury Risk Reduction in Female Athletes: A Meta-Analysis

PubMed Central

Sugimoto, Dai; Myer, Gregory D.; Bush, Heather M.; Klugman, Maddie F.; McKeon, Jennifer M. Medina; Hewett, Timothy E.

2012-01-01

Context No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury. Objective To systematically review and synthesize the published literature to determine if compliance with neuromuscular training is associated with reduced incidence of ACL injury in young female athletes. Data Sources We searched PubMed, SPORTDiscus, CINAHL, and MEDLINE for articles published from 1995 to 2010 using the key words anterior cruciate ligament prevention, ACL prevention, knee prevention, prospective knee prevention, neuromuscular training, and neuromuscular intervention. Study Selection Criteria for inclusion required that (1) the number of ACL injuries was reported, (2) a neuromuscular training program was used, (3) females were included as participants, (4) the study design was prospective and controlled, and (5) compliance data for the neuromuscular training program were provided. Data Extraction Extracted data included the number of ACL injuries, total number of participants per group, observation time period, number of participants who completed each session, number of sessions completed by an entire team, and number of total sessions. Attendance was calculated as the number of participants who completed each session converted into a percentage of the total number of participants. Intervention completion was calculated as the number of sessions completed by an entire team converted into a percentage of the total number of training sessions. These data were used to calculate an overall rate of compliance. Data Synthesis Six of 205 identified studies were included. Incidence rates of ACL injury were lower in studies with high rates of compliance with neuromuscular training than in studies with low compliance rates (incidence rate ratio = 0.27 [95% confidence interval = 0.07, 0.80]). Tertile analysis indicated rates of ACL injury incidence were lower in studies with high compliance

Effects of an age-specific anterior cruciate ligament injury prevention program on lower extremity biomechanics in children.

PubMed

DiStefano, Lindsay J; Blackburn, J Troy; Marshall, Stephen W; Guskiewicz, Kevin M; Garrett, William E; Padua, Darin A

2011-05-01

Implementing an anterior cruciate ligament injury prevention program to athletes before the age at which the greatest injury risk occurs (15-17 years) is important from a prevention standpoint. However, it is unknown whether standard programs can modify lower extremity biomechanics in pediatric populations or if specialized training is required. To compare the effects of traditional and age-specific pediatric anterior cruciate ligament injury prevention programs on lower extremity biomechanics during a cutting task in youth athletes. The authors hypothesized that the age-specific pediatric program would result in greater sagittal plane motion (ie, hip and knee flexion) and less motion in the transverse and frontal plane (ie, knee valgus, knee and hip rotation) as compared with the traditional program. Randomized controlled trial; Level of evidence, 1. Sixty-five youth soccer athletes (38 boys, 27 girls) volunteered to participate. The mean age of participants was 10 ± 1 years. Teams (n, 7) were cluster randomized to a pediatric injury prevention program, a traditional injury prevention program, or a control group. The pediatric program was modified from the traditional program to include more feedback, progressions, and variety. Teams performed their programs as part of their normal warm-up routine. Three-dimensional lower extremity biomechanics were assessed during a sidestep cutting task before and after completion of the 9-week intervention period. The pediatric program reduced the amount of knee external rotation at initial ground contact during the cutting task, F ((2,62)) = 3.79, P = .03 (change: pediatric, 7.73° ± 10.71°; control, -0.35° ± 7.76°), as compared with the control group after the intervention period. No other changes were observed. The injury prevention program designed for a pediatric population modified only knee rotation during the cutting task, whereas the traditional program did not result in any changes in cutting biomechanics. These

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

PubMed Central

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

2016-01-01

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

Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013

PubMed Central

Dodson, Christopher C.; Secrist, Eric S.; Bhat, Suneel B.; Woods, Daniel P.; Deluca, Peter F.

2016-01-01

Background: There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown. Purpose: This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury. Study Design: Descriptive epidemiological study. Methods: A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position. Results: NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05). Conclusion: In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in

THE BTK INHIBITOR PCI-32765 SYNERGISTICALLY INCREASES PROTEASOME INHIBITOR ACTIVITY IN DLBCL AND MCL CELLS SENSITIVE OR RESISTANT TO BORTEZOMIB

PubMed Central

Dasmahapatra, Girija; Patel, Hiral; Dent, Paul; Fisher, Richard I.; Friedberg, Jonathan; Grant, Steven

2012-01-01

Summary Interactions between the Bruton tyrosine kinase (BTK) inhibitor PCI-32765 and the proteasome inhibitor (bortezomib) were examined in diffuse large-B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) cells, including those highly resistant to bortezomib. Co-administration of PCI-32765/bortezomib synergistically increased mitochondrial injury and apoptosis in germinal centre- or activated B-cell-like-DLBCL cells and in MCL cells. These events were accompanied by marked AKT and nuclear factor (NF)-κB (NFKB1) inactivation, down-regulation of Mcl-1 (MCL1), Bcl-xL (BCL2L1), and XIAP, and enhanced DNA damage (e.g., γH2A.X formation) and endoplasmic reticulum (ER) stress. Similar interactions were observed in highly bortezomib-resistant DLBCL and MCL cells, and in primary DLBCL cells. In contrast, PCI-32765/bortezomib regimens displayed minimal toxicity toward normal CD34+ bone marrow cells. Transfection of DLBCL cells with a constitutively active AKT construct attenuated AKT inactivation and significantly diminished cell death, whereas expression of an NF-κB “super-repressor” (IκBαser34/36) increased both PCI-32765 and bortezomib lethality. Moreover, cells in which the ER stress response was disabled by a dominant-negative eIF2α construct were resistant to this regimen. Finally, combined exposure to PCI-32765 and bortezomib resulted in more pronounced and sustained reactive oxygen species (ROS) generation, and ROS scavengers significantly diminished lethality. Given promising early clinical results for PCI-32765 in DLBCL and MCL, a strategy combining BTK/ proteasome inhibitor warrants attention in these malignancies. PMID:23360303

Tissue-engineering strategies for the tendon/ligament-to-bone insertion.

PubMed

Smith, Lester; Xia, Younan; Galatz, Leesa M; Genin, Guy M; Thomopoulos, Stavros

2012-01-01

Injuries to connective tissues are painful and disabling and result in costly medical expenses. These injuries often require reattachment of an unmineralized connective tissue to bone. The uninjured tendon/ligament-to-bone insertion (enthesis) is a functionally graded material that exhibits a gradual transition from soft tissue (i.e., tendon or ligament) to hard tissue (i.e., mineralized bone) through a fibrocartilaginous transition region. This transition is believed to facilitate force transmission between the two dissimilar tissues by ameliorating potentially damaging interfacial stress concentrations. The transition region is impaired or lost upon tendon/ligament injury and is not regenerated following surgical repair or natural healing, exposing the tissue to risk of reinjury. The need to regenerate a robust tendon-to-bone insertion has led a number of tissue engineering repair strategies. This review treats the tendon-to-bone insertion site as a tissue structure whose primary role is mechanical and discusses current and emerging strategies for engineering the tendon/ligament-to-bone insertion in this context. The focus lies on strategies for producing mechanical structures that can guide and subsequently sustain a graded tissue structure and the associated cell populations.

Capsular lesions with glenohumeral ligament injuries in patients with primary shoulder dislocation: magnetic resonance imaging and magnetic resonance arthrography evaluation

PubMed Central

Liavaag, S; Stiris, M G; Svenningsen, S; Enger, M; Pripp, A H; Brox, J I

2011-01-01

The glenohumeral ligaments are important structures for the stability of the shoulder. They are integrated parts of the capsule and are at risk to be injured in a traumatic shoulder dislocation. The aim was to examine the prevalence of capsular ligament lesions in the acute phase and at minimum 3 weeks' follow-up after first-time traumatic shoulder dislocation. Forty-two patients aged 16–40 years were included. All patients underwent computed tomography and magnetic resonance imaging (MRI) scans shortly after the injury and MR-arthrography (MRA) at follow-up. The median time from dislocation to MRI was 7 (range 2–14) days and to MRA 30 (range 21–54) days. We found capsular ligament lesions in 22 patients (52.4%) in the acute stage and in five patients (11.9%) at follow up. Nine patients (21.4%) had a humeral avulsion of the anterior glenohumeral ligament (HAGL lesion) on MRI. Three patients (7.1%) had this lesion at follow-up. The rate of HAGL lesions in the acute stage was higher than reported previously, but the prevalence at follow-up was in keeping with earlier published studies. PMID:21401723

[Application of pie-crusting the medial collateral ligament release in arthroscopic surgery for posterior horn of 
medial meniscus in knee joint].

PubMed

Zhu, Weihong; Tang, Qi; Liao, Lele; Li, Ding; Yang, Yang; Chen, You

2017-09-28

To explore the effectiveness and safety of pie-crusting the medial collateral ligament release (MCL) in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint.
 Methods: Thirty-two consecutive patients with PHMM tear in tight medial tibiofemoral compartment of knee joint were admitted to our department from January, 2013 to December, 2014. All patients were performed pie-crusting the MCL release at its tibial insertion with 18-gauge intravenous needle. All patients were evaluated by valgus stress test and bilateral valgus stress radiograph at postoperative 1st day, 4th week and 12th week. Visual Analogue Scales (VAS), Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) scores were recorded at the 1st, 3th, 6th month follow-up, then follow-up every 6 months.
 Results: The mean follow-up was 28 (24-36) months. All cases were negative in valgus stress test. MCL rupture, femoral fracture, articular cartilage lesion and neurovascular injury were not found at the last follow-up. The median medial joint space width of affected side and unaffected side for valgus stress radiographs were 6.8 mm and 4.3 mm (P<0.05) at the 1st day, 5.5 mm and 4.2 mm 
(P<0.05) in the 4th week and 4.8 mm and 4.3 mm (P>0.05) at the 12th week, respectively. VAS scores was changed from 4.5±1.5 preoperatively to 1.7±1.0 at the final follow-up (t=16.561, P<0.05). Lysholm scores was changed from 52.3±5.8 preoperatively to 93.2±6.3 at the final follow-up (t=-41.353, P<0.05). Tegner scores was changed from 4.1±1.1 preoperatively to 5.5±0.6 at the final follow-up (t=-18.792, P<0.05). IKDC scores was changed from 54.5±6.2 preoperative to 93.8±4.5 at the final follow-up (t=-38.253, P<0.05).
 Conclusion: Pie-crusting the medial collateral ligament release is a safe, minimal invasive and effective surgical option for posterior horn of medial meniscus tear in tight medial tibiofemoral compartment of knee

Anatomic deltoid ligament repair with anchor-to-post suture reinforcement: technique tip.

PubMed

Lack, William; Phisitkul, Phinit; Femino, John E

2012-01-01

The deltoid ligament is the primary ligamentous stabilizer of the ankle joint. Both superficial and deep components of the ligament can be disrupted with a rotational ankle fracture, chronic ankle instability, or in late stage adult acquired flatfoot deformity. The role of deltoid ligament repair in these conditions has been limited and its contribution to arthritis is largely unknown. Neglect of the deltoid ligament in the treatment of ankle injuries may be due to difficulties in diagnosis and lack of an effective method for repair. Most acute repair techniques address the superficial deltoid ligament with direct end-to-end repair, fixation through bone tunnels, or suture anchor repair of avulsion injuries. Deep deltoid ligament repair has been described using direct end-to-end repair with sutures, as well as by autograft and allograft tendon reconstruction utilizing various techniques. Newer tenodesis techniques have been described for late reconstruction of both deep and superficial components in patients with stage 4 adult acquired flatfoot deformity. We describe a technique that provides anatomic ligament-to-bone repair of the superficial and deep bundles of the deltoid ligament while reducing the talus toward the medial malleolar facet of the tibiotalar joint with anchor-to-post reinforcement of the ligamentous repair. This technique may protect and allow the horizontally oriented fibers of the deep deltoid ligament to heal with the appropriate resting length while providing immediate stability of the construct.

The Epidemiology of Deltoid Ligament Sprains in 25 National Collegiate Athletic Association Sports, 2009–2010 Through 2014–2015 Academic Years

PubMed Central

Kopec, Thomas J.; Hibberd, Elizabeth E.; Roos, Karen G.; Djoko, Aristarque; Dompier, Thomas P.; Kerr, Zachary Y.

2017-01-01

Context: Deltoid ligament sprains among collegiate student-athletes have not been extensively investigated. Research regarding the mechanisms, participation-restriction time, and recurrence of deltoid ligament sprains in collegiate student-athletes is lacking. Objective: To describe the epidemiology of deltoid ligament sprains in 25 National Collegiate Athletic Association championship sports. Design: Descriptive epidemiology study. Setting: National Collegiate Athletic Association Injury Surveillance Program. Main Outcome Measure(s): We analyzed deltoid ligament sprains recorded in the Injury Surveillance Program for the 2009–2010 through 2014–2015 academic years. Deltoid ligament sprain injury rates, rate ratios, and injury proportion ratios with 95% confidence intervals (CIs) were reported. Results: During the study period, 380 deltoid ligament sprains were reported, resulting in a combined injury rate of 0.79/10 000 athlete-exposures (AEs; 95% CI = 0.71, 0.87). Most deltoid ligament sprains occurred in practices (54.2%, n = 206). However, the competition injury rate was higher than the practice injury rate (rate ratio = 3.74; 95% CI = 3.06, 4.57). The highest deltoid ligament sprain rates were in women's gymnastics (2.30/10 000 AEs; 95% CI = 1.05, 3.55), men's soccer (1.73/10 000 AEs; 95% CI = 1.14, 2.32), women's soccer (1.61/10 000 AEs; 95% CI = 1.13, 2.09), and men's football (1.40/10 000 AEs; 95% CI = 1.18, 1.62). Nearly half of all deltoid ligament sprains (49.7%, n = 189) were due to player contact, and 39.5% (n = 150) were non–time-loss injuries (ie, participation restricted for less than 24 hours). Only 8.2% (n = 31) of deltoid ligament sprains were recurrent. Conclusions: The highest deltoid ligament sprain rates were in women's gymnastics, men's and women's soccer, and men's football. However, the rate for women's gymnastics was imprecise (ie, the CI was wide), highlighting the need for further surveillance of deltoid ligament sprains

Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015

PubMed Central

Shaw, Louise; Finch, Caroline F.

2017-01-01

Anterior cruciate ligament (ACL) injuries in children and adolescents have been the focus of recent media attention and parental concern, given their potential for adverse long-term health outcomes and healthcare costs. However, there is limited formal evidence on trends in the incidence of ACL injuries in children. This study utilizes the Victorian Admitted Episodes Dataset (VAED) to characterize epidemiologic trends of hospital-admitted ACL injuries in those aged 5 to 14 years over a period of 10 years from 2005 to 2015. There was a total of 320 cases and the overall annual rate of ACL injuries increased by 147.8% from 2.74 per 100,000 population in 2005/2006 to 6.79 per 100,000 in 2014/2015. The majority (96.9%) of these injuries were in 10- to 14-year-olds. The main in-hospital procedure provided to over 80% of the hospitalized cases involved ACL reconstruction. Sporting activities accounted for 56.6% of ACL injuries. For females, over half (52.4%) of ACL injuries occurred whilst playing ball sports, compared to 35.4% of males. The large increase in ACL injuries in 5- to 14-year-olds in the state of Victoria, Australia over a 10-year period indicates they are a significant and emerging health burden. Population-wide ACL prevention policies are required to halt these trends. Cost effective prevention programs that involve neuromuscular training must be implemented in schools and junior sports teams. PMID:28587262

Acute Management of Anterior Cruciate Ligament Injuries Using Novel Canine Models.

PubMed

Bozynski, Chantelle C; Stannard, James P; Smith, Pat; Hanypsiak, Bryan T; Kuroki, Keiichi; Stoker, Aaron; Cook, Cristi; Cook, James L

2016-10-01

The objective of this study was to compare treatment options for acute management of anterior cruciate ligament (ACL) injuries using preclinical models. Twenty-seven adult purpose-bred research hounds underwent knee surgery (sham control, exposed ACL, or partial-tear ACL) and were assessed over the following 8 weeks. Dogs were randomized into three treatment groups: standard of care (i.e., rest and nonsteroidal anti-inflammatory drugs [NSAIDs]), washout, or leukoreduced platelet-rich plasma (PRP) so that a total of nine dogs received each treatment. Data from the two ACL-injury groups were pooled for each treatment ( n  = 6 per treatment group) and analyzed for treatment effects. The washout and PRP groups experienced less lameness, pain, and effusion, and greater function and comfortable range of motion compared with the NSAID group, with the PRP group showing most benefits. PRP was associated with the lowest severity of ACL pathology based on arthroscopic assessment. Measurable levels of inflammatory and degradative biomarkers were present in synovial fluid with significant differences noted over time. Based on these findings, washout had positive clinical effects compared with the standard-of-care group especially within the first week of treatment, but became less beneficial over time. A single injection of leukoreduced PRP was associated with favorable clinical results. However, no treatment was significantly "protective" against progression toward osteoarthritis after ACL injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

WITHDRAWN: Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults.

PubMed

Kerkhoffs, Gino M M J; Rowe, Brian H; Assendelft, Willem J J; Kelly, Karen D; Struijs, Peter A A; van Dijk, C N

2013-03-28

Acute lateral ankle ligament injuries (ankle sprains) are common problems in acute medical care. The treatment variation observed for the acutely injured lateral ankle ligament complex suggests a lack of evidence-based management strategies for this problem. The objective of this review was to assess the effectiveness of methods of immobilisation for acute lateral ankle ligament injuries and to compare immobilisation with functional treatment methods. We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (December 2001); the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1966-May 2000), EMBASE (1988-May 2000), reference lists of articles, and contacted organisations and researchers in the field. Randomised and quasi-randomised controlled trials comparing either different types of immobilisation or immobilisation versus functional treatments for injuries to the lateral ligament complex of the ankle in adults were included. Trials which investigated the treatment of chronic instability or post-surgical treatment were excluded. Data were independently extracted by two authors. Where appropriate, results of comparable studies were pooled using fixed effects models. Individual and pooled statistics were reported as relative risks with 95% confidence intervals for dichotomous outcomes and weighted (WMD) or standardised (SMD) mean differences and 95% confidence intervals for continuous outcome measures. Heterogeneity between trials was tested using a standard chi-squared test. Twenty-one trials involving 2184 participants were included. The mean validity score of the included trials increased from 9.1 (SD 3.0) to 10 (SD 2.9) after retrieving further information (maximum 18 points). Statistically significant differences in favour of functional treatment when compared with immobilisation were found for seven outcome measures: more patients returned to sport in the long term (relative risk (RR) 1.86, 95

Clinical course and recommendations for patients after anterior cruciate ligament injury and subsequent reconstruction

PubMed Central

Gokeler, Alli; Dingenen, Bart; Mouton, Caroline; Seil, Romain

2017-01-01

Almost all athletes who have suffered an anterior cruciate ligament (ACL) injury expect a full return to sports at the same pre-injury level after ACL reconstruction (ACLR). Detailed patient information on the reasonable outcomes of the surgery may be essential to improve patient satisfaction. Pre-operative rehabilitation before ACLR should be considered as an addition to the standard of care to maximise functional outcomes after ACLR. We propose an optimised criterion-based rehabilitation programme within a biopsychosocial framework. No benchmark exists for evaluating return-to-sport (RTS) readiness after ACLR. Therefore, the authors propose a multi-factorial RTS test battery. A combination of both physical and psychological elements should be included in the RTS test battery. There is need for shared decision-making regarding RTS. Cite this article: EFORT Open Rev 2017;2:410-420. DOI: 10.1302/2058-5241.2.170011 PMID:29209517

Effectiveness of surgical reconstruction to restore radiocarpal joint mechanics after scapholunate ligament injury: an in vivo modeling study.

PubMed

Johnson, Joshua E; Lee, Phil; McIff, Terence E; Toby, E Bruce; Fischer, Kenneth J

2013-05-31

Disruption of the scapholunate ligament can cause a loss of normal scapholunate mechanics and eventually lead to osteoarthritis. Surgical reconstruction attempts to restore scapholunate relationship show improvement in functional outcomes, but postoperative effectiveness in restoring normal radiocarpal mechanics still remains a question. The objective of this study was to investigate the benefits of surgical repair by observing changes in contact mechanics on the cartilage surface before and after surgical treatment. Six patients with unilateral scapholunate dissociation were enrolled in the study, and displacement driven magnetic resonance image-based surface contact modeling was used to investigate normal, injured and postoperative radiocarpal mechanics. Model geometry was acquired from images of wrists taken in a relaxed position. Kinematics were acquired from image registration between the relaxed images, and images taken during functional loading. Results showed a trend for increase in radiocarpal contact parameters with injury. Peak and mean contact pressures significantly decreased after surgery in the radiolunate articulation and there were no significant differences between normal and postoperative wrists. Results indicated that surgical repair improves contact mechanics after injury and that contact mechanics can be surgically restored to be similar to normal. This study provides novel contact mechanics data on the effects of surgical repair after scapholunate ligament injury. With further work, it may be possible to more effectively differentiate between treatments and degenerative changes based on in vivo contact mechanics data. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mcl-1 Degradation Is Required for Targeted Therapeutics to Eradicate Colon Cancer Cells.

PubMed

Tong, Jingshan; Wang, Peng; Tan, Shuai; Chen, Dongshi; Nikolovska-Coleska, Zaneta; Zou, Fangdong; Yu, Jian; Zhang, Lin

2017-05-01

The Bcl-2 family protein Mcl-1 is often degraded in cancer cells subjected to effective therapeutic treatment, and defective Mcl-1 degradation has been associated with intrinsic and acquired drug resistance. However, a causal relationship between Mcl-1 degradation and anticancer drug responses has not been directly established, especially in solid tumor cells where Mcl-1 inhibition alone is insufficient to trigger cell death. In this study, we present evidence that Mcl-1 participates directly in determining effective therapeutic responses in colon cancer cells. In this setting, Mcl-1 degradation was induced by a variety of multikinase inhibitor drugs, where it relied upon GSK3β phosphorylation and FBW7-dependent ubiquitination. Specific blockade by genetic knock-in (KI) abolished apoptotic responses and conferred resistance to kinase inhibitors. Mcl-1 -KI also suppressed the antiangiogenic and anti-hypoxic effects of kinase inhibitors in the tumor microenvironment. Interestingly, these same inhibitors also induced the BH3-only Bcl-2 family protein PUMA, which is required for apoptosis. Degradation-resistant Mcl-1 bound and sequestered PUMA from other prosurvival proteins to maintain cell survival, which was abolished by small-molecule Mcl-1 inhibitors. Our findings establish a pivotal role for Mcl-1 degradation in the response of colon cancer cells to targeted therapeutics, and they provide a useful rational platform to develop Mcl-1-targeting agents that can overcome drug resistance. Cancer Res; 77(9); 2512-21. ©2017 AACR . ©2017 American Association for Cancer Research.

C-Type Lectin Receptor MCL Facilitates Mincle Expression and Signaling through Complex Formation.

PubMed

Miyake, Yasunobu; Masatsugu, Oh-hora; Yamasaki, Sho

2015-06-01

C-type lectin receptors expressed in APCs are recently defined pattern recognition receptors that play a crucial role in immune responses against pathogen-associated molecular patterns. Among pathogen-associated molecular patterns, cord factor (trehalose-6,6'-dimycolate [TDM]) is the most potent immunostimulatory component of the mycobacterial cell wall. Two C-type lectin receptors, macrophage-inducible C-type lectin (Mincle) and macrophage C-type lectin (MCL), are required for immune responses against TDM. Previous studies indicate that MCL is required for TDM-induced Mincle expression. However, the mechanism by which MCL induces Mincle expression has not been fully understood. In this study, we demonstrate that MCL interacts with Mincle to promote its surface expression. After LPS or zymosan stimulation, MCL-deficient bone marrow-derived dendritic cells (BMDCs) had a lower level of Mincle protein expression, although mRNA expression was comparable with wild-type BMDCs. Meanwhile, BMDCs from MCL transgenic mice showed an enhanced level of Mincle expression on the cell surface. MCL was associated with Mincle through the stalk region and this region was necessary and sufficient for the enhancement of Mincle expression. This interaction appeared to be mediated by the hydrophobic repeat of MCL, as substitution of four hydrophobic residues within the stalk region with serine (MCL(4S)) abolished the function to enhance the surface expression of Mincle. MCL(4S) mutant failed to restore the defective TDM responses in MCL-deficient BMDCs. These results suggest that MCL positively regulates Mincle expression through protein-protein interaction via its stalk region, thereby magnifying Mincle-mediated signaling. Copyright © 2015 by The American Association of Immunologists, Inc.

Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis

PubMed Central

Collins, Jamie E.; Yang, Heidi Y.; Goczalk, Melissa G.; Katz, Jeffrey N.; Losina, Elena

2015-01-01

Objective Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. Methods We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs) weighted by their precision (1/variance) using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis. Results Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0–5 scale). The summary incidence rate ratio was estimated at 0.731 (95% CI: 0.614, 0.871) for knee injury and 0.493 (95% CI: 0.285, 0.854) for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy. Conclusion The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs. PMID:26637173

Sex-Specific Predictors of Intra-articular Injuries Observed During Anterior Cruciate Ligament Reconstruction

PubMed Central

Kluczynski, Melissa A.; Marzo, John M.; Rauh, Michael A.; Bernas, Geoffrey A.; Bisson, Leslie J.

2015-01-01

Background: Male patients tend to have more meniscal and chondral injuries at the time of anterior cruciate ligament (ACL) reconstruction than females. No studies have examined sex-specific predictors of meniscal and chondral lesions in ACL-injured patients. Purpose: To identify sex-specific predictors of meniscal and chondral lesions, as well as meniscal tear management, in patients undergoing ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected prospectively from 689 patients (56.2% males) undergoing ACL reconstruction between 2005 and 2014. Predictors of meniscal tears, meniscal tear management, and chondral injuries were determined using multivariate logistic regression models stratified by sex. Predictors were age, body mass index (BMI; 25-29.99 and ≥30 vs ≤24.99 kg/m2), mechanism (contact vs noncontact) and type (high-impact sports [basketball, football, soccer, and skiing] and other sports vs not sports-related) of injury, interval from injury to surgery (≤6 vs >6 weeks), and instability episodes (vs none). Odds ratios and 95% CIs were reported. Results: Males had more lateral (46% vs 27.8%; P < .0001) and medial (40.2% vs 31.5%; P = .01) meniscal tears, as well as more lateral (72.1% vs 27.9%; P < .0001) and medial (61.4% vs 38.6%; P = .01) meniscectomies than females. For males, age predicted chondral injuries and medial meniscectomy; BMI ≥30 kg/m2 predicted medial meniscal tears; high-impact and other sports predicted medial meniscal tears, medial meniscectomies, and medial meniscal repairs; injuries ≤6 weeks from surgery predicted lateral meniscal repairs; and instability episodes predicted medial meniscal tears, medial tears left in situ, medial meniscectomies, and medial meniscal repairs. For females, age predicted chondral injuries, BMI ≥30 kg/m2 predicted lateral meniscectomies and repairs, and instability episodes predicted medial meniscectomies. Conclusion: Sex differences were observed. For

Sex-Specific Predictors of Intra-articular Injuries Observed During Anterior Cruciate Ligament Reconstruction.

PubMed

Kluczynski, Melissa A; Marzo, John M; Rauh, Michael A; Bernas, Geoffrey A; Bisson, Leslie J

2015-02-01

Male patients tend to have more meniscal and chondral injuries at the time of anterior cruciate ligament (ACL) reconstruction than females. No studies have examined sex-specific predictors of meniscal and chondral lesions in ACL-injured patients. To identify sex-specific predictors of meniscal and chondral lesions, as well as meniscal tear management, in patients undergoing ACL reconstruction. Cohort study; Level of evidence, 3. Data were collected prospectively from 689 patients (56.2% males) undergoing ACL reconstruction between 2005 and 2014. Predictors of meniscal tears, meniscal tear management, and chondral injuries were determined using multivariate logistic regression models stratified by sex. Predictors were age, body mass index (BMI; 25-29.99 and ≥30 vs ≤24.99 kg/m(2)), mechanism (contact vs noncontact) and type (high-impact sports [basketball, football, soccer, and skiing] and other sports vs not sports-related) of injury, interval from injury to surgery (≤6 vs >6 weeks), and instability episodes (vs none). Odds ratios and 95% CIs were reported. Males had more lateral (46% vs 27.8%; P < .0001) and medial (40.2% vs 31.5%; P = .01) meniscal tears, as well as more lateral (72.1% vs 27.9%; P < .0001) and medial (61.4% vs 38.6%; P = .01) meniscectomies than females. For males, age predicted chondral injuries and medial meniscectomy; BMI ≥30 kg/m(2) predicted medial meniscal tears; high-impact and other sports predicted medial meniscal tears, medial meniscectomies, and medial meniscal repairs; injuries ≤6 weeks from surgery predicted lateral meniscal repairs; and instability episodes predicted medial meniscal tears, medial tears left in situ, medial meniscectomies, and medial meniscal repairs. For females, age predicted chondral injuries, BMI ≥30 kg/m(2) predicted lateral meniscectomies and repairs, and instability episodes predicted medial meniscectomies. Sex differences were observed. For males, predictors included age, BMI, sports

Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees

PubMed Central

Gupta, Ravi; Masih, Gladson David; Chander, Gaurav; Bachhal, Vikas

2016-01-01

Background: Despite improvements in instability after anterior cruciate ligament (ACL) reconstruction, associated intraarticular injuries remain a major cause of concern and important prognostic factor for long term results as it may lead to osteoarthritis. Delay in ACL reconstruction has been in variably linked to increase in these injuries but there is lack of consensus regarding optimal timing of reconstruction. The goal of this study was to investigate delay in surgery and other factors, associated with intraarticular injuries in ACL deficient knees. Materials and Methods: A total of 438 patients (42 females; 396 males) enrolled for this prospective observational study. The average age of patients was 26.43 (range 17–51 years) years with a mean surgical delay of 78.91 (range 1 week - 18 years) weeks after injury. We analyzed the factors of age, sex, surgical delay, instability, and level of activity for possible association with intraarticular injuries. Results: Medial meniscus injuries had a significant association with surgical delay (P = 0.000) after a delay of 6 months. Lateral meniscus injuries had a significant association with degree of instability (P = 0.001). Medial-sided articular injuries were significantly affected by age (0.005) with an odds ratio (OR) of 1.048 (95% confidence interval [CI] of 1.014–1.082) reflecting 4.8% rise in incidence with each year. Lateral-sided injuries were associated with female sex (P = 0.018) with OR of 2.846 (95% CI of 1.200–6.752). The level of activity failed to reveal any significant associations. Conclusion: Surgical delay predicts an increase in medial meniscal and lateral articular injuries justifying early rather than delayed reconstruction in ACL deficient knees. Increasing age is positively related to intraarticular injuries while females are more susceptible to lateral articular injuries. PMID:27746491

Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees.

PubMed

Gupta, Ravi; Masih, Gladson David; Chander, Gaurav; Bachhal, Vikas

2016-09-01

Despite improvements in instability after anterior cruciate ligament (ACL) reconstruction, associated intraarticular injuries remain a major cause of concern and important prognostic factor for long term results as it may lead to osteoarthritis. Delay in ACL reconstruction has been in variably linked to increase in these injuries but there is lack of consensus regarding optimal timing of reconstruction. The goal of this study was to investigate delay in surgery and other factors, associated with intraarticular injuries in ACL deficient knees. A total of 438 patients (42 females; 396 males) enrolled for this prospective observational study. The average age of patients was 26.43 (range 17-51 years) years with a mean surgical delay of 78.91 (range 1 week - 18 years) weeks after injury. We analyzed the factors of age, sex, surgical delay, instability, and level of activity for possible association with intraarticular injuries. Medial meniscus injuries had a significant association with surgical delay ( P = 0.000) after a delay of 6 months. Lateral meniscus injuries had a significant association with degree of instability ( P = 0.001). Medial-sided articular injuries were significantly affected by age (0.005) with an odds ratio (OR) of 1.048 (95% confidence interval [CI] of 1.014-1.082) reflecting 4.8% rise in incidence with each year. Lateral-sided injuries were associated with female sex ( P = 0.018) with OR of 2.846 (95% CI of 1.200-6.752). The level of activity failed to reveal any significant associations. Surgical delay predicts an increase in medial meniscal and lateral articular injuries justifying early rather than delayed reconstruction in ACL deficient knees. Increasing age is positively related to intraarticular injuries while females are more susceptible to lateral articular injuries.

Anticipatory effects on anterior cruciate ligament loading during sidestep cutting.

PubMed

Weinhandl, Joshua T; Earl-Boehm, Jennifer E; Ebersole, Kyle T; Huddleston, Wendy E; Armstrong, Brian S R; O'Connor, Kristian M

2013-07-01

A key to understanding potential anterior cruciate ligament injury mechanisms is to determine joint loading characteristics associated with an injury-causing event. However, direct measurement of anterior cruciate ligament loading during athletic tasks is invasive. Thus, previous research has been unable to study the association between neuromuscular variables and anterior cruciate ligament loading. Therefore, the purpose of this study was to determine the influence of movement anticipation on anterior cruciate ligament loading using a musculoskeletal modeling approach. Twenty healthy recreationally active females were recruited to perform anticipated and unanticipated sidestep cutting. Three-dimensional kinematics and kinetics of the right leg were calculated. Muscle, joint and anterior cruciate ligament forces were then estimated using a musculoskeletal model. Dependent t-tests were conducted to investigate differences between the two cutting conditions. ACL loading significantly increased during unanticipated sidestep cutting (p<0.05). This increase was primarily due to a significant increase in the sagittal plane ACL loading, which contributed 62% of the total loading. Frontal plane ACL loading contributed 26% and transverse plane ACL loading contributed 12%. These results suggest that anterior cruciate ligament loading resulted from a multifaceted interaction of the sagittal plane shear forces (i.e., quadriceps, hamstrings, and tibiofemoral), as well as the frontal and transverse plane knee moments. Additionally, the results of this study confirm the hypothesis in the current literature that unanticipated movements such as sidestep cutting increase anterior cruciate ligament loading. Copyright © 2013 Elsevier Ltd. All rights reserved.

Interrelated roles for Mcl-1 and BIM in regulation of TRAIL-mediated mitochondrial apoptosis.

PubMed

Han, Jie; Goldstein, Leslie A; Gastman, Brian R; Rabinowich, Hannah

2006-04-14

The current study demonstrates a novel cross-talk mechanism between the TRAIL receptor death signaling pathway and the mitochondria. This newly identified pathway is regulated at the mitochondrial outer membrane by a complex between the prosurvival Bcl-2 member, Mcl-1 and the BH3-only protein, Bim. Under non-apoptotic conditions, Bim is sequestered by Mcl-1. Direct degradation of Mcl-1 by TRAIL-activated caspase-8 or caspase-3 produces Mcl-1-free Bim that mediates a Bax-dependent apoptotic cascade. Using Mcl-1 or Bim RNAi, we demonstrate that a loss in Mcl-1 expression significantly enhances the mitochondrial apoptotic response to TRAIL that is now mediated by freed Bim. Whereas overexpression of Mcl-1 contributes to the preservation of the mitochondrial membrane potential, Mcl-1 knockdown facilitates the Bim-mediated dissipation of this potential. Loss of Mcl-1 contributes to an increased level of caspase activity downstream of the mitochondrial response to TRAIL. Furthermore, the Mcl-1 expression level at the mitochondrial outer membrane determines the release efficiency for the apoptogenic proteins cytochrome c, Smac, and HtrA2 in response to Bim. These are the first findings to demonstrate the involvement of Bim in the TRAIL-mediated mitochondrial cascade. They also suggest that Mcl-1 may serve as a direct substrate for TRAIL-activated caspases implying the existence of a novel TRAIL/caspase-8/Mcl-1/Bim communication mechanism between the extrinsic and the intrinsic apoptotic pathways.

Injury of the posterior ligamentous complex of the thoracolumbar spine: a prospective evaluation of the diagnostic accuracy of magnetic resonance imaging.

PubMed

Vaccaro, Alexander R; Rihn, Jeffrey A; Saravanja, Davor; Anderson, David G; Hilibrand, Alan S; Albert, Todd J; Fehlings, Michael G; Morrison, William; Flanders, Adam E; France, John C; Arnold, Paul; Anderson, Paul A; Friel, Brian; Malfair, David; Street, John; Kwon, Brian; Paquette, Scott; Boyd, Michael; Dvorak, Marcel F S; Fisher, Charles

2009-11-01

Prospective diagnostic imaging study. To determine the accuracy of magnetic resonance imaging (MRI) in diagnosing injury of the posterior ligamentous complex (PLC) in patients with thoracolumbar trauma. Treatment decisions in thoracolumbar injury patients are currently based on the status of the PLC. It is, therefore, important to understand the accuracy of MRI in diagnosing varying degrees of PLC injury. Prior studies report that MRI is up to 100% sensitive for diagnosing PCL injury. Patients with an acute injury from T1 to L3 who required posterior surgery were prospectively studied. A musculoskeletal radiologist, based on the preoperative MRI findings, characterized each of the 6 components of the PLC as intact, incompletely disrupted, or disrupted. During the surgical procedure, the surgeon identified each component of the PLC as intact, incompletely disrupted, or disrupted. The radiologist's interpretation and surgical findings were compared. Forty-two patients with 62 levels of injury were studied. There were 33 males (78.6%) and 9 females (21.4%), and the average age was 35.7 years. According to the kappa score, there was a moderate level of agreement between the radiologist's interpretation and the intraoperative findings for all PLC components except the thoracolumbar fascia, for which there was slight agreement. The sensitivity for the various PLC components ranged from 79% (left facet capsule) to 90% (interspinous ligament). The specificity ranged from 53% (thoracolumbar fascia) to 65% (ligamentum flavum). There was less agreement between the radiologist and surgeon for the patients with less severe neurologic compromise, i.e., those patients with an AIS grade of either D or E. The sensitivity and specificity of MRI for diagnosing injury of the PLC are lower than previously reported in the literature. The integrity of the PLC as determined by MRI should not be used in isolation to determine treatment.

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

PubMed Central

Lohmander, Stefan; Frobell, Richard B.

2017-01-01

Context:  After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear. Objective:  To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury. Design:  Cross-sectional exploratory analysis of a randomized clinical trial. Setting:  Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants:  As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age = 26 ± 5 years, height = 1.8 ± 0.1 m, weight = 76 ± 13 kg) with an ACL tear were studied. Main Outcome Measure(s):  The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations. Results:  Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (β = −0.09, P = .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (β = –0.46, P = .02), whereas no association was found for those with a depression fracture (β = 0.0, P = .96). Larger medial (β = –0.48, P = .02) but not lateral (β = –0.03, P = .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms. Conclusions:  We confirmed the absence of relationships between whole-knee BML volume and pain and

The effectiveness of Pilates for partial anterior cruciate ligament injury.

PubMed

Çelik, Derya; Turkel, Nilgun

2017-08-01

This study explored the effects of Pilates on the muscle strength, function, and instability of patients with partial anterior cruciate ligament (ACL) injuries in situations in which a non-surgical treatment option is preferred. Fifty participants 20-45 years of age who were diagnosed with isolated ACL injuries were included in the study. The participants were randomly assigned to either the Pilates exercise group (n = 24) or the control group (n = 26). The subjects in the Pilates exercise group performed basic mat exercises that focused on the muscle strength and flexibility of the lower limbs and core muscles during each class session, which met three times per week for 12 weeks. The control group did not receive any treatment or home exercise programme. All patients were evaluated using the Lysholm Knee Scale, the Cincinnati Knee Rating System, and isokinetic quadriceps and hamstring strength. Patient satisfaction regarding improvement in knee stability was assessed using the Global Rating of Change scale. The Pilates group experienced significant improvement over the control group as measured by the difference in quadriceps strength at 12 weeks (p = 0.03). Both groups showed some clinical change over time, but the Pilates group improved for all outcome measurements at the 12-week follow-up, and the control group only improved for functional outcomes. Patient satisfaction with the level of knee stability based on the Global Rating of Change scale was higher in the Pilates group than in the control group. Although both groups exhibited improvements in knee strength and functional outcomes, the results suggest that Pilates is a superior management approach over a control treatment for increasing quadriceps strength in participants with partial ACL injury. Pilates may provide clinicians a novel option when choosing a treatment for a partial ACL injury. Further study is needed to determine whether certain subgroups of individuals might achieve an added

2018 International Olympic Committee Consensus Statement on Prevention, Diagnosis, and Management of Pediatric Anterior Cruciate Ligament Injuries

PubMed Central

Ardern, Clare L.; Ekås, Guri; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F.; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J.; Feller, Julian A.; Karlsson, Jón; Kocher, Mininder S.; LaPrade, Robert F.; McNamee, Mike; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas G.H.; Reider, Bruce; Roe, Justin P.; Seil, Romain; Siebold, Rainer; Silvers-Granelli, Holly J.; Soligard, Torbjørn; Witvrouw, Erik; Engebretsen, Lars

2018-01-01

In October 2017, the International Olympic Committee hosted an international expert group of physical therapists and orthopaedic surgeons who specialize in treating and researching pediatric anterior cruciate ligament (ACL) injuries. The purpose of this meeting was to provide a comprehensive, evidence-informed summary to support the clinician and help children with ACL injury and their parents/guardians make the best possible decisions. Representatives from the following societies attended: American Orthopaedic Society for Sports Medicine; European Paediatric Orthopaedic Society; European Society for Sports Traumatology, Knee Surgery, and Arthroscopy; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; Pediatric Orthopaedic Society of North America; and Sociedad Latinoamericana de Artroscopia, Rodilla, y Deporte. Physical therapists and orthopaedic surgeons with clinical and research experience in the field and an ethics expert with substantial experience in the area of sports injuries also participated. This consensus statement addresses 6 fundamental clinical questions regarding the prevention, diagnosis, and management of pediatric ACL injuries. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision making with children and the potential long-term ramifications of the injury. PMID:29594177

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harper, J.; Amiel, D.; Harper, E.

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

Alterations of the transverse ligament: an MRI study comparing patients with acute whiplash and matched control subjects.

PubMed

Ulbrich, Erika Jasmin; Eigenheer, Sandra; Boesch, Chris; Hodler, Juerg; Busato, André; Schraner, Christian; Anderson, Suzanne E; Bonel, Harald; Zimmermann, Heinz; Sturzenegger, Matthias

2011-10-01

The objective of our study was to evaluate whether there is injury to the transverse ligament of the atlas in patients with acute whiplash. Ninety patients with an acute (< 48 hours) symptomatic whiplash-associated injury and 90 healthy age- and sex-matched asymptomatic control subjects (mean age of patients and control subjects, 36 years) were included. The maximal sagittal thickness of the transverse ligament was measured on midsagittal T1 volumetric interpolated breath-hold examination (VIBE) images and transverse reformatted VIBE images. The signal intensity of the transverse ligament was measured on transverse STIR images and on transverse reformatted T1 VIBE images before and after IV administration of gadoterate. Contrast between the transverse ligament and CSF and alterations of contrast after gadoterate injection were calculated. Patients had a minimally thicker transverse ligament (posttraumatic swelling) than control subjects, and the difference in thickness was significant in men only (p = 0.03). In patients, a significant signal alteration of the transverse ligament (p = 0.03) was seen on STIR (posttraumatic edema) and native VIBE sequences. The contrast between the transverse ligament and the CSF on VIBE images was significantly (p = 0.005) lower in patients than in control subjects. With the application of a contrast agent, the contrast difference between the transverse ligament and CSF in patients and control subjects was less pronounced (p = 0.038). There was no abnormal uptake of contrast agent by the transverse ligament or CSF. The results of our study indicate possible involvement of the transverse ligament in whiplash injury. Although MRI may be helpful to study injury-related changes of anatomic structures in cohorts, it is not suited for individual diagnosis because the alterations are too small.

Trends in Materials Science for Ligament Reconstruction.

PubMed

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

2017-01-01

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

Loading rate effect on mechanical properties of cervical spine ligaments.

PubMed

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

2014-01-01

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

Melphalan-induced apoptosis in multiple myeloma cells is associated with a cleavage of Mcl-1 and Bim and a decrease in the Mcl-1/Bim complex.

PubMed

Gomez-Bougie, Patricia; Oliver, Lisa; Le Gouill, Steven; Bataille, Régis; Amiot, Martine

2005-12-01

Multiple myeloma (MM) is a rapidly fatal plasma-cell malignancy that evolves mainly in the bone marrow. Melphalan is widely used to treat patients with MM but as yet its mechanisms of action are poorly documented. In the current study, we demonstrate that melphalan induces a drastic downregulation of Mcl-1L, Bcl-x(L) and BimEL in human melphalan-sensitive myeloma cells while the most potent proapoptotic isoforms, BimL and S, are affected to a lesser extent. Moreover, Mcl-1L and BimEL disappearance is associated with the generation of proapoptotic cleaved forms generated by a caspase cleavage. In myeloma cells, we have previously shown that Mcl-1 neutralizes the proapoptotic function of Bim and therefore, prevents the activation of death effectors. In this study, we demonstrate that melphalan disrupts the Mcl-1/Bim complex whereas the Bcl-2/Bim complex is not modified. The disappearance of full length Mcl-1 allows the release of Bim isoforms, particularly L and S, which can exert their proapoptotic function and leads to Bax activation and cytochrome c release. Thus, we can hypothesize that the cleaved 26 kDa proapoptotic Mcl-1 and the 19 and 12 kDa of Bim, generated during melphalan treatment could contribute to the amplification loop of apoptosis.

Management of acromioclavicular joint injuries.

PubMed

Li, Xinning; Ma, Richard; Bedi, Asheesh; Dines, David M; Altchek, David W; Dines, Joshua S

2014-01-01

Acromioclavicular joint injuries are among the most common shoulder girdle injuries in athletes and most commonly result from a direct force to the acromion with the arm in an adducted position. Acromioclavicular joint injuries often present with associated injuries to the glenohumeral joint, including an increased incidence of superior labrum anterior posterior (SLAP) tears that may warrant further evaluation and treatment. Anteroposterior stability of the acromioclavicular joint is conferred by the capsule and acromioclavicular ligaments, of which the posterior and superior ligaments are the strongest. Superior-inferior stability is maintained by the coracoclavicular (conoid and trapezoid) ligaments. Type-I or type-II acromioclavicular joint injuries have been treated with sling immobilization, early shoulder motion, and physical therapy, with favorable outcomes. Return to activity can occur when normal shoulder motion and strength are obtained and the shoulder is asymptomatic as compared with the contralateral normal extremity. The management of type-III injuries remains controversial and is individualized. While a return to the previous level of functional activity with nonsurgical treatment has been documented in a number of case series, surgical reduction and coracoclavicular ligament reconstruction has been associated with a favorable outcome and can be considered in patients who place high functional demands on their shoulders or in athletes who participate in overhead sports. Surgical management is indicated for high-grade (≥type IV) acromioclavicular joint injuries to achieve anatomic reduction of the acromioclavicular joint, reconstruction of the coracoclavicular ligaments, and repair of the deltotrapezial fascia. Outcomes after surgical reconstruction of the coracoclavicular ligaments have been satisfactory with regard to achieving pain relief and return to functional activities, but further improvements in the biomechanical strength of these

Different roles of the medial and lateral hamstrings in unloading the anterior cruciate ligament.

PubMed

Guelich, David R; Xu, Dali; Koh, Jason L; Nuber, Gordon W; Zhang, Li-Qun

2016-01-01

Anterior cruciate ligament injuries are closely associated with excessive loading and motion about the off axes of the knee, i.e. tibial rotation and knee varus/valgus. However, it is not clear about the 3-D mechanical actions of the lateral and medial hamstring muscles and their differences in loading the ACL. The purpose of this study was to investigate the change in anterior cruciate ligament strain induced by loading the lateral and medial hamstrings individually. Seven cadaveric knees were investigated using a custom testing apparatus allowing for six degree-of-freedom tibiofemoral motion induced by individual muscle loading. With major muscles crossing the knee loaded moderately, the medial and lateral hamstrings were loaded independently to 200N along their lines of actions at 0°, 30°, 60° and 90° of knee flexion. The induced strain of the anterior cruciate ligament was measured using a differential variable reluctance transducer. Tibiofemoral kinematics was monitored using a six degrees-of-freedom knee goniometer. Loading the lateral hamstrings induced significantly more anterior cruciate ligament strain reduction (mean 0.764 [SD 0.63] %) than loading the medial hamstrings (mean 0.007 [0.2] %), (P=0.001 and effect size=0.837) across the knee flexion angles. The lateral and medial hamstrings have significantly different effects on anterior cruciate ligament loadings. More effective rehabilitation and training strategies may be developed to strengthen the lateral and medial hamstrings selectively and differentially to reduce anterior cruciate ligament injury and improve post-injury rehabilitation. The lateral and medial hamstrings can potentially be strengthened selectively and differentially as a more focused rehabilitation approach to reduce ACL injury and improve post-injury rehabilitation. Different ACL reconstruction procedures with some of them involving the medial hamstrings can be compared to each other for their effect on ACL loading. Copyright �

Mouse Noxa uses only the C-terminal BH3-domain to inactivate Mcl-1.

PubMed

Weber, Arnim; Ausländer, David; Häcker, Georg

2013-09-01

Noxa is a member of the pro-apoptotic BH3-only group of Bcl-2 proteins that is known to bind specifically to anti-apoptotic Mcl-1 and A1, antagonizing their function. Mcl-1 has been reported to have a short half-life, and Noxa up-regulation accelerates Mcl-1 degradation by the proteasome. Unlike human Noxa, mouse Noxa has two BH3-domains, which both have affinity for Mcl-1. We here investigate two aspects of the molecular function of Noxa, namely the requirements for the two BH3-domains in mouse Noxa and the role of Noxa in Mcl-1-degradation. We found that only the C-terminal BH3-domain of mouse Noxa is active in neutralizing Mcl-1. This was the result of the targeting of Noxa to the outer mitochondrial membrane through its C-terminal alpha-helix, which allowed Mcl-1-neutralization only when the BH3-domain was immediately N-terminal of the membrane anchor. However, the N-terminal BH3-domain enhanced interaction with Mcl-1 and A1. The Noxa-dependent degradation of Mcl-1 was independent of the kinase GSK3 and the deubiquitinase Usp9x in mouse embryonic fibroblasts. These data show that Noxa is targeted to the mitochondrial membrane where it neutralises Mcl-1 via its C-terminal BH3-domain and suggest that Noxa is co-degraded with Noxa, in a way independent of ubiquitin-modifying enzymes described for Mcl-1.

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

PubMed

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

2014-04-16

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

Effects of anterior cruciate ligament injury on neuromuscular tensiomyographic characteristics of the lower extremity in competitive male soccer players.

PubMed

Alvarez-Diaz, Pedro; Alentorn-Geli, Eduard; Ramon, Silvia; Marin, Miguel; Steinbacher, Gilbert; Boffa, Juan José; Cuscó, Xavier; Ares, Oscar; Ballester, Jordi; Cugat, Ramon

2016-07-01

To investigate the effects of anterior cruciate ligament injury on mechanical and contractile characteristics of the skeletal muscles of the lower extremity in competitive soccer players through tensiomyography (TMG). All competitive male soccer players with confirmed acute anterior cruciate ligament tear included underwent resting TMG assessment of muscles of both lower extremities before anterior cruciate ligament reconstruction. The same values were obtained from a sex- and sports level-matched control group. The maximal displacement, delay time, contraction time, sustained time, and half-relaxation time were obtained for the following muscles in all subjects: vastus medialis, vastus laterals, rectus femoris, semitendinosus, biceps femoris, gastrocnemius medialis, and gastrocnemius lateralis. The majority of TMG parameters were higher in the injured compared to the control group. The contraction time of the vastus medialis, vastus lateralis, and rectus femoris was significantly higher in the injured compared to the control group (p = 0.003, p = 0.001, and p < 0.001, respectively). The biceps femoris was the only hamstring muscle with significant differences between groups, with increased contraction time and maximal displacement in the injured compared to the control group (p = 0.002 and p < 0.001, respectively). The gastrocnemius medialis was clearly more affected than the gastrocnemius lateralis, with contraction time, half-relaxation time, and maximal displacement significantly higher (p = 0.01, p = 0.03, and p < 0.001, respectively), and the sustained time significantly lower (p = 0.01), in the injured compared to the control group. The contraction time of the vastus medialis, vastus lateralis, rectus femoris, semitendinosus, and biceps femoris was significantly higher in the injured compared to non-injured side in the anterior cruciate ligament-injured group (p = 0.007, p = 0.04, p = 0.004, p = 0.02, and p = 0.02, respectively

Equivalent Knee Injury and Osteoarthritis Outcome Scores 12 and 24 Months After Anterior Cruciate Ligament Reconstruction: Results From the Swedish National Knee Ligament Register.

PubMed

Samuelsson, Kristian; Magnussen, Robert A; Alentorn-Geli, Eduard; Krupic, Ferid; Spindler, Kurt P; Johansson, Christer; Forssblad, Magnus; Karlsson, Jón

2017-07-01

It is not clear whether Knee injury and Osteoarthritis Outcome Score (KOOS) results will be different 1 or 2 years after anterior cruciate ligament (ACL) reconstruction. To investigate within individual patients enrolled in the Swedish National Knee Ligament Register whether there is equivalence between KOOS at 1 and 2 years after primary ACL reconstruction. Cohort study; Level of evidence, 2. This cohort study was based on data from the Swedish National Knee Ligament Register during the period January 1, 2005, through December 31, 2013. The longitudinal KOOS values for each individual at the 1- and 2-year follow-up evaluations were assessed through the two one-sided test (TOST) procedure with an acceptance criterion of 4. Subset analysis was performed with patients classified by sex, age, graft type, and type of injury (meniscal and/or cartilage injury). A total of 23,952 patients were eligible for analysis after exclusion criteria were applied (10,116 women, 42.2%; 13,836 men, 57.8%). The largest age group was between 16 and 20 years of age (n = 6599; 27.6%). The most common ACL graft was hamstring tendon (n = 22,504; 94.0%), of which the combination of semitendinosus and gracilis was the most common. A total of 7119 patients reported on the KOOS Pain domain at both 1- and 2-year follow-ups, with a mean difference of 0.21 (13.1 SD, 0.16 SE [90% CI, -0.05 to 0.46], P < .001). The same results were found for the other KOOS subscales: symptoms (mean difference -0.54, 14.1 SD, 0.17 SE [90% CI, -0.81 to -0.26], P < .001), activities of daily living (mean difference 0.45, 10.8 SD, 0.13 SE [90% CI, 0.24 to 0.66], P < .001), sports and recreation (mean difference -0.35, 22.7 SD, 0.27 SE [90% CI, -0.79 to 0.09], P < .001), quality of life (mean difference -0.92, 20.0 SD, 0.24 SE [90% CI, -1.31 to -0.53], P < .001), and the combined KOOS-4 score (mean difference -0.41, 14.5 SD, 0.17 SE [90% CI, -0.70 to -0.13], P < .001). Analyses within specific subsets of patients showed

Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction

PubMed Central

Wiggins, Amelia J.; Grandhi, Ravi K.; Schneider, Daniel K.; Stanfield, Denver; Webster, Kate E.; Myer, Gregory D.

2017-01-01

Background Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized. Purpose To provide a current review of the literature to evaluate age and activity level as the primary risk factors in reinjury after ACLR. Study Design Systematic review and meta-analysis. Methods A systematic review of the literature was conducted via searches in PubMed (1966 to July 2015) and EBSCO host (CINAHL, Medline, SPORTDiscus [1987 to July 2015]). After the search and consultation with experts and rating of study quality, 19 articles met inclusion for review and aggregation. Population demographic data and total reinjury (ipsilateral and contralateral) rate data were recorded from each individual study and combined using random-effects meta-analyses. Separate meta-analyses were conducted for the total population data as well as the following subsets: young age, return to sport, and young age + return to sport. Results Overall, the total second ACL reinjury rate was 15%, with an ipsilateral reinjury rate of 7% and contralateral injury rate of 8%. The secondary ACL injury rate (ipsilateral + contralateral) for patients younger than 25 years was 21%. The secondary ACL injury rate for athletes who return to a sport was also 20%. Combining these risk factors, athletes younger than 25 years who return to sport have a secondary ACL injury rate of 23%. Conclusion This systematic review and meta-analysis demonstrates that younger age and a return to high level of activity are salient factors associated with secondary ACL injury. These combined data indicate that nearly 1 in 4 young athletic patients who sustain an ACL injury and return to high-risk sport

Return to Sport After Pediatric Anterior Cruciate Ligament Reconstruction and Its Effect on Subsequent Anterior Cruciate Ligament Injury.

PubMed

Dekker, Travis J; Godin, Jonathan A; Dale, Kevin M; Garrett, William E; Taylor, Dean C; Riboh, Jonathan C

2017-06-07

Anterior cruciate ligament (ACL) graft failure and contralateral ACL tears are more frequent in children and adolescents than adults. The reasons for higher subsequent injury rates in this population are incompletely understood. We analyzed a continuous cohort of patients who were <18 years of age. Subjects underwent isolated, primary ACL reconstruction with autograft between 2006 and January 1, 2014, and had a minimum 2-year follow-up. Return-to-sport characteristics were described, and multivariable Cox regression modeling was used to identify predictors of a second ACL injury. Candidate variables included patient factors (age, sex, physeal status, tibial slope, notch width index), surgical characteristics (graft type, surgical technique), measures of recovery (time to return to sport, duration of physical therapy), and patients' preoperative and postoperative sports involvement (primary and secondary sports, number of sports). A total of 112 subjects met inclusion criteria; of these patients, 85 (76%) had complete follow-up data and were analyzed. The mean age (and standard deviation) was 13.9 ± 2.1 years (range, 6 to 17 years); 77% had open physes. The mean follow-up was 48.3 ± 15.3 months. Seventy-seven patients (91%) returned to sports, and 84% returned to the same sport. The mean Marx activity score at the time of the latest follow-up was 13.7 ± 3.5 points. Patients were involved in fewer sports after ACL reconstruction, 1.48 ± 0.92 compared with 1.83 ± 1.01 sports before reconstruction (p = 0.002). Sixteen patients (19%) sustained an ACL graft rupture, 11 patients (13%) sustained a contralateral ACL tear, and 1 of these patients (1%) sustained both. The overall prevalence of a second ACL injury was 32%. Time to return to sport was the only significant predictor of a second ACL injury, with a slower return being protective (hazard ratio per month, 0.87 [95% confidence interval, 0.73 to 0.99]; p = 0.04). Pediatric athletes return to sports at a high rate

Molecular dynamics study of segment peptides of Bax, Bim, and Mcl-1 BH3 domain of the apoptosis-regulating proteins bound to the anti-apoptotic Mcl-1 protein.

PubMed

Zhao, Run-Ning; Fan, Song; Han, Ju-Guang; Liu, Guang

2015-01-01

Mcl-1 has emerged as a potential therapeutic target in the treatment of several malignancies. Peptides representing BH3 region of pro-apoptotic proteins have been shown to bind the hydrophobic cleft of anti-apoptotic Mcl-1 and this segment is responsible for modulating the apoptotic pathways in living cells. Understanding the molecular basis of protein-peptide interaction is required to develop potent inhibitors specific for Mcl-1. Molecular dynamics simulations were performed for Mcl-1 in complex with three different BH3 peptides derived from Mcl-1, Bax, and Bim. Accordingly, the calculated binding free energies using MM-PBSA method are obtained and comparison with the experimentally determined binding free energies is made. The interactions involving two conserved charged residues (Aspi, and Arg/Lysi-4) and three upstream conserved hydrophobic residues (Leui-5, Ile/Vali-2, and Glyi-1, respectively) of BH3 peptides play the important roles in the structural stability of the complexes. The calculated results exhibit that the interactions of Bim BH3 peptides to Mcl-1 is stronger than the complex with Bax 19BH3 peptides. The hydrophobic residues (position i - 9, i - 8 and i + 2) of BH3 peptides can be involved in their inhibitory specificity. The calculated results can be used for designing more effective MCL-1 inhibitors.

Change-of-Direction Biomechanics: Is What's Best for Anterior Cruciate Ligament Injury Prevention Also Best for Performance?

PubMed

Fox, Aaron S

2018-05-02

Change-of-direction maneuvers (e.g., side-step cutting) are an important aspect of performance in multi-directional sports, but these maneuvers are also associated with anterior cruciate ligament (ACL) injury. Despite this, the impact of biomechanics on ACL injury risk and performance is often examined in isolation. The purpose of this review was to examine the alignment between biomechanical recommendations for ACL injury prevention and performance with regard to change-of-direction maneuvers. Several studies linking change-of-direction biomechanics to both ACL injury risk and performance were examined. A degree of overlap was identified between biomechanical strategies that could both reduce ACL injury risk and enhance performance during change-of-direction maneuvers. A fore-foot footfall pattern along with trunk rotation and lateral flexion in the intended cutting direction were identified as biomechanical strategies that could both reduce potentially hazardous knee joint moments and enhance change-of-direction speed. Minimizing knee valgus during change-of-direction maneuvers may also reduce ACL injury risk, with this biomechanical strategy found to have no impact on performance. Certain biomechanical strategies proposed to reduce ACL injury risk were linked to reduced change-of-direction performance. A narrow foot placement and "soft" landings with greater knee flexion were identified as ACL injury prevention strategies that could have a negative impact on performance. The findings of this review emphasize the need to consider both ACL injury risk and performance when examining the biomechanics of change-of-direction maneuvers.

Prediction of posterior ligamentous complex injury in thoracolumbar fractures using non-MRI imaging techniques.

PubMed

Rajasekaran, Shanmuganathan; Maheswaran, Anupama; Aiyer, Siddharth N; Kanna, Rishi; Dumpa, Srikanth Reddy; Shetty, Ajoy Prasad

2016-06-01

We aimed to formulate a radiological index based on plain radiographs and computer tomography (CT) to reliably detect posterior ligamentous complex (PLC) injury without need for MRI. Sixty out of 148 consecutive thoracolumbar fractures with doubtful PLC were assessed with MRI, CT and radiographs. PLC injury was assessed with the following radiological parameters: superior-inferior end plate angle (SIEA), vertebral body height (BH), local kyphosis (LK), inter-spinous distance (ISD) and inter-pedicular distance (IPD) and correlated with MRI findings of PLC injury. Statistical analysis was performed to identify the predictive values for the parameters to identify PLC damage. MRI identified PLC injury in 25/60 cases. The ISD and LK were found to be significant predictors of PLC injury. On radiographs the mean LK with PLC damage was 25.86° compared to 21.02° with an intact PLC (p = 0.006). The ISD difference was 6.70 mm in cases with PLC damage compared to 2.86 mm with an intact PLC (p = 0.011). In CT images, the mean LK with PLC damage was 22.96° compared to 18.44° with an intact PLC ( p = 0.019). The ISD difference was 3.10 mm with PLC damage compared to 1.62 mm without PLC damage (p = 0.005). On plain radiographs the presence of LK greater than 20 °(CI 64-95) and ISD difference greater than 2 mm (CI 70-97) can predict PLC injury. These guidelines may be utilised in the emergency room especially when the associated cost, availability and time delay in performing MRI are a concern.

Lateral thrust of anterior cruciate ligament-insufficient knees and posterior cruciate ligament-insufficient knees.

PubMed

Yoshimura, Ichiro; Naito, Masatoshi; Zhang, Jingfan

2002-01-01

Leaving anterior cruciate ligament (ACL) insufficiency and posterior cruciate ligament (PCL) insufficiency untreated frequently leads to osteoarthritis (OA). The purpose of this study was to evaluate dynamically the lateral thrust of ACL-insufficient knees and PCL-insufficient knees, and from the findings investigate the relationship between cruciate ligament insufficiency and OA occurrence. An acceleration sensor was attached to the affected and control anterior tibial tubercles, acting in medial-lateral and perpendicular directions. The lateral thrust immediately after heel strike was measured continuously by a telemeter under stabilised walking conditions. When compared to the contralateral healthy knee, the peak value of lateral acceleration immediately after heel strike was significantly larger in the ACL-insufficient knee; and lateral thrust was increased, but not significantly, in the PCL-insufficient knee. Given that lateral thrust of the knee during walking increases due to ACL or PCL injury, it may be a principal contributor to OA progression.

Mechanisms of anterior cruciate ligament injuries in elite women's netball: a systematic video analysis.

PubMed

Stuelcken, Max C; Mellifont, Daniel B; Gorman, Adam D; Sayers, Mark G L

2016-08-01

This study involved a systematic video analysis of 16 anterior cruciate ligament (ACL) injuries sustained by elite-level netball players during televised games in order to describe the game situation, the movement patterns involved, the player's behaviour, and a potential injury mechanism. Eight of the ACL injuries were classified as "indirect contact" and eight as "non-contact". Two common scenarios were identified. In Scenario A the player was jumping to receive or intercept a pass and whilst competing for the ball experienced a perturbation in the air. As a result the player's landing was unbalanced with loading occurring predominantly on the knee of the injured side. In Scenario B the player was generally in a good position at ground contact, but then noticeably altered the alignment of the trunk before the landing was completed. This involved rotating and laterally flexing the trunk without altering the alignment of the feet. Apparent knee valgus collapse on the knee of the injured side was observed in 3/6 Scenario A cases and 5/6 Scenario B cases. Players may benefit from landing training programmes that incorporate tasks that use a ball and include decision-making components or require players to learn to cope with being unbalanced.

The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up.

PubMed

Hughston, J C

1994-09-01

Forty-one of fifty patients (fifty knees) who had had a repair of an acute tear of the medial ligaments, a procedure in which repair of the posterior oblique ligament and the semimembranosus complex was emphasized, were re-evaluated after an average duration of follow-up of twenty-two years (range, eighteen to thirty years). The ages of the patients at the time of the injury had ranged from fifteen to twenty-one years. In twenty-four of the forty-one knees, the anterior cruciate ligament had been torn. In seventeen of these knees, the torn ligament had been debrided; in six others, which had had avulsion of a bone fragment or a terminal tear, the ligament had been repaired with absorbable sutures; and in the remaining knee, the repaired anterior cruciate ligament had been augmented. Four patients had had a pes anserinus transfer to supplement the medial repair. The medial meniscus had been intact or repaired in twenty-five of the forty-one knees and had been removed from the remaining sixteen. The lateral meniscus had been retained in thirty-nine knees and removed from two. Postoperatively, all knees had been immobilized for six weeks in 60 degrees of flexion by means of a plaster cast. This had not caused lasting loss of motion, persistent muscle atrophy, or clinically demonstrable deterioration of the articular cartilage. In the twenty-four knees that had had a tear of the anterior cruciate ligament, the rates of instability, meniscal injury, and deterioration of the joint had not increased since the time of treatment, compared with those in the knees with an intact ligament, even though repair and augmentation of this ligament had not been performed (except in one patient, in whom it was unsuccessful). Thirty-eight patients had good stability and a normal range of motion, as well as little or no muscle atrophy. Radiographic changes were slight or absent in all but four knees. Most patients had maintained a high level of physical fitness and recreational athletic

Sources of adult mesenchymal stem cells for ligament and tendon tissue engineering.

PubMed

Dhinsa, Baljinder S; Mahapatra, Anant N; Khan, Wasim S

2015-01-01

Tendon and ligament injuries are common, and repair slowly with reduced biomechanical properties. With increasing financial demands on the health service and patients to recover from tendon and ligament injuries faster, and with less morbidity, health professionals are exploring new treatment options. Tissue engineering may provide the answer, with its unlimited source of natural cells that in the correct environment may improve repair and regeneration of tendon and ligament tissue. Mesenchymal stem cells have demonstrated the ability to self renew and have multilineage differentiation potential. The use of bone marrow-derived mesenchymal stem cells has been reported, however significant in vitro culture expansion is required due to the low yield of cells, which has financial implications. Harvesting of bone marrow cells also has associated morbidity. Several studies have looked at alternative sources for mesenchymal stem cells. Reports in literature from animal studies have been encouraging, however further work is required. This review assesses the potential sources of mesenchymal stem cells for tissue engineering in tendons and ligaments.

Biomimetic tissue-engineered anterior cruciate ligament replacement

PubMed Central

Cooper, James A.; Sahota, Janmeet S.; Gorum, W. Jay; Carter, Janell; Doty, Stephen B.; Laurencin, Cato T.

2007-01-01

There are >200,000 anterior cruciate ligament (ACL) ruptures each year in the United States, and, due to the poor healing properties of the ACL, surgical reconstruction with autograft or allograft tissue is the current treatment of these injuries. To regenerate the ACL, the ideal matrix should be biodegradable, porous, and exhibit sufficient mechanical strength to allow formation of neoligament tissue. Researchers have developed ACL scaffolds with collagen fibers, silk, biodegradable polymers, and composites with limited success. Our group has developed a biomimetic ligament replacement by using 3D braiding technology. In this preliminary in vivo rabbit model study for ACL reconstruction, the histological and mechanical evaluation demonstrated excellent healing and regeneration with our cell-seeded, tissue-engineered ligament replacement. PMID:17360607

PuReD-MCL: a graph-based PubMed document clustering methodology.

PubMed

Theodosiou, T; Darzentas, N; Angelis, L; Ouzounis, C A

2008-09-01

Biomedical literature is the principal repository of biomedical knowledge, with PubMed being the most complete database collecting, organizing and analyzing such textual knowledge. There are numerous efforts that attempt to exploit this information by using text mining and machine learning techniques. We developed a novel approach, called PuReD-MCL (Pubmed Related Documents-MCL), which is based on the graph clustering algorithm MCL and relevant resources from PubMed. PuReD-MCL avoids using natural language processing (NLP) techniques directly; instead, it takes advantage of existing resources, available from PubMed. PuReD-MCL then clusters documents efficiently using the MCL graph clustering algorithm, which is based on graph flow simulation. This process allows users to analyse the results by highlighting important clues, and finally to visualize the clusters and all relevant information using an interactive graph layout algorithm, for instance BioLayout Express 3D. The methodology was applied to two different datasets, previously used for the validation of the document clustering tool TextQuest. The first dataset involves the organisms Escherichia coli and yeast, whereas the second is related to Drosophila development. PuReD-MCL successfully reproduces the annotated results obtained from TextQuest, while at the same time provides additional insights into the clusters and the corresponding documents. Source code in perl and R are available from http://tartara.csd.auth.gr/~theodos/

Stereoscopic filming for investigating evasive side-stepping and anterior cruciate ligament injury risk

NASA Astrophysics Data System (ADS)

Lee, Marcus J. C.; Bourke, Paul; Alderson, Jacqueline A.; Lloyd, David G.; Lay, Brendan

2010-02-01

Non-contact anterior cruciate ligament (ACL) injuries are serious and debilitating, often resulting from the performance of evasive sides-stepping (Ssg) by team sport athletes. Previous laboratory based investigations of evasive Ssg have used generic visual stimuli to simulate realistic time and space constraints that athletes experience in the preparation and execution of the manoeuvre. However, the use of unrealistic visual stimuli to impose these constraints may not be accurately identifying the relationship between the perceptual demands and ACL loading during Ssg in actual game environments. We propose that stereoscopically filmed footage featuring sport specific opposing defender/s simulating a tackle on the viewer, when used as visual stimuli, could improve the ecological validity of laboratory based investigations of evasive Ssg. Due to the need for precision and not just the experience of viewing depth in these scenarios, a rigorous filming process built on key geometric considerations and equipment development to enable a separation of 6.5 cm between two commodity cameras had to be undertaken. Within safety limits, this could be an invaluable tool in enabling more accurate investigations of the associations between evasive Ssg and ACL injury risk.

Physical injury risks associated with drinking water arsenic treatment.

PubMed

Frost, Floyd J; Chwirka, Joseph; Craun, Gunther F; Thomson, Bruce; Stomps, John

2002-04-01

We estimated the number of transportation deaths that would be associated with water treatment in Albuquerque to meet the EPA's recently proposed revisions of the Maximum Contaminant Level (MCL) for arsenic. Vehicle mileage was estimated for ion exchange, activated alumina, and iron coagulation/microfiltration water treatment processes to meet an MCL of 0.020 mg/L, 0.010 mg/L, 0.005 mg/L, and 0.003 mg/L. Local crash, injury, and death rates per million vehicle miles were used to estimate the number of injuries and deaths. Depending on the water treatment options chosen, we estimate that meeting an arsenic MCL of 0.005 mg/L will result in 143 to 237 crashes, 58 to 98 injuries, and 0.6 to 2.6 deaths in Albuquerque over a 70-year period, resulting in 26 to 113 years of life lost. The anticipated health benefits for Albuquerque residents from a 0.005 mg/L arsenic MCL, estimated using either a multistage Weibull or Poisson model, ranged from 3 to 80 arsenic-related bladder and lung cancer deaths prevented over a 70-year period, adding between 43 and 1,123 years of life. Whether a revised arsenic MCL increases or reduces overall loss of life in Albuquerque depends on the accuracy of EPA's cancer risk assessment. If the multistage Weibull model accurately estimates the benefits, the years of life added is comparable or lower than the anticipated years lost due to transportation associated with the delivery of chemicals, disposal of treatment waste, and operation of the water treatment system. Coagulation/microfiltration treatment will result in substantially fewer transportation deaths than either ion exchange or activated alumina.

Cafestol overcomes ABT-737 resistance in Mcl-1-overexpressed renal carcinoma Caki cells through downregulation of Mcl-1 expression and upregulation of Bim expression.

PubMed

Woo, S M; Min, K-J; Seo, B R; Nam, J-O; Choi, K S; Yoo, Y H; Kwon, T K

2014-11-06

Although ABT-737, a small-molecule Bcl-2/Bcl-xL inhibitor, has recently emerged as a novel cancer therapeutic agent, ABT-737-induced apoptosis is often blocked in several types of cancer cells with elevated expression of Mcl-1. Cafestol, one of the major compounds in coffee beans, has been reported to have anti-carcinogenic activity and tumor cell growth-inhibitory activity, and we examined whether cafestol could overcome resistance against ABT-737 in Mcl-1-overexpressed human renal carcinoma Caki cells. ABT-737 alone had no effect on apoptosis, but cafestol markedly enhanced ABT-737-mediated apoptosis in Mcl-1-overexpressed Caki cells, human glioma U251MG cells, and human breast carcinoma MDA-MB231 cells. By contrast, co-treatment with ABT-737 and cafestol did not induce apoptosis in normal human skin fibroblast. Furthermore, combined treatment with cafestol and ABT-737 markedly reduced tumor growth compared with either drug alone in xenograft models. We found that cafestol inhibited Mcl-1 protein expression, which is important for ABT-737 resistance, through promotion of protein degradation. Moreover, cafestol increased Bim expression, and siRNA-mediated suppression of Bim expression reduced the apoptosis induced by cafestol plus ABT-737. Taken together, cafestol may be effectively used to enhance ABT-737 sensitivity in cancer therapy via downregulation of Mcl-1 expression and upregulation of Bim expression.

Combined Volar Hamate Dislocation and Scapholunate Ligament Rupture: A Case Report.

PubMed

Walmsley, David; Dhotar, Herman; Geddes, Christopher; Axelrod, Terry

2015-04-22

A twenty-two-year-old male patient presented to our trauma center after a motor-vehicle accident in which he sustained multiple injuries, including a volar dislocation of the hamate and ipsilateral scapholunate dissociation. Following closed reduction of the hamate dislocation, open reduction and stabilization of these carpal injuries was undertaken two days post-injury via a dorsal approach. Percutaneous Kirschner wires were used as well as two mini suture anchors to repair the scapholunate ligament. The patient was immobilized for six weeks and Kirschner wires were removed at twelve weeks postoperatively. To our knowledge, hamate dislocation with scapholunate dissociation and its surgical treatment have not previously been described. Successful surgical treatment for this injury pattern may be performed dorsally via direct reduction and repair of the scapholunate ligament with percutaneous pinning of the affected carpal bones.

A Maltose-Binding Protein Fusion Construct Yields a Robust Crystallography Platform for MCL1

PubMed Central

Clifton, Matthew C.; Dranow, David M.; Leed, Alison; Fulroth, Ben; Fairman, James W.; Abendroth, Jan; Atkins, Kateri A.; Wallace, Ellen; Fan, Dazhong; Xu, Guoping; Ni, Z. J.; Daniels, Doug; Van Drie, John; Wei, Guo; Burgin, Alex B.; Golub, Todd R.; Hubbard, Brian K.; Serrano-Wu, Michael H.

2015-01-01

Crystallization of a maltose-binding protein MCL1 fusion has yielded a robust crystallography platform that generated the first apo MCL1 crystal structure, as well as five ligand-bound structures. The ability to obtain fragment-bound structures advances structure-based drug design efforts that, despite considerable effort, had previously been intractable by crystallography. In the ligand-independent crystal form we identify inhibitor binding modes not observed in earlier crystallographic systems. This MBP-MCL1 construct dramatically improves the structural understanding of well-validated MCL1 ligands, and will likely catalyze the structure-based optimization of high affinity MCL1 inhibitors. PMID:25909780

The superficial medial collateral ligament is the primary medial restraint to knee laxity after cruciate-retaining or posterior-stabilised total knee arthroplasty: effects of implant type and partial release.

PubMed

Athwal, Kiron K; Daou, Hadi El; Kittl, Christoph; Davies, Andrew J; Deehan, David J; Amis, Andrew A

2016-08-01

The aim of this study was to quantify the contributions of medial soft tissues to stability following cruciate-retaining (CR) or posterior-stabilised (PS) total knee arthroplasty (TKA). Using a robotic system, eight cadaveric knees were subjected to ±90-N anterior-posterior force, ±5-Nm internal-external and ±8-Nm varus-valgus torques at various flexion angles. The knees were tested intact and then with CR and PS implants, and successive cuts of the deep and superficial medial collateral ligaments (dMCL, sMCL) and posteromedial capsule (PMC) quantified the percentage contributions of each structure to restraining the applied loads. In implanted knees, the sMCL restrained valgus rotation (62 % across flexion angles), anterior-posterior drawer (24 and 10 %, respectively) and internal-external rotation (22 and 37 %). Changing from CR TKA to PS TKA increased the load on the sMCL when resisting valgus loads. The dMCL restrained 11 % of external and 13 % of valgus rotations, and the PMC was significant at low flexion angles. This work has shown that medial release in the varus knee should be minimised, as it may inadvertently result in a combined laxity pattern. There is increasing interest in preserving constitutional varus in TKA, and this work argues for preservation of the sMCL to afford the surgeon consistent restraint and maintain a balanced knee for the patient.

The potential European genetic predisposition for non-contact anterior cruciate ligament injury.

PubMed

Astur, Diego Costa; Andrade, Edilson; Arliani, Gustavo Gonçalves; Debieux, Pedro; Loyola, Leonor Casilla; Dos Santos, Sidney Emanuel Batista; Burbano, Rommel Mario Rodriguez; Leal, Mariana Ferreira; Cohen, Moises

2018-05-04

Previous research has provided evidence of a hereditary predisposition for anterior cruciate ligament (ACL) injury. The purpose of this study was to evaluate the association between ancestral population genetics and risk of non-contact ACL injuries. Blood samples were collected from 177 individuals with a history of non-contact ACL injury and 556 non-injured control individuals for analysis of the genetic material through the use of a panel of 48 INDELs ancestry genetic markers from three ancestral origins. Among patients with non-contact ACL injury, 82% were male and 18% were female. In the control group, 78% were male, and 22% were female. The mean age of the non-contact ACL injury group was 31.7 years (± 10.2), and the control group was 33.8 years (± 13.2). The individual genetic contribution from INDELs of each ancestral origin varied considerably: ranging between 1.5-94.8% contribution for INDELs of African origin (mean of 21.4% of INDELs); between 2 and 96.1% contribution for INDELs of European origin (mean of 66.7% of INDELs); and between 1.3-96.4% contribution for INDELs of Amerindian origin (mean of 11.7% of INDELs). When comparing paired subjects from the non-contact ACL and control groups, the genetic analysis showed that the European ancestry score was higher in the non-contact ACL group than control group (0.70 ± 0.21 vs 0.63 ± 0.22 respectively, p < 0.001), whereas African ancestry scores (ACL group 0.18 ± 0.18 vs control group 0.24 ± 0.21, p < 0.001) and Amerindian ancestry scores (ACL group 0.11 ± 0.09 vs control group 0.12 ± 0.10, n.s.) were lower among the non-contact ACL group than in controls. European INDELs markers were found to represent a potential genetic predisposition for non-contact ACL injuries when compared to African and Amerindian INDELs. This study has the potential to correlate a measurable and distinct genetic marker with risk of a non-contact ACL injury. Thus, it increases knowledge

Creep behaviour and creep mechanisms of normal and healing ligaments

NASA Astrophysics Data System (ADS)

Thornton, Gail Marilyn

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

Magnetic Resonance Imaging Predictors of Failure in the Nonoperative Management of Ulnar Collateral Ligament Injuries in Professional Baseball Pitchers.

PubMed

Frangiamore, Salvatore J; Lynch, T Sean; Vaughn, Michael D; Soloff, Lonnie; Forney, Michael; Styron, Joseph F; Schickendantz, Mark S

2017-07-01

A medial ulnar collateral ligament (UCL) injury of the elbow is an increasingly common injury in professional baseball pitchers. Predictors of success and failure are not well defined for the nonoperative management of these injuries. To evaluate the efficacy of objective measures to predict failure of the nonoperative management of UCL injuries. Case-control study; Level of evidence, 3. Thirty-two professional pitchers (82%) met inclusion criteria and underwent an initial trial of nonoperative treatment for UCL tears based on clinical and radiological findings. Age, preseason physical examination results, magnetic resonance imaging (MRI) characteristics, and performance metrics were analyzed for these pitchers. Successful nonoperative management was defined as a return to the same level of play or higher for >1 year. Failure was defined as recurrent pain or weakness requiring a surgical intervention after a minimum of 3 months' rest when attempting a return to a throwing rehabilitation program. Thirty-two pitchers (mean age, 22.3 years) who underwent initial nonoperative treatment of UCL injuries were evaluated. Thirty-four percent (11/32) failed and required subsequent ligament reconstruction. Sixty-six percent (21/32) successfully returned to the same level of play for 1 year without a surgical intervention. There was no significant difference seen in physical examination findings or performance metrics between these patients. When comparing MRI findings between the groups, 82% (9/11) ( P < .001) who failed nonoperative management had distal tears, and 81% (17/21) who did not fail had proximal tears ( P < .001). When adjusting for age, location, and evidence of chronic changes on MRI, the likelihood of failing nonoperative management was 12.40 times greater ( P = .020) with a distal tear. No other variable alone or in combination reached significance. When combining the parameters of a high-grade tear and distal location, 88% (7/8) failed nonoperative management

Ultrasound phonophoresis of panax notoginseng improves the strength of repairing ligament: a rat model.

PubMed

Ng, Gabriel Y F; Wong, Richard Y F

2008-12-01

This study examined the phonophoretic effect of a therapeutic ultrasound coupled with a Panax notoginseng (PN) gel and compared it with a therapeutic ultrasound alone for medial collateral ligament repair in rats. Twenty mature male Sprague-Dawley rats receiving surgical transection to the left medial collateral ligament (MCL) were divided randomly into three groups: ultrasound (US, n = 7), ultrasound with PN coupling gel (PNUS, n = 7) and control (n = 6). The treatments started on day 3 after surgery for six days per week over a two-week period. The US group received 4 min of pulsed ultrasound (1 MHz) at the intensity of 0.5W/cm(2) with a normal ultrasonic coupling gel. The PNUS group received the same ultrasound treatment, but with a coupling gel that contained PN extract. The control group received a placebo ultrasound treatment similar to the other two groups. On day 17, the ligaments were mechanically tested for load-relaxation, stiffness and ultimate tensile strength (UTS). Values of the left side were normalized against that of the right side of each animal for analysis. Results revealed significantly higher normalized stiffness (p = 0.009) and UTS (p = 0.022) in the PNUS group than the other two groups, but insignificant difference in load-relaxation among all groups. This study reveals a positive ultrasonic phonophoretic effect of Panax notoginseng extract for improving the strength of ligament repair than ultrasound therapy alone.

Metformin enhances TRAIL-induced apoptosis by Mcl-1 degradation via Mule in colorectal cancer cells.

PubMed

Park, Seong Hye; Lee, Dae-Hee; Kim, Jung Lim; Kim, Bo Ram; Na, Yoo Jin; Jo, Min Jee; Jeong, Yoon A; Lee, Suk-Young; Lee, Sun Il; Lee, Yong Yook; Oh, Sang Cheul

2016-09-13

Metformin is an anti-diabetic drug with a promising anti-cancer potential. In this study, we show that subtoxic doses of metformin effectively sensitize human colorectal cancer (CRC) cells to tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL), which induces apoptosis. Metformin alone did not induce apoptosis, but significantly potentiated TRAIL-induced apoptosis in CRC cells. CRC cells treated with metformin and TRAIL showed activation of the intrinsic and extrinsic pathways of caspase activation. We attempted to elucidate the underlying mechanism, and found that metformin significantly reduced the protein levels of myeloid cell leukemia 1 (Mcl-1) in CRC cells and, the overexpression of Mcl-1 inhibited cell death induced by metformin and/or TRAIL. Further experiments revealed that metformin did not affect mRNA levels, but increased proteasomal degradation and protein stability of Mcl-1. Knockdown of Mule triggered a significant decrease of Mcl-1 polyubiquitination. Metformin caused the dissociation of Noxa from Mcl-1, which allowed the binding of the BH3-containing ubiquitin ligase Mule followed by Mcl-1ubiquitination and degradation. The metformin-induced degradation of Mcl-1 required E3 ligase Mule, which is responsible for the polyubiquitination of Mcl-1. Our study is the first report indicating that metformin enhances TRAIL-induced apoptosis through Noxa and favors the interaction between Mcl-1 and Mule, which consequently affects Mcl-1 ubiquitination.

Osteoligamentous injuries of the medial ankle joint.

PubMed

Lötscher, P; Lang, T H; Zwicky, L; Hintermann, B; Knupp, M

2015-12-01

Injuries of the ankle joint have a high incidence in daily life and sports, thus, playing an important socioeconomic role. Therefore, proper diagnosis and adequate treatment are mandatory. While most of the ligament injuries around the ankle joint are treated conservatively, great controversy exists on how to treat deltoid ligament injuries in ankle fractures. Missed injuries and inadequate treatment of the medial ankle lead to inferior outcome with instability, progressive deformity, and ankle joint osteoarthritis.

Degradation of Mcl-1 by granzyme B: implications for Bim-mediated mitochondrial apoptotic events.

PubMed

Han, Jie; Goldstein, Leslie A; Gastman, Brian R; Froelich, Christopher J; Yin, Xiao-Ming; Rabinowich, Hannah

2004-05-21

Recent studies have suggested that in the absence of Bid, granzyme B (GrB) can utilize an unknown alternative pathway to mediate mitochondrial apoptotic events. The current study has elucidated just such a pathway for GrB-mediated mitochondrial apoptotic alterations. Two Bcl-2 family members have been identified as interactive players in this newly discovered mitochondrial response to GrB: the pro-survival protein Mcl-1L and the pro-apoptotic protein, Bim. Expression of Mcl-1L, which localizes mainly to the outer mitochondrial membrane, decreases significantly in cells subjected to CTL-free cytotoxicity mediated by a combination of GrB and replication-deficient adenovirus. The data suggest that Mcl-1L is a substrate for GrB and for caspase-3, but the two enzymes appear to target different cleavage sites. The cleavage pattern of endogenous Mcl-1L resembles that of in vitro translated Mcl-1L subjected to similar proteolytic activity. Co-immunoprecipitation experiments performed with endogenous as well as with in vitro translated proteins suggest that Mcl-1L is a high affinity binding partner of the three isoforms of Bim (extra-long, long, and short). Bim, a BH3-only protein, is capable of mediating the release of mitochondrial cytochrome c, and this activity is inhibited by the presence of exogenous Mcl-1L. The findings presented herein imply that Mcl-1L degradation by either GrB or caspase-3 interferes with Bim sequestration by Mcl-1L.

Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy

PubMed Central

Behairy, Noha H.; Dorgham, Mohsen A.

2008-01-01

The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. Level of evidence: 4. PMID:18506445

A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

PubMed Central

Marieswaran, M.; Jain, Ishita; Garg, Bhavuk; Sharma, Vijay

2018-01-01

The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on

Demographics and Injuries Associated With Knee Dislocation: A Prospective Review of 303 Patients

PubMed Central

Moatshe, Gilbert; Dornan, Grant J.; Løken, Sverre; Ludvigsen, Tom C.; LaPrade, Robert F.; Engebretsen, Lars

2017-01-01

Background: Information on the incidence, injury mechanisms, ligament injury patterns, and associated injuries of knee dislocations is lacking in the literature. There is a need to characterize ligament injury patterns and associated injuries in knee dislocations to avoid missing common associated diagnoses and to plan surgical treatment. Purpose: To evaluate patient demographics, ligament injury patterns and associated injury patterns, and associated injuries in patients with knee dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 303 patients with knee dislocations treated at a single level 1 trauma center were followed prospectively. Injury mechanism; ligament injury patterns; associated neurovascular, meniscal, and cartilage injuries; and surgical complications were recorded. The Schenck knee dislocation classification was used to classify the ligament injury patterns. Results: The mean age at injury was 37.8 ± 15.3 years. Of the 303 patients included, 65% were male and 35% were female. There was an equal distribution of high-energy and low-energy injuries. Injury to 3 major ligaments was the most common, with Schenck classification type KD III-M constituting 52.4% of the injuries and KD III-L comprising 28.1%. Meniscal injuries and cartilage injuries occurred in 37.3% and 28.3% of patients, respectively. Patients with acute injuries had significantly lower odds of a cartilage injury than those with chronic injuries (odds ratio [OR], 0.28; 95% CI, 0.15-0.50; P < .001). Peroneal nerve injuries were recorded in 19.2% of patients (10.9% partial and 8.3% complete deficit), while vascular injuries were recorded in 5%. The odds of having a common peroneal nerve injury were 42 times greater (P < .001) among those with posterolateral corner injury (KD III-L) than those without. The odds for popliteal artery injury were 9 times greater (P = .001) among those with KD III-L injuries than other ligament injury types. Conclusion

[Evaluation of early physiotherapy in patients after surgical treatment of cruciate ligament injury by bone-tendon-bone method].

PubMed

Klupiński, Kamil; Krekora, Katarzyna; Woldańska-Okońska, Marta

2014-01-01

Anterior cruciate ligament (ACL) is one of the most important structures of the knee joint. It has a stabilizing function and causes sliding movement between the articular surfaces. Most frequently there comes to the anterior cruciate ligament injury during practicing sports such as skiing, football, sports which require sudden turns and those which are associated with jumps for height like basketball and volleyball. The aim of study was to evaluate of the outcomes of complex physiotherapy after reconstruction of anterior cruciate ligament by bone -tendon-bone (BTB) method. The study involved 41 patients, 8 women and 33 men, aged 20 to 45 years, body height 1.60-1.90 cm and body weight 50-100 kg. The patients were divided into two groups. Group I included 26 patients (3 women and 23 men) after arthroscopic ACL reconstruction. Group II--control-group included 15 patients (5 women and 10 men) after ACL injury but not subjected to the ligament reconstruction. The patients from both groups underwent rehabilitation according to the same rehabilitation program suggested by the Medical Magnus Clinic in Lodz, which consisted in performing daily exercises in open and closed kinetic chains. All group I and II patients were examined three times: after surgery (before the start of the rehabilitation), in the sixth week of rehabilitation and 12 weeks afterwards. The clinical examination included: measurement of the range of movement in the knee joint, the measurement of musculoskeletal strength with Lovett scale, knee pain assessment using Visual Analog Scale (VAS), transpatellar anthropometric measurement of the knee joint, linear measurements of the thigh and shin (at two points: 5 and 10 cm above the patellar apex and at two points: 5 and 10 cm below the patellar base). Introduction of early highly specialized physiotherapy has been demonstrated to contribute to the improvement of the rehabilitation outcomes and to the shortening of the therapy. A statistically significant

Differential responses of Mcl-1 in photosensitized epithelial vs lymphoid-derived human cancer cells.

PubMed

Xue, Liang-yan; Chiu, Song-mao; Oleinick, Nancy L

2005-10-20

The antiapoptotic Bcl-2-family proteins, Bcl-2 and Bcl-xL, are recognized phototargets of photodynamic therapy (PDT) with the mitochondrion-targeting phthalocyanine photosensitizer Pc 4. In the present study, we found that myeloid cell leukemia 1 (Mcl-1), another antiapoptotic member of the Bcl-2 family, was not photodamaged in Pc 4-PDT-treated human carcinoma cells MCF-7c3, MDA-MB468, DU145, and A431, although Mcl-1 turnover was observed after exposure of HeLa or MCF-7c3 cells to a supralethal dose of UVC. In contrast, when human lymphoma U937 and Jurkat cells were treated with Pc 4-PDT, staurosporine (STS) or UVC, Mcl-1 was cleaved to generate a 28-kDa fragment over a 2-4 h period. The cleavage of Mcl-1 was accompanied by the activation of caspases-3, -9, and -8. The broad-specificity caspase inhibitor z-VAD-fmk completely blocked Mcl-1 cleavage induced by PDT, STS or UVC, providing evidence for Mcl-1 as a substrate for caspases. Western blot analysis localized Mcl-1 to mitochondria, ER, and cytosol of both MCF-7c3 and U937 cells, suggesting that Mcl-1 protein, unlike Bcl-2 and Bcl-xL, is not a target for Pc 4-PDT, probably due to its localization to sites removed from those of Pc 4 binding. The 28-kDa cleaved fragment of Mcl-1, which has proapoptotic activity, was produced in PDT-treated lymphoid-derived cells, but not in cells of epithelial origin, suggesting that PDT-induced rapid and extensive apoptosis in lymphoma cells may result in part from the sensitivity of their Mcl-1 to caspase cleavage, removing an important negative control on apoptosis.

Mcl-1-Bim complexes accommodate surprising point mutations via minor structural changes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fire, Emiko; Gullá, Stefano V.; Grant, Robert A.

2010-06-25

Mcl-1 is an antiapoptotic Bcl-2-family protein that protects cells against death. Structures of Mcl-1, and of other anti-apoptotic Bcl-2 proteins, reveal a surface groove into which the {alpha}-helical BH3 regions of certain proapoptotic proteins can bind. Despite high overall structural conservation, differences in this groove afford binding specificity that is important for the mechanism of Bcl-2 family function. We report the crystal structure of human Mcl-1 bound to a BH3 peptide derived from human Bim and the structures for three complexes that accommodate large physicochemical changes at conserved Bim sites. The mutations had surprisingly modest effects on complex stability, andmore » the structures show that Mcl-1 can undergo small changes to accommodate the mutant ligands. For example, a shift in a leucine side chain fills a hole left by an isoleucine-to-alanine mutation at the first hydrophobic buried position of Bim BH3. Larger changes are also observed, with shifting of helix {alpha}3 accommodating an isoleucine-to-tyrosine mutation at this same position. We surveyed the variation in available Mcl-1 and Bcl-x{sub L} structures and observed moderate flexibility that is likely critical for facilitating interactions of diverse BH3-only proteins with Mcl-1. With the antiapoptotic Bcl-2 family members attracting significant attention as therapeutic targets, these structures contribute to our growing understanding of how specificity is achieved and can help to guide the design of novel inhibitors that target Mcl-1.« less

Structural Insights into the Degradation of Mcl-1 Induced by BH3 Domains

DOE Office of Scientific and Technical Information (OSTI.GOV)

Czabotar,P.; Lee, E.; van Delft, M.

2007-01-01

Apoptosis is held in check by prosurvival proteins of the Bcl-2 family. The distantly related BH3-only proteins bind to and antagonize them, thereby promoting apoptosis. Whereas binding of the BH3-only protein Noxa to prosurvival Mcl-1 induces Mcl-1 degradation by the proteasome, binding of another BH3-only ligand, Bim, elevates Mcl-1 protein levels. We compared the three-dimensional structures of the complexes formed between BH3 peptides of both Bim and Noxa, and we show that a discrete C-terminal sequence of the Noxa BH3 is necessary to instigate Mcl-1 degradation.

Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery.

PubMed

Müller, Ulrike; Krüger-Franke, Michael; Schmidt, Michael; Rosemeyer, Bernd

2015-12-01

The aim of the study was to find predictive parameters for a successful resumption of pre-injury level of sport 6 months post anterior cruciate ligament (ACL) reconstruction. In a prospective study, 40 patients with a ruptured ACL were surgically treated with semitendinosus tendon autograft. Six months after surgery, strength of knee extensors and flexors, four single-leg hop tests, Anterior Cruciate Ligament-Return to Sport after Injury Scale (ACL-RSI), subjective International Knee Documentation Committee (IKDC) 2000 and the Tampa Scale of Kinesiophobia-11 (TSK-11) were assessed. Seven months post-operatively, a standardized interview was conducted to identify "return to sport" (RS) and "non-return to sport" (nRS) patients. Logistic regression and "Receiver Operating Characteristic" (ROC) analyses were used to determine predictive parameters. No significant differences could be detected between RS and nRS patients concerning socio-demographic data, muscle tests, square hop and TSK-11. In nRS patients, the Limb Symmetry Index (LSI) of single hop for distance (p = 0.005), crossover hop (p = 0.008) and triple hop (p = 0.001) were significantly lower, in addition to the ACL-RSI (p = 0.013) and IKDC 2000 (p = 0.037). The cut-off points for LSI single hop for distance were 75.4 % (sensitivity 0.74; specificity 0.88), and for ACL-RSI 51.3 points (sensitivity 0.97; specificity 0.63). Logistic regression distinguished between RS and nRS subjects (sensitivity 0.97; specificity 0.63). The single hop for distance and ACL-RSI were found to be the strongest predictive parameters, assessing both the objective functional and the subjective psychological aspects of returning to sport. Both tests may help to identify patients at risk of not returning to pre-injury sport. II.

Whiplash causes increased laxity of cervical capsular ligament

PubMed Central

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

2009-01-01

Background Previous clinical studies have identified the cervical facet joint, including the capsular ligaments, as sources of pain in whiplash patients. The goal of this study was to determine whether whiplash caused increased capsular ligament laxity by applying quasi-static loading to whiplash-exposed and control capsular ligaments. Methods A total of 66 capsular ligament specimens (C2/3 to C7/T1) were prepared from 12 cervical spines (6 whiplash-exposed and 6 control). The whiplash-exposed spines had been previously rear impacted at a maximum peak T1 horizontal acceleration of 8 g. Capsular ligaments were elongated at 1 mm/s in increments of 0.05 mm until a tensile force of 5 N was achieved and subsequently returned to neutral position. Four pre-conditioning cycles were performed and data from the load phase of the fifth cycle were used for subsequent analyses. Ligament elongation was computed at tensile forces of 0, 0.25, 0.5, 0.75, 1.0, 2.5, and 5.0 N. Two factor, non-repeated measures ANOVA (P<0.05) was performed to determine significant differences in the average ligament elongation at tensile forces of 0 and 5 N between the whiplash-exposed and control groups and between spinal levels. Findings Average elongation of the whiplash-exposed capsular ligaments was significantly greater than that of the control ligaments at tensile forces of 0 and 5 N. No significant differences between spinal levels were observed. Interpretation Capsular ligament injuries, in the form of increased laxity, may be one component perpetuating chronic pain and clinical instability in whiplash patients. PMID:17959284

Myeloid cell leukemia 1 (MCL-1), an unexpected modulator of protein kinase signaling during invasion.

PubMed

Young, Adelaide Ij; Timpson, Paul; Gallego-Ortega, David; Ormandy, Christopher J; Oakes, Samantha R

2017-12-21

Myeloid cell leukemia-1 (MCL-1), closely related to B-cell lymphoma 2 (BCL-2), has a well-established role in cell survival and has emerged as an important target for cancer therapeutics. We have demonstrated that inhibiting MCL-1 is efficacious in suppressing tumour progression in pre-clinical models of breast cancer and revealed that in addition to its role in cell survival, MCL-1 modulated cellular invasion. Utilizing a MCL-1-specific genetic antagonist, we found two possible mechanisms; firstly MCL-1 directly binds to and alters the phosphorylation of the cytoskeletal remodeling protein, Cofilin, a protein important for cytoskeletal remodeling during invasion, and secondly MCL-1 modulates the levels SRC family kinases (SFKs) and their targets. These data provide evidence that MCL-1 activities are not limited to endpoints of extracellular and intracellular signaling culminating in cell survival as previously thought, but can directly modulate the output of SRC family kinases signaling during cellular invasion. Here we review the pleotropic roles of MCL-1 and discuss the implications of this newly discovered effect on protein kinase signaling for the development of cancer therapeutics.

Acute inversion injury of the ankle: magnetic resonance imaging and clinical outcomes.

PubMed

Tochigi, Y; Yoshinaga, K; Wada, Y; Moriya, H

1998-11-01

This study was undertaken to compare the clinical and magnetic resonance imaging results of 24 patients who had sustained ligament injuries after acute inversion injury of the ankle. On magnetic resonance imaging, the following lesions were detected: anterior talofibular ligament tear in 23 patients, calcaneofibular ligament lesion in 15, posterior talofibular ligament lesion in 11, interosseous talocalcaneal ligament lesion in 13, cervical ligament lesion in 12, and deltoid ligament lesion in 8. Compared with the clinical outcome at the follow-up study, there was a statistically significant relationship between interosseous talocalcaneal ligament lesion and each of giving way, pain, and limitation of ankle motion; between cervical ligament lesion and both giving way and pain; and between deltoid ligament lesion and giving way (P < 0.05).

A review of ultrasonographic methods for the assessment of the anterior cruciate ligament in patients with knee instability – diagnostics using a posterior approach

PubMed Central

Kielar, Maciej

2016-01-01

Aim The purpose of the study was to improve the ultrasonographic assessment of the anterior cruciate ligament by an inclusion of a dynamic element. The proposed functional modification aims to restore normal posterior cruciate ligament tension, which is associated with a visible change in the ligament shape. This method reduces the risk of an error resulting from subjectively assessing the shape of the posterior cruciate ligament. It should be also emphasized that the method combined with other ultrasound anterior cruciate ligament assessment techniques helps increase diagnostic accuracy. Methods Ultrasonography is used as an adjunctive technique in the diagnosis of anterior cruciate ligament injury. The paper presents a sonographic technique for the assessment of suspected anterior cruciate ligament insufficiency supplemented by the use of a dynamic examination. This technique can be recommended as an additional procedure in routine ultrasound diagnostics of anterior cruciate ligament injuries. Results Supplementing routine ultrasonography with the dynamic assessment of posterior cruciate ligament shape changes in patients with suspected anterior cruciate ligament injury reduces the risk of subjective errors and increases diagnostic accuracy. This is important especially in cases of minor anterior knee instability and bilateral anterior knee instability. Conclusions An assessment of changes in posterior cruciate ligament using a dynamic ultrasound examination effectively complements routine sonographic diagnostic techniques for anterior cruciate ligament insufficiency. PMID:27679732

Investigation of whiplash injuries in the upper cervical spine using a detailed neck model.

PubMed

Fice, Jason B; Cronin, Duane S

2012-04-05

Whiplash injuries continue to have significant societal cost; however, the mechanism and location of whiplash injury is still under investigation. Recently, the upper cervical spine ligaments, particularly the alar ligament, have been identified as a potential whiplash injury location. In this study, a detailed and validated explicit finite element model of a 50th percentile male cervical spine in a seated posture was used to investigate upper cervical spine response and the potential for whiplash injury resulting from vehicle crash scenarios. This model was previously validated at the segment and whole spine levels for both kinematics and soft tissue strains in frontal and rear impact scenarios. The model predicted increasing upper cervical spine ligament strain with increasing impact severity. Considering all upper cervical spine ligaments, the distractions in the apical and alar ligaments were the largest relative to their failure strains, in agreement with the clinical findings. The model predicted the potential for injury to the apical ligament for 15.2 g frontal or 11.7 g rear impacts, and to the alar ligament for a 20.7 g frontal or 14.4 g rear impact based on the ligament distractions. Future studies should consider the effect of initial occupant position on ligament distraction. Copyright © 2012 Elsevier Ltd. All rights reserved.

Relationships between posterior ligamentous complex injury and radiographic parameters in patients with thoracolumbar burst fractures.

PubMed

Hiyama, Akihiko; Watanabe, Masahiko; Katoh, Hiroyuki; Sato, Masato; Nagai, Toshihiro; Mochida, Joji

2015-02-01

The purpose of this study was to determine whether radiographic findings associated with thoracolumbar burst fractures could also indicate the presence of posterior ligamentous complex (PLC) injuries, which were identified through short-tau inversion-recovery (STIR)-weighted MRI. Sixty-four patients were surgically treated for thoracolumbar burst fractures between April 2007 and February 2014 at our institution. Twenty-four patients were excluded from this study because of the lack of STIR-weighted MRIs, and therefore 40 patients were included in this study. The patients were divided into two groups based upon the integrity of the PLC, which was evaluated using STIR-weighted MRI: a P group with a PLC injury and a C group without such injury. The following radiographic parameters were evaluated: loss of vertebral body height (LOVBH), local kyphosis (LK), vertebral body translation, canal compromise (sagittal transverse ratio, STR), interlaminar distance (ISD), supraspinous distance (SSD) and interspinous distance (ISD). Frankel scale score and total severity score (load sharing and thoracolumbar injury classification systems, respectively) were also evaluated. Preoperative STIR-weighted MRI showed that 25 patients had a PLC injury (P group: 15 men and 10 women), and 15 patients did not have a PLC injury (C group: 8 men and 7 women). More patients in the P group had an LK>20°: 14 patients in the P group and 1 patient in the C group (p<0.01). The % SSD differed between the P and C groups (118.8%±53.4% and 88.0%±24.3%, respectively; p<0.05). Multivariate logistic analysis showed that an LK>20° was a risk factor for PLC injury in patients with thoracolumbar burst fractures (odds ratio, 55.5 [95% confidence interval, 1.30-2360.1]; p<0.05). These results demonstrate that while LOVBH, vertebral body translation, and canal compromise do not correlate significantly with the presence of a PLC injury in patients with thoracolumbar fractures, an LK>20° and increased % SSD

Complete vs partial-thickness tears of the posterior cruciate ligament: MR findings.

PubMed

Patten, R M; Richardson, M L; Zink-Brody, G; Rolfe, B A

1994-01-01

We sought to define the MRI appearance of both complete and partial-thickness tears of the posterior cruciate ligament (PCL) and to describe patterns of injury and associated MRI findings. Three radiologists retrospectively reviewed MR images and medical records on 32 patients with PCL tears (15 complete, 17 partial) and correlated MRI findings to results of clinical testing and surgery. The PCL had indistinct margins in 27 (84%) of 32 patients and was abnormally thick in 25 (78%) patients. In 31 (97%) patients, the torn PCL showed increased signal intensity on both T1- and T2-weighted pulse sequences. Although there was no statistically significant difference between patients with complete tears and those with partial tears with regard to thickness, margination, and signal intensity of the PCL, MR images in patients with complete tears were more likely to show focal areas of ligamentous discontinuity (10 of 15 cases) (p = 0.01). Associated knee injuries were seen in 21 (66%) patients and were seen more frequently in patients with complete PCL tears (p = 0.015). Bony injury (n = 11, 34%) and tears of the medial collateral ligament (n = 13, 41%) and menisci (n = 10, 31%) were common. No specific pattern of bony injury was found. Posterior cruciate ligament tears can be diagnosed readily by multiplanar MRI using both morphological and signal intensity characteristics. Although differentiation between complete and partial-thickness PCL tears by MRI criteria alone is more problematic, complete tears are more likely to show focal areas of discontinuity and partial tears are more likely to show at least some intact fibers.

Aquatic versus land-based exercises as early functional rehabilitation for elite athletes with acute lower extremity ligament injury: a pilot study.

PubMed

Kim, Eunkuk; Kim, Taegyu; Kang, Hyunyong; Lee, Jongha; Childers, Martin K

2010-08-01

To compare outcomes between aquatic and land-based exercises during early-phase recovery from acute lower extremity ligament injuries in elite athletes. A single-blinded, covariate adaptive randomized, controlled study. National training center for elite athletes. Twenty-two athletes with isolated grade I or II ligament injury in ankles or knees were randomized into either an aquatic or land-based exercise group. Early functional rehabilitation program (ranging, strengthening, proprioceptive training, and functional exercises) was performed in both groups. All exercises were identical except for the training environment. Data were collected at baseline and at 2 and 4 weeks using a visual analog scale (VAS) for pain; static stability (overall stability index [OSI] level 5 and 3); dynamic stability (TCT), and percentage single-limb support time (%SLST). Both groups showed decreases in VAS, OSI 5 and 3, and TCT, with a concomitant increase in %SLST at 2 and 4 weeks (P < .05). No significant differences were detected between the 2 groups in any of the outcome measures. However, the line graphs for VAS, OSI 3, TCT, and %SLST in the aquatic exercise group were steeper than those in the land-based exercise group indicating significant group by time interactions (P < .05). These data indicate that the aquatic exercise group improved more rapidly than the land-based exercise group. For elite athletes with acute ligament sprains in the lower limb, aquatic exercises may provide advantages over standard land-based therapy for rapid return to athletic activities. Consequently, aquatic exercise could be recommended for the initial phase of a rehabilitation program. Copyright © 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Femoral intercondylar notch width size: a comparison between siblings with and without anterior cruciate ligament injuries.

PubMed

Keays, S L; Keays, R; Newcombe, P A

2016-03-01

Anterior cruciate ligament (ACL) injuries in siblings are commonly observed in the clinic. One, possibly genetic, factor contributing to the pathogenesis of sibling injuries may be narrow intercondylar notches, which are well recognized as predisposing to ACL injury. This study aimed primarily to: (1) assess the incidence of ACL injuries in siblings within an existing study cohort, (2) compare intercondylar notch width size in injured compared to matched uninjured control siblings and (3) compare the number of injured versus control sibling pairs sharing a narrow notch. Twenty-four ACL-injured siblings from 10 families were matched for age, gender, family composition and sports activity, with 24 uninjured siblings from another 10 families. Intercondylar radiographs were taken to calculate anterior and posterior notch width indices (NWI). Notch size and the number of narrow notches in sibling pairs were compared between groups. Thirteen of 72 ACL-study participants had siblings with torn ACLs. Mean anterior NWI was 0.18 and 0.24 (p < 0.001), and mean posterior NWI was 0.26 and 0.3 (p = 0.006) for injured and uninjured siblings, respectively. Sixty percent of injured sibling pairs shared a narrow notch, while no uninjured sibling pairs did so (p = 0.003). This study showed that siblings (and often sibling pairs) with injuries do have significantly narrower notches than those without. This could partly explain the prevalence of ACL injuries in siblings. To reduce ACL-injury rates, we advise that siblings of ACL-injured athletes with narrow notches, be radiologically screened, and if necessary, cautioned and counselled regarding preventative training. Case-control study, Level III.

The reverse Segond fracture: not associated with knee dislocation and rarely with posterior cruciate ligament tear.

PubMed

Peltola, Erno K; Lindahl, Jan; Koskinen, Seppo K

2014-06-01

The aims of this study were to assess the incidence of reverse Segond fracture, to examine the associated ligamentous injuries, and to examine how often reverse Segond fracture coexists with a knee dislocation. At a level 1 trauma center, an 11-year period of emergency department multidetector-row computed tomography (MDCT) examinations for knee trauma was evaluated for reverse Segond and Segond fractures. Surgical findings served as the reference standard for intra-articular injuries. The hospital discharge register was searched for the diagnosis of knee dislocation from August 2000 through the end of August 2011. A total of 1,553 knee MDCT examinations were evaluated. Ten patients with a reverse Segond fracture were found, comprising 0.64 % of emergency room acute knee trauma MDCT examinations. Seven patients who had a reverse Segond fracture were operated: Three had an avulsion fracture of the anterior cruciate ligament, one had an avulsion fracture of posterior cruciate ligament, two had a lateral meniscal tear, and two had a medial collateral ligament tear. The ratio of reverse Segond fractures to Segond fractures was 1:4. None of the 71 knee dislocation patients had a reverse Segond fracture. Reverse Segond fracture is a rare finding even in a level 1 trauma center. Cruciate ligament injuries appear to be associated with avulsion fracture, but every patient does not have PCL injury, as previously reported. Our results do not support the association of knee dislocation with reverse Segond fracture.

Chronic ankle instability and common fibular nerve injury.

PubMed

Benchortane, Michaël; Collado, Hervé; Coudreuse, Jean-Marie; Desnuelle, Claude; Viton, Jean-Michel; Delarque, Alain

2011-03-01

The lateral collateral ligaments of the ankle are often damaged in ankle inversion injuries. Ankle inversion may also cause injury to other structures located around the ankle or further away, such as the common fibular nerve. Few descriptions exist of common fibular nerve injury associated with ankle sprains and chronic ankle instability. We describe the case of a patient who sustained common fibular nerve injury during each of two ankle sprain recurrences involving the lateral collateral ligaments. Our objectives are to illustrate the links between common fibular nerve and lateral collateral ligament injuries and to emphasize the importance of the neurological evaluation in patients seen for ankle sprains or chronic ankle instability. Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Real-time biofeedback to target risk of anterior cruciate ligament injury: a technical report for injury prevention and rehabilitation.

PubMed

Ford, Kevin R; DiCesare, Christopher A; Myer, Gregory D; Hewett, Timothy E

2015-05-20

Biofeedback training enables an athlete to alter biomechanical and physiological function by receiving biomechanical and physiological data concurrent with or immediately after a task. To compare the effects of 2 different modes of real-time biofeedback focused on reducing risk factors related to anterior cruciate ligament injury. Randomized crossover study design. Biomechanics laboratory and sports medicine center. Female high school soccer players (age 14.8 ± 1.0 y, height 162.6 ± 6.8 cm, mass 55.9 ± 7.0 kg; n = 4). A battery of kinetic- or kinematic-based real-time biofeedback during repetitive double-leg squats. Baseline and posttraining drop vertical jumps were collected to determine if either feedback method improved high injury risk landing mechanics. Maximum knee abduction moment and angle during the landing was significantly decreased after kinetic-focused biofeedback (P = .04). The reduced knee abduction moment during the drop vertical jumps after kinematic-focused biofeedback was not different (P = .2). Maximum knee abduction angle was significantly decreased after kinetic biofeedback (P < .01) but only showed a trend toward reduction after kinematic biofeedback (P = .08). The innovative biofeedback employed in the current study reduced knee abduction load and posture from baseline to posttraining during a drop vertical jump.

Amount of Minutes Played Does Not Contribute to Anterior Cruciate Ligament Injury in National Basketball Association Athletes.

PubMed

Okoroha, Kelechi R; Marfo, Kojo; Meta, Fabien; Matar, Robert; Shehab, Ramsy; Thompson, Terry; Moutzouros, Vasilios; Makhni, Eric C

2017-07-01

There is limited information on the potential risk factors for sustaining an anterior cruciate ligament (ACL) tear in National Basketball Association (NBA) athletes. This study evaluated 83 NBA players who sustained an ACL injury between 1984 and 2015 to determine the influence of minutes played on injury risk. Minutes played in the injury game, during the season, and over their career were assessed, along with the ability to return to play, player efficiency rating, and playing time after return. Athletes in the NBA played significantly fewer minutes before sustaining an ACL injury (17.1 minutes) than their average minutes per game that season (23.5 minutes; P<.01) or over their career (24.0 minutes; P<.01). One-third of all injuries occurred during the first quarter of the season (preseason to November). There was a 95% rate of return (78 players) to NBA competition the season following ACL injury. Players who were drafted as lottery picks (draft pick 1 to 15) or those who were starters played significantly more minutes the season following injury than those who were not (both P<.01). Players who returned to play had decreased player efficiency ratings when compared with matched controls. This study found that minutes played in a single NBA game did not contribute to the risk of sustaining an ACL injury. Although there was a high rate of return to NBA competition the season following injury, those who were elite athletes played more minutes per game than those who were not. Athletes who returned to play sustained a decrease in player efficiency ratings compared with similar athletes without ACL injury. [Orthopedics. 2017; 40(4):e658-e662.]. Copyright 2017, SLACK Incorporated.

Sports injury of the pediatric musculoskeletal system.

PubMed

Rosendahl, Karen; Strouse, Peter J

2016-05-01

Sports related injuries are common in children and adolescents, with a reported incidence of around one in ten children each year. Boys incur more and severer sports injuries than girls, and chance for injury is greater with contact or jumping sports. Sports injuries seen in children under 10-years of age are non-specific, including contusions, mild sprains, and extremity fractures, usually Salter fractures of the physes (growth plate) or plastic fractures. In the very young athlete, sports injury of the ligaments or muscle is rare as are spine or head injuries. With growth and adolescence, the intensity of sports involvement increases. Pre-pubertal children still have open physes that are prone to injury, both acute or due to stress from a repetitive activity. In addition to injury of the physes of the long bones, injuries to the physes of apophyses are common. Ligamentous injury is uncommon before physeal closure, but can occur. After the physes fuse, ligamentous injury is seen with patterns similar to adults. This review will include a description of sports related injuries seen in children and adolescents. We will concentrate on injuries that are specific for the growing skeleton, with a brief mention of those seen after fusion of the physes.

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review.

PubMed

Swain, Michael S; Henschke, Nicholas; Kamper, Steven J; Downie, Aron S; Koes, Bart W; Maher, Chris G

2014-01-01

Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury. Systematic review. The review protocol was registered through PROSPERO (CRD42012002069). Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots. A total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman's test, prone Lachman's test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy. Despite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research. Clinicians should be aware of the limitations associated with the use of clinical tests for diagnosis of ACL injury.

The effect of isolated valgus moments on ACL strain during single-leg landing: A simulation study

PubMed Central

Shin, Choongsoo S.; Chaudhari, Ajit M.; Andriacchi, Thomas P.

2009-01-01

Valgus moments on the knee joint during single-leg landing have been suggested as a risk factor for anterior cruciate ligament (ACL) injury. The purpose of this study was to test the influence of isolated valgus moment on ACL strain during single-leg landing. Physiologic levels of valgus moments from an in vivo study of single-leg landing were applied to a three-dimensional dynamic knee model, previously developed and tested for ACL strain measurement during simulated landing. The ACL strain, knee valgus angle, tibial rotation, and medial collateral ligament (MCL) strain were calculated and analyzed. The study shows that the peak ACL strain increased nonlinearly with increasing peak valgus moment. Subjects with naturally high valgus moments showed greater sensitivity for increased ACL strain with increased valgus moment, but ACL strain plateaus below reported ACL failure levels when the applied isolated valgus moment rises above the maximum values observed during normal cutting activities. In addition, the tibia was observed to rotate externally as the peak valgus moment increased due to bony and soft-tissue constraints. In conclusion, knee valgus moment increases peak ACL strain during single-leg landing. However, valgus moment alone may not be sufficient to induce an isolated ACL tear without concomitant damage to the MCL, because coupled tibial external rotation and increasing strain in the MCL prevent proportional increases in ACL strain at higher levels of valgus moment. Training that reduces the external valgus moment, however, can reduce the ACL strain and thus may help athletes reduce their overall ACL injury risk. PMID:19100550

Arthroscopic study of injuries in articular fractures of distal radius extremity

PubMed Central

Araf, Marcelo; Mattar, Rames

2014-01-01

OBJECTIVE: To analyze the incidence of wrist ligament and cartilage associated fractures of the distal radius, through arthroscopy, correlating with AO/ASIF classification. METHODS: Thirty patients aged between 20 and 50 years old, with closed fracture from groups B and C according to AO/ASIF classification were selected. All of them were submitted to wrist arthroscopy to address intra-articular injuries and reduction and osteosynthesis of the fracture. RESULTS: A high incidence of intra-articular injuries was noticed, and 76.6% of them presented injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic triquetrolunate ligament, and 33% articular cartilage injury larger than three millimeters. Patients with fractures from type C according to AO/ASIF classification presented a higher incidence of ligament injuries. CONCLUSION: There is no relationship between the presence of chondral injury and the AO/ASIF classification of the fractures in the cases reported in this study. Level of Evidence III, Non Randomized Controlled Trial. PMID:25061421

The role of isolated posterior cruciate ligament reconstruction in knees with combined posterior cruciate ligament and posterolateral complex injury.

PubMed

Lee, Dong-Yeong; Park, Young-Jin; Kim, Dong-Hee; Kim, Hyun-Jung; Nam, Dae-Cheol; Park, Jin-Sung; Hwang, Sun-Chul

2017-08-14

This is a meta-analysis comparing biomechanical outcomes to determine whether an isolated posterior cruciate ligament (PCL) reconstruction can restore normal knee kinematics in a combined PCL/posterolateral complex (PLC) injury and whether double-bundle (DB) PCL reconstruction is superior in controlling posterior and rotational laxity compared with single-bundle (SB) PCL reconstruction in a PCL/PLC-deficient knee. A number of electronic databases were searched for relevant articles published through August 2016 that compared biomechanical outcomes of PCL reconstruction in patients who underwent reconstruction for combined PCL/PLC deficiencies. Data were searched, extracted, analysed, and assessed for quality according to Cochrane Collaboration guidelines, and biomechanical outcomes were evaluated using various outcome values. The results are presented as relative ratios for binary outcomes and standard mean differences for continuous outcomes with 95% confidence intervals. Five biomechanical studies were included in this meta-analysis. There were significant differences in laxities such as posterior tibial translation (PTT), external rotation, varus rotation, and PTT coupled with external rotation in the isolated PCL reconstruction group compared with the native PCL group. Furthermore, there were no significant differences in laxities such as PTT, external rotation, or varus rotation between the SB and DB PCL reconstruction groups. Isolated PCL reconstruction, whether SB or DB, could not restore normal knee kinematics in the PCL/PLC-deficient knee. In such cases, residual laxity after isolated PCL reconstruction can be controlled successfully with PLC reconstruction. Therefore, simultaneous PCL and PLC reconstruction is recommended for patients with combined PCL/PLC injury.

Apoptosis is rapidly triggered by antisense depletion of MCL-1 in differentiating U937 cells.

PubMed

Moulding, D A; Giles, R V; Spiller, D G; White, M R; Tidd, D M; Edwards, S W

2000-09-01

Mcl-1 is a member of the Bcl-2 protein family, which has been shown to delay apoptosis in transfection and/or overexpression experiments. As yet no gene knockout mice have been engineered, and so there is little evidence to show that loss of Mcl-1 expression is sufficient to trigger apoptosis. U937 cells constitutively express the antiapoptotic protein Bcl-2; but during differentiation, in response to the phorbol ester PMA (phorbol 12 beta-myristate 13 alpha-acetate), Mcl-1 is transiently induced. The purpose of this investigation was to determine the functional role played by Mcl-1 in this differentiation program. Mcl-1 expression was specifically disrupted by chimeric methylphosphonate/phosphodiester antisense oligodeoxynucleotides to just 5% of control levels. The depletion of Mcl-1 messenger RNA (mRNA) and protein was both rapid and specific, as indicated by the use of control oligodeoxynucleotides and analysis of the expression of other BCL2 family members and PMA-induced tumor necrosis factor-alpha (TNF-alpha). Specific depletion of Mcl-1 mRNA and protein, in the absence of changes in cellular levels of Bcl-2, results in a rapid entry into apoptosis. Levels of the proapoptotic protein Bax remained unchanged during differentiation, while Bak expression doubled within 24 hours. Apoptosis was detected within 4 hours of Mcl-1 antisense treatment by a variety of parameters including a novel live cell imaging technique allowing correlation of antisense treatment and apoptosis in individual cells. The induction of Mcl-1 is required to prevent apoptosis during differentiation of U937 cells, and the constitutive expression of Bcl-2 is unable to compensate for the loss of Mcl-1. (Blood. 2000;96:1756-1763)

Cranial cruciate ligament injury in the dog: pathophysiology, diagnosis and treatment.

PubMed

Jerram, R M; Walker, A M

2003-08-01

Cranial cruciate ligament (CCL) disease in the dog is a multifactorial complex problem that requires a thorough understanding of the biomechanics of the stifle joint to be understood. Successful treatment of rupture of the CCL should be based on managing underlying anatomical and conformational abnormalities rather than attempting to eliminate the tibial cranial drawer sign. The cranial and caudal cruciate ligaments, the patella ligament and quadriceps mechanism, the medial and lateral collateral ligaments, the medial and lateral menisci and the joint capsule provide stability of the joint and load-sharing. The function of the stifle is also significantly influenced by the musculature of the pelvic limb. An active model of biomechanics of the stifle has been described that incorporates not only the ligamentous structures of the stifle but also the forces created by weight-bearing and the musculature of the pelvic limb. This model recognises a force called cranial tibial thrust, which occurs during weight-bearing, and causes compression of the femoral condyles against the tibial plateau. In middle-aged, large-breed dogs, forces acting on the CCL together with conformation-related mild hyperextension of the stifle and slightly increased tibial plateau slopes are suspected to cause progressive degeneration of the ligament. Palpation of craniolateral stifle laxity has become pathognomonic for CCL rupture; however, chronic periarticular fibrosis, a partial CCL rupture, and a tense patient, may make evaluation of instability of the stifle difficult. Surgical treatment is broadly separated into three groups: intracapsular, extracapsular, and tibial osteotomy techniques. Tibial osteotomy techniques do not serve to provide stability of the stifle but rather alter the geometry of the joint to eliminate cranial tibial thrust such that functional joint stability is achieved during weight-bearing. Visualisation of both menisci is a critical aspect of CCL surgery, irrespective

Notch signaling regulates expression of Mcl-1 and apoptosis in PPD-treated macrophages.

PubMed

Palaga, Tanapat; Ratanabunyong, Siriluk; Pattarakankul, Thitiporn; Sangphech, Naunpun; Wongchana, Wipawee; Hadae, Yukihiro; Kueanjinda, Patipark

2013-09-01

Macrophages are cellular targets for infection by bacteria and viruses. The fate of infected macrophages plays a key role in determining the outcome of the host immune response. Apoptotic cell death of macrophages is considered to be a protective host defense that eliminates pathogens and infected cells. In this study, we investigated the involvement of Notch signaling in regulating apoptosis in macrophages treated with tuberculin purified protein derivative (PPD). Murine bone marrow-derived macrophages (BMMs) treated with PPD or infected with Mycobacterium bovis Bacillus Calmette-Guérin (BCG) induced upregulation of Notch1. This upregulation correlated well with the upregulation of the anti-apoptotic gene mcl-1 both at the transcriptional and translational levels. Decreased levels of Notch1 and Mcl-1 were observed in BMM treated with PPD when a gamma secretase inhibitor (GSI), which inhibits the processing of Notch receptors, was used. Moreover, silencing Notch1 in the macrophage-like cell line RAW264.7 decreased Mcl-1 protein expression, suggesting that Notch1 is critical for Mcl-1 expression in macrophages. A significant increase in apoptotic cells was observed upon treatment of BMM with PPD in the presence of GSI compared to the vehicle-control treated cells. Finally, analysis of the mcl-1 promoter in humans and mice revealed a conserved potential CSL/RBP-Jκ binding site. The association of Notch1 with the mcl-1 promoter was confirmed by chromatin immunoprecipitation. Taken together, these results indicate that Notch1 inhibits apoptosis of macrophages stimulated with PPD by directly controlling the mcl-1 promoter.

Mcl-1–Bim complexes accommodate surprising point mutations via minor structural changes

PubMed Central

Fire, Emiko; Gullá, Stefano V; Grant, Robert A; Keating, Amy E

2010-01-01

Mcl-1 is an antiapoptotic Bcl-2-family protein that protects cells against death. Structures of Mcl-1, and of other anti-apoptotic Bcl-2 proteins, reveal a surface groove into which the α-helical BH3 regions of certain proapoptotic proteins can bind. Despite high overall structural conservation, differences in this groove afford binding specificity that is important for the mechanism of Bcl-2 family function. We report the crystal structure of human Mcl-1 bound to a BH3 peptide derived from human Bim and the structures for three complexes that accommodate large physicochemical changes at conserved Bim sites. The mutations had surprisingly modest effects on complex stability, and the structures show that Mcl-1 can undergo small changes to accommodate the mutant ligands. For example, a shift in a leucine side chain fills a hole left by an isoleucine-to-alanine mutation at the first hydrophobic buried position of Bim BH3. Larger changes are also observed, with shifting of helix α3 accommodating an isoleucine-to-tyrosine mutation at this same position. We surveyed the variation in available Mcl-1 and Bcl-xL structures and observed moderate flexibility that is likely critical for facilitating interactions of diverse BH3-only proteins with Mcl-1. With the antiapoptotic Bcl-2 family members attracting significant attention as therapeutic targets, these structures contribute to our growing understanding of how specificity is achieved and can help to guide the design of novel inhibitors that target Mcl-1. PMID:20066663

Selective FLT3 inhibitor FI-700 neutralizes Mcl-1 and enhances p53-mediated apoptosis in AML cells with activating mutations of FLT3 through Mcl-1/Noxa axis.

PubMed

Kojima, K; Konopleva, M; Tsao, T; Andreeff, M; Ishida, H; Shiotsu, Y; Jin, L; Tabe, Y; Nakakuma, H

2010-01-01

Treatment using Fms-like tyrosine kinase-3 (FLT3) inhibitors is a promising approach to overcome the dismal prognosis of acute myeloid leukemia (AML) with activating FLT3 mutations. Current trials are combining FLT3 inhibitors with p53-activating conventional chemotherapy. The mechanisms of cytotoxicity of FLT3 inhibitors are poorly understood. We investigated the interaction of FLT3 and p53 pathways after their simultaneous blockade using the selective FLT3 inhibitor FI-700 and the MDM2 inhibitor Nutlin-3 in AML. We found that FI-700 immediately reduced antiapoptotic Mcl-1 levels and enhanced Nutlin-induced p53-mediated mitochondrial apoptosis in FLT3/internal tandem duplication cells through the Mcl-1/Noxa axis. FI-700 induced proteasome-mediated degradation of Mcl-1, resulting in the reduced ability of Mcl-1 to sequester proapoptotic Bim. Nutlin-3 induced Noxa, which displaced Bim from Mcl-1. The FI-700/Nutlin-3 combination profoundly activated Bax and induced apoptosis. Our findings suggest that FI-700 actively enhances p53 signaling toward mitochondrial apoptosis and that a combination strategy aimed at inhibiting FLT3 and activating p53 signaling could potentially be effective in AML.

Mineralization can be an incidental ultrasonographic finding in equine tendons and ligaments.

PubMed

O'Brien, Etienne J O; Smith, Roger K W

2018-05-18

Tendon/ligament mineralization is recognized in horses but information regarding its clinical significance is limited. The aims of this observational study were to report the structures most commonly affected by ultrasonographically detectable mineralization and, for these, determine frequency of diagnosis and key clinical features. Cases presented at our hospital in April 1999-April 2013 and September 2014-November 2015 were included: a total of 27 horses (22 retrospective, five prospective). Mineralizations were most common in deep digital flexor tendons (10) and suspensory ligament branches (eight), representing 10% and 7% (estimated), respectively, of horses diagnosed with injuries to these structures during the study. Two deep digital flexor tendon and three suspensory ligament branch cases showed bilateral mineralization. Deep digital flexor tendon mineralization was restricted to the digital flexor tendon sheath, most commonly in the proximal sheath (±sesamoidean canal), and seven of 10 cases involved hindlimbs. Suspensory ligament branch mineralization was visible in the same ultrasound window as the proximal sesamoid bones in 10/11 limbs and six of eight cases involved forelimbs. Previous corticosteroid medication was a feature of one deep digital flexor tendon and one suspensory ligament branch case. Mineralization was associated with lameness in some but not all limbs. Mineralized foci within the deep digital flexor tendon preceded hypoechoic lesion formation in two limbs. Of the cases with deep digital flexor tendon or suspensory ligament branch injury only, one of three and two of three cases, respectively, became sound. Findings indicated that tendon/ligament mineralization can be associated with lameness in some horses, but can also be an incidental finding. © 2018 American College of Veterinary Radiology.

Mechanisms of the Anterior Cruciate Ligament Injury in Sports Activities: A Twenty-Year Clinical Research of 1,700 Athletes

PubMed Central

Kobayashi, Hirokazu; Kanamura, Tomonao; Koshida, Sentaro; Miyashita, Koji; Okado, Tsuruo; Shimizu, Takuya; Yokoe, Kiyoshi

2010-01-01

The mechanisms of anterior cruciate ligament (ACL) injuries are still inconclusive from an epidemiological standpoint. An epidemiological approach in a large sample group over an appropriate period of years will be necessary to enhance the current knowledge of the ACL injury mechanism. The objective of the study was to investigate the ACL injury occurrence in a large sample over twenty years and demonstrate the relationships between the ACL injury occurrence and the dynamic knee alignment at the time of the injury. We investigated the activity, the injury mechanism, and the dynamic knee alignment at the time of the injury in 1,718 patients diagnosed as having the ACL injuries. Regarding the activity at the time of the injury, “competition ”was the most common, accounting for about half of all the injuries. The current result also showed that the noncontact injury was the most common, which was observed especially in many female athletes. Finally, the dynamic alignment of “Knee-in & Toe- out ”(i.e. dynamic knee valgus) was the most common, accounting for about half. These results enhance our understanding of the ACL injury mechanism and may be used to guide future injury prevention strategies. Key points We investigated the situation of ACL injury occurrence, especially dynamic alignments at the time of injury, in 1,718 patients who had visited our institution for surgery and physical therapy for twenty years. Our epidemiological study of the large patient group revealed that “knee-in & toe-out ”alignment was the most frequently seen at the time of the ACL injury. From an epidemiological standpoint, we need to pay much attention to avoiding “Knee-in & Toe-out ”alignment during sports activities. PMID:24149795

Self-reported worst injuries in women's Australian football identify lower limb injuries as a prevention priority

PubMed Central

Fortington, Lauren V; Donaldson, Alex; Finch, Caroline F

2016-01-01

Background Increasing participation by women in Australian football (AF) has made understanding their specific injury prevention needs a priority. In other sports, men and women have different injury profiles. This study aims to provide the first overview of self-reported injuries in women's AF. Methods Nationwide survey of women aged 17+ years who played in an AF competition was conducted following the 2014 playing season. The players' self-reported worst injury from the 2014 season is presented according to injury type, body part injured, treatment sought and games/training missed. Results Three-quarters of 553 respondents (n=431, 78%) reported at least 1 injury. Over half (n=235, 55%) of injuries were to the lower limb. Ankle ligament tears/sprains (n=50, 12% of all injuries) and knee ligament tears/sprains (n=45, 10%) were most frequent lower limb injuries reported. Two-thirds (65%) of all lower limb injuries led to at least 1 missed game. Of 111 (26% of all injuries) upper limb injuries reported, over half (n=57, 62%) were to the hand/fingers/thumb, including fractures (n=28, 6% of all injuries), ligament tears/sprains (n=18, 4%) and dislocations (n=11, 3%). Half of the upper limb injuries (51%) resulted in players missing matches/training. Conclusions The most frequent self-reported worst injuries for women playing AF were joint damage to the ankle and knee. A prospective injury study is needed to confirm the causes and rate of these lower limb injuries to identify the most suitable prevention interventions. PMID:27900178

Anterior Cruciate Ligament Injuries in National Football League Athletes From 2010 to 2013: A Descriptive Epidemiology Study.

PubMed

Dodson, Christopher C; Secrist, Eric S; Bhat, Suneel B; Woods, Daniel P; Deluca, Peter F

2016-03-01

There is a high incidence of anterior cruciate ligament (ACL) injuries among National Football League (NFL) athletes; however, the incidence of reinjury in this population is unknown. This retrospective epidemiological study analyzed all publicly disclosed ACL tears occurring in NFL players between 2010 and 2013 to characterize injury trends and determine the incidence of reinjury. Descriptive epidemiological study. A comprehensive online search identified any NFL player who had suffered an ACL injury from 2010 to 2013. Position, playing surface, activity, and date were recorded. Each player was researched for any history of previous ACL injury. The NFL games database from USA Today was used to determine the incidence of ACL injuries on artificial turf and grass fields. Databases from Pro Football Focus and Pro Football Reference were used to determine the injury rate for each position. NFL players suffered 219 ACL injuries between 2010 and 2013. Forty players (18.3%) had a history of previous ACL injury, with 27 (12.3%) retears and 16 (7.3%) tears contralateral to a previous ACL injury. Five players (2.28%) suffered their third ACL tear. Receivers (wide receivers and tight ends) and backs (linebackers, fullbacks, and halfbacks) had significantly greater injury risk than the rest of the NFL players, while perimeter linemen (defensive ends and offensive tackles) had significantly lower injury risk than the rest of the players. Interior linemen (offensive guards, centers, and defensive tackles) had significantly greater injury risk compared with perimeter linemen. ACL injury rates per team games played were 0.050 for grass and 0.053 for turf fields (P > .05). In this retrospective epidemiological study of ACL tears in NFL players, retears and ACL tears contralateral to a previously torn ACL constituted a substantial portion (18.3%) of total ACL injuries. The significant majority of ACL injuries in players with a history of previous ACL injury were retears. Skilled

Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification.

PubMed

Bakir, Mustafa Sinan; Merschin, David; Unterkofler, Jan; Guembel, Denis; Langenbach, Andreas; Ekkernkamp, Axel; Schulz-Drost, Stefan

2017-01-01

Introduction: Although shoulder girdle injuries are frequent, those of the medial clavicle are widely unexplored. An applied classification is less used just as a standard management. Methods: A retrospective analysis of medial clavicle injuries (MCI) during a 5-year-term in a Level-1-Trauma-Center. We analyzed amongst others concomitant injuries, therapy strategies and the classification following the AO standards. Results: 19 (2.5%) out of 759 clavicula injuries were medial ones (11 A, 6 B and 2 C-Type fractures) thereunder 27,8% were displaced and thus operatively treated Locked plate osteosynthesis was employed in unstable fractures and a reconstruction of the ligaments at the sternoclavicular joint (SCJ) in case of their disruption. 84,2% of the patients sustained relevant concomitant injuries. Numerous midshaft fractures were miscoded as medial fracture, which limited the study population. Conclusions: MCI resulted from high impact mechanisms of injury, often with relevant dislocation and concomitant injuries. Concerning medial injury's complexity, treatment should occur in specialized hospitals. Unstable fractures and injuries of the SCJ ligaments should be considered for operative treatment. Midshaft fractures should be clearly distinguished from the medial ones in ICD-10-coding. Further studies are required also regarding a subtyping of the AO classification for medial clavicle fractures including ligamental injuries. Celsius.

[Minimally invasive reconstruction of the posterolateral corner with simultaneous replacement of the anterior cruciate ligament for complex knee ligament injuries].

PubMed

Vega-España, E A; Vilchis-Sámano, H; Ruiz-Mejía, O

2017-01-01

To evaluate and describe the results of a simultaneous reconstruction with minimally invasive technique of the posterolateral complex (PLC) and the anterior cruciate ligament (ACL). ACL and PLC reconstruction was performed in seven patients using the technique described, in the period from March to November 2012. All patients were evaluated at six months after the procedure using IKDC and IKSS subjective tests. Their return to work activities and their level of satisfaction were assessed. Six male and one female patients ranging in age between 26 and 46 years were evaluated. The injuries were mostly caused by sports related accidents. All patients were economically active and required an average period of three months of disability. The assessment and outcomes at six months, according to the IKDC scale, were: one patient with IKDC A, four with IKDC B, one patient with C, and one with D. In the subjective scale IKSS, 80% averaged a knee stability of over 90 points, a patient had a 100-point scale and another, of 70 points.

Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review.

PubMed

Balachandar, Vivek; Marciniak, Jan-Luigi; Wall, Owen; Balachandar, Chandrika

2017-01-01

Anterior cruciate ligament (ACL) injury has a devastating impact on physical and psychological disability. Rates of ACL rupture are significantly greater in females than males during the same sports. Hormonal mechanisms have been proposed but are complex and poorly understood. This systematic review evaluates the effects of menstrual cycle on: 1) lower-limb biomechanics, 2) neuromuscular control, and 3) ACL injury risk. The MEDLINE, CINAHL, SPORTSDiscus, Web of Science, and Google Scholar databases were searched from inception to August 2016 for studies investigating the effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and ACL injury risk in females. Three independent reviewers assessed each paper for inclusion and two assessed for quality. Seventeen studies were identified. There is strong evidence that: 1) greatest risk of ACL injury is within the pre-ovulatory phase of the menstrual cycle, and 2) females with greater ACL laxity in the pre-ovulatory phase experience greater knee valgus and greater tibial external rotation during functional activity. Females are at greatest risk of ACL injury during the pre-ovulatory phase of the menstrual cycle through a combination of greater ACL laxity, greater knee valgus, and greater tibial external rotation during functional activity. Ib.

Feedback Techniques to Target Functional Deficits Following Anterior Cruciate Ligament Reconstruction: Implications for Motor Control and Reduction of Second Injury Risk

PubMed Central

Benjaminse, Anne; Hewett, Timothy E.; Paterno, Mark V.; Ford, Kevin R.; Otten, Egbert; Myer, Gregory D.

2014-01-01

Primary anterior cruciate ligament (ACL) injury prevention training has been shown to reduce the risk of injury. Less is known about the effect of prevention on second injury after ACL reconstruction (ACLR). Given recent findings that second injury rates exceed 20 % in only the first year following the return to sport, it is imperative that rehabilitation after ACLR is scrutinized so that second injury preventative strategies can be optimized. A potential limitation of current rehabilitative processes following ACLR could be a deficiency in the transition from conscious awareness achieved during rehabilitation sessions to unexpected and automatic movements required for athletic activities on the field. Learning strategies with an internally directed focus have traditionally been utilized but may be less suitable for acquisition of control of complex motor skills required for sport reintegration. Conversely, an externally focused rehabilitation strategy may enhance skill acquisition more efficiently and increase the potential to transfer to competitive sport. This article presents new insights gained from the motor learning domain that may improve neuromuscular training programmes via increased retention from improved techniques and may ultimately reduce the incidence of second ACL injuries. PMID:24062274

Refined diagnostic criteria and classification of mast cell leukemia (MCL) and myelomastocytic leukemia (MML): a consensus proposal

PubMed Central

Valent, P.; Sotlar, K.; Sperr, W. R.; Escribano, L.; Yavuz, S.; Reiter, A.; George, T. I.; Kluin-Nelemans, H. C.; Hermine, O.; Butterfield, J. H.; Hägglund, H.; Ustun, C.; Hornick, J. L.; Triggiani, M.; Radia, D.; Akin, C.; Hartmann, K.; Gotlib, J.; Schwartz, L. B.; Verstovsek, S.; Orfao, A.; Metcalfe, D. D.; Arock, M.; Horny, H.-P.

2014-01-01

Mast cell leukemia (MCL), the leukemic manifestation of systemic mastocytosis (SM), is characterized by leukemic expansion of immature mast cells (MCs) in the bone marrow (BM) and other internal organs; and a poor prognosis. In a subset of patients, circulating MCs are detectable. A major differential diagnosis to MCL is myelomastocytic leukemia (MML). Although criteria for both MCL and MML have been published, several questions remain concerning terminologies and subvariants. To discuss open issues, the EU/US-consensus group and the European Competence Network on Mastocytosis (ECNM) launched a series of meetings and workshops in 2011–2013. Resulting discussions and outcomes are provided in this article. The group recommends that MML be recognized as a distinct condition defined by mastocytic differentiation in advanced myeloid neoplasms without evidence of SM. The group also proposes that MCL be divided into acute MCL and chronic MCL, based on the presence or absence of C-Findings. In addition, a primary (de novo) form of MCL should be separated from secondary MCL that typically develops in the presence of a known antecedent MC neoplasm, usually aggressive SM (ASM) or MC sarcoma. For MCL, an imminent prephase is also proposed. This prephase represents ASM with rapid progression and 5%–19% MCs in BM smears, which is generally accepted to be of prognostic significance. We recommend that this condition be termed ASM in transformation to MCL (ASM-t). The refined classification of MCL fits within and extends the current WHO classification; and should improve prognostication and patient selection in practice as well as in clinical trials. PMID:24675021

MCL-1 inhibition provides a new way to suppress breast cancer metastasis and increase sensitivity to dasatinib.

PubMed

Young, Adelaide I J; Law, Andrew M K; Castillo, Lesley; Chong, Sabrina; Cullen, Hayley D; Koehler, Martin; Herzog, Sebastian; Brummer, Tilman; Lee, Erinna F; Fairlie, Walter D; Lucas, Morghan C; Herrmann, David; Allam, Amr; Timpson, Paul; Watkins, D Neil; Millar, Ewan K A; O'Toole, Sandra A; Gallego-Ortega, David; Ormandy, Christopher J; Oakes, Samantha R

2016-12-08

Metastatic disease is largely resistant to therapy and accounts for almost all cancer deaths. Myeloid cell leukemia-1 (MCL-1) is an important regulator of cell survival and chemo-resistance in a wide range of malignancies, and thus its inhibition may prove to be therapeutically useful. To examine whether targeting MCL-1 may provide an effective treatment for breast cancer, we constructed inducible models of BIMs2A expression (a specific MCL-1 inhibitor) in MDA-MB-468 (MDA-MB-468-2A) and MDA-MB-231 (MDA-MB-231-2A) cells. MCL-1 inhibition caused apoptosis of basal-like MDA-MB-468-2A cells grown as monolayers, and sensitized them to the BCL-2/BCL-XL inhibitor ABT-263, demonstrating that MCL-1 regulated cell survival. In MDA-MB-231-2A cells, grown in an organotypic model, induction of BIMs2A produced an almost complete suppression of invasion. Apoptosis was induced in such a small proportion of these cells that it could not account for the large decrease in invasion, suggesting that MCL-1 was operating via a previously undetected mechanism. MCL-1 antagonism also suppressed local invasion and distant metastasis to the lung in mouse mammary intraductal xenografts. Kinomic profiling revealed that MCL-1 antagonism modulated Src family kinases and their targets, which suggested that MCL-1 might act as an upstream modulator of invasion via this pathway. Inhibition of MCL-1 in combination with dasatinib suppressed invasion in 3D models of invasion and inhibited the establishment of tumors in vivo. These data provide the first evidence that MCL-1 drives breast cancer cell invasion and suggests that MCL-1 antagonists could be used alone or in combination with drugs targeting Src kinases such as dasatinib to suppress metastasis.

[The syndrome of external ligament sprain in the horse].

PubMed

Collard, X R; Danse, E M; Rombouts, J J

2000-06-01

The treatment of acute complete (grade III) tears of the lateral ligaments of the ankle has generated much controversy in the medical literature. Functional treatment has become the standard treatment as it has been shown that there is no significant difference in long term results whatever the treatment (operative repair and cast, cast alone, or early controlled mobilization). Functional treatment includes only a short period of protection by tape bandage or brace and allows early weight-bearing. Major trauma with avulsion of bone and severe ligamentous damage on both medial and lateral sides of the ankle is however an indication for surgical treatment in the acute phase. Secondary operative reconstruction can be performed in case of persistent instability and laxity of the ankle. Secondary anatomic repair as proposed by Brodström, Duquennoy et al. and Karlsson et al. has a high rate of success and avoids the potential morbidity of harvesting partially or totally the peroneus brevis or other tendon grafts. Evaluation of the injured ankle has improved and in selected patients ultrasonography, arthrography, magnetic resonance imaging or bone scintigraphy may be useful for further evaluation of the injury. The frequency of associated injuries has probably been underestimated. Although ankle sprain is often thought of as an injury involving only the lateral ankle ligaments, there are varied and multiple components to the common sprained ankle. This condition would perhaps more appropriately be designated as the sprained ankle syndrome.

Visibility of Anterolateral Ligament Tears in Anterior Cruciate Ligament-Deficient Knees With Standard 1.5-Tesla Magnetic Resonance Imaging.

PubMed

Hartigan, David E; Carroll, Kevin W; Kosarek, Frank J; Piasecki, Dana P; Fleischli, James F; D'Alessandro, Donald F

2016-10-01

To attempt to visualize the ligament with standard 1.5-tesla magnetic resonance imaging (MRI) in the acute anterior cruciate ligament (ACL)-torn knee, and if it is visible, attempt to characterize it as torn or intact at its femoral, meniscal, and tibial attachment sites. This was a retrospective MRI study based on arthroscopic findings of a known ACL tear in 72 patients between the years 2006 and 2010. Patients all had hamstring ACL reconstructions, no concomitant lateral collateral ligament, or posterolateral corner injury based on imaging and physical examination, and had a preoperative 1.5-tesla MRI scan with standard sequences performed within 3 weeks of the injury. Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the preoperative MRI for visualization of the anterolateral ligament (ALL) for concomitant tears. Inter- and intraobserver reliability was calculated. Learning effect was analyzed to determine if radiologists' agreement improved as reads progressed. Both radiologists were able to visualize the ALL in 100% of the scans. Overall, ALL tears were noted in 26% by radiologist 1 and in 62% by radiologist 2. The agreement between the ligament being torn or not had a kappa of 0.54 between radiologists. The agreements in torn or not torn between radiologists in the femoral, meniscal, and tibial sites were 0.14, 0.15, and 0.31. The intraobserver reliability by radiologist 1 for femoral, meniscal, and tibial tears was 0.04, 0.57, and 0.54 respectively. For radiologist 2, they were 0.75, 0.61, and 0.55. There was no learning effect noted. ALL tears are currently unable to be reliably identified as torn or intact on standard 1.5-tesla MRI sequences. Proper imaging sequences are of crucial importance to reliably follow these tears to determine their clinical significance. Level IV, therapeutic case series study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Noxa/Mcl-1 Balance Regulates Susceptibility of Cells to Camptothecin-Induced Apoptosis1

PubMed Central

Mei, Yide; Xie, Chongwei; Xie, Wei; Tian, Xu; Li, Mei; Wu, Mian

2007-01-01

Although camptothecin (CPT) has been reported to induce apoptosis in various cancer cells, the molecular details of this regulation remain largely unknown. In this study, we demonstrate that BH3-only protein Noxa is upregulated during CPT-induced apoptosis, which is independent of p53. In addition, we show that phosphatidylinositol 3-kinase (PI3K)/Akt signaling pathway is responsible for Noxa's induction. Luciferase assay and cAMP response element binding protein (CREB) knockdown experiments further demonstrate that CREB is involved in the transcriptional upregulation of Noxa. Moreover, blocking Noxa expression using specific small interfering ribonucleic acid (siRNA) significantly reduces the apoptosis in response to CPT, indicating that Noxa is an essential mediator for CPT-induced apoptosis. Interestingly, antiapoptotic Mcl-1 was also upregulated through PI3K/Akt signaling pathway upon CPT treatment. Using immunoprecipitation assay, Noxa was found to interact with Mcl-1 in the presence or absence of CPT. Knockdown of Mcl-1 expression by short hairpin ribonucleic acid (shRNA) was shown to potentiate CPT-induced apoptosis. Consistently, ectopic overexpression of Mcl-1 rescued cells from apoptosis induced by CPT. Cells coexpressing Noxa and Mcl-1 at different ratio correlates well with the extent of apoptosis, suggesting that the balance between Noxa and Mcl-1 may determine the susceptibility of HeLa cells to CPT-induced apoptosis. PMID:17971907

HipMCL: a high-performance parallel implementation of the Markov clustering algorithm for large-scale networks

PubMed Central

Azad, Ariful; Ouzounis, Christos A; Kyrpides, Nikos C; Buluç, Aydin

2018-01-01

Abstract Biological networks capture structural or functional properties of relevant entities such as molecules, proteins or genes. Characteristic examples are gene expression networks or protein–protein interaction networks, which hold information about functional affinities or structural similarities. Such networks have been expanding in size due to increasing scale and abundance of biological data. While various clustering algorithms have been proposed to find highly connected regions, Markov Clustering (MCL) has been one of the most successful approaches to cluster sequence similarity or expression networks. Despite its popularity, MCL’s scalability to cluster large datasets still remains a bottleneck due to high running times and memory demands. Here, we present High-performance MCL (HipMCL), a parallel implementation of the original MCL algorithm that can run on distributed-memory computers. We show that HipMCL can efficiently utilize 2000 compute nodes and cluster a network of ∼70 million nodes with ∼68 billion edges in ∼2.4 h. By exploiting distributed-memory environments, HipMCL clusters large-scale networks several orders of magnitude faster than MCL and enables clustering of even bigger networks. HipMCL is based on MPI and OpenMP and is freely available under a modified BSD license. PMID:29315405

HipMCL: a high-performance parallel implementation of the Markov clustering algorithm for large-scale networks

DOE PAGES

Azad, Ariful; Pavlopoulos, Georgios A.; Ouzounis, Christos A.; ...

2018-01-05

Biological networks capture structural or functional properties of relevant entities such as molecules, proteins or genes. Characteristic examples are gene expression networks or protein–protein interaction networks, which hold information about functional affinities or structural similarities. Such networks have been expanding in size due to increasing scale and abundance of biological data. While various clustering algorithms have been proposed to find highly connected regions, Markov Clustering (MCL) has been one of the most successful approaches to cluster sequence similarity or expression networks. Despite its popularity, MCL’s scalability to cluster large datasets still remains a bottleneck due to high running times andmore » memory demands. In this paper, we present High-performance MCL (HipMCL), a parallel implementation of the original MCL algorithm that can run on distributed-memory computers. We show that HipMCL can efficiently utilize 2000 compute nodes and cluster a network of ~70 million nodes with ~68 billion edges in ~2.4 h. By exploiting distributed-memory environments, HipMCL clusters large-scale networks several orders of magnitude faster than MCL and enables clustering of even bigger networks. Finally, HipMCL is based on MPI and OpenMP and is freely available under a modified BSD license.« less

HipMCL: a high-performance parallel implementation of the Markov clustering algorithm for large-scale networks

DOE Office of Scientific and Technical Information (OSTI.GOV)

Azad, Ariful; Pavlopoulos, Georgios A.; Ouzounis, Christos A.

Biological networks capture structural or functional properties of relevant entities such as molecules, proteins or genes. Characteristic examples are gene expression networks or protein–protein interaction networks, which hold information about functional affinities or structural similarities. Such networks have been expanding in size due to increasing scale and abundance of biological data. While various clustering algorithms have been proposed to find highly connected regions, Markov Clustering (MCL) has been one of the most successful approaches to cluster sequence similarity or expression networks. Despite its popularity, MCL’s scalability to cluster large datasets still remains a bottleneck due to high running times andmore » memory demands. In this paper, we present High-performance MCL (HipMCL), a parallel implementation of the original MCL algorithm that can run on distributed-memory computers. We show that HipMCL can efficiently utilize 2000 compute nodes and cluster a network of ~70 million nodes with ~68 billion edges in ~2.4 h. By exploiting distributed-memory environments, HipMCL clusters large-scale networks several orders of magnitude faster than MCL and enables clustering of even bigger networks. Finally, HipMCL is based on MPI and OpenMP and is freely available under a modified BSD license.« less

Fibroblast growth factor receptor inhibition induces loss of matrix MCL1 and necrosis in cholangiocarcinoma.

PubMed

Kabashima, Ayano; Hirsova, Petra; Bronk, Steven F; Hernandez, Matthew C; Truty, Mark J; Rizvi, Sumera; Kaufmann, Scott H; Gores, Gregory J

2018-03-08

Myeloid cell leukemia 1 (MCL1), a prosurvival member of the BCL2 protein family, has a pivotal role in human cholangiocarcinoma (CCA) cell survival. We previously reported that fibroblast growth factor receptor (FGFR) signalling mediates MCL1-dependent survival of CCA cells in vitro and in vivo. However, the mode and mechanisms of cell death in this model were not delineated. Human CCA cell lines were treated with the pan-FGFR inhibitor LY2874455 and the mode of cell death examined by several complementary assays. Mitochondrial oxidative metabolism was examined using a XF24 extracellular flux analyser. The efficiency of FGFR inhibition in patient-derived xenografts (PDX) was also assessed. CCA cells expressed two species of MCL1, a full-length form localised to the outer mitochondrial membrane, and an N terminus-truncated species compartmentalised within the mitochondrial matrix. The pan-FGFR inhibitor LY2874455 induced non-apoptotic cell death in the CCA cell lines associated with cellular depletion of both MCL1 species. The cell death was accompanied by failure of mitochondrial oxidative metabolism and was most consistent with necrosis. Enforced expression of N terminus-truncated MCL1 targeted to the mitochondrial matrix, but not full-length MCL1 targeted to the outer mitochondrial membrane, rescued cell death and mitochondrial function. LY2874455 treatment of PDX-bearing mice was associated with tumour cell loss of MCL1 and cell necrosis. FGFR inhibition induces loss of matrix MCL1, resulting in cell necrosis. These observations support a heretofore unidentified, alternative MCL1 survival function, namely prevention of cell necrosis, and have implications for treatment of human CCA. Herein, we report that therapeutic inhibition of a cell receptor expressed by bile duct cancer cells resulted in the loss of a critical survival protein termed MCL1. Cellular depletion of MCL1 resulted in the death of the cancer cells by a process characterised by cell rupture. Cell

Strain Distribution in the Anterior Inferior Tibiofibular Ligament, Posterior Inferior Tibiofibular Ligament, and Interosseous Membrane Using Digital Image Correlation.

PubMed

Xu, Daorong; Wang, Yibei; Jiang, Chunyu; Fu, Maoqing; Li, Shiqi; Qian, Lei; Sun, Peidong; Ouyang, Jun

2018-05-01

Ligament repair and augmentation techniques can stabilize syndesmosis injuries. However, little is known about the mechanical behavior of syndesmotic ligaments. The aim of this study was to analyze full-field strain, strain trend under foot rotation, and subregional strain differences of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous membrane (IOM). Eleven fresh-frozen lower limbs were dissected to expose the AITFL, PITFL, and IOM. The foot underwent rotation from 0° to 25° internal and 35° external, with 3 ankle positions (neutral, 15° dorsiflexion, and 25° plantarflexion) and a vertical load of 430 N. Ligament strain was recorded using digital image correlation. The mean strain on the AITFL with 35° external rotation was greater in the proximal portion compared with distal portion in the neutral position ( P = .009) and dorsiflexion ( P = .003). The mean strain in the tibial insertion and midsubstance near tibial insertion were greater when compared with other regions ( P = .018 and P = .009). The subregions of mean strain in the PITFL and IOM groups were not significantly different. The strain trend of AITFL, PITFL, and IOM showed common transformation, just when the foot was externally rotated. The findings of this study show that a significantly high strain was observed on the proximal part and the midsubstance near the Chaput tubercle of the AITFL when the ankle was externally rotated. All 3 ligaments resisted the torque in the syndesmosis by external rotation of the foot. This study allows for better understanding of the mechanical behavior of the syndesmosis ligaments, which could influence the repair technique and AITFL augmentation techniques.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors.

PubMed

Alentorn-Geli, Eduard; Myer, Gregory D; Silvers, Holly J; Samitier, Gonzalo; Romero, Daniel; Lázaro-Haro, Cristina; Cugat, Ramón

2009-07-01

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high

[Return to sport after surgical treatment of a posterior cruciate ligament injury : A retrospective study of 60 patients].

PubMed

Ahrend, M; Ateschrang, A; Döbele, S; Stöckle, U; Grünwald, L; Schröter, S; Ihle, C

2016-12-01

Injuries of the posterior cruciate ligament (PCL) lead to an initial reduction of sporting activity. However, in previous studies, return to sport after operative treatment of PCL injuries has been analysed insufficiently. The aim of this study was (1) to determine the rate of return to sport in physically active patients, (2) to analyse possible changes in sporting activities and (3) to examine the influence of the severity of the initial injury. Within a retrospective clinical and radiological follow-up at least 24 months after surgery (80.3 ± 28.2 months), 60 patients (44.8 ± 12.1 years) with surgically treated isolated or combined PCL injuries were included in the study. Pre-accidental and post-operative sporting activities were queried and compared in a standardised questionnaire. Possible differences with respect to the initial injury severity (Cooper classification) were examined. The return-to-sport rate of the physically active patients was 87.0 %. 17.6 % of patients with a combined PCL injury and 4.8 % of patients with isolated PCL injury were not able to return to sport. Significant reductions in the frequency of exercise (p = 0.0087), the duration of exercise (p = 0.0003) and the amount of regularly performed sports (p < 0.0001) were found. A change from high-impact sports to low-impact sports was noted. Patients with operatively treated PCL injuries can return to sport. However, for competitive athletes an injury to the PCL can lead to the end of their career. A reduction of sporting activities and a change from high-impact sports to low-impact sports can be expected. A persisting inability to return to sporting activities in patients with isolated PCL injuries cannot be assumed.

Lateral and syndesmotic ankle sprain injuries: a narrative literature review

PubMed Central

Dubin, Joshua C.; Comeau, Doug; McClelland, Rebecca I.; Dubin, Rachel A.; Ferrel, Ernest

2011-01-01

Objective The purpose of this article is to review the literature that discusses normal anatomy and biomechanics of the foot and ankle, mechanisms that may result in a lateral ankle sprain or syndesmotic sprain, and assessment and diagnostic procedures, and to present a treatment algorithm based on normal ligament healing principles. Methods Literature was searched for years 2000 to 2010 in PubMed and CINAHL. Key search terms were ankle sprain$, ankle injury and ankle injuries, inversion injury, proprioception, rehabilitation, physical therapy, anterior talofibular ligament, syndesmosis, syndesmotic injury, and ligament healing. Discussion Most ankle sprains respond favorably to nonsurgical treatment, such as those offered by physical therapists, doctors of chiropractic, and rehabilitation specialists. A comprehensive history and examination aid in diagnosing the severity and type of ankle sprain. Based on the diagnosis and an understanding of ligament healing properties, a progressive treatment regimen can be developed. During the acute inflammatory phase, the goal of care is to reduce inflammation and pain and to protect the ligament from further injury. During the reparative and remodeling phase, the goal is to progress the rehabilitation appropriately to facilitate healing and restore the mechanical strength and proprioception. Radiographic imaging techniques may need to be used to rule out fractures, complete ligament tears, or instability of the ankle mortise. A period of immobilization and ambulating with crutches in a nonweightbearing gait may be necessary to allow for proper ligament healing before commencing a more active treatment approach. Surgery should be considered in the case of grade 3 syndesmotic sprain injuries or those ankle sprains that are recalcitrant to conservative care. Conclusion An accurate diagnosis and prompt treatment can minimize an athlete's time lost from sport and prevent future reinjury. Most ankle sprains can be successfully

Ankle syndesmotic injury.

PubMed

Zalavras, Charalampos; Thordarson, David

2007-06-01

Ankle syndesmotic injury does not necessarily lead to ankle instability; however, the coexistence of deltoid ligament injury critically destabilizes the ankle joint. Syndesmotic injury may occur in isolation or may be associated with ankle fracture. In the absence of fracture, physical examination findings suggestive of injury include ankle tenderness over the anterior aspect of the syndesmosis and a positive squeeze or external rotation test. Radiographic findings usually include increased tibiofibular clear space decreased tibiofibular overlap, and increased medial clear space. However, syndesmotic injury may not be apparent radiographically; thus, routine stress testing is necessary for detecting syndesmotic instability. The goals of management are to restore and maintain the normal tibiofibular relationship to allow for healing of the ligamentous structures of the syndesmosis. Fixation of the syndesmosis is indicated when evidence of a diastasis is present. This may be detected preoperatively, in the absence of fracture, or intraoperatively, after rigid fixation of the medial malleolus and fibula fractures. Failure to diagnose and stabilize syndesmotic disruption adversely affects outcome.

A real-time computational model for estimating kinematics of ankle ligaments.

PubMed

Zhang, Mingming; Davies, T Claire; Zhang, Yanxin; Xie, Sheng Quan

2016-01-01

An accurate assessment of ankle ligament kinematics is crucial in understanding the injury mechanisms and can help to improve the treatment of an injured ankle, especially when used in conjunction with robot-assisted therapy. A number of computational models have been developed and validated for assessing the kinematics of ankle ligaments. However, few of them can do real-time assessment to allow for an input into robotic rehabilitation programs. An ankle computational model was proposed and validated to quantify the kinematics of ankle ligaments as the foot moves in real-time. This model consists of three bone segments with three rotational degrees of freedom (DOFs) and 12 ankle ligaments. This model uses inputs for three position variables that can be measured from sensors in many ankle robotic devices that detect postures within the foot-ankle environment and outputs the kinematics of ankle ligaments. Validation of this model in terms of ligament length and strain was conducted by comparing it with published data on cadaver anatomy and magnetic resonance imaging. The model based on ligament lengths and strains is in concurrence with those from the published studies but is sensitive to ligament attachment positions. This ankle computational model has the potential to be used in robot-assisted therapy for real-time assessment of ligament kinematics. The results provide information regarding the quantification of kinematics associated with ankle ligaments related to the disability level and can be used for optimizing the robotic training trajectory.

Trampoline injuries

PubMed Central

Nysted, M; Drogset, J O

2006-01-01

Objective To describe the mechanism, location and types of injury for all patients treated for trampoline‐associated injuries at St Olav's University Hospital, Trondheim, Norway, from March 2001to October 2004. Materials and methods Patients were identified from a National Injury Surveillance System. All patients were asked to complete a standard questionnaire at their first visit at the hospital. Most data were recorded prospectively, but data on the mechanism of injury, the number of participants on the trampoline at the time of injury, adult supervision and whether the activity occurred at school or in another organised setting were collected retrospectively. Results A total of 556 patients, 56% male and 44% female, were included. The mean age of patients was 11 (range 1–62) years. 77% of the injuries occurred on the body of the trampoline, including falls on to the mat, collisions with another jumper, falls on to the frame or the springs, and performing a somersault, whereas 22% of the people fell off the trampoline. In 74% of the cases, more than two people were on the trampoline, with as many as nine trampolinists noted at the time of injury. For children <11 years, 22% had adult supervision when the injury occurred. The most common types of injuries were fractures (36%) and injury to ligaments (36%). Injuries to the extremities predominated (79%), and the lower extremities were the most commonly injured part of the body (44%). A ligament injury in the ankle was the most often reported diagnosis (20%), followed by an overstretching of ligaments in the neck (8%) and a fracture of the elbow (7%). Regarding cervical injuries, two patients had cervical fractures and one patient had an atlantoaxial subluxation. Three patients with fractures in the elbow region reported an ulnar nerve neuropathy. 13% of the patients were hospitalised for a mean of 2.2 days. Conclusion Trampolining can cause serious injuries, especially in the neck and elbow areas of young

Trampoline injuries.

PubMed

Nysted, M; Drogset, J O

2006-12-01

To describe the mechanism, location and types of injury for all patients treated for trampoline-associated injuries at St Olav's University Hospital, Trondheim, Norway, from March 2001to October 2004. Patients were identified from a National Injury Surveillance System. All patients were asked to complete a standard questionnaire at their first visit at the hospital. Most data were recorded prospectively, but data on the mechanism of injury, the number of participants on the trampoline at the time of injury, adult supervision and whether the activity occurred at school or in another organised setting were collected retrospectively. A total of 556 patients, 56% male and 44% female, were included. The mean age of patients was 11 (range 1-62) years. 77% of the injuries occurred on the body of the trampoline, including falls on to the mat, collisions with another jumper, falls on to the frame or the springs, and performing a somersault, whereas 22% of the people fell off the trampoline. In 74% of the cases, more than two people were on the trampoline, with as many as nine trampolinists noted at the time of injury. For children <11 years, 22% had adult supervision when the injury occurred. The most common types of injuries were fractures (36%) and injury to ligaments (36%). Injuries to the extremities predominated (79%), and the lower extremities were the most commonly injured part of the body (44%). A ligament injury in the ankle was the most often reported diagnosis (20%), followed by an overstretching of ligaments in the neck (8%) and a fracture of the elbow (7%). Regarding cervical injuries, two patients had cervical fractures and one patient had an atlantoaxial subluxation. Three patients with fractures in the elbow region reported an ulnar nerve neuropathy. 13% of the patients were hospitalised for a mean of 2.2 days. Trampolining can cause serious injuries, especially in the neck and elbow areas of young children. The use of a trampoline is a high-risk activity

[Rupture of lateral ligaments of the ankle joint: MR imaging before and after functional therapy].

PubMed

Grebe, P; Kreitner, K F; Roeder, W; Kersjes, W; Hennes, R; Runkel, M

1995-09-01

Documentation via MRI of the healing of ruptured lateral collateral ankle ligaments after functional therapy. 35 patients with ankle sprain were examined by MRI and stress radiographs, 13 were operated afterwards, 22 patients underwent a functional conservative therapy and were examined by MRI and stress radiographs and second time after three months. MRI reports were correct in 12 of 13 operated cases. After conservative therapy we did not find any disrupted ankle ligament. MRI showed intact ligaments thickened by scar. MRI is able to show injuries of the lateral collateral ankle ligaments and demonstrates the healing by scar after conservative therapy.

MACC1 regulates Fas mediated apoptosis through STAT1/3 - Mcl-1 signaling in solid cancers.

PubMed

Radhakrishnan, Harikrishnan; Ilm, Katharina; Walther, Wolfgang; Shirasawa, Senji; Sasazuki, Takehiko; Daniel, Peter T; Gillissen, Bernhard; Stein, Ulrike

2017-09-10

MACC1 was identified as a novel player in cancer progression and metastasis, but its role in death receptor-mediated apoptosis is still unexplored. We show that MACC1 knockdown sensitizes cancer cells to death receptor-mediated apoptosis. For the first time, we provide evidence for STAT signaling as a MACC1 target. MACC1 knockdown drastically reduced STAT1/3 activating phosphorylation, thereby regulating the expression of its apoptosis targets Mcl-1 and Fas. STAT signaling inhibition by the JAK1/2 inhibitor ruxolitinib mimicked MACC1 knockdown-mediated molecular signatures and apoptosis sensitization to Fas activation. Despite the increased Fas expression, the reduced Mcl-1 expression was instrumental in apoptosis sensitization. This reduced Mcl-1-mediated apoptosis sensitization was Bax and Bak dependent. MACC1 knockdown also increased TRAIL-induced apoptosis. MACC1 overexpression enhanced STAT1/3 phosphorylation and increased Mcl-1 expression, which was abrogated by ruxolitinib. The central role of Mcl-1 was strengthened by the resistance of Mcl-1 overexpressing cells to apoptosis induction. The clinical relevance of Mcl-1 regulation by MACC1 was supported by their positive expression correlation in patient-derived tumors. Altogether, we reveal a novel death receptor-mediated apoptosis regulatory mechanism by MACC1 in solid cancers through modulation of the STAT1/3-Mcl-1 axis. Copyright © 2017 Elsevier B.V. All rights reserved.

[Simultaneous Traumatic Rupture of Patellar Ligament and Contralateral Rupture of Quadriceps Femoris Muscle].

PubMed

Hladký, V; Havlas, V

2017-01-01

Our paper presents a unique case of a 64-year-old patient after a fall, treated with oral antidiabetic drugs for type II diabetes mellitus. Following a series of examinations, a bilateral injury was diagnosed - patellar ligament tear on the right side and rupture of quadriceps femoris muscle on the left side. It is a rare injury, complicated by simultaneous involvement of both knee joints. The used therapy consisted of a bilateral surgery followed by gradual verticalisation, first with the support of a walking frame and later with the use of forearm crutches. During the final examination, the patient demonstrated full flexion at both knees, while an extension deficit of approx. 5 degrees was still present on the left side. The right knee X-ray showed a proper position of the patella after the removal of temporary tension band wire. Although the clinical results of operative treatment of both the patellar ligament rupture and rupture of quadriceps femoris muscle are in most cases good, early operative treatment, proper technique and post-operative rehabilitation are a prerequisite for success. Key words: knee injuries, patellar ligament, quadriceps muscle, rupture.

Anterior cruciate ligament injury alters preinjury lower extremity biomechanics in the injured and uninjured leg: the JUMP-ACL study.

PubMed

Goerger, Benjamin M; Marshall, Stephen W; Beutler, Anthony I; Blackburn, J Troy; Wilckens, John H; Padua, Darin A

2015-02-01

Information as to how anterior cruciate ligament (ACL) injury and reconstructive surgery (ACLR) alter lower extremity biomechanics may improve rehabilitation and return to play guidelines, reducing the risk for repeat ACL injury. To compare lower extremity biomechanics before ACL injury and after subsequent ACLR for the injured and uninjured leg. Baseline unilateral lower extremity biomechanics were collected on the dominant leg of participants without ACL injury when they entered the Joint Undertaking to Monitor and Prevent ACL (JUMP-ACL) study. Thirty-one participants with subsequent ACL injury, reconstructive surgery and full return to physical activity completed repeat, follow-up biomechanical testing, as did 39 uninjured, matched controls. Not all injured participants suffered injury to the dominant leg, requiring separation of those with ACL injury into two groups: ACLR-injured leg group (n=12) and ACLR-uninjured leg group (n=19). We compared the landing biomechanics of these three groups (ACLR-injured leg, ACLR-uninjured leg, control) before ACL injury (baseline) with biomechanics after ACL injury, surgery and return to physical activity (follow-up). ACL injury and ACLR altered lower extremity biomechanics, as both ACLR groups demonstrated increases in frontal plane movement (increased hip adduction and knee valgus). The ACLR-injured leg group also exhibited decreased sagittal plane loading (decreased anterior tibial shear force, knee extension moment and hip flexion moment). No high-risk biomechanical changes were observed in control group participants. ACL injury and ACLR caused movement pattern alterations of the injured and uninjured leg that have previously shown to increase the risk for future non-contact ACL injury. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children.

PubMed

Maeda, Manabu; Maeda, Nana; Takaoka, Takanori; Tanaka, Yasuhito

2017-02-01

In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula. © 2017 by the American Institute of Ultrasound in Medicine.

Antagonism between MCL-1 and PUMA governs stem/progenitor cell survival during hematopoietic recovery from stress

PubMed Central

Delbridge, Alex R. D.; Opferman, Joseph T.; Grabow, Stephanie

2015-01-01

Understanding the critical factors that govern recovery of the hematopoietic system from stress, such as during anticancer therapy and bone marrow transplantation, is of clinical significance. We investigated the importance of the prosurvival proteins myeloid cell leukemia-1 (MCL-1) and B-cell lymphoma–extra large (BCL-XL) in stem/progenitor cell survival and fitness during hematopoietic recovery from stress. Loss of a single Mcl-1 allele, which reduced MCL-1 protein levels, severely compromised hematopoietic recovery from myeloablative challenge and following bone marrow transplantation, whereas BCL-XL was dispensable in both contexts. We identified inhibition of proapoptotic p53 upregulated modulator of apoptosis (PUMA) as the key role of MCL-1 in both settings, with Mcl-1+/−;Puma−/− mice completely protected from the deleterious effects of loss of 1 Mcl-1 allele. These results reveal the molecular mechanisms that govern cell survival during hematopoietic recovery from stress. PMID:25847014

Enhancing venetoclax activity in acute myeloid leukemia by co-targeting MCL1.

PubMed

Teh, T-C; Nguyen, N-Y; Moujalled, D M; Segal, D; Pomilio, G; Rijal, S; Jabbour, A; Cummins, K; Lackovic, K; Blombery, P; Thompson, E; Ekert, P G; Lessene, G; Glaser, S P; Huang, D C S; Roberts, A W; Guthridge, M A; Wei, A H

2018-02-01

Targeted therapies are frequently combined with standard cytotoxic drugs to enhance clinical response. Targeting the B-cell lymphoma 2 (BCL-2) family of proteins is an attractive option to combat chemoresistance in leukemia. Preclinical and clinical studies indicate modest single-agent activity with selective BCL-2 inhibitors (for example, venetoclax). We show that venetoclax synergizes with cytarabine and idarubicin to increase antileukemic efficacy in a TP53-dependent manner. Although TP53 deficiency impaired sensitivity to combined venetoclax and chemotherapy, higher-dose idarubicin was able to suppress MCL1 and induce cell death independently of TP53. Consistent with an MCL1-specific effect, cell death from high-dose idarubicin was dependent on pro-apoptotic Bak. Combining higher-dose idarubicin with venetoclax was able to partially overcome resistance in Bak-deficient cells. Using inducible vectors and venetoclax to differentially target anti-apoptotic BCL-2 family members, BCL-2 and MCL1 emerged as critical and complementary proteins regulating cell survival in acute myeloid leukemia. Dual targeting of BCL-2 and MCL1, but not either alone, prolonged survival of leukemia-bearing mice. In conclusion, our findings support the further investigation of venetoclax in combination with standard chemotherapy, including intensified doses of idarubicin. Venetoclax should also be investigated in combination with direct inhibitors of MCL1 as a chemotherapy-free approach in the future.

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

PubMed

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

2016-09-01

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

Volitional Spine Stabilization During a Drop Vertical Jump From Different Landing Heights: Implications for Anterior Cruciate Ligament Injury.

PubMed

Haddas, Ram; Hooper, Troy; James, C Roger; Sizer, Phillip S

2016-12-01

Volitional preemptive abdominal contraction (VPAC) during dynamic activities may alter trunk motion, but the role of the core musculature in positioning the trunk during landing tasks is unclear. To determine whether volitional core-muscle activation incorporated during a drop vertical jump alters lower extremity kinematics and kinetics, as well as trunk and lower extremity muscle activity at different landing heights. Controlled laboratory study. Clinical biomechanics laboratory. Thirty-two young healthy adults, consisting of 17 men (age = 25.24 ± 2.88 years, height = 1.85 ± 0.06 m, mass = 89.68 ± 16.80 kg) and 15 women (age = 23.93 ± 1.33 years, height = 1.67 ± 0.08 m, mass = 89.68 ± 5.28 kg). Core-muscle activation using VPAC. We collected 3-dimensional ankle, knee, and hip motions, moments, and powers; ground reaction forces; and trunk and lower extremity muscle activity during 0.30- and 0.50-m drop vertical-jump landings. During landing from a 0.30-m height, VPAC performance increased external oblique and semitendinosis activity, knee flexion, and knee internal rotation and decreased knee-abduction moment and knee-energy absorption. During the 0.50-m landing, the VPAC increased external oblique and semitendinosis activity, knee flexion, and hip flexion and decreased ankle inversion and hip-energy absorption. The VPAC performance during landing may protect the anterior cruciate ligament during different landing phases from different heights, creating a protective advantage just before ground contact and after the impact phase. Incorporating VPAC during high injury-risk activities may enhance pelvic stability, improve lower extremity positioning and sensorimotor control, and reduce anterior cruciate ligament injury risk while protecting the lumbar spine.

Potential for mcl-PHA production from nonanoic and azelaic acids.

PubMed

Gillis, James; Ko, Kenton; Ramsay, Juliana A; Ramsay, Bruce A

2018-01-01

Greater than 65% of canola and high-oleic soy oil fatty acids is oleic acid, which is readily converted to nonanoic (NA) and azelaic (AzA) acids by ozonolysis. NA is an excellent substrate for medium-chain-length polyhydroxyalkanoate (mcl-PHA) production but AzA has few uses. Pseudomonas citronellolis DSM 50332 and Pseudomonas fluorescens ATCC 17400, both able to produce mcl-PHA from fatty acids and to grow on AzA as the sole source of carbon and energy, were assessed for the accumulation of mcl-PHA from AzA and NA. In N-limited shake flasks using NA, P. citronellolis produced 32% of its dry biomass as mcl-PHA containing 78% 3-hydroxynonanoate with 22% 3-hydroxyheptanoate. Pseudomonas fluorescens produced only 2% PHA. N-limited P. citronellolis on AzA produced 20% dry weight PHA containing 75% 3-hydroxydecanoate and 25% 3-hydroxyoctanoate, indicative of de novo synthesis. Although selective pressure, including β-oxidation inhibition, under well-controlled (chemostat) conditions was applied to P. citronellolis, no side-chain carboxyl groups were detected. It was concluded that one or more of FabG and PhaJ or the PHA synthase cannot catalyze reactions involving ω-carboxy substrates. However, a process based on oleic acid could be established if Pseudomonas putida was engineered to grow on AzA.

Assessment of knee laxity using a robotic testing device: a comparison to the manual clinical knee examination.

PubMed

Branch, T P; Stinton, S K; Siebold, R; Freedberg, H I; Jacobs, C A; Hutton, W C

2017-08-01

The purpose of this study was to collect knee laxity data using a robotic testing device. The data collected were then compared to the results obtained from manual clinical examination. Two human cadavers were studied. A medial collateral ligament (MCL) tear was simulated in the left knee of cadaver 1, and a posterolateral corner (PLC) injury was simulated in the right knee of cadaver 2. Contralateral knees were left intact. Five blinded examiners carried out manual clinical examination on the knees. Laxity grades and a diagnosis were recorded. Using a robotic knee device which can measure knee laxity in three planes of motion: anterior-posterior, internal-external tibia rotation, and varus-valgus, quantitative data were obtained to document tibial motion relative to the femur. One of the five examiners correctly diagnosed the MCL injury. Robotic testing showed a 1.7° larger valgus angle, 3° greater tibial internal rotation, and lower endpoint stiffness (11.1 vs. 24.6 Nm/°) in the MCL-injured knee during varus-valgus testing when compared to the intact knee and 4.9 mm greater medial tibial translation during rotational testing. Two of the five examiners correctly diagnosed the PLC injury, while the other examiners diagnosed an MCL tear. The PLC-injured knee demonstrated 4.1 mm more lateral tibial translation and 2.2 mm more posterior tibial translation during varus-valgus testing when compared to the intact knee. The robotic testing device was able to provide objective numerical data that reflected differences between the injured knees and the uninjured knees in both cadavers. The examiners that performed the manual clinical examination on the cadaver knees proved to be poor at diagnosing the injuries. Robotic testing could act as an adjunct to the manual clinical examination by supplying numbers that could improve diagnosis of knee injury. Level II.

Accuracy of clinical tests in the diagnosis of anterior cruciate ligament injury: a systematic review

PubMed Central

2014-01-01

Background Numerous clinical tests are used in the diagnosis of anterior cruciate ligament (ACL) injury but their accuracy is unclear. The purpose of this study is to evaluate the diagnostic accuracy of clinical tests for the diagnosis of ACL injury. Methods Study Design: Systematic review. The review protocol was registered through PROSPERO (CRD42012002069). Electronic databases (PubMed, MEDLINE, EMBASE, CINAHL) were searched up to 19th of June 2013 to identify diagnostic studies comparing the accuracy of clinical tests for ACL injury to an acceptable reference standard (arthroscopy, arthrotomy, or MRI). Risk of bias was appraised using the QUADAS-2 checklist. Index test accuracy was evaluated using a descriptive analysis of paired likelihood ratios and displayed as forest plots. Results A total of 285 full-text articles were assessed for eligibility, from which 14 studies were included in this review. Included studies were deemed to be clinically and statistically heterogeneous, so a meta-analysis was not performed. Nine clinical tests from the history (popping sound at time of injury, giving way, effusion, pain, ability to continue activity) and four from physical examination (anterior draw test, Lachman’s test, prone Lachman’s test and pivot shift test) were investigated for diagnostic accuracy. Inspection of positive and negative likelihood ratios indicated that none of the individual tests provide useful diagnostic information in a clinical setting. Most studies were at risk of bias and reported imprecise estimates of diagnostic accuracy. Conclusion Despite being widely used and accepted in clinical practice, the results of individual history items or physical tests do not meaningfully change the probability of ACL injury. In contrast combinations of tests have higher diagnostic accuracy; however the most accurate combination of clinical tests remains an area for future research. Clinical relevance Clinicians should be aware of the limitations associated

Discovery of Potent Myeloid Cell Leukemia 1 (Mcl-1) Inhibitors Using Fragment-Based Methods and Structure-Based Design

DOE Office of Scientific and Technical Information (OSTI.GOV)

Friberg, Anders; Vigil, Dominico; Zhao, Bin

2012-12-17

Myeloid cell leukemia 1 (Mcl-1), a member of the Bcl-2 family of proteins, is overexpressed and amplified in various cancers and promotes the aberrant survival of tumor cells that otherwise would undergo apoptosis. Here we describe the discovery of potent and selective Mcl-1 inhibitors using fragment-based methods and structure-based design. NMR-based screening of a large fragment library identified two chemically distinct hit series that bind to different sites on Mcl-1. Members of the two fragment classes were merged together to produce lead compounds that bind to Mcl-1 with a dissociation constant of <100 nM with selectivity for Mcl-1 over Bcl-xLmore » and Bcl-2. Structures of merged compounds when complexed to Mcl-1 were obtained by X-ray crystallography and provide detailed information about the molecular recognition of small-molecule ligands binding Mcl-1. The compounds represent starting points for the discovery of clinically useful Mcl-1 inhibitors for the treatment of a wide variety of cancers.« less

Binding affinity of pro-apoptotic BH3 peptides for the anti-apoptotic Mcl-1 and A1 proteins: Molecular dynamics simulations of Mcl-1 and A1 in complex with six different BH3 peptides.

PubMed

Modi, Vivek; Sankararamakrishnan, Ramasubbu

2017-05-01

The anti-apoptotic members of Bcl-2 family of proteins bind to their pro-apoptotic counterparts to induce or prevent cell death.Based on the distinct binding profiles for specific pro-apoptotic BH3 peptides, the anti-apoptotic Bcl-2 proteins can be divided into at least two subclasses. The subclass that includes Bcl-X L binds strongly to Bad BH3 peptide while it has weak binding affinity for the second subclass of Bcl-2 proteins such as Mcl-1 and A1. Anti-apoptotic Bcl-2 proteins are considered to be attractive drug targets for anti-cancer drugs. BH3-mimetic inhibitors such as ABT-737 have been shown to be specific to Bcl-X L subclass while Mcl-1 and A1 show resistance to the same drug. An efficacious inhibitor should target all the anti-apoptotic Bcl-2 proteins. Hence, development of inhibitors selective to Mcl-1 and A1 is of prime importance for targeted cancer therapeutics. The first step to achieve this goal is to understand the molecular basis of high binding affinities of specific pro-apoptotic BH3 peptides for Mcl-1 and A1. To understand the interactions between the BH3 peptides and Mcl-1/A1, we performed multi-nanosecond molecular dynamics (MD) simulations of six complex structures of Mcl-1 and A1. With the exception of Bad, all complex structures were experimentally determined. Bad complex structures were modeled. Our simulation studies identified specific pattern of polar interactions between Mcl-1/A1 and high-affinity binding BH3 peptides. The lack of such polar interactions in Bad peptide complex is attributed to specific basic residues present before and after the highly conserved Leu residue. The close approach of basic residues in Bad and Mcl-1/A1 is hypothesized to be the cause of weak binding affinity. To test this hypothesis, we generated in silico mutants of these basic residues in Bad peptide and Mcl-1/A1 proteins. MD simulations of the mutant systems established the pattern of stable polar interactions observed in high-affinity binding BH3

Injury Characteristics of Low-Energy Lisfranc Injuries Compared With High-Energy Injuries.

PubMed

Renninger, Christopher H; Cochran, Grant; Tompane, Trevor; Bellamy, Joseph; Kuhn, Kevin

2017-09-01

Lisfranc injuries result from high- and low-energy mechanisms though the literature has been more focused on high-energy mechanisms. A comparison of high-energy (HE) and low-energy (LE) injury patterns is lacking. The objective of this study was to report injury patterns in LE Lisfranc joint injuries and compare them to HE injury patterns. Operative Lisfranc injuries were identified over a 5-year period. Patient demographics, mechanism of injury, injury pattern, associated injuries, missed diagnoses, clinical course, and imaging studies were reviewed and compared. HE mechanism was defined as motor vehicle crash, motorcycle crash, direct crush, and fall from greater than 4 feet and LE mechanism as athletic activity, ground level twisting, or fall from less than 4 feet. Thirty-two HE and 48 LE cases were identified with 19.3 months of average follow-up. There were no differences in demographics or missed diagnosis frequency (21% HE vs 18% LE). Time to seek care was not significantly different. HE injuries were more likely to have concomitant nonfoot fractures (37% vs 6%), concomitant foot fractures (78% vs 4%), cuboid fractures (31% vs 6%), metatarsal base fractures (84% vs 29%), displaced intra-articular fractures (59% vs 4%), and involvement of all 5 rays (23% vs 6%). LE injuries were more commonly ligamentous (68% vs 16%), with fewer rays involved (2.7 vs 4.1). LE mechanisms were a more common cause of Lisfranc joint injury in this cohort. These mechanisms generally resulted in an isolated, primarily ligamentous injury sparing the lateral column. Both types had high rates of missed injury that could result in delayed treatment. Differences in injury patterns could help direct future research to optimize treatment algorithms. Level III, comparative series.

Prospective study of the " Inside-Out" arthroscopic ankle ligament technique: Preliminary result.

PubMed

Nery, Caio; Fonseca, Lucas; Raduan, Fernando; Moreno, Marcus; Baumfeld, Daniel

2017-03-22

Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the "Inside-Out" variant of the fully arthroscopic Broström-Gould technique. Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive "anterior drawer" and "talar tilt" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair. Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery. After a mean follow-up of 27 months (range 21-36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved

Postural stability does not differ among female sports with high risk of anterior cruciate ligament injury.

PubMed

Cortes, Nelson; Porter, Larissa D; Ambegaonkar, Jatin P; Caswell, Shane V

2014-12-01

Dancers have a lower incidence of anterior cruciate ligament (ACL) injury compared to athletes in sports that involve cutting and landing motions. Balance can impact ACL injury risk and is related to neuromuscular control during movement. The purpose of this study was to investigate whether balance differences exist among female dancers and female soccer and basketball athletes. Fifty-eight female dancers, soccer, and basketball athletes (16.5 ± 1.6 yrs, 1.6 ± 0.2 m, 60.2 ± 14.1 kg) completed the Stability Evaluation Test (SET) on the NeuroCom VSR Sport (NeuroCom International, Clackamas, OR) to measure sway velocity. Video records of the SET test were used for Balance Error Scoring System (BESS) test scoring. A oneway ANCOVA compared composite sway velocity and BESS scores among sports. There was no statistically significant difference for sway velocity or BESS among sports (sway velocity soccer 2.3 ± 0.4, dance 2.2 ± 0.4, and basketball 2.4 ± 0.4; BESS soccer 13.6 ± 5.0, dance 11.9 ± 5.5, and basketball 14.9 ± 5.1, p>0.05). Balance was similar among athletes participating in different sports (dance, basketball, and soccer). Quasi-static balance may not play a significant role in neuromuscular control during movement and not be a significant risk factor to explain the disparity in ACL injury incidence among sports. Future research should examine the effects of dynamic balance and limb asymmetries among sports to elucidate on the existing differences on ACL injury incidence rates.

The Bruton tyrosine kinase (BTK) inhibitor PCI-32765 synergistically increases proteasome inhibitor activity in diffuse large-B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) cells sensitive or resistant to bortezomib.

PubMed

Dasmahapatra, Girija; Patel, Hiral; Dent, Paul; Fisher, Richard I; Friedberg, Jonathan; Grant, Steven

2013-04-01

Interactions between the Bruton tyrosine kinase (BTK) inhibitor PCI-32765 and the proteasome inhibitor (bortezomib) were examined in diffuse large-B cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) cells, including those highly resistant to bortezomib. Co-administration of PCI-32765/bortezomib synergistically increased mitochondrial injury and apoptosis in germinal centre- or activated B-cell-like-DLBCL cells and in MCL cells. These events were accompanied by marked AKT and nuclear factor (NF)-κB (NFKB1) inactivation, down-regulation of Mcl-1 (MCL1), Bcl-xL (BCL2L1), and XIAP, and enhanced DNA damage (e.g., γH2A.X formation) and endoplasmic reticulum (ER) stress. Similar interactions were observed in highly bortezomib-resistant DLBCL and MCL cells, and in primary DLBCL cells. In contrast, PCI-32765/bortezomib regimens displayed minimal toxicity toward normal CD34(+) bone marrow cells. Transfection of DLBCL cells with a constitutively active AKT construct attenuated AKT inactivation and significantly diminished cell death, whereas expression of an NF-κB "super-repressor" (IκBαser34/36 ) increased both PCI-32765 and bortezomib lethality. Moreover, cells in which the ER stress response was disabled by a dominant-negative eIF2α construct were resistant to this regimen. Finally, combined exposure to PCI-32765 and bortezomib resulted in more pronounced and sustained reactive oxygen species (ROS) generation, and ROS scavengers significantly diminished lethality. Given promising early clinical results for PCI-32765 in DLBCL and MCL, a strategy combining BTK/proteasome inhibitor warrants attention in these malignancies. © 2013 Blackwell Publishing Ltd.

A Competitive Stapled Peptide Screen Identifies a Selective Small Molecule that Overcomes MCL-1-dependent Leukemia Cell Survival

PubMed Central

Cohen, Nicole A.; Stewart, Michelle L.; Gavathiotis, Evripidis; Tepper, Jared L.; Bruekner, Susanne R.; Koss, Brian; Opferman, Joseph T.; Walensky, Loren D.

2012-01-01

SUMMARY Cancer cells hijack BCL-2 family survival proteins to suppress the death effectors and thereby enforce an immortal state. This is accomplished biochemically by an anti-apoptotic surface groove that neutralizes the pro-apoptotic BH3 α-helix of death proteins. Anti-apoptotic MCL-1 in particular has emerged as a ubiquitous resistance factor in cancer. Whereas targeting the BCL-2 anti-apoptotic subclass effectively restores the death pathway in BCL-2-dependent cancer, the development of molecules tailored to the binding specificity of MCL-1 has lagged. We previously discovered that a hydrocarbon-stapled MCL-1 BH3 helix is an exquisitely selective MCL-1 antagonist. By deploying this unique reagent in a competitive screen, we identified an MCL-1 inhibitor molecule that selectively targets the BH3-binding groove of MCL-1, neutralizes its biochemical lockhold on apoptosis, and induces caspase activation and leukemia cell death in the specific context of MCL-1 dependence. PMID:22999885

Neuromuscular Training Availability and Efficacy in Preventing Anterior Cruciate Ligament Injury in High School Sports: A Retrospective Cohort Study.

PubMed

Murray, Jared J; Renier, Colleen M; Ahern, Jenny J; Elliott, Barbara A

2017-11-01

To document neuromuscular training (NMT) availability and its relationship to anterior cruciate ligament (ACL) injuries in 4 major high school sports by gender, sport, and rural/urban geography, with the hypothesis that increased exposure to NMT would be associated with fewer ACL injuries. A retrospective cohort study. All Minnesota high schools identified in the Minnesota State High School League (MSHSL) database for fall 2014 boys' football and soccer, and girls' volleyball and soccer. All high school athletic directors were surveyed to report their school's fall 2014 experience; 53.5% returned the survey reporting experience with one or more of the sports. Athletic directors documented each sport's preseason and in-season exposure to NMT (plyometric exercises, proximal/core muscle strengthening, education and feedback regarding proper body mechanics, and aerobics) and licensed athletic trainers. Reported ACL injuries by sport, gender and rural/urban. More than two-thirds of teams incorporated facets of NMT into their sport. Among male athletes, soccer players exposed to licensed athletic trainers experienced significantly fewer ACL injuries (P < 0.005), and NMT was associated with significantly fewer ACL injuries in football (P < 0.05) and soccer (P < 0.05). Female athletes did not demonstrate similar associated improvements, with volleyball injuries associated with increased NMT (P < 0.001), and soccer injuries not associated with NMT. However, girl soccer players in rural settings reported fewer ACL injures compared with urban teams (P < 0.001). Most fall high school sports teams were exposed to NMT, which was associated with fewer ACL injuries for male, but not for female athletes. Improved gender- and sport-specific preventive training programs are indicated.

Enhanced Medial Collateral Ligament Healing using Mesenchymal Stem Cells: Dosage Effects on Cellular Response and Cytokine Profile

PubMed Central

Saether, Erin E.; Chamberlain, Connie S.; Leiferman, Ellen M.; Kondratko-Mittnacht, Jaclyn R.; Li, Wan Ju; Brickson, Stacey L.; Vanderby, Ray

2013-01-01

Mesenchymal stem cells (MSCs) have potential therapeutic applications for musculoskeletal injuries due to their ability to differentiate into several tissue cell types and modulate immune and inflammatory responses. These immune-modulatory properties were examined in vivo during early stage rat medial collateral ligament healing. Two different cell doses (low dose 1×106 or high dose 4×106 MSCs) were administered at the time of injury and compared with normal ligament healing at days 5 and 14 post-injury. At both times, the high dose MSC group demonstrated a significant decrease in M2 macrophages compared to controls. At day 14, fewer M1 macrophages were detected in the low dose group compared to the high dose group. These results, along with significant changes in procollagen I, proliferating cells, and endothelialization suggest that MSCs can alter the cellular response during healing in a dose-dependent manner. The higher dose ligaments also had increased expression of several pro-inflammatory cytokines at day 5 (IL-1β, IFNγ, IL-2) and increased expression of IL-12 at day 14. Mechanical testing at day 14 revealed increased failure strength and stiffness in low dose ligaments compared to controls. Based on these improved mechanical properties, MSCs enhanced functional healing when applied at a lower dose. Different doses of MSCs uniquely affected the cellular response and cytokine expression in healing ligaments. Interestingly, the lower dose of cells proved to be most effective in improving functional properties. PMID:24174129

Simultaneous targeting of ATM and Mcl-1 increases cisplatin sensitivity of cisplatin-resistant non-small cell lung cancer.

PubMed

Zhang, Fuquan; Shen, Mingjing; Yang, Li; Yang, Xiaodong; Tsai, Ying; Keng, Peter C; Chen, Yongbing; Lee, Soo Ok; Chen, Yuhchyau

2017-08-03

Development of cisplatin-resistance is an obstacle in non-small cell lung cancer (NSCLC) therapeutics. To investigate which molecules are associated with cisplatin-resistance, we analyzed expression profiles of several DNA repair and anti-apoptosis associated molecules in parental (A549P and H157P) and cisplatin-resistant (A549CisR and H157CisR) NSCLC cells. We detected constitutively upregulated nuclear ATM and cytosolic Mcl-1 molcules in cisplatin-resistant cells compared with parental cells. Increased levels of phosphorylated ATM (p-ATM) and its downstream molecules, CHK2, p-CHK2, p-53, and p-p53 were also detected in cisplatin-resistant cells, suggesting an activation of ATM signaling in these cells. Upon inhibition of ATM and Mcl-1 expression/activity using specific inhibitors of ATM and/or Mcl-1, we found significantly enhanced cisplatin-cytotoxicity and increased apoptosis of A549CisR cells after cisplatin treatment. Several A549CisR-derived cell lines, including ATM knocked down (A549CisR-siATM), Mcl-1 knocked down (A549CisR-shMcl1), ATM/Mcl-1 double knocked down (A549CisR-siATM/shMcl1) as well as scramble control (A549CisR-sc), were then developed. Higher cisplatin-cytotoxicity and increased apoptosis were observed in A549CisR-siATM, A549CisR-shMcl1, and A549CisR-siATM/shMcl1 cells compared with A549CisR-sc cells, and the most significant effect was shown in A549CisR-siATM/shMcl1 cells. In in vivo mice studies using subcutaneous xenograft mouse models developed with A549CisR-sc and A549CisR-siATM/shMcl1 cells, significant tumor regression in A549CisR-siATM/shMcl1 cells-derived xenografts was observed after cisplatin injection, but not in A549CisR-sc cells-derived xenografts. Finally, inhibitor studies revealed activation of Erk signaling pathway was most important in upregulation of ATM and Mcl-1 molcules in cisplatin-resistant cells. These studies suggest that simultaneous blocking of ATM/Mcl-1 molcules or downstream Erk signaling may recover the

Predisposing Risk Factors for Non-Contact ACL Injuries in Military Subjects

DTIC Science & Technology

2011-01-01

with activity: epidemiology of anterior cruciate ligament injuries in a young, athletic population. Am J Sports Med 35:1635–1642 21. Nicholas JA (1970...Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch steno - sis. Am J Sports Med 16:449–454 27. Uhorchak JM, Scoville CR