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Acute elbow pain can be the result of traumatic and atraumatic processes. Pathologic processes include osseous, ligamentous, and tendinous etiologies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Nonabsorbable suture augmentation of ligament reconstruction has seen an increase in use over the past several years with the goal of protecting the newly reconstructed ligament while allowing early rehabilitation for a potential earlier return to activity and sport. By spanning the joint with a durable nonabsorbable suture, this construct shares the stress and load seen by the reconstructed ligament, thereby protecting it from forces that could result in an early failure during the early ligamentization phase of the tendon graft. However, stress shielding of the ligament via nonabsorbable suture augmentation is also a double-edged sword, as a reduction in the stress and load seen by the ligament during this healing phase may ultimately have an impact on the final strength and composition of the reconstructed ligament. Although the long-term effects of this stress shielding have yet to be studied or reported in human subjects, multiple biomechanical and animal studies have demonstrated overall changes in architecture, tensile strength, and mechanical properties of a stress-shielded autograft ligament reconstruction. [ABSTRACT FROM AUTHOR]

Gout is the most common inflammatory arthritis due to deposition of monosodium urate (MSU) crystals in joints and connective tissues. In contrast to joint disease, the majority of extra-articular involvement remains asymptomatic in patients with gout. Achilles tendon is the most common site of involvement and the inflammation elicited by MSU crystals can be falsely attributed to injury or overuse. In addition, tendon or ligament damage secondary to MSU crystal deposition can lead to ligament tear or tendon rupture. However, the diagnosis of gout in patients with extra-articular involvement is often delayed or even missed because tissue sampling is not feasible in routine clinical practice. Advanced imaging techniques using ultrasound and dual-energy computer tomography (DECT) can detect MSU crystal deposition in a non-invasive manner and confirm the diagnosis of gout in patients with extra-articular involvement. The following case demonstrates an atypical presentation of gout causing multiple ligament tears in the ankle and highlights the role of DECT in the diagnosis of gout with extra-articular involvement.

Introduction: Ankle injuries are common in daily orthopaedic trauma practice, with a high incidence of lateral ligament complex (lat-lig-com) injuries of the ankle joint (AJ). Primarily, these lat-lig-com injuries heal sufficiently, although there is a risk of developing chronic ankle instability. However, there is a lack of knowledge about the clinical application and routine for rehabilitation strategies so as to prevent chronic instability. This study investigates the current rehabilitation concepts in clinical routine after ligament injuries of the AJ. Methods: Rehabilitation protocols, provided by orthopaedic and trauma surgery institutions in German speaking countries, were analysed in terms of weight-bearing, range of motion (ROM), physiotherapy and choice of orthosis. All protocols for operatively and non-operatively (nop) treated ligament ruptures of the AJ were included. Results: 120 of 213 institutions provided protocols of lat-lig-com injuries of the AJ. Regarding the orthosis, the nop-treatment group mainly used ankle braces; in contrast, the operative group preferred the use of an ankle boot. The operative group recommends 6–12 weeks for duration of orthosis in contrast to only 6 weeks in the nop group. Significant differences prevail in ROM, with free ROM in non-operative treatment from the first day after trauma (p<0.001) in contrast to a careful increase in ROM in the first 6 weeks post-operatively. Conclusion: Early functional treatment is clinical standard in rehabilitation after lat-lig-com injuries of the ankle. Regarding current literature the differences of restrictions in ROM and orthosis treatment after lat-lig-com injuries suggest a trivialization of conservative treatment in the first period after trauma compared to post-operative aftercare. [ABSTRACT FROM AUTHOR]

This prospective case series compared the accuracy of ultrasound (US) to magnetic resonance imaging (MRI) in differentiating complete displaced (CD) thumb ulnar collateral ligament (UCL) tears from nondisplaced injuries in 10 patients with suspected traumatic thumb UCL injuries. Ultrasound identified 100% (2 of 2) of MRI‐documented CD tears, both of which were further confirmed during surgical repair. Ultrasound identified the absence of CD tears in the remaining 8 patients. Although MRI is the reference standard imaging modality for characterizing thumb UCL injuries, ultrasound should be considered an accurate, cost‐effective, and alternative imaging modality to differentiate surgical versus nonsurgical thumb UCL injuries. [ABSTRACT FROM AUTHOR]

Background: The knee joint assessment to detect anterior cruciate ligament (ACL) injury after trauma involves clinical examination and radiography. The gold standard method is doing arthroscopy. We did this study seeking to evaluate the effectiveness of other non-invasive diagnostic methods, including the Anterior Drawer test, Lachman test and magnetic resonance imaging (MRI) in detecting ACL tears after trauma, compared to the reference standard method (the arthroscopy)., Methodology: This descriptive cross-sectional study was conducted in the Orthopaedic Department of the Khyber Teaching Hospital, Peshawar, for six months. A total of 86 participants with knee injuries fulfilling the inclusion criteria were recruited for the study. Mechanism of injury, side of injury and body weight were recorded. The Anterior Drawer test and Lachman test for ACL injury were performed by orthopaedic surgeons with at least five years of post-fellowship experience in orthopaedic surgery. Sensitivities, specificities and accuracy of the clinical tests and MRI were calculated., Results: The statistical analysis revealed that the mean age of participants was 35.73 (SD 12.7) years, with a range from 18 to 55 years. Among the participants, 67 (77.91%) were male and 19 (22.09%) were female. The side of injury was predominantly right in 50 (58.14%) and left in 36 (41.86%) participants. Road traffic accidents (RTAs) were the leading cause of knee injury, accounting for 63.95% (55) of cases, followed by sports injuries at 23.26% (20). Regarding diagnostic accuracy, MRI showed a sensitivity of 98.57%, specificity of 87.50% and diagnostic accuracy of 96.51% in detecting ACL tears. The Lachman test demonstrated a sensitivity of 90%, specificity of 87.5% and diagnostic accuracy of 89.53% compared to arthroscopy. Similarly, the anterior Drawer test exhibited a sensitivity of 88.57%, specificity of 87.50% and diagnostic accuracy of 88.37% against the gold standard of arthroscopy. These findings underscore the effectiveness of these diagnostic modalities in identifying ACL injuries., Conclusions: All three tests (MRI, Lachman test and anterior Drawer test) can be used for the diagnosis of anterior cruciate ligament injury with optimal results., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zeb et al.)

Mobile Taschen-Ultraschallgeräte ermöglichen eine Bildgebung an Orten, an denen das Mitführen großer Geräte erschwert ist. Aktuell liegt die Qualität ihrer Bildgebung noch unter der von Hochleistungsultraschallgeräten. Es besteht aber wissenschaftliche Evidenz aus verschiedenen medizinischen Disziplinen, dass die Sensitivität und Spezifität dieser neuen Gerätegeneration ausreichend ist, um relevante Erkrankungen und Verletzungen zu detektieren. Am Bewegungsapparat betrifft das, strukturelle Verletzungen von Muskeln, Sehnen und Bändern sowie Gelenkergüsse und Hämatome. Damit kann das mobile Taschen-Ultraschallgerät dem betreuenden Sportarzt für die Weichenstellung weiterführender Diagnostik und Therapie wertvolle Informationen geben. Weitere wissenschaftliche Studien sind jedoch dringend notwendig, um die Sensitivität und Spezifität dieser neuen Ultraschallgerätegeneration für die verschiedenen muskuloskelettalen Verletzungen und Überlastungsschäden zu evaluieren. Mobile pocket ultrasound devices enable imaging in places where it is difficult to carry large devices. The quality of their imaging is still below that of high-performance ultrasound devices. However, there is scientific evidence from various medical disciplines that the sensitivity and specificity of this new generation of devices is sufficient to detect relevant diseases and injuries. On the musculoskeletal system, this affects structural injuries to muscles, tendons and ligaments as well as joint effusions and hematomas. The mobile pocket ultrasound device can thus give the attending sports doctor valuable information in order to design the further diagnosis and therapy of the detected injury. However, further scientific studies are urgently needed to evaluate the sensitivity and specificity of this new generation of ultrasound devices for the various musculoskeletal injuries and overload damage. [ABSTRACT FROM AUTHOR]

Multiligamentous knee injuries (MLKIs) are rare and challenging to manage in many aspects. The injury requires prompt diagnosis, reconstruction of multiple ligaments, and management of associated neurovascular injuries. Another important aspect that surgeons should consider is resource availability. Successful management of a case of MLKI using the cost-effective 'modified confluent tunnel technique' is described in this case report. We used confluent tunnels for intra- and extra-articular ligament reconstructions at the femoral side. We incorporated the weave technique for medial collateral ligament (MCL) reconstruction, and Larson's technique for posterolateral corner (PLC) reconstruction in this construct, and augmented the anterior cruciate ligament (ACL) and posterior cruciate ligament reconstruction with the remaining PLC and MCL grafts, respectively. This was cost-effective and resulted in good functional outcomes. The technique also helped us to avoid tunnel convergence which is an expected complication in MLKI surgeries., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteochondral lesions. Purpose: To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular ligament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) on foot-ankle kinematics during simulated gait. Study Design: Controlled laboratory study. Methods: Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFL rupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and the average angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait. Results: Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kinematics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the 5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AA in inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in 1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 of the 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA in inversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Both isolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talonavicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still better at restoring motion in the talocalcaneal joint than isolated reconstruction (1/3 for ROM and 1/3 for the AA with isolated reconstruction compared to 1/3 for ROM and 2/3 for the AA with combined reconstruction). Conclusion: Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFL reconstruction after a combined ATFL-CFL rupture. Clinical Relevance: This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kinematics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Broström-Gould technique is followed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessive ROM after a ligament rupture. [ABSTRACT FROM AUTHOR]

Kombinierte zeit- und kriterienbasierte × rücken in der modernen Nachbehandlung zunehmend in den klinischen Fokus, um nach operativen Eingriffen am Bewegungsapparat den individuellen Bedürfnissen der Patienten Rechnung tragen zu können und die sichere Rückkehr zu Alltag und Sport zu gewährleisten. In diesem Zusammenhang ist ein interdisziplinäres Vorgehen nötig, bei dem Physiotherapeuten, Sportwissenschaftler und Ärzte den Patienten in komplementärer Zusammenarbeitet im Konsensverfahren begleiten. Die funktionelle Diagnostik bietet qualitative und quantitative Tests, um objektivierbare Ergebnisse für das Rehabilitationsschema zu liefern. So kann eine optimale Entscheidung für eine sichere Rückkehr in Alltagsaktivitäten/zum Arbeitsalltag und zum Sport gegeben und das Risiko von Rezidiv-Verletzungen und resultierende Folgekosten langfristig reduziert werden. After orthopedic surgeries, the combination of a time- and evidence-based rehabilitation for patients moved into clinical focus. This novel approach considers the individual prerequisites in patient care coupled with a safe and controlled return to sports. With an emphasis on transdisciplinary collaborations, physiotherapist, sport scientists and orthopedic surgeon work consensually together to establish a progressive rehabilitations treatment for the individuum. The underlying rehabilitation schematics are guided by functional diagnostics that provide a quantitative and qualitative test batteriy to deliver objective results which justify the rehabilitation progress. As a result, a successful return to daily life or sports can be assured in combination with significantly reduced recurrence injuries and a sustainably diminished follow-up cost. [ABSTRACT FROM AUTHOR]

Abstract The primary objective of this investigation was to determine the level of agreement and reliability of the stress examination of the Lisfranc tarsometatarsal joint complex. Secondary objectives were to determine surgeon preferences with respect to this testing and to use gaze recognition software to perform an eye-tracking assessment during the performance of the test. Twelve foot and ankle surgeons, 12 residents, and 12 students were shown 2 intraoperative fluoroscopic still images and 1 video of the stress examination of the tarsometatarsal joint complex using stress abduction of the forefoot on the rearfoot. Participants were asked to evaluate the result as being "positive" or "negative" for tarsometatarsal joint stability. The overall reliability of the interpretation of the stress examination was a kappa of 0.281 (surgeons 0.182; residents 0.423; students 0.256) indicating "fair" agreement. Survey results indicated wide variability in the perioperative preferences and protocols of surgeons dealing with the evaluation and treatment of the tarsometatarsal joint. Eye-tracking results also demonstrated variability in the anatomic structures of interest focused on during performance of this testing. The results of this investigation provide evidence of reliability well below what would be expected of a gold standard test during stress examination of the Lisfranc tarsometatarsal joint complex. These results indicate that future scientific endeavors are required to standardize the performance and interpretation of this testing. [ABSTRACT FROM AUTHOR]

Die Differenzierung einer traumatischen von einer unfallunabhängigen Schädigung des Lig. scapholunare (SLL) stellt auch weiterhin eine Herausforderung an den Gutachter dar. Der Nachweis einer traumatischen Zerreißung gelingt zuverlässig bei gesichertem, adäquatem Unfallhergang und beim Vorliegen von Begleitverletzungen (weitere Band-Kapsel-Rupturen, knöcherne Verletzungen und/oder einem „bone bruise"). Schwierig gestaltet sich die Zusammenhangsbeurteilung bei unklaren Ereignisabläufen, einer damit verbundenen geringen Krafteinleitung und erst später aufgetretenen, klinischen Symptomen, die dann im Rahmen weiterer Diagnostik die SLL-Ruptur aufzeigen. Hierbei gilt es, nach konkurrierenden Ursachen (angeborene Aplasie des SLL, verschleißbedingter Bandaufbrauch oder weitere traumatische Ereignisse) zu fahnden, die dann aber auch mit Sicherheit nachzuweisen sind. Häufigste Ursache für die traumatische SLL-Ruptur ist der Sturz auf die Handfläche des nach vorn ausgestreckten Armes. [ABSTRACT FROM AUTHOR]

Copyright of Pesquisa Veterinaria Brasileira is the property of Colegio Brasileiro de Patologia Animal - CBPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This article reviews tendon and ligament injury incidence and severity within elite rugby union and rugby league. Furthermore, it discusses the biological makeup of tendons and ligaments and how genetic variation may influence this and predisposition to injury. Elite rugby has one of the highest reported injury incidences of any professional sport. This is likely due to a combination of well-established injury surveillance systems and the characteristics of the game, whereby high-impact body contact frequently occurs, in addition to the high intensity, multispeed and multidirectional nature of play. Some of the most severe of all these injuries are tendon and ligament/joint (non-bone), and therefore, potentially the most debilitating to a player and playing squad across a season or World Cup competition. The aetiology of these injuries is highly multi-factorial, with a growing body of evidence suggesting that some of the inter-individual variability in injury susceptibility may be due to genetic variation. However, little effort has been devoted to the study of genetic injury traits within rugby athletes. Due to a growing understanding of the molecular characteristics underpinning the aetiology of injury, investigating genetic variation within elite rugby is a viable and worthy proposition. Therefore, we propose several single nucleotide polymorphisms within candidate genes of interest; COL1A1, COL3A1, COL5A1, MIR608, MMP3, TIMP2, VEGFA, NID1 and COLGALT1 warrant further study within elite rugby and other invasion sports.

The objective of this study was to simulate the movements of the bones involved in human forearm rotation. We developed a biomechanical arm model comprising bone, muscle, and ligament components. Computed tomography (CT) scans of a human arm were used to determine the morphology of the humerus, ulna, radius, and hand bones. Magnetic resonance (MR) images were used to create muscle spring models simulating the pronator teres, pronator quadratus, and supinator muscles. Twenty-seven ligaments connecting the bone components were approximated by wire models. We also created several ligament rupture models by eliminating some of the 27 ligaments. Ligaments were removed according to the following four stages: Stage a-I, only dorsal triangular fibrocartilage complex (TFCC); Stage b-I, only palmar TFCC; Stage II, both dorsal and palmar TFCC; Stage III, both dorsal and palmar TFCC plus distal interosseous membrane. In the complete 27-ligament model and in the ligament rupture models, the forearm was rotated to 90° supination and 85° pronation for comparison. In supination, the rupture of the palmar TFCC (Stage b-I) caused a larger difference between the two types of models than the rupture of the dorsal TFCC (Stage a-I). The distal radioulnar joint instability and radial laxity occurred for Stage III rather than Stage II. The distal radioulnar joint was more stable and radial laxity was less pronounced during pronation in the presence of the pronator quadratus muscle than during supination in the absence of this muscle. These findings were in good accord with previous study results.

In recent years, the distributions of vehicle types include a substantial number of Sport Utility Vehicles (SUVs). Pedestrian injury distribution of SUVs is different from that of passenger cars and head, torso, and lower extremities are most frequently injured body regions of pedestrian impacted with SUV. Therefore, kinematics of pedestrian and mechanism of injuries of pedestrian, who is impacted by SUV, are emerging research area. In this paper, the kinematics and lower extremity injuries of pedestrian were simulated by using a human FE model “Total Human Model for Safety” (THUMS) and SUV FE model. The result by the simulation was validated with test result and showed generally good correlations. Kinematics of whole pedestrian and mechanism of injuries of lower extremities of pedestrians impacted by SUV were discussed.

Post-traumatic arthritis can result in significant pain and difficulty in managing daily life activities. Multiple factors are weighed in selecting the proper surgical intervention, with patient age and level of activity being most important. Isolated osteoarthritis is a well-known indication for unicompartmental knee arthroplasty, where a better range of motion, preservation of natural knee kinematics and less invasive resection of knee joint bone are used. Moreover, the high improvement rate and long-term results after anterior cruciate ligament (ACL) reconstruction and restoration of knee stability can make the combined procedure favourable, particularly for young active patients.We report on an active man in his 30s presenting with isolated medial compartment advanced arthritis after sustaining distal femur intra-articular fracture. He was initially treated with partial unicompartmental knee replacement combined with ACL reconstruction, delivering a good short-term follow-up outcome.Though this case involves just a single patient, the positive outcome suggests that combined partial unicompartmental knee replacement with an ACL reconstruction should be considered for young and active patients diagnosed with isolated advanced medial compartment osteoarthritis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Knee dislocations are severe injuries difficult to treat. Specially in low-resources scenarios, reconstruction of multiple ligaments can be challenging. We describe a technical note that can be reconstruct multi ligaments using ipsilateral hamstrings autograft. A posteromedial knee incision is made to visualise the medial corner of the knee and to reconstruct medial collateral ligament (MCL) and posterior cruciate ligament (PCL) with semitendinosus and gracilis tendon graft, using one femoral tunnel from the anatomic femoral insertion of the MCL to the anatomic femoral insertion of the PCL. After 1-year follow-up, the patient returned to his previous function with a Lysholm score of 86. This technique can reconstruct more than one ligament anatomically with limited graft resource., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

The proteins ELN and FBN2 are important in extracellular matrix function. The ELN rs2071307 and FBN2 rs331079 gene variants have been associated with soft tissue pathologies. We aimed to determine whether these variants were predisposing factors for both Achilles tendinopathy (AT) and anterior cruciate ligament (ACL) ruptures. For the AT study, 135 cases (TEN group) and 239 asymptomatic controls were recruited. For the ACL rupture study our cohort consisted of 141 cases (ACL group) and 219 controls. Samples were genotyped for both the ELN rs2071307 and FBN2 rs331079 variants using TaqMan assays. Analysis of variance and chi-squared tests were used to determine whether either variant was associated with AT or ACL rupture with significance set at p < 0.05. The GG genotype of the FBN2 variant was significantly over-represented within the TEN group (p=0.035; OR=1.83; 95% CI 1.04-3.25) compared to the CON group. We also found that the frequency of the G allele was significantly different between the TEN (p=0.017; OR=1.90; 95% CI 1.11-3.27) and ACL groups (p=0.047; OR=1.76; 95% CI 1.00-3.10) compared to controls. The ELN rs207137 variant was not associated with either AT or ACL rupture. In conclusion, DNA sequence variation within the FBN2 gene is associated with both AT and ACL rupture. [ABSTRACT FROM AUTHOR]

The ligamentum capitis femoris ( LCF) has increased in clinical significance through the development of hip arthroscopy. The histological pathologies and molecular composition of the femoral attachment of the LCF and the degeneration caused by LCF disruption were investigated in the human hip joint. Twenty-four LCFs were retrieved at surgery for femoral neck fracture (age range: 63-87 years). In the 'intact' (i.e., intact throughout its length, n = 12) group, the attachment consisted of rich fibrocartilage. Fibrocartilage cells were present in the midsubstance. In contrast, the construction of the attachment in the 'disrupted' (i.e., ligament no longer attached to the femoral head, n = 12) group had disappeared. The attachment in the disrupted group was not labeled for type II collagen or aggrecan, while that in the intact group was labeled for types I, II and III collagen, chondroitin 4-sulfate, chondroitin 6-sulfate, aggrecan, and versican. The percentage of single-stranded DNA-positive chondrocytes was significantly higher in the disrupted group than in the intact group. We conclude that the femoral attachment of the LCF has a characteristic fibrocartilaginous structure that is likely to adjust to the mechanical load, and suggest that its degeneration is advanced by disruption and should be regarded as a clinical pathology. [ABSTRACT FROM AUTHOR]

Rupture of the upper ankle joint ligaments is a common injury. Therapy in patients with Ehlers Danlos Syndrome (EDS) is a challenge due to the autosomal-dominant collagenopathy. Therapeutic recommendations and long term results in treatment of patients with EDS are rare. Therefore uncertainty exists. We present a case of clinical and radiologic long term results after ligament rupture of the upper ankle joint in a patient with EDS. A literature review tries to reveal current therapeutic strategies in patients with EDS. [ABSTRACT FROM AUTHOR]

Collagen is the primary structural protein of the human body and the main component of connective tissue. In the form of elongated fibrils, collagen is mostly found in fibrous tissues such as tendon, ligament, and skin. We have already demonstrated that pathologic changes of human collagen structures could be monitored by differential scanning calorimetry (DSC), besides the classical histological methods. The aim of the study was to find whether there is a consistent increase or decrease of the thermal parameters, if we compare the changes of calorimetric enthalpy and denaturation temperature of (1) group: degenerative with (2) group: inflamed collagen structures. The degenerative samples were collected from ruptured Quadriceps, Achilles, patellar and anterior cruciate ligament, and degenerated joint capsule of the shoulder. The inflamed tissue samples were collected from palmar aponeurosis in Dupuytren disease, transverse carpal ligament in carpal tunnel syndrome (CTS), and transverse ligament of the first dorsal compartment in De Quervain disease. The thermal denaturation of human samples was monitored by a SETARAM Micro DSC-II calorimeter. All the experiments were performed between 0 and 100 °C. The heating rate was 0.3 K min. DSC scans clearly demonstrated significant differences between the two groups, proving that the thermal stability of the degenerative and inflamed pathologic collagens is significantly different. In cases of degenerative samples, the enthalpy decreased, while the melting temperature showed an increase. On the contrary, inflamed samples demonstrated a significant increase in the enthalpy and the melting temperature decreased. Our results indicate that DSC may be a clinically relevant method in the diagnosis of different collagen diseases. [ABSTRACT FROM AUTHOR]

Copyright of Arthroskopie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: An analytical, dynamic model of the human knee joint has been developed to simulate the unloaded knee joint behaviour in 6 degrees of freedom. It is based on extensive robot-based measurements of the elastic properties of a human cadaver knee joint. The measured data are compared with data from the literature to ensure that a proper database for modelling is used. The analytical modelling of the passive elastic joint properties is done with Local Linear Model Trees. The deduced knee joint model incorporates passive elastic properties of the internal knee joint structures, passive elastic muscle forces, damping forces, gravitational forces, and external forces. There are two sets of parameters, one simulating the movement of the intact knee joint, and a second simulating the knee joint with ruptured anterior cruciate ligament. The dynamic model can be easily processed in real-time. It is implemented in the haptic display of the Munich Knee Joint Simulator (MKS), which enables a person to move a plastic leg driven by a robot manipulator and feel the simulated knee joint force. Orthopaedic physicians judged the performance of the dynamic knee joint model by executing physical knee joint tests at the MKS. [Copyright &y& Elsevier]

Ruptures of the posterior cruciate ligament (PCL) and especially proximal bony avulsion fractures in children are very rare. This in combination with a rupture of the popliteal artery is extremely rare. Thus, an exact incidence is not available from the literature. Overall, these injuries are severe and often lead to chronic knee instability. We report a case of a 9-year-old boy who suffered a traumatic displacement of the left knee with a rupture of the popliteal artery. Prior to transfer to our department, he was treated by a saphenous vein bypass graft and by a transfixation of the knee using two oblique percutaneous pins. We performed magnetic resonance imaging (MRI) scan of the knee which revealed a femoral avulsion fracture of the PCL. Other ligaments and menisci were intact. A transosseous femoral fixation using non-absorbable stitches was carried out. A 1-year follow-up after surgery demonstrates intact peripheral perfusion and sensation, straight axes of both legs and a physiological gait. Minimal differences of the length and circumference of both legs could be measured. The posterior laxity (Lachman-test) was about 5/8 mm (right/left knee) and 2/5 mm (right/left knee) in 90 degrees flexion. The range of motion (extension/flexion) was 5/0/140 degrees -/5/100 degrees (right-left knee). Intact cruciate ligaments were confirmed by MRI. Minimal experience exists in treatment of combined injuries to the PCL and the popliteal artery in children. [ABSTRACT FROM AUTHOR]

This study compared the therapeutic efficacy between cast immobilization and functional treatment of grade III ruptures of the lateral ankle ligaments. Subjects (n=121) had closed physeal cartilage, age under 35 years, grade III rupture without previous or associated injuries, and practiced regular sports. Patients were randomized into an immobilization group (21 days plaster cast) or a functional one (15 days strapping plus early controlled mobilization). Symptoms (pain, swelling, stiffness, subjective instability), joint laxity, return to preinjury activity (time and level) and rate of reinjury were assessed 3, 6, and 12 months after sprain. Objective joint laxity was related to constitutional laxity, creating a new variable [talar tilt at injury – talar tilt at control]/contralateral talar tilt. The functional group showed significantly earlier and better return to physical activity, fewer symptoms at 3 and 6 months but no intergroup difference at 12 months. Functional treatment also showed better decrease in joint laxity. No intergroup differences were found in the reinjury rate. We conclude that functional treatment is safe, associated with a more rapid recovery, and particularly suitable in athletic populations. [ABSTRACT FROM AUTHOR]