The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligamen...The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands(anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion. In individuals who fail co-mprehensive non-operative treatment, surgical repair or reconstruction of the MUCL is commonly required to restore elbow function and stability. A comprehensive understanding of the anatomy and biomechanical properties of the MUCL is imperative to optimize reconstructive efforts, and to enhance clinical and radiographic outcomes. Our understanding of the native anatomy and biomechanics of the MUCL has evolved over time. The precise locations of the origin and insertion footprint centers guide surgeons in proper graft placement with relation to bony anatomic landmarks. In recent studies, the ulnar insertion of the MUCL is described as larger than previously thought, with the center of the footprint at varying distances relative to the ulnar ridge, joint line, or sublime tubercle. The purpose of this review is to consolidate and summarize the existing literature regarding the native anatomy, biomechanical, and clinical significance of the entire medial ulnar collateral ligament complex, including the MUCL(AB), PB, and transverse ligament.展开更多
AIM To examine the normal morphology of the epiligament tissue of the knee medial collateral ligament(MCL) in humans. METHODS Several samples of the mid-substance of the MCL of the knee joint from 7 fresh human cadave...AIM To examine the normal morphology of the epiligament tissue of the knee medial collateral ligament(MCL) in humans. METHODS Several samples of the mid-substance of the MCL of the knee joint from 7 fresh human cadavers(3 females and 4 males) were taken. Examination of the epiligament tissue was conducted by light microscopy and photomicrography on semi-thin sections of formalin fixed paraffin-embedded blocks that were routinely stained with haematoxylin and eosin, Mallory stain and Van Gieson's stain. Electron microscopy of the epiligament tissue was performed on ultra-thin sections incubated in 1% osmium tetroxide and contrasted with 2.5% uranyl acetate, lead nitrate, and sodium citrate.RESULTS The current light microscopic study demonstrated that the epiligament of the MCL consisted of fibroblasts, fibrocytes, adipocytes, neuro-vascular bundles and numerous multidirectional collagen fibers. In contrast, the ligament body was poorly vascularised, composed of hypo-cellular fascicles which were formed of longitudinal groups of collagen fibers. Moreover, most of the vessels of the epiligament-ligament complex were situated in the epiligament tissue. The electron microscopic study revealed fibroblasts with various shapes in the epiligament substance. All of them had the ultrastructural characteristics of active cells with large nuclei, well developed rough endoplasmic reticulum, multiple ribosomes, poorly developed Golgi apparatus, elliptical mitochondria and oval lysosomes. The electron microscopy also confirmed the presence of adipocytes, mast cells, myelinated and unmyelinated nerve fibers and chaotically oriented collagen fibers.CONCLUSION Significant differences exist between the normal structure of the ligament and the epiligament whose morphology and function is to be studied further.展开更多
The drastic difference in healing capacity between the anterior cruciate ligament and medial collateral ligament injuries is still largely unexplained.So,studying the molecular expression after anterior cruciate ligam...The drastic difference in healing capacity between the anterior cruciate ligament and medial collateral ligament injuries is still largely unexplained.So,studying the molecular expression after anterior cruciate ligament and medial collateral ligament injury could be a new direction to explain such differences.In this study,eighteen male 3-month-old New Zealand white rabbits were randomly divided into six groups by injury modeling to study the molecular expression after anterior cruciate ligament and medial collateral ligament injury.The expression of molecular genes and proteins was examined using reverse transcriptase chain reaction and Western blotting.Marked differences were found in the postinjury changes in gene levels and proteins in the anterior cruciate ligament compared to the medial collateral ligament.The results show that there were drastic differences in angiogenesis,collagen and matrix metalloproteinases after anterior cruciate ligament and medial collateral ligament injury.It can be found that the repair ability of the anterior cruciate ligament and medial collateral ligament after injury may be related to the differences in molecular expression.展开更多
<span style="font-family:Verdana;">This study aimed to evaluate the influence of measuring the length of the medial collateral ligament (MCL) to compare the MCL burden when the knee joint is placed und...<span style="font-family:Verdana;">This study aimed to evaluate the influence of measuring the length of the medial collateral ligament (MCL) to compare the MCL burden when the knee joint is placed under valgus stress in the open and closed and closed kinetic chain.</span><b> </b><span style="font-family:Verdana;">Two examiners conducted the examination. The MCL length was measured using ultrasonography. Two subjects were measured in unload bearing and load-bearing positions, with and without valgus stress test at the knee joint extension and 30<span style="white-space:nowrap;">°</span> flexion, under eight different measurement conditions. The MCL of the subject was delineated in the longitudinal direction using an ultrasound system. The attachment points of the medial femoral and tibial condyle of the MCL were identified, and the ligament length was measured. The MCL rate before and after the valgus stress test in the loading and unloading positions was calculated.</span><b> </b><span style="font-family:Verdana;">The MCL length increased by an average of 8.9% when the external stress test was performed in the non-weight bearing and knee extension positions and by an average of 17.0% when external stress was applied in the non-weight bearing and knee flexion positions. The MCL length increased by an average of 12.2% when the external stress test was performed in the load-bearing and knee extension positions and an average of 8.9% when the valgus stress test was applied in load-bearing and knee flexion positions. In conclusion, the effect of valgus stress on the MCL differs between load-bearing and non-load-bearing positions. It is considered that the dynamic stabilization mechanism works in the knee joint flexion position in the load position and works simultaneously as the static stabilization mechanism, which limits the knee joint valgus and reduces the extension rate of MCL. Therefore, this study reconsiders the shifting of traditional therapy from open kinetic chain to close kinetic chain.</span>展开更多
In the rare cases with serious damage of the Medial Collateral Ligament (MCL) of the knee requiring surgical treatment, ligament remnants may be inadequate for a good repair. In such cases, reconstruction should be pe...In the rare cases with serious damage of the Medial Collateral Ligament (MCL) of the knee requiring surgical treatment, ligament remnants may be inadequate for a good repair. In such cases, reconstruction should be performed and technical options may be limited. We used an Achilles tendon allograft and applied it using the Pulvertaft weave technique for tendon repair. We found no previous reports of allograft application for MCL repair though the technique has been extensively used for Anterior Cruciate Ligament reconstruction.展开更多
文摘The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands(anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion. In individuals who fail co-mprehensive non-operative treatment, surgical repair or reconstruction of the MUCL is commonly required to restore elbow function and stability. A comprehensive understanding of the anatomy and biomechanical properties of the MUCL is imperative to optimize reconstructive efforts, and to enhance clinical and radiographic outcomes. Our understanding of the native anatomy and biomechanics of the MUCL has evolved over time. The precise locations of the origin and insertion footprint centers guide surgeons in proper graft placement with relation to bony anatomic landmarks. In recent studies, the ulnar insertion of the MUCL is described as larger than previously thought, with the center of the footprint at varying distances relative to the ulnar ridge, joint line, or sublime tubercle. The purpose of this review is to consolidate and summarize the existing literature regarding the native anatomy, biomechanical, and clinical significance of the entire medial ulnar collateral ligament complex, including the MUCL(AB), PB, and transverse ligament.
文摘AIM To examine the normal morphology of the epiligament tissue of the knee medial collateral ligament(MCL) in humans. METHODS Several samples of the mid-substance of the MCL of the knee joint from 7 fresh human cadavers(3 females and 4 males) were taken. Examination of the epiligament tissue was conducted by light microscopy and photomicrography on semi-thin sections of formalin fixed paraffin-embedded blocks that were routinely stained with haematoxylin and eosin, Mallory stain and Van Gieson's stain. Electron microscopy of the epiligament tissue was performed on ultra-thin sections incubated in 1% osmium tetroxide and contrasted with 2.5% uranyl acetate, lead nitrate, and sodium citrate.RESULTS The current light microscopic study demonstrated that the epiligament of the MCL consisted of fibroblasts, fibrocytes, adipocytes, neuro-vascular bundles and numerous multidirectional collagen fibers. In contrast, the ligament body was poorly vascularised, composed of hypo-cellular fascicles which were formed of longitudinal groups of collagen fibers. Moreover, most of the vessels of the epiligament-ligament complex were situated in the epiligament tissue. The electron microscopic study revealed fibroblasts with various shapes in the epiligament substance. All of them had the ultrastructural characteristics of active cells with large nuclei, well developed rough endoplasmic reticulum, multiple ribosomes, poorly developed Golgi apparatus, elliptical mitochondria and oval lysosomes. The electron microscopy also confirmed the presence of adipocytes, mast cells, myelinated and unmyelinated nerve fibers and chaotically oriented collagen fibers.CONCLUSION Significant differences exist between the normal structure of the ligament and the epiligament whose morphology and function is to be studied further.
文摘The drastic difference in healing capacity between the anterior cruciate ligament and medial collateral ligament injuries is still largely unexplained.So,studying the molecular expression after anterior cruciate ligament and medial collateral ligament injury could be a new direction to explain such differences.In this study,eighteen male 3-month-old New Zealand white rabbits were randomly divided into six groups by injury modeling to study the molecular expression after anterior cruciate ligament and medial collateral ligament injury.The expression of molecular genes and proteins was examined using reverse transcriptase chain reaction and Western blotting.Marked differences were found in the postinjury changes in gene levels and proteins in the anterior cruciate ligament compared to the medial collateral ligament.The results show that there were drastic differences in angiogenesis,collagen and matrix metalloproteinases after anterior cruciate ligament and medial collateral ligament injury.It can be found that the repair ability of the anterior cruciate ligament and medial collateral ligament after injury may be related to the differences in molecular expression.
文摘<span style="font-family:Verdana;">This study aimed to evaluate the influence of measuring the length of the medial collateral ligament (MCL) to compare the MCL burden when the knee joint is placed under valgus stress in the open and closed and closed kinetic chain.</span><b> </b><span style="font-family:Verdana;">Two examiners conducted the examination. The MCL length was measured using ultrasonography. Two subjects were measured in unload bearing and load-bearing positions, with and without valgus stress test at the knee joint extension and 30<span style="white-space:nowrap;">°</span> flexion, under eight different measurement conditions. The MCL of the subject was delineated in the longitudinal direction using an ultrasound system. The attachment points of the medial femoral and tibial condyle of the MCL were identified, and the ligament length was measured. The MCL rate before and after the valgus stress test in the loading and unloading positions was calculated.</span><b> </b><span style="font-family:Verdana;">The MCL length increased by an average of 8.9% when the external stress test was performed in the non-weight bearing and knee extension positions and by an average of 17.0% when external stress was applied in the non-weight bearing and knee flexion positions. The MCL length increased by an average of 12.2% when the external stress test was performed in the load-bearing and knee extension positions and an average of 8.9% when the valgus stress test was applied in load-bearing and knee flexion positions. In conclusion, the effect of valgus stress on the MCL differs between load-bearing and non-load-bearing positions. It is considered that the dynamic stabilization mechanism works in the knee joint flexion position in the load position and works simultaneously as the static stabilization mechanism, which limits the knee joint valgus and reduces the extension rate of MCL. Therefore, this study reconsiders the shifting of traditional therapy from open kinetic chain to close kinetic chain.</span>
文摘In the rare cases with serious damage of the Medial Collateral Ligament (MCL) of the knee requiring surgical treatment, ligament remnants may be inadequate for a good repair. In such cases, reconstruction should be performed and technical options may be limited. We used an Achilles tendon allograft and applied it using the Pulvertaft weave technique for tendon repair. We found no previous reports of allograft application for MCL repair though the technique has been extensively used for Anterior Cruciate Ligament reconstruction.
文摘目的:比较体外冲击波疗法(extracorporeal shockwave therapy,ESWT)联合传统治疗和单纯传统治疗对膝内侧副韧带陈旧性损伤患者的效果。方法:回顾性分析2019年11月—2022年1月在珠海市第五人民医院治疗的85例膝内侧副韧带陈旧性损伤患者,根据治疗方案不同分组,其中对照组41例予以传统治疗,治疗组44例予以ESWT联合传统治疗。评估患者治疗前、治疗后和随访时的疼痛视觉模拟评分法(visual analog scale,VAS)评分、膝关节活动度、Lysholm膝关节评分和疗效。结果:在治疗后及随访时,两组患者在VAS评分、膝关节活动度、Lysholm膝关节评分方面均较治疗前有改善(P<0.05)。治疗组各项指标的改善效果明显优于对照组(P<0.05)。对照组临床治疗总有效率达46.34%,治疗组总有效率达95.45%,治疗组的总有效率显著高于对照组,差异有统计学意义(P<0.05)。结论:ESWT联合传统治疗能明显缓解膝内侧副韧带陈旧性损伤患者膝关节疼痛,改善膝关节功能,疗效优于单纯传统治疗。
