The intercarpal ligaments of the equine midcarpal joint, Part 1: The anatomy of the palmar and dorsomedial intercarpal ligaments of the midcarpal joint

OBJECTIVE: To describe in detail the structure of the medial palmar intercarpal ligament (MPICL), the lateral palmar intercarpal ligament (LPICL), and a dorsomedial intercarpal ligament (DMICL) of the equine midcarpal joint. STUDY DESIGN: Dissections of equine midcarpal joints. ANIMALS AND SAMPLE POPULATION: Ten carpal joints from eight thoroughbred horses. METHODS: Detailed dissections of the midcarpal joint were performed, with particular attention paid to the MPICL, the LPICL, and the DMICL. The attachments and dimensions of these structures were recorded, as well as their behavior during joint movement. RESULTS: The DMICL arose from the dorsomedial surface of the radial carpal bone (CR) and coursed palmarodistally to insert on the dorsomedial aspect of the second carpal bone (C2). The LPICL attached proximally predominantly on the distal part of the palmaromedial surface of the ulnar carpal bone (CU). From here the ligament coursed distomedially and slightly palmarly to the proximal palmarolateral surface of the third carpal bone (C3). The structure of the MPICL was complex. It attached proximally to the distolateral surface of the CR and distally to the proximal palmaromedial surface of C3, and the proximal palmarolateral aspect of the C2. It could be divided into four fiber bundles in all carpi. The predominant direction of fibers was dorsoproximal to palmarodistal, whereas the palmaromedial bundle coursed palmaroproximal to dorsodistal. CONCLUSIONS: The orientation of their fibers indicate that the MPICL and DMICL primarily resist dorsomedial displacement of CR, whereas the LPICL resists dorsolateral displacement of the CU and intermediate carpal bone. CLINICAL RELEVANCE: An understanding of the structure of the intercarpal ligaments of the midcarpal joint is important in interpreting their function and the reasons for damage to their structure.     

Adhesive lesions of the talocrural joint

Iatrogenic and posttraumatic adhesive lesions of the ankle joint are rather common, although infrequently reported, clinical entities. Ankle arthroscopy has proved to be a valuable asset in the assessment and treatment of recalcitrant symptomatic cases of both localized adhesions and adhesive capsulitis. This article intends to broaden the reader's understanding of the clinical presentation and intra-articular derangements of these lesions.     

Fibula and its ligaments in load transmission and ankle joint stability

A study was made of the role of the fibula in weightbearing and its contribution to ankle joint stability in 10 anatomic specimen lower limbs. On axial loading of the lower limb, the fibula was found to take an average of 17% of a 1500 N axial load. The proportion of the load carried by the fibula increased with the total loading. It also increased when the line of load was displaced laterally and when the ankle joint was in dorsiflexion and decreased when the line of loading shifted medially or the joint was plantar flexed. With loading, the lateral malleolus migrated distally relative to the medial malleolus, except after fibular osteotomy, when it migrated proximally. There was an approximately inverse relationship between proportional fibular loading and distal fibular migration. Cutting the inferior tibiofibular ligament reduced the proportional load in the fibula and increased its distal migration. The interosseous membrane modified the load distribution between the tibia and the fibula, with the distal fibula carrying a higher proportion of the axial load than did the proximal. Surgical repair of a ruptured inferior tibiofibular ligament, using either 1 or 2 screws, was associated with an abnormal pattern of load distribution and fibular displacement.     

Functional evaluation of the ligaments at the acromioclavicular joint during anteroposterior and superoinferior translation

We examined the anatomy and measured the in situ force in ligaments at the acromioclavicular joint using a universal force-moment sensor. The in situ force in the coracoacromial, conoid, trapezoid, superior acromioclavicular capsular, and inferior acromioclavicular capsular ligaments of 10 fresh-frozen cadaveric shoulders was determined for a load of 70 N applied to the clavicle in anteroposterior and superoinferior directions. The lengths of the conoid and trapezoid ligaments were found to be 15.1 +/- 4.1 and 11.5 +/- 2.2 mm, respectively; the widths of the conoid and trapezoid ligaments were 10.7 +/- 1.5 and 11.0 +/- 2.8 mm, respectively. The in situ force of the trapezoid (42.9 +/- 15.4 N) was significantly greater than that for the other ligaments during posterior displacement. Otherwise, no statistically significant differences could be found between any of the in situ forces in each ligament during all other motions examined. During anterior displacement, the inferior acromioclavicular capsular ligament appeared to be the major restraint. The trapezoid ligament was the primary restraint during posterior displacement and provided 55.8% +/- 20.0% of the resisting force. Our results suggest that the coracoclavicular and other acromioclavicular joint capsular ligaments should be considered for reconstruction to restore normal joint function, especially in the anterior, posterior, and superior directions.     

Computed tomography of sternoclavicular joint lesions in spondylarthropathies

To evaluate the computed tomography (CT) findings of inflammatory lesions of the sternoclavicular joints (SCJ) in spondylarthropathies. DESIGN AND PATIENTS: CT scans of the SCJs were obtained in 23 patients (group 1) with inflammatory SCJ lesions in spondylarthropathies. These scans were reviewed by four readers and compared with the CT scans of 23 matched controls (group 2). Each reader had to complete a 27-item grid. RESULTS AND CONCLUSION: In the 23 patients of group 1, the mean number of observed signs was 5.3 +/- 4.2 higher (P < 0.01) than in the group of 23 matched controls (2.4 +/- 1.6). Four signs were more frequently observed (P < 0.05) in group 1: surrounded subchondral clavicular erosions and cysts, surrounded subchondral sternal cysts and sternal bone sclerosis. A cyst and/or an erosion was associated with hyperostosis and/or bone sclerosis in 9 of 23 patients in group 1. This association was not observed in group 2; the difference was significant (P < 0.001). A cyst and/or an erosive lesion was observed 18 times in group 1 versus 11 times in group 2; the difference was significant (P < 0.05). Conversely, signs of degenerative lesions (osteophytes, subchondral sclerosis, unevenness of joint surface) were no more frequently observed in controls than in group 1. This study emphasizes the diagnostic value of CT, in particular in the identification of inflammatory lesions, even when pre-existing degenerative disease is present.     

Diagnosis and surgical treatment of cystlike lesions of the equine paranasal sinuses

Development of cysts in the equine paranasal sinuses is probably a congenital disease; however, signs may not appear for several years. In 4 cases, clinical signs were observed when fluid accumulation within the cysts resulted in nasal discharge or facial swelling, or when secondary infection occurred. Treatment required surgical removal of the lining membrane and other involved tissues. Postoperative care included lavage of the sinuses and systemic antibiotic therapy.     

Structural, material, and anatomic characteristics of the collateral ligaments of the canine cubital joint

Surgical resection remains the mainstay of treatment for patients with hepatic tumors, despite the associated morbidity including the need for blood transfusion. Acute isovolemic hemodilution (AIH) has been shown to decrease the transfusion requirement for cardiac, urologic, and orthopedic procedures. However, the reported experience with AIH during hepatic resections is limited. Seven patients underwent major hepatic resection from July 1992 to June 1994 with standard AIH. Their clinical parameters were compared with those of nine matched control patients during the same time period. AIH and control patients had similar preoperative laboratory values (hematocrit, bilirubin, and coagulation studies), extent of liver resection, and pathologic diagnoses. Mean tumor diameters were larger in the AIH group (9.3 cm vs. 5.8 cm). Most important, patients managed with AIH required homologous blood transfusions significantly less often than the control group (14% vs. 67%; P=0.05). Furthermore, if they did receive transfusions, AIH patients needed fewer units of red cells (0.1+/-0.1 units vs. 1.7+/-0.6 units). There was no morbidity associated with AIH. AIH can be safely performed in patients undergoing major hepatic resection for malignancy. AIH appears to reduce the number of patients requiring homologous blood transfusion as well as the number of units transfused per patient. This technique warrants further study in a larger prospective, randomized trial.     

Correlation between anatomic features and low-field magnetic resonance imaging of the equine metacarpophalangeal joint

OBJECTIVE: To expand our current knowledge and to establish limits of correlation between signal intensities of the magnetic resonance (MR) image and actual macroscopic and microscopic anatomic features of the imaged structures of the equine metacarpophalangeal joint (MCPJ). SAMPLE POPULATION: The right MCPJ was obtained from 4 adult horses that were euthanatized for reasons unrelated to the musculoskeletal system. PROCEDURE: The distal portion of the right forelimbs was collected from 4 equine cadavers. The bones were drilled to provide fixed reference points and examined by MR imaging. After imaging, the joints were sectioned for gross and histologic inspection. The MR images were aligned and correlated with digitized gross and histologic images to identify tissue types. RESULTS: Comparison of the images resulted in identification of different bone types, articular cartilage, and soft tissue structures of the equine MCPJ. CONCLUSION: Results provided relevant information regarding the appearance of the imaged tissues of the equine MCPJ. CLINICAL RELEVANCE: Although MR imaging does not have current clinical applications for equine practitioners, its wide acceptance as the imaging modality used for most human musculoskeletal derangements may aid in developing more realistic applications in equine medicine.     

Rheumatoid-like joint lesions in rabbits injected intravenously with bovine serum

Rheumatoid-like synovial lesions have been produced experimentally in 21% of rabbits receiving intravenous injections of bovine serum by various regimens. They were characterized by lining cell hyperplasia, accumulations, often follicular, of lymphocytes and plasma cells just under the lining layer, sometimes with extensive fibroplasia and pannus formation with cartilage erosion.     

MRI arthrography in labrum lesions of the hip joint. Method and diagnostic value

PURPOSE: Several pilot studies have indicated that low-dose radiation therapy might have a beneficial effect on the course of choroidal neovascularization (CNV) in age-related macular degeneration (AMD). This study aimed to ascertain whether such treatment might halt the progression of neovascular AMD and whether a low or a high radiation dose should be applied. PATIENTS: The patients comprised some randomized to 0 vs 10 vs 36 Gy of radiation and (after a change of the study protocol became necessary) others who participated in a prospective, controlled non-randomized pilot study. Enclosed were eyes with visual acuity of > or = 0.1 and < or = 0.6 revealing a juxta-subfoveal CNV either of the occult type (type 1) or the classic type (isolated or as part of a predominantly occult lesion). RESULTS: Eyes treated with 10 Gy for occult CNV (n = 12) were subject to severe visual loss in 41.6% of the cases compared to 38.5% in the control group (n = 13) at 12 months of follow-up. For eyes treated with 10 Gy because of classic CNV, the corresponding figures were 33% (n = 18) and 57% (n = 14) respectively. At 18 months of follow-up, the percentages were 63% and 75% respectively. Fluorescein angiographic growth of classic and occult CNV could not be halted by 10 Gy, while a temporary growth retardation was observed in cases irradiated with 36 Gy. CONCLUSION: In the study presented, the natural course of occult CNV could not be improved by irradiation with 10 or 36 Gy. In cases of classic CNV, low-dose irradiation with 10 Gy postponed severe visual loss by a maximum of 18 months. A positive treatment effect was also observed in cases irradiated with 36 Gy; however, a 25% incidence of radiation retinopathy seems unacceptable.     

Tumours and pseudotumorous lesions of the temporomandibular joint: a diagnostic challenge

Tumours and pseudotumorous lesions originating from the synovial membrane of the temporomandibular joint are rare. We report a series of six cases of such disorders. There were two cases of synovial chondromatosis, two of calcium pyrophosphate dihydrate crystal deposition disease, one nodular synovitis and one synovial sarcoma. Three patients were female and three were male. Their ages ranged from 36 to 70 years. All had atypical clinical and radiographical presentation. The prevalence, clinical and radiographical findings and pathological features of each disease entity are discussed and a review of the literature is made concerning all tumours and pseudotumours arising from the temporomandibular joint.     

Radiography of the medial elbow ligaments

The anterior, posterior, and transverse bundles of the medial collateral ligaments of fresh cadaveric elbows were painted with a special radiopaque tantalum cyanoacrylic preparation. The extent of each ligament and their origins and insertions were examined with radiography. This study provided radiographic correlation for these important soft tissue structures and an anatomic understanding of elbow fractures with ligament avulsion.     

Labrum lesions and residual dysplasia of the hip joint. Definition and prospectives

Labral lesions are a sign of biomechanical decompensation of the hip joint and often represent the first clinical symptom of residual hip dysplasia (RHD) in the adult. Provocation tests (impingement, apprehension) are typical but not specific. Labral lesions and concomitant findings (intra- and extraosseous ganglia, stress bone marrow oedema) can be detected by magnetic resonance arthrography (MRA) with an accuracy of 91%. Primary therapeutic goal is the normalization of the underlying pathomorphology and instability by a redirectional acetabular osteotomy. There are several concepts concerning simultaneous arthrotomy at the time of osteotomy: no arthrotomy at all, selective arthrotomy, routine arthrotomy in every case. There are more clinical studies necessary before one of these concepts can be widely accepted and recommended. Based on preliminary results, palliative arthrotomy with partial labral resection but without corrective osteotomy in osteoarthritis secondary to residual hip dysplasia gives poor results; we therefore urgently dissuade from palliative labral surgery via arthrotomy. Whether labral surgery via arthroscopy might be a useful concept in symptomatic residual hip dysplasia, is still an open question. In this review article, the "state of the art" presented at the "Vienna Labral Symposium 1997" is reflected and summarized. At the end of this article, a "common statement" of the experts is published in English and German language.     

Late reconstruction of the ligaments following acromioclavicular separation

Complete separation of the acromion from the clavicle in nine young patients was repaired by a new technique with use of a tendon graft. The operation was performed, on average, twenty-nine weeks after the injury. After surgery seven patients were enabled to engage in strenuous sports or construction work and the other two to return to daily activities with occasional heavy lifting.