Lateral Ligament Tears Research Articles

Is antero-lateral complex of knee joint of critical importance in restoring rotational instability in patients with anterior cruciate ligament tear?

Antero-lateral ligament complex (ALC) is a vital structure for maintaining rotational stability of the knee. Evaluation of ALC radiologically (MRI) is still unpopular in setting of anterior cruciate ligament injury. A dire necessity exists for the orthopedic surgeons in outdoor patient department settings to rule out involvement of ALC. So, that it can be addressed during operating for Anterior Cruciate Ligament injury. The authors have formulated an algorithm on a personal level and have implemented this screening program and initiated screening of young to middle aged patients reporting with rotational knee instability for ALC involvement before recommending final operative plan. This screening program which uses specifically devised physical tests have significantly reduced the number of underdiagnosed Antero Lateral Ligament tear.

Regeneration of grade 3 ankle sprain, using the recombinant human amelogenin protein (rHAM+ ) in a rat model.

Lateral ligament tears, also known as high-grade ankle sprains, are common, debilitating, and usually heal slowly. Ten to thirty percent of patients continue to suffer from chronic pain and ankle instability even after 3 to 9 months. Previously, we showed that the recombinant human amelogenin (rHAM+ ) induced regeneration of fully transected rat medial collateral ligament, a common proof-of-concept model. Our aim was to evaluate whether rHAM+ can regenerate torn ankle calcaneofibular ligament (CFL), an important component of the lateral ankle stabilizers. Right CFLs of Sabra rats were transected and treated with 0, 0.5, or 1 µg/µL rHAM+ dissolved in propylene glycol alginate (PGA). Results were compared with the normal group, without surgery. Healing was evaluated 12 weeks after treatment by mechanical testing (ratio between the right and left, untransected ligaments of the same rat), and histology including immunohistochemical staining of collagen I and S100. The mechanical properties, structure, and composition of transected ligaments treated with 0.5 μg/μL rHAM+ (experimental) were similar to untransected ligaments. PGA (control) treated ligaments were much weaker, lax, and unorganized compared with untransected ligaments. Treatment with 1 μg/μL rHAM+ was not as efficient as 0.5 μg/μL rHAM+ . Normal arrangement of collagen I fibers and of proprioceptive nerve endings, parallel to the direction of the force, was detected in ligaments treated with 0.5 μg/μL rHAM+ , and scattered arrangement, resembling scar tissue, in control ligaments. In conclusion, we showed that rHAM+ induced significant mechanical and structural regeneration of torn rat CFLs, which might be translated into treatment for grades 2 and 3 ankle sprain injuries.

Conservative and surgical management of foot and ankle sporting injuries in the weekend warrior

A clinical based review of the injuries that are regularly suffered by Joan and John Average is presented. Common presentations of conditions such as lateral ligament tears, talar osteochondral lesions, syndesmotic injuries and 5 th Metatarsal fractures are discussed along with the management and prognosis of these problems. Questions are answered including how does it occur; what should I do about it; what can somebody else do about it and what occurs in the future?

The Role of sonography in detecting radial head subluxation in a child

Injuries around the elbow joint in children can be difficult to diagnose on the basis of findings on physical examination and radiographs. We present the case of a 4-year-old girl with a probable subluxation of the radial head, based on the findings on physical examination and radiographs. Radiography raised the possibility of a radial head subluxation. Sonography demonstrated displacement of the cartilaginous head of the radius away from the capitellum in the affected elbow. The child underwent corrective surgery. During fluoroscopy, results of an ulnar stress test were positive for lateral ligament tears. The patient's arm was put in a cast for 6 weeks. At 1-year follow-up, the patient had full range of motion of the elbow without pain. We present the findings of sonographic studies used to confirm the diagnosis.

Common Rugby League Injuries

Rugby league is the main professional team sport played in Eastern Australia. It is also very popular at a junior and amateur level. However, injuries are common because of the amount of body contact that occurs and the amount of running that is required to participate in the game. Injuries to the lower limbs account for over 50% of all injuries. The most common specific injuries are ankle lateral ligament tears, knee medial collateral and anterior cruciate ligament tears, groin musculotendinous tears, hamstring and calf muscle tears, and quadriceps muscle contusions. Head injuries are common and consist of varying degrees of concussion as well as lacerations and facial fractures. Serious head injury is rare. Some of the more common upper limb injuries are to the acromioclavicular and glenohumeral joints. Accurate diagnosis of these common injuries using appropriate history, examination and investigations is critical in organising a treatment and rehabilitation plan that will return the player to competition as soon as possible. An understanding of the mechanism of injury is also important in order to develop preventative strategies.

足関節外側側副靭帯損傷の観血的治療

19 ankles with lateral ligament tears treated surgically were analized by the stress roentgenograms before and after operation and evaluated by the Seligson scale clinically. The result shows that early repair cases were all satisfactory and in late repair cases, instability remains unsatisfactorily compared with early repair cases, and 3 ankles were below 8 points by the Seligson scale.

Lateral ligament injury of the knee.

Injury to the lateral ligament complex is an injury of greater magnitude than that seen with anterior cruciate or medial collateral ligament. The prognosis is influenced adversely by the associated injuries. Lateral ligament tear is often associated with anterior cruciate ligament tear. Results from this study indicate that if associated injuries permit, patients should have acute repair.

A prospective study of the treatment of severe tears of the lateral ligament of the ankle

A prospective randomized clinical study was undertaken to compare bandaging, plaster cast immobilisation and operative treatment for recent tears of the lateral ligament of the ankle. The follow-up period was two years. Subjectively, only the fear of giving-way showed a clear difference in favour of operative repair. Objective evaluation, including stress radiographs, demonstrated no statistical differences between the three methods of treatment. Although bandaging appeared somewhat less satisfactory with respect to the resulting stability of the ankle, the differences were not statistically significant. The lateral ligament in patients over 40 years of age showed a statistically significant tendency to heal less well than that of younger patients. Severe ankle sprains in patients under 40 years of age should preferably be treated by operation, especially in younger patients and if the person is physically active. Lateral ligament tears in patients over 40 years of age should be treated conservatively and a secondary reconstruction carried out later, if necessary.

足関節外側側副靭帯損傷（ギプス固定例の治療成績）

Stress roentgenograms before and after treatment of lateral ligament tears of the 15 ankles treated by cast immobilization were analyzed.Eleven out of 15 ankles recovered roentgenographic stability satisfactorily.To the above cases and chronic cases, we asked questionnaires based on Seligson scale by letter.Results showed a tendency that the greater the roentgenographic instability of the ankle is, the lower the functional rating of the ankle is.

Nonoperative treatment of double lateral ligament tears of the ankle.

In this article the objective evaluation of 39 cases of double lateral ligament tears of the ankle treated by cast immobilization is described. Such treatment resulted in a 79.5% success rate as determined by repeat stress roentgenograms. In addition, a statistical method which may aid the orthopaedist in deciding whether to use nonoperative or operative treatment is presented.

ANKLE ARTHROGRAPHY

Ankle arthrography allows radiologists to assess accurately the degree of damage caused by ankle sprains. Ankle sprains are a significant problem to a large number of people, particularly those who participate in sports. Proper care of these ankle injuries requires the combined expertise of many disciplines. Radiologists should be aware of the significance of these lesions and utilize all modalities, including plain films, stress films, and ankle arthrograms, when indicated, to obtain the exact pathologic diagnosis of severe sprains. The primary role of arthrography is to separate those patients who have moderate or severe sprains that may require surgery from those who will respond to more conservative therapy. Many orthopedists believe that combined lateral ligament tears, or any tear involving the deltoid ligament and perhaps the interosseous ligament, may require surgery. At the other end of the spectrum of ankle sprains, occasionally, one may not be able to distinguish between a very slight sprain and a more severe sprain with rupture of the ankle ligament. This is an important distinction, particularly in young athletes who would like to continue to play a competitive sport despite their injury. Utilizing arthrography, the orthopedic surgeon can suggest a more accurate prognosis as to whether the patient might be able to participate with proper taping. Obviously, if the patient has ruptured a ligament, it is not in the best interest of the patient to participate in a competitive sport without allowing a proper interval for healing. I heartily recommend arthrography of the ankle to any radiologist who is not yet utilizing this procedure. I believe that it can add significantly to the care of those patients who sustain ankle sprains.

Reconstruction of Lateral Ligament Tears of the Ankle

Experimental cadaver studies showed that Elmslie type of repair for rupture of the anterior and interior lateral ligaments of the ankle and subtalar joints is more effective that other procedures. A new modification of the Elmslie operation is described. It has been used successfully on seven patients followed for over two years. The procedure is simple and effective, although it does cause limitation of foot inversion amounting to 15 to 30 degrees.