Valgus Stress Radiography in Normal Ankles

Deltoid ligament injury is thought to be rare. Signs of complete rupture of the deltoid ligament may be subtle or interpreted as another injury condition and thus are often missed acutely. No standardized method has been created to evaluate medial ligament insufficiency in acute or chronic laxity. To establish a diagnostic test for suspected isolated ruptures of the deltoid ligament, 32 subjects with no previous ankle injury underwent valgus stress radiography and nonstressed radiography of both ankles. Stress radiography in this study showed that there is a measurable but minimal range of talar tilt on valgus stress in previously uninjured ankles. This study provides the basis for diagnosis of the rare isolated rupture of the deltoid ligament of the ankle.

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Assessment of valgus laxity after release of the medial structure in medial open-wedge high tibial osteotomy: an in vivo biomechanical study using quantitative valgus stress radiography

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2859-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Dai Sato ◽

Eiji Kondo ◽

Koji Yabuuchi ◽

Jun Onodera ◽

Tomohiro Onodera ◽

...

Keyword(s):

High Tibial Osteotomy ◽

Biomechanical Study ◽

Trial Registration ◽

Tibial Osteotomy ◽

Open Wedge ◽

Stress Radiography ◽

Valgus Stress ◽

Plate Removal ◽

Wedge High Tibial Osteotomy

Abstract Background To perform medial open-wedge high tibial osteotomy (OWHTO), surgeons expose the medial-proximal tibia by releasing or cutting the superficial layer of the medial collateral ligament (sMCL). Biomechanically, the sMCL provides primary restraint against valgus forces. Therefore, any release of the sMCL can cause valgus instability of the knee joint. The purpose of this study was to assess valgus laxity after release of the medial structure of the knee during OWHTO. Methods Between 2009 and 2015, 84 consecutive patients (93 knees) who underwent OWHTO using a locking plate were enrolled in this study. All patients underwent radiological examinations before surgery, during surgery, 1 year after surgery, and after plate removal to objectively assess valgus laxity. The medial joint space (MJS) and the joint line convergence angle (JLCA) of the knee were evaluated using quantitative valgus stress radiography. Clinical evaluation was performed 2 years after surgery. Results The mean functional knee score improved significantly, from 65.5 to 91.1 points (p < 0.0001). The mechanical axis percentage shifted to pass through a point 69.7% lateral from the medial edge of the tibial plateau. The MJS and JLCA increased significantly during OWHTO surgery (11.0 mm, 7.4 °, p < 0.0001). However, no significant differences were noted in the MJS and JLCA among preoperative, 1-year postoperative periods and after plate removal. Conclusion Valgus laxity was significantly greater after release of the sMCL. However, no significant differences were noted in valgus laxity in preoperative, 1-year postoperative periods and after plate removal. Complete release of the sMCL did not cause postoperative valgus laxity after OWHTO surgery. Trial registration Trial registration number: No.012–0360.

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The lateral joint space width can be measured reliably with Telos valgus stress radiography in medial knee osteoarthritis

Skeletal Radiology ◽

10.1007/s00256-018-3111-5 ◽

2018 ◽

Vol 48 (7) ◽

pp. 1069-1077 ◽

Cited By ~ 2

Author(s):

Daan Koppens ◽

Ole Gade Sørensen ◽

Stig Munk ◽

Søren Rytter ◽

Solveig Kärk Abildtrup Larsen ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Joint Space Width ◽

Joint Space ◽

Stress Radiography ◽

Valgus Stress ◽

Medial Knee ◽

Medial Knee Osteoarthritis ◽

Space Width

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Simultaneous Reconstruction of the Medial and Lateral Collateral Ligaments for Chronic Combined Ligament Injuries of the Ankle

The American Journal of Sports Medicine ◽

10.1177/0363546517700859 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2052-2060 ◽

Cited By ~ 4

Author(s):

Toshito Yasuda ◽

Hiroaki Shima ◽

Katsunori Mori ◽

Seiya Tsujinaka ◽

Masashi Neo

Keyword(s):

Arthroscopic Surgery ◽

Case Series ◽

Lateral Collateral Ligament ◽

Sports Participation ◽

Stress Radiography ◽

Collateral Ligament ◽

Level Of Evidence ◽

Valgus Stress ◽

Anterior Displacement ◽

Simultaneous Surgery

Background: Objective data on chronic injuries of the medial collateral ligament (MCL) of the ankle are scarce. Chronic MCL injuries are frequently associated with lateral collateral ligament (LCL) injuries. For patients with chronic combined MCL and LCL injuries, the authors have performed simultaneous surgery of the 2 ligaments. Hypothesis: Simultaneous surgery of the 2 ligaments may be effectively used to treat chronic combined MCL and LCL injuries. Study Design: Case series; Level of evidence, 4. Methods: Surgical outcomes were evaluated in 29 consecutive patients presenting with chronic MCL and LCL injuries (30 ankles; 15 men and 14 women; mean age, 31 years; 13 competitive and 10 recreational athletes). Preoperative and postoperative clinical outcomes were measured with the Karlsson score and the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale score. The patients underwent preoperative and postoperative functional measurements and a radiological examination. In addition, preoperative magnetic resonance imaging (MRI) results, arthroscopic findings, and histology of the MCL were evaluated. Results: Preoperatively, the deep fibers of the MCL did not appear striated in 29 ankles, and high-intensity signal changes were observed in 23 ankles on T2-weighted or gradient echo MRI. MCL ruptures were confirmed with arthroscopic surgery. Medial impingement lesions and focal chondral lesions were confirmed in 10 and 21 ankles, respectively. Histology of the reconstructed MCL showed dense collagen fibers with vessels. The mean postoperative follow-up period was 30 months (range, 24-52 months). There was a significant change between preoperative and postoperative Karlsson scores (69.0 vs 96.1 points, respectively; P < .0001) and JSSF scores (69.8 vs 94.5 points, respectively; P < .0001). On varus and valgus stress radiography, the postoperative talar tilt angle was significantly lower than the preoperative angle. Postoperative anterior displacement on stress radiography was significantly lower than preoperative anterior displacement. Postoperatively, all 23 athletes returned to their preinjury level of sports participation. Conclusion: MCL insufficiency resulted from medial ankle instability and medial impingement lesions. Outcomes in the patients indicated that MCL reconstruction or resection of medial impingement lesions, performed in addition to LCL reconstruction, is effective for treating chronic combined MCL and LCL injuries of the ankle.

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Medial Elbow Joint Laxity in Professional Baseball Pitchers

The American Journal of Sports Medicine ◽

10.1177/03635465980260031301 ◽

1998 ◽

Vol 26 (3) ◽

pp. 420-424 ◽

Cited By ~ 121

Author(s):

Todd S. Ellenbecker ◽

Angelo J. Mattalino ◽

Erik A. Elam ◽

Roger A. Caplinger

Keyword(s):

Elbow Joint ◽

Joint Space Width ◽

Ulnar Collateral Ligament ◽

Joint Space ◽

Professional Baseball ◽

Stress Radiography ◽

Collateral Ligament ◽

Valgus Stress ◽

Baseball Pitchers ◽

Space Width

Injuries to the ulnar collateral ligament frequently occur in throwing athletes because of large, repetitive valgus stresses to the elbow during the cocking and acceleration phases of throwing. Identification of injury to this ligament is important in evaluating the throwing elbow. The purpose of this study was to determine whether differences in medial elbow laxity exist between the dominant and nondominant extremities in uninjured baseball pitchers. Forty uninjured professional baseball pitchers were tested bilaterally with a Telos GA-IIE stress radiography device. Joint space width between the trochlea of the humerus and the coronoid process of the ulna was measured on anteroposterior radiographs obtained with no stress applied and with a 15-daN valgus stress. Results showed significant differences between the medial joint space opening of the dominant and nondominant elbows with no stress applied. With stress, the dominant elbow opened 1.20 0.97 mm, while the nondominant elbow opened 0.88 0.55 mm. A significantly greater difference in medial joint space opening between the stressed and unstressed elbows was measured in the dominant elbow compared with the nondominant elbow (0.32 0.42 mm). This study identifies increased medial elbow laxity in the dominant arm in uninjured pitchers.

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Elbow Valgus Stress Radiography in an Uninjured Population

The American Journal of Sports Medicine ◽

10.1177/03635465980260031401 ◽

1998 ◽

Vol 26 (3) ◽

pp. 425-427 ◽

Cited By ~ 45

Author(s):

Guy A. Lee ◽

Stephen D. Katz ◽

Mark D. Lazarus

Keyword(s):

False Positive ◽

False Positive Rate ◽

Stress Radiography ◽

Valgus Stress ◽

Stress Radiographs ◽

Significant Difference ◽

Positive Rate ◽

Positive Assessment ◽

Valgus Instability ◽

The Difference

Valgus instability of the elbow joint is a clinical diagnosis. However, many authors describe valgus stress radiographs as an aid in making this diagnosis. We studied valgus stress radiographs of 20 men (40 elbows) and 20 women (40 elbows), none with a history of elbow trauma or instability. The medial ulnohumeral distance was measured with no stress, valgus stress by gravity, and an applied valgus stress of 25 N (approximately 5 pounds). Measurements were made with the elbow positioned in extension and in 30° of flexion. The increase in medial ulnohumeral gapping with either gravity or 5 pounds of stress was statistically significant at both extension and 30° of flexion compared with the unstressed condition. The difference in ulnohumeral gapping between gravity stress and 5 pounds of valgus stress in extension and in 30° of flexion was also significant. We found no differences with regard to hand dominance or sex. We conclude that uninjured elbows have significant medial ulnohumeral gapping on valgus stress radiography. Although this is an important tool in diagnosing valgus instability of the elbow, it may yield a false-positive assessment of valgus instability. Valgus stress radiographs comparing contralateral elbows may reduce the false-positive rate since there appears to be no significant difference in medial ulnohumeral gapping between the two elbows.

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Computer-Assisted System in Stress Radiography for Anterior Cruciate Ligament Injury with Correspondent Evaluation of Relevant Diagnostic Factors

Diagnostics ◽

10.3390/diagnostics11030419 ◽

2021 ◽

Vol 11 (3) ◽

pp. 419

Author(s):

Chien-Kuo Wang ◽

Liang-Ching Lin ◽

Yung-Nien Sun ◽

Cheng-Shih Lai ◽

Chia-Hui Chen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Cruciate Ligament ◽

Anterior Tibial Translation ◽

Computer Assisted ◽

Time Interval ◽

Stress Radiography ◽

Factors Affecting ◽

Anterior Tibial ◽

Anterior Cruciate ◽

Tibial Translation

We sought to design a computer-assisted system measuring the anterior tibial translation in stress radiography, evaluate its diagnostic performance for an anterior cruciate ligament (ACL) tear, and assess factors affecting the diagnostic accuracy. Retrospective research for patients with both knee stress radiography and magnetic resonance imaging (MRI) at our institution was performed. A complete ACL rupture was confirmed on an MRI. The anterior tibial translations with four different methods were measured in 249 patients by the designed algorithm. The diagnostic accuracy of each method in patients with all successful measurements was evaluated. Univariate logistic regression analysis for factors affecting diagnostic accuracy of method four was performed. In the inclusive 249 patients, 177 patients (129 with completely torn ACLs) were available for analysis. Mean anterior tibial translations were significantly increased in the patients with a completely torn ACL by all four methods, with diagnostic accuracies ranging from 66.7% to 75.1%. The diagnostic accuracy of method four was negatively associated with the time interval between stress radiography and MRI as well as force-joint distance on stress view, and not significantly associated with age, gender, flexion angle, intercondylar distance, and force-joint angle. A computer-assisted system measuring the anterior tibial translation in stress radiography showed acceptable diagnostic performance of complete ACL injury. A shorter time interval between stress radiography and MRI as well as shorter force-joint distance were associated with higher diagnostic accuracy.

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The Effectiveness of a Hinged Elbow Orthosis in Medial Collateral Ligament Injuries: An In Vitro Biomechanical Study

The American Journal of Sports Medicine ◽

10.1177/0363546519870517 ◽

2019 ◽

Vol 47 (12) ◽

pp. 2827-2835

Author(s):

Ranita H.K. Manocha ◽

James A. Johnson ◽

Graham J.W. King

Keyword(s):

Medial Collateral Ligament ◽

Muscle Activation ◽

Mechanical Stability ◽

Biomechanical Study ◽

Return To Play ◽

Collateral Ligament ◽

Valgus Stress ◽

Active Motion ◽

Early Return

Background: Medial collateral ligament (MCL) injuries are common after elbow trauma and in overhead throwing athletes. A hinged elbow orthosis (HEO) is often used to protect the elbow from valgus stress early after injury and during early return to play. However, there is minimal evidence regarding the efficacy of these orthoses in controlling instability and their influence on long-term clinical outcomes. Purpose: (1) To quantify the effect of an HEO on elbow stability after simulated MCL injury. (2) To determine whether arm position, forearm rotation, and muscle activation influence the effectiveness of an HEO. Study Design: Controlled laboratory study. Methods: Seven cadaveric upper extremity specimens were tested in a custom simulator that enabled elbow motion via computer-controlled actuators and motors attached to relevant tendons. Specimens were examined in 2 arm positions (dependent, valgus) and 2 forearm positions (pronation, supination) during passive and simulated active elbow flexion while unbraced and then while braced with an HEO. Testing was performed in intact elbows and repeated after simulated MCL injury. An electromagnetic tracking device measured valgus angulation as an indicator of elbow stability. Results: When the arm was dependent, the HEO increased valgus angle with the forearm in pronation (+1.0°± 0.2°, P = .003) and supination (+1.5°± 0.0°, P = .006) during active motion. It had no significant effect on elbow stability during passive motion. In the valgus position, the HEO had no effect on elbow stability during passive or active motion in pronation and supination. With the arm in the valgus position with the HEO, muscle activation reduced instability during pronation (–10.3°± 2.5°, P = .006) but not supination ( P = .61). Conclusion: In this in vitro study, this HEO did not enhance mechanical stability when the arm was in the valgus and dependent positions after MCL injury. Clinical Relevance: After MCL injury, an HEO likely does not provide mechanical elbow stability during rehabilitative exercises or when the elbow is subjected to valgus stress such as occurs during throwing.

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