Effect of a calcaneo-tibial screw on medial and lateral stability of the canine tarsocrural joint ex vivo

2017 ◽  
Vol 30 (05) ◽  
pp. 331-338
Author(s):  
Janis Bridges ◽  
Andrew Worth ◽  
Kevin Frame
Keyword(s):  
Ex Vivo ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Ligament Injury ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Injured Limb ◽  
Significant Difference ◽  
Adequate Method ◽  
Intact Limb

SummaryObjective: To evaluate the use of a temporary calcaneo-tibial screw for stabilization of the tarsocrural joint in dogs with surgically treated collateral ligament injury.Methods: The degree of varus and valgus laxity of the tarsocrural joint in various states of injury and stabilization was measured in paired cadaveric limbs of Greyhound dogs. The angle of varus or valgus laxity was calculated following simulated collateral ligament injury (long collateral ligament only, long and short collateral ligaments, and bilateral long and short collateral ligaments) and stabilization with a calcaneo-tibial screw.Results: The joint was significantly more stable after placement of a calcaneo-tibial screw compared to limbs with any combination of injured collateral ligaments. There was not a significant difference between stability of the intact limb compared to the injured limb with calcaneo-tibial screw fixation.Clinical significance: Calcaneo-tibial screw fixation appears to be an adequate method of stabilizing the tarsocrural joint following collateral ligament injury, and warrants clinical evaluation as a less expensive alternative to external skeletal fixation application. It is likely that this method would need to be supplemented with a cranial half cast to prevent screw failure during weight bearing.

Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury

2021 ◽  
pp. 036354652199080
Author(s):  
Sean M. Kennedy ◽  
Joseph P. Hannon ◽  
John E. Conway ◽  
Kalyssa Creed ◽  
J. Craig Garrison
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Significant Difference ◽  
Ulnar Collateral Ligament Injury ◽  
Baseball Pitchers ◽  
Group 2 ◽  
Group 1

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.

Tibiotarsal arthroscopy

2008 ◽  
Vol 21 (02) ◽  
pp. 159-165 ◽  
Author(s):  
B. Beale ◽  
J. Miller
Keyword(s):  
Septic Arthritis ◽  
Weight Bearing ◽  
Force Plate ◽  
Joint Disease ◽  
Ligament Injury ◽  
Joint Stability ◽  
Collateral Ligament ◽  
Long Term Outcome

SummaryThe objective of this retrospective article was to describe the use of, and to determine long-term outcome of, tibiotarsal arthroscopy in dogs. The medical records of 20 client-owned dogs with tibiotarsal joint disease with arthroscopic treatment were reviewed. Long-term follow-up evaluation of lameness, force plate gait analysis, and radiographs to assess progression of degenerative joint disease (DJD) were performed. Arthroscopy was utilized in the diagnosis of talar osteochondritis dissecans (OCD), collateral ligament injury, septic arthritis, immune mediated arthritis, and a distal talar fragment. Sixteen joints with OCD treated resulted in 10/14 dogs with lameness after exercise only, progression of DJD in most cases, and chronic lameness when comparing operated to unoperated limbs with force plate evaluation at a mean follow-up of 35 months. Following treatment, three dogs with collateral ligament injury had reduced weight bearing on the operated limb, radiographic progression of DJD, and minimal lameness at a mean follow-up of 27 months. Tibiotarsal arthroscopy can be successfully used to help diagnose, and often to treat: OCD, collateral ligament injury, fractures, septic and non-septic arthritis in the dog. The minimally invasive nature of arthroscopy preserved joint stability while allowing complete examination of the articular cartilage. In most cases long term tibiotarsal DJD advancement was the rule.

scholarly journals Anterior elbow dislocation without fracture in an adult: a rare injury pattern

2019 ◽  
Vol 12 (9) ◽  
pp. e230115 ◽  
Author(s):  
Sandeep Vijayan ◽  
Vijayaraghavan Chalappurath ◽  
Sudeep Jose ◽  
Sharath Kumar Rao
Keyword(s):  
Elbow Dislocation ◽  
Functional Results ◽  
Ligament Injury ◽  
Anterior Dislocation ◽  
Joint Stability ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Rare Injury ◽  
Elbow Injury ◽  
Medial Collateral Ligament Injury

Anterior elbow dislocation without periarticular fracture (simple dislocation) is an extremely rare injury and is usually caused by distraction or torsional forces. It is important to look for associated ligamentous and musculotendinous injuries in this pattern. We report an elderly patient who sustained simple anterior dislocation of the elbow and in whom successful closed reduction could be achieved. Reduction by closed method is possible if we know the exact mechanism of elbow injury. Despite the presence of medial collateral ligament injury, he was managed non-operatively and had full functional recovery. Checking for joint stability and collateral ligaments after reduction and getting additional radiological investigations help in better treatment planning. Early protected active mobilisation should be initiated to achieve better functional results.

scholarly journals Effect of CAM boot immobilization on weightbearing stability in syndesmotic injuries

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0030
Author(s):  
Stéphanie Lamer ◽  
Vincent Dube ◽  
Jonah Hebert-Davies ◽  
Leduc Stephane ◽  
Jeremie Menard ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Weight Bearing ◽  
Axial Loading ◽  
Nonoperative Treatment ◽  
Ankle Injuries ◽  
Ligament Injury ◽  
Ankle Motion ◽  
Parametric Data ◽  
Custom Made ◽  
Significant Difference

Category: Trauma Introduction/Purpose: Ankle injuries are one of the most frequent traumas of the lower limb. They typically involve the lower lateral ligaments of the ankle, but the syndesmosis is also affected in up to 18% of cases. The degree of instability of syndesmotic joint depends on which ligaments are affected. Adequate management of syndesmotic injuries is crucial to avoid long term complications. The primary goal of our study was to evaluate the effect of simulated weightbearing on syndesmotic instability resulting from isolated AiTFL injury and from combined AiTFL/IOL injuries. The secondary goal was to evaluate the effect of a controlled ankle motion walking boot on syndesmosis stability following injury. We hypothesized that the CAM boot would prevent significant instability even in two ligaments injuries. Methods: Ten cadaveric specimens were dissected to expose the syndesmosis to create progressive iatrogenic syndesmosis ruptures. Uninjured syndesmoses were compared to isolated AiTFL and combined AiTFL/IOL ruptures. The specimens were fitted in a custom-made device to allow stabilization of the leg and apply a reproducible axial load (AL) of 750 N, equivalent to the weight of a 168-pound person. For each specimen and injury pattern, CT-scan images were obtained with and without AL, and with a CAM boot under AL. Distal tibio-fibular relationship was evaluated in three planes using a previously validated measurement system developed on CT. Wilcoxon tests for paired samples and non-parametric data were done to compare the different conditions. Results: For our first objective, when comparing ankles with isolated AiTFL to combined AiTFL/IOL rupture with and without AL, the only significant difference was an increase in internal rotation between the incisura and a line drawn in the axis of the fibula. Even with minimal statistical differences, it appears that axial loading does not impact syndesmotic stability apart from a slight increase in internal rotation with a single or two-ligament injury. As for our second end point, with the CAM orthopedic boot, no significant widening of the syndesmosis happened when either one or both ligaments were sectioned, in an axial loading state. We therefore confirmed our hypothesis that even with two syndesmotic ligament injuries, axial loading in a CAM boot does not affect distal tibio-fibular anatomy. Conclusion: This study reveals that weight bearing without rotational force does not affect the stability of the syndesmosis. Incomplete syndesmotic injuries can likely be treated with nonoperative treatment in a CAM boot and weight bearing as tolerated. Further clinical studies are needed to confirm these findings.

scholarly journals Transcuneiform Screw Fixation in Ligamentous Lisfranc Injuries

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0043
Author(s):  
Philip J. Shaheen ◽  
Benjamin Crawford ◽  
Nathan J. Kopydlowski ◽  
Shwetang Patel ◽  
John G. Bledsoe ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Pain Control ◽  
Screw Fixation ◽  
Weight Bearing ◽  
Potential Reduction ◽  
Second Metatarsal ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Bearing Stress ◽  
Lisfranc Injuries

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Ligamentous Lisfranc injuries represent a devastating injury complex to the midfoot. Treatment with screw fixation across the first tarsometatarsal (TMT) joint and across the first cuneiform-second metatarsal joint (C1-M2) joint has been described, however there are no studies examining the utility of adding a transcuneiform screw across the first cuneiform-second cuneiform (C1-C2) joint. The purpose of this study was to evaluate the effectiveness of transcuneiform screws at minimizing interosseous displacement in ligamentous Lisfranc injuries when added to traditional Lisfranc screw fixation. Methods: Unstable ligamentous Lisfranc injuries were created on ten fresh-frozen cadaveric specimens by sectioning the interosseous ligaments in a manner that has been described previously. Simulated weight bearing stress (222.4 N) as well as manual abduction and adduction stresses were applied to each specimen and interosseous displacement at the C1-C2 and C1-M2 joints was measured on gross images using calibration with 2mm radiographic marker balls. These measurements were performed initially with no screws, followed by with two-screw fixation across the C1-M2 joint and the first TMT joint, and finally with a third transcuneiform screw across the C1-C2 joint. The images were analyzed and statistical analysis was performed to determine the effect of transcuneiform fixation on interosseous displacement at the C1-C2 and C1-M2 joints. Results: The addition of transcuneiform screw fixation to traditional two-screw fixation decreased the amount of interosseous widening at C1-M2 by an average of 0.03mm at rest, 0.39mm during abduction stress, 0.21mm during adduction stress, and 0.19mm during weight bearing. The interosseous widening at C1-C2 decreased with the addition of transcuneiform fixation by an average of 0.30mm at rest, 0.11mm during abduction stress, 0.18mm during adduction stress, and 0.05mm during weight bearing. Of these findings, only the change in interosseous widening at C1-M2 during abduction stress demonstrated a statistically significant difference (p=0.031) with the addition of the transcuneiform screw compared to traditional two-screw fixation. Conclusion: The addition of transcuneiform screw fixation in ligamentous lisfranc injuries allows less interosseous widening at the C1-M2 joint during abduction stress when compared to traditional two-screw Lisfranc fixation. Further research is required to determine the clinical significance of fixing the transcuneiform joint in Lisfranc injuries and whether or not this potential reduction in motion affects outcomes such as pain control, healing, or function.

scholarly journals Performance Analytics and Pitch Metrics as Predictors of Ulnar Collateral Ligament Injury in Major League Baseball Pitchers (128)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0027
Author(s):  
Matthew Fury ◽  
Donna Scarborough ◽  
Luke Oh ◽  
Joshua Wright-Chisem ◽  
Jacob Fury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Injury Risk ◽  
Major League Baseball ◽  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Control Group ◽  
Collateral Ligament ◽  
Significant Difference ◽  
Major League

Objectives: Ulnar collateral ligament (UCL) injury is a significant concern in elite throwers, and it is associated with prolonged time away from competition in Major League Baseball (MLB) pitchers. Identifying athletes at higher risk of injury, with the subsequent goal of injury prevention, may positively impact pitcher health while mitigating the significant economic impact of this injury on professional organizations. As technology continues to advance, more granular assessments of performance are becoming possible. In 2015, Major League Baseball introduced StatCast, a spatiotemporal data tracking system that uses a standardized camera system and radar technology, to optically track player and ball movement to measure and quantify game events. This technology allows for further investigation of the science of pitching and provides new frontiers for injury research. Understanding UCL injuries in MLB pitchers may also provide insight into youth pitching injuries. To date, there is a paucity of evidence regarding risk factors of UCL injury in MLB pitchers. Methods: All MLB pitchers who underwent primary UCLR between 2015 and 2019 were identified from publicly available reports. This date range was selected to capture the seasons in which Statcast data was available. Advanced analytics and pitch metrics from the injury season—including velocity, spin rates, and pitch movement from MLB StatCast data—were collected as well as the seasonal data of an uninjured control group. Binomial logistic regression analysis was performed to determine risk factors for UCL injury. Results: Seventy-six MLB pitchers undergoing primary UCL reconstruction were included, and a control group of 95 uninjured pitchers was identified. There was no significant difference in age, height, weight, or BMI between the two cohorts. A logistic regression model was created using the following variables: 4-seam fastball velocity, 4-seam fastball spin rate, slider spin rate, curveball spin rate, strikeout percentage, and wins above replacement (WAR). The model explained 18.4% of the variance and predicted 70.4% of UCL injuries. Increasing WAR was associated with increasing likelihood of subsequent UCL injury (odds ratio [OR] 2.34; 95% CI, 1.08–5.07; p = 0.031). Conclusions: When controlling for fastball velocity and pitch spin rates, MLB pitchers who are more valuable, as indicated by WAR, may be at an elevated risk of UCL injury. While velocity is a known risk factor for UCL injury, this model indicates that other factors, including performance or pitch metrics, may influence single-season injury risk and warrant future investigation in multi-year studies.

scholarly journals Effect of McGlamry Elevator Placement on the Plantar Plate Origin

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0045
Author(s):  
Natalie Singer ◽  
Fred Finney ◽  
Paul Talusan
Keyword(s):  
Soft Tissues ◽  
Surgical Techniques ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Dorsal Approach ◽  
Deep Placement ◽  
Plantar Plate ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Relationship Of

Category: Lesser Toes Introduction/Purpose: Lesser metatarsal phalangeal (MTP) joint plantar plate tears have been implicated in a variety of lesser toe pathologies, and plantar plate repair (PPR) through a dorsal approach has become increasingly popular as a treatment of lesser toe deformities and lesser MTP instability. With the aid of a McGlamry elevator, releasing the collateral ligaments and micro-suture passing techniques, the plantar plate is repaired under direct visualization. While this approach is seen as a reliable alternative, the consequence of this technique on local MTP joint anatomy is not yet well understood. The purpose of this study is to describe the proximal plantar plate attachment and to quantify the amount of soft tissue disruption of the lesser toe MTP joint anatomy with insertion of a McGlamry elevator. Methods: Fresh frozen human cadaveric feet were dissected, and the proximal plantar plate attachment of the second, third, and fourth toe MTP joints (n=6) were examined, focusing on the relationship of structures connecting the distal metatarsal shaft and head to the plantar plate. The accessory collateral ligament insertions and proximal plantar plate attachments were measured using digital calipers. Next, the second, third, and fourth rays (n=12) of separate fresh frozen cadaveric specimens were isolated. An 11mm McGlamry elevator was then inserted in standard surgical fashion in both a more shallow (limited exposure) and deeper (greater exposure) position. Using mini C-arm fluoroscopy, radiographs were taken in both positions, and the depth of insertion along the metatarsal was measured. Results: The proximal plantar plate attachment to the metatarsal is most robust just proximal to the lateral articular margin and this attachment extends an average of 10.42mm (SD= 2.71mm) proximally along the metatarsal neck and shaft. In addition there are stout proximal plantar plate attachments at the bilateral insertion sites of the accessory collateral ligament (ACL) which are thick and broad with an average insertion length of 9.01mm (SD=1.35mm). Insertion of a McGlamry elevator resulted in stripping of the distal plantar soft tissues over an average of 21.58% of the total metatarsal length (SD=4.43%) for shallow placement and 34.87% (SD=4.40%) for deep placement with a significant difference of 7.96% between the two positions (p<.00001). Conclusion: Current techniques of plantar plate repair through a dorsal approach require releasing collateral ligaments and proximal stripping of the plantar plate from the metatarsal for adequate visualization. We suggest that this significantly destabilizes the metatarsal from the plantar plate as it strips approximately the distal most one third of the metatarsal including all major proximal plantar plate attachments to the metatarsal. As surgical techniques continue to evolve and improve, surgeons should consider avoiding the placement of a McGlamry elevator as this can destabilize the proximal attachment of the plantar plate to the metatarsal.

Can Physical Examination Create a Stener Lesion?

2017 ◽  
Vol 22 (03) ◽  
pp. 350-354
Author(s):  
Manesha Lankachandra ◽  
John P. Eggers ◽  
James W. Bogener ◽  
Richard L. Hutchison
Keyword(s):  
Physical Examination ◽  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Visual Examination ◽  
Stener Lesion ◽  
Significant Difference ◽  
Fresh Frozen ◽  
Ulnar Collateral Ligament Injury ◽  
Joint Flexion

Background: The purpose of this study is to determine whether a Stener lesion can be created while testing stability of the ulnar collateral ligament (UCL) of the thumb. Testing was performed in a manner that reproduced clinical examination. Methods: Six fresh frozen hand and forearm specimens underwent sequential sectioning of the accessory UCL, the proper UCL, and the ulnar sagittal band. Measurements of radial deviation of the metacarpophalangeal (MCP) joint were taken with the thumb in neutral rotation, pronation and supination, both with 0 degrees and with 30 degrees of flexion of the MCP joint. Visual examination was performed to assess the presence of a Stener lesion. Results: No Stener lesion was created in any position as long as the fascial origin of the ulnar sagittal band at the adductor pollicis longus remained intact. After creating a defect in the ulnar sagittal band, a Stener lesion was created in two specimens, but only when the thumb was flexed and supinated. Pronation provided more stability, and supination provided less stability, with one or both components cut, especially when testing at 30° of flexion. Compared to both components cut without flexion or rotation, there was a statistically significant difference in angulation with the 30 degrees of MCP joint flexion in both neutral rotation in supination. Conclusions: Performing a physical examination to assess the amount of instability of an ulnar collateral ligament injury did not create a Stener lesion if the exam was performed in a controlled, gentle manner with the thumb held without rotation. If the thumb is held in neutral rotation during the exam, an iatrogenic Stener lesion should not be created.

Elbow Arthrography

2019 ◽  
pp. 151-152
Author(s):  
Matthew DelGiudice
Keyword(s):  
Mr Arthrography ◽  
Lateral Radiograph ◽  
Ligament Injury ◽  
Osteochondral Lesions ◽  
Imaging Findings ◽  
Collateral Ligaments ◽  
Collateral Ligament ◽  
Younger Patients ◽  
Radial Collateral Ligament ◽  
Clinical Concern

Chapter 99 describes indications, technique, and imaging findings of elbow arthrography. Elbow arthrography is selectively performed for MR arthrography (MRA), typically in younger patients for evaluation of ligamentous (ulnar or radial collateral ligaments) injuries and osteochondral lesions. Indications also include therapeutic injections. The posterior transtriceps approach is preferred when the clinical concern is for radial collateral ligament injury. Contrast should easily inject and disperse throughout the joint. Contrast opacifies the anterior (coronoid), posterior (olecranon), and periradial (annular) recesses, which are easily depicted on lateral radiograph. Complications are rare but include infection and bleeding.

scholarly journals Passive Posterior Tibial Subluxation on Routine Knee MRI as a Secondary Sign of PCL Tear

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Andrew J. Degnan ◽  
Catherine Maldjian ◽  
Richard J. Adam ◽  
Christopher D. Harner
Keyword(s):  
Interobserver Agreement ◽  
Weight Bearing ◽  
Intraclass Correlation ◽  
Ligament Injury ◽  
Clinical Test ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Knee Mri ◽  
Significant Difference ◽  
Tibial Translation

The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93 mm versus +0.03 mm,P=0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17 mm versus −0.57 mm,P=0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding.

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