Ligamentous Laxity
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John Ong Ying Wei ◽  
Tin Chan ◽  
William Lo ◽  
Buddhika Wimalachandra

Atlantoaxial rotary subluxation (AARS) is a rare condition that may cause persistent torticollis if not treated appropriately. AARS is associated with ligamentous abnormalities, which may result from acquired or congenital disorders. We report the case of a paediatric patient with congenital Marfan syndrome and AARS due to a minor traumatic head injury. A 9-year-old boy with a known diagnosis of Marfan syndrome (and extensive family history) encountered a traumatic head injury that presented as torticollis with a typical “cock-robin” head and neck orientation. AARS was diagnosed through a head and neck CT scan. He underwent initial conservative treatment involving a muscle relaxant (diazepam) and Miami-J collar. This was followed up with manipulation under anaesthesia (MUA) and further cervical traction, which resolved the subluxation without more invasive treatment. To the best of our knowledge, AARS associated with Marfan syndrome has been rarely reported in literature. It is postulated that the ligamentous laxity associated with Marfan syndrome would increase the patient’s predisposition to AARS and more importantly, the propensity to require more invasive treatment (internal fixation). However, our patient unexpectedly responded well to conservative management, namely MUA and cervical traction. This illustrates that despite the increased ligamentous laxity in Marfan syndrome, it is still advisable to conservatively manage AARS before deciding to perform invasive internal fixation.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S15

2021 ◽  
Vol 70 (2) ◽  
pp. 97-101
Nicol Kossuthová ◽  
Jan Mejzlík ◽  
Karel Zadrobílek ◽  
Jana Dědková ◽  
Viktor Chrobok

Introduction: By definition from the literature, Grisel’s syndrome is described as non-traumatic rotational atlantoaxial instability between C1 and C2 vertebrae. It can occur during an infection of a soft tissue in the cervicocranial region or after an operation in the ENT region. Because of the frequent occurrence after operations, we inclined to the definition which includes a traumatic subluxation as a cause of origin, and it’s not defined as non-traumatic only. The instability manifests itself with abnormal head posture that is called torticollis. Increased incidence in adolescence is more common because of a greater ligamentous laxity of the joint capsules, increased perfusion of antlantoaxial regions and longer alar ligaments. In this article, the case of a child with Grisel’s syndrome after adenotomy is described. The pathophysiology, symptomatology, diagnostic management and treatment are discussed. Keywords: Grisel’s syndrome – torticollis – atlantoaxial instability – adenotomy

2021 ◽  
Angelos Trellopoulos ◽  
Emmanouil Brilakis ◽  
Emmanouil Antonogiannakis

AbstractAnterior glenohumeral instability is a widespread pathological condition, not only in athletes but also in the general population. The variations in the lesions (soft tissue and bone defects) that occur after traumatic dislocation or recurrence, combined with the degree of ligamentous laxity and activity, have led to numerous surgical techniques. Following the introduction of arthroscopy in the treatment of shoulder pathology, several new procedures and modifications of old methods were introduced to treat anterior instability. Despite this, there is still controversy regarding the proper management of instability cases combined with bone loss or insufficient anterior soft tissue wall or laxity. Additional soft tissue procedures, along with the simple Bankart repair, strengthen the stability of the repair and can fill the gap in the transition from the classic Bankart repair to the potential overtreatment of bony procedures. This literature review attempts to summarize all the critical studies referring to soft tissue techniques and highlight the most crucial points of their conclusions.

2021 ◽  
Vol 1 (1) ◽  
pp. 263502542199002
Jordan D. Walters ◽  
Brian C. Werner

Background: This technique video reviews medial meniscal allograft transplantation (MAT) using a representative case example. Indications: Medial meniscal allograft transplantation is indicated in symptomatic patients with a deficient medial tibiofemoral compartment that has not progressed to arthritic changes. Concomitant procedures to address focal cartilage defects, ligamentous laxity, and/or limb malalignment should be performed prior to MAT or in the same surgical setting. Technique Description: Preoperative workup includes magnetic resonance imaging (MRI), prior arthroscopic pictures, and sizing radiographs. The Pollard radiographic method measures for the appropriate cryopreserved allograft size. Arthroscopic instruments remove residual meniscal tissue to a 1 mm base around the capsule. Percutaneous lengthening of the medial collateral ligament (MCL) at its femoral attachment aids visualization/instrumentation. This technique employs 8-mm bone plugs for anterior and posterior meniscal root fixation. Tunnels size 8.5 mm diameter and 10 mm depth are created. Once the meniscal allograft is placed in the joint, inside-out sutures are placed throughout the meniscal body. Sutures from the meniscal roots are secured with an anchor in the anterior proximal tibia. Results: There are numerous outcomes studies of meniscal allograft transplantation with a reported overall graft survivorship of roughly 70% at 10 years and 60% at 15 years follow-up. Discussion/Conclusion: Meniscal allograft transplantation is a temporizing measure that provides good midterm clinical results, although long-term failure rates increase incrementally. Most studies suggest return to sport is possible although activity modification is recommended.

2020 ◽  
Vol 4 (2) ◽  
pp. 069-074
Mazzola Catherine A ◽  
Christie Catherine ◽  
Snee Isabel A ◽  
Iqbal Hamail

Objective: Atlantoaxial subluxation (AAS) occurs when there is misalignment of the atlantoaxial joint. Several etiologies confer increased risk of AAS in children, including neck trauma, inflammation, infection, or inherent ligamentous laxity of the cervical spine. Methods: A single-center, retrospective case review was performed. Thirty-four patients with an ICD-10 diagnosis of S13.1 were identified. Demographics and clinical data were reviewed for etiology, imaging techniques, treatment, and clinical outcome. Results: Out of thirty-four patients, twenty-two suffered cervical spine trauma, seven presented with Grisel’s Syndrome, four presented with ligamentous laxity, and one had an unrecognizable etiology. Most diagnoses of cervical spine subluxation and/or instability were detected on computerized tomography (CT), while radiography and magnetic resonance imaging (MRI) were largely performed for follow-up monitoring. Six patients underwent cervical spine fusion, five had halo traction, twelve wore a hard and/or soft collar without having surgery or halo traction, and eight were referred to physical therapy without other interventions. Conclusion: Pediatric patients with atlantoaxial subluxation may benefit from limited 3D CT scans of the upper cervical spine for accurate diagnosis. Conservative treatment with hard cervical collar and immobilization after reduction may be attempted, but halo traction and halo vest immobilization may be necessary. If non-operative treatment fails, cervical spine internal reduction and fixation may be necessary to maintain normal C1-C2 alignment.

2020 ◽  
Vol 44 (12) ◽  
pp. 2635-2644
Amrath Raj B.K. ◽  
Kumar Amerendra Singh ◽  
Hitesh Shah

Abstract Purpose Congenital dislocation of the knee and hip is a rare congenital disorder. The specific aim of the study was to evaluate the clinical and radiological outcomes of the children with congenital dislocation of the knee and hip who presented after six months of age. Methods All the consecutive children with congenital dislocation of the knee and hip joints were retrospectively reviewed. We included cases that were treated after six months of age and followed up for a minimum of two years. Twenty-four children with congenital dislocation of the knee and hip (thirteen with ligamentous laxity, eleven children with stiff joints) were included. The knee was dislocated in 45 limbs; the hip was dislocated in 40 instances. The knee joint dislocation was treated with quadricepsplasty in all twenty-four children (45 knees). The hip dislocation (n = 32) was addressed with either closed reduction (n = 8) or open reduction of the hip (n = 24). Eight hip dislocations were not addressed. The outcome of the hip and knee was evaluated. Results The clinical and radiological outcomes were better in children with ligamentous laxity than without laxity. Twenty-two children were community walkers. An orthosis was needed in eight children. The frequency of spontaneous reduction of unreduced dislocation of the hip was noted in three children (5/8 hips). Conclusion Outcome in combined dislocation of knee and hip is good in most cases with surgical interventions. The outcome is better in children with ligamentous laxity. Spontaneous reduction of the dislocated hips might be achieved after gaining knee flexion following knee surgery for congenital the knee in a few cases.

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0045
Benjamin Domb ◽  
Jeffrey Chen ◽  
Philip Rosinsky ◽  
Jacob Shapira ◽  
Ajay Lall ◽  

Objectives: (1) To report minimum two-year PROs in patients with generalized ligamentous laxity (GLL) who underwent hip arthroscopy and (2) to compare clinical results to a matched-pair control group without GLL. Methods: Data from a prospectively collected database was retrospectively reviewed between August 2014 and December 2016. Patients were considered eligible if they received primary arthroscopic treatment for symptomatic labral tears and femoroacetabular impingement (FAI). Inclusion criteria included preoperative and minimum two-year follow-up scores for the following PROs: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Scale (HOS-SSS), and Visual Analogue Scale (VAS). Patients were excluded if they had preoperative Tönnis ≥ 2, ipsilateral hip condition, prior hip surgery, worker’s compensation status, or dysplasia. From the sample population, two groups were created: the GLL group (Beighton ≥ 4) and the control group (Beighton < 4). Patients were matched in a 1:2 ratio via propensity-score matching according to age, gender, body mass index (BMI), acetabular and femoral head Outerbridge grade, and preoperative lateral center-edge angle (LCEA). Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. PASS was also calculated for International Hip Outcome Tool-12 (iHOT-12) as well as MCID for VAS. Significant differences were noted if P < 0.05. Results: 95 patients with GLL were matched to 143 control patients. Age, gender, BMI, and follow-up times were not different (P > 0.05). Preoperative radiographic measurements demonstrated no difference. Intraoperative findings and procedures between groups were similar except for capsular treatment, with the GLL group receiving more plications (P = 0.004). Both groups reported similar baseline PROs and VAS. At minimum two-year follow-up both groups showed significant improvement in PROs and VAS (P < 0.001), furthermore, the postoperative PROs at minimum two-year follow-up showed no difference (P > 0.05) and the magnitude of improvement (delta value) was similar for mHHS (P = 0.93), NAHS (P = 0.809), HOS-SSS (0.398) and VAS (P = 0.824). Moreover, groups reached comparable rates of MCID and/or PASS for mHHS, HOS-SSS, iHOT-12, and VAS. Conclusions: Patients with GLL following hip arthroscopy for symptomatic FAI and labral tears, may expect favorable outcomes with appropriate labral and capsular management at minimum two-year follow-up. When compared to a pair-matched control group without GLL, results were comparable for mHHS, NAHS, HOS-SSS, VAS and reaching PASS and/or MCID for mHHS, HOS-SSS, iHOT-12 and VAS.

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