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Kazuomi Sugamoto - One of the best experts on this subject based on the ideXlab platform.
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Changes in shape and length of the collateral and accessory collateral Ligaments of the metacarpophalangeal joint during flexion.
The Journal of bone and joint surgery. American volume, 2011Co-Authors: Toshiyuki Kataoka, Tsuyoshi Murase, Hisao Moritomo, Hideki Yoshikawa, Junichi Miyake, Kazuomi SugamotoAbstract:Background: Although the collateral and accessory collateral Ligaments of the metacarpophalangeal joint contribute to the stability of this joint, the functional role of the various portions of these Ligaments during flexion is unclear. We investigated changes in the three-dimensional shape and length of the collateral and accessory collateral Ligaments during flexion to determine how each portion stabilized the metacarpophalangeal joint. Methods: Twelve fingers from three embalmed cadavers were examined. The origin and the insertion point of the dorsal, middle, and volar portions of the radial and the ulnar collateral ligament and of the radial and the ulnar accessory collateral ligament were precisely identified. Microcomputed tomograms were obtained at 10° intervals during passive flexion from 0° to 80°. We created three-dimensional models of the metacarpal, the proximal phalange, and the paths of the twelve ligament portions. Finally, we calculated the change in the shape and length of the path of each ligament portion during flexion. Results: The region of contact between each collateral ligament and the lateral edge of the metacarpal gradually lengthened during flexion of the joint, and the ligament gradually stretched to pass around the convex radial or ulnar surface of the metacarpal head. In contrast, each accessory collateral ligament curved around the volar tubercle of the metacarpal head at all flexion angles. The length of the volar portion of each collateral ligament and the length of the dorsal and middle portions of each accessory collateral ligament underwent little change during flexion. However, the lengths of the dorsal and middle portions of each collateral ligament increased significantly during flexion, and the length of the volar portion of each accessory collateral ligament decreased significantly. Conclusions: The collateral and accessory collateral Ligaments can each be functionally divided into three portions—dorsal, middle, and volar. The volar portion of each collateral ligament and the dorsal and middle portions of each accessory collateral ligament are nearly isometric, the dorsal and middle portions of each collateral ligament become taut only in flexion, and the volar portion of each accessory collateral ligament becomes taut only in extension. Clinical Relevance: The results of the current study provide a good starting point for future research on the pathology of volar subluxation of the metacarpophalangeal joint.
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Interosseous membrane of the forearm: length change of Ligaments during forearm rotation.
Journal of Hand Surgery (European Volume), 2009Co-Authors: Hisao Moritomo, Kazuo Noda, Tsuyoshi Murase, Akira Goto, Hideki Yoshikawa, Kazuomi SugamotoAbstract:Purpose An earlier anatomic study described five ligamentous components in the interosseous membrane of the forearm (central band, accessory band, distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord) and provided their precise location of attachment. In the present study, we investigated in vivo length changes of these five Ligaments during forearm rotation to understand the function of each ligament. Methods We acquired computed tomographies of nine forearms from seven healthy volunteers for 3 rotation positions: maximum pronation, neutral position, and maximum supination. We created 3-dimensional models of the radius, ulna, and the 5 Ligaments by combining osseous images and anatomic data of ligament attachment. We calculated 3-dimensional ligament lengths between attachments during forearm rotation using a markerless bone registration technique. We also examined relationships between the axis of forearm rotation and each ligament. Results The distal 3 Ligaments (central band, accessory band, and distal oblique bundle) had little change in length during forearm rotation, with their ulnar attachments located almost on the axis of forearm rotation. The 2 proximal Ligaments (proximal oblique cord and dorsal oblique accessory cord) changed substantially in length, with their attachments out of the course of the axis. Conclusions The distal 3 Ligaments of the interosseous membrane are essentially isometric stabilizers of the forearm. The distal oblique bundle in the distal membranous portion may stabilize the distal radioulnar joint in 40% of human subjects who have this ligament.
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change in the length of the ulnocarpal Ligaments during radiocarpal motion possible impact on triangular fibrocartilage complex foveal tears
Journal of Hand Surgery (European Volume), 2008Co-Authors: Hisao Moritomo, Tsuyoshi Murase, Hideki Yoshikawa, Sayuri Arimitsu, Kunihiro Oka, Kazuomi SugamotoAbstract:Purpose The fovea of the ulnar head is the primary attachment site for both the distal radioulnar and the ulnocarpal Ligaments. Thus, both Ligaments should be simultaneously affected by the traumatic avulsion of the triangular fibrocartilage complex from its ulnar attachment. Little attention, however, has been directed toward the role of the ulnocarpal Ligaments in the mechanics of this type of injury. The purpose of this study was to investigate the changes in length of the ulnocarpal Ligaments during various radiocarpal motions and to determine the type of radiocarpal motion that makes the ulnocarpal ligament taut and that could cause foveal avulsion if it were excessive. Methods The 3-dimensional kinematics of the wrist joint were investigated noninvasively using a markerless bone registration technique in vivo . Magnetic resonance images of the wrists of 15 healthy volunteers were acquired in at least 5 positions during each wrist flexion–extension motion, radioulnar deviation, or the so called dart-throwing motion (radial extension–ulnar flexion motion). The 3-dimensional ligament paths of the ulnotriquetral, ulnolunate, ulnocapitate, and palmar radioulnar Ligaments were modeled as the shortest paths between the fovea and the insertion point of each ligament. Changes in the 3-dimensional ligament length of each ligament between the neutral position and each wrist position were then calculated. Results The lengths of the ulnotriquetral and ulnocapitate Ligaments increased the most on wrist radial extension, and the length of the ulnolunate ligament increased the most on wrist extension. The length of the palmar radioulnar ligament changed minimally during any motion. Conclusions The ulnocarpal Ligaments are likely to be stretched tensely in wrist radial extension and wrist extension. This study supports the hypothesis that one of the mechanisms responsible for a triangular fibrocartilage complex foveal tear is excessive traction of the ulnocarpal ligament caused by a fall on the outstretched hand.
Elisabet Hagert - One of the best experts on this subject based on the ideXlab platform.
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Histological analysis of the structural composition of ankle Ligaments.
Foot & Ankle International, 2015Co-Authors: Susanne Rein, Armin Fieguth, Wolfgang Schneiders, Elisabet Hagert, Hans ZwippAbstract:Background:Various ankle Ligaments have different structural composition. The aim of this study was to analyze the morphological structure of ankle Ligaments to further understand their function in ankle stability.Methods:One hundred forty Ligaments from 10 fresh-frozen cadaver ankle joints were dissected: the calcaneofibular, anterior, and posterior talofibular Ligaments; the inferior extensor retinaculum, the talocalcaneal oblique ligament, the canalis tarsi ligament; the deltoid ligament; and the anterior tibiofibular ligament. Hematoxylin-eosin and Elastica van Gieson stains were used for determination of tissue morphology.Results:Three different morphological compositions were identified: dense, mixed, and interlaced compositions. Densely packed Ligaments, characterized by parallel bundles of collagen, were primarily seen in the lateral region, the canalis tarsi, and the anterior tibiofibular Ligaments. Ligaments with mixed tight and loose parallel bundles of collagenous connective tissue were mainly...
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Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis
Clinical Orthopaedics and Related Research®, 2014Co-Authors: Nathalie Mobargha, Cassie Ludwig, Amy L. Ladd, Elisabet HagertAbstract:Background The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, little is known about CMC-1 ligament innervation characteristics in patients with OA. We studied the dorsal radial ligament (DRL) and the anterior oblique ligament (AOL), Ligaments with a reported divergent presence of mechanoreceptors in nonosteoarthritic joints. Questions/purposes This study’s purposes were (1) to examine the ultrastructural architecture of CMC-1 Ligaments in surgical patients with OA; (2) to describe innervation, specifically looking at mechanoreceptors, of these Ligaments using immunohistochemical techniques and compare the AOL and DRL in terms of innervation; and (3) to determine whether there is a correlation between age and mechanoreceptor density. Methods The AOL and DRL were harvested from 11 patients with OA during trapeziectomy (10 women, one man; mean age, 67 years). The 22 Ligaments were sectioned in paraffin and analyzed using immunoflourescent triple staining microscopy. Results In contrast to the organized collagen bundles of the DRL, the AOL appeared to be composed of disorganized connective tissue with few collagen fibers and little innervation. Mechanoreceptors were identified in CMC-1 Ligaments of all patients with OA. The DRL was significantly more innervated than the AOL. There was no significant correlation between innervation of the DRL and AOL and patient age. Conclusions The dense collagen structure and rich innervation of the DRL in patients with OA suggest that the DRL has an important proprioceptive and stabilizing role. Clinical Relevance Ligament innervation may correlate with proprioceptive and neuromuscular changes in OA pathophysiology and consequently support further investigation of innervation in disease prevention and treatment strategies.
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macroscopic and microscopic analysis of the thumb carpometacarpal Ligaments a cadaveric study of ligament anatomy and histology
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Amy L. Ladd, Elisabet HagertAbstract:Background: Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four Ligaments have been described as primary stabilizers, but controversy exists as to which Ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the Ligaments of the thumb carpometacarpal joint would further define their role in joint stability. Methods: Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting Ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar Ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between Ligaments. Results: Seven principal Ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped Ligaments (dorsal radial, dorsal central, posterior oblique), two volar Ligaments (anterior oblique and ulnar collateral), and two ulnar Ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal Ligaments were significantly thicker (p < 0.001) than the volar Ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity. Conclusions: The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and is more structurally consistent with a capsular structure than a proper ligament. Clinical Relevance: Delineation of the structural and microscopic anatomy of the Ligaments of the thumb carpometacarpal joint provides further evidence regarding the stability and mobility of this joint that is often affected by osteoarthritis.
Richard A Berger - One of the best experts on this subject based on the ideXlab platform.
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the anatomy of the Ligaments of the wrist and distal radioulnar joints
Clinical Orthopaedics and Related Research, 2001Co-Authors: Richard A BergerAbstract:The Ligaments of the wrist are responsible for guiding and constraining the complex motion of the carpal bones relative to the forearm bones, the metacarpals, and contiguous carpal bones. The majority of wrist Ligaments are found within the joint capsule as organized thickenings composed of parallel collagen fascicles, small caliber nerves and blood vessels, and lined on their deep surfaces by synoviocytes. The palmar radiocarpal ligament complex is composed of the radioscaphocapitate, long radiolunate, radioscapholunate and short radiolunate Ligaments. The ulnocarpal Ligaments include the ulnolunate, ulnotriquetral and ulnocapitate Ligaments. Dorsally, the radiocarpal joint is spanned by the dorsal radiocarpal ligament. Palmar Ligaments connecting the proximal and distal carpal rows include the scaphotrapeziotrapezoid, scaphocapitate, triquetrocapitate and triquetrohamate Ligaments. Within each row are interosseous Ligaments connecting adjacent carpal bones, each divisible into dorsal and palmar components. There are unique regions within some of the Ligaments, such as a zone of fibrocartilage in the proximal regions of the scapholunate and lunotriquetral interosseous Ligaments, and strong deep regions connecting the trapezoid, capitate, and hamate. The distal radioulnar joint is connected by the triangular fibrocartilage complex, composed of a fibrocartilaginous disc and the palmar and dorsal radioulnar Ligaments. The ulnocarpal Ligaments attach to the palmar radioulnar ligament rather than directly to the ulna, allowing increased independence between wrist and forearm motion.
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an anatomic study of the stabilizing Ligaments of the trapezium and trapeziometacarpal joint
Journal of Hand Surgery (European Volume), 1999Co-Authors: Paul C Bettinger, Ronald L. Linscheid, Richard A Berger, William P. CooneyAbstract:We provide a detailed and comprehensive anatomic description of the Ligaments stabilizing the trapezium and trapeziometacarpal joint. Sixteen Ligaments were identified. Fourteen Ligaments inserted onto the trapezium and 2 others attached independently to the thumb metacarpal. The Ligaments inserting onto the trapezium were the superficial anterior oblique, deep anterior oblique (beak ligament), dorsoradial, posterior oblique, ulnar collateral, dorsal trapezio-trapezoid, volar trapezio-trapezoid, dorsal trapezio-second metacarpal, volar trapezio-second metacarpal, trapezio-third metacarpal, volar scaphotrapezial, radial scaphotrapezial, transverse carpal, and trapezio-capitate Ligaments. The remaining 2 Ligaments attach onto the thumb metacarpal and are the proper intermetacarpal and the dorsal intermetacarpal. The dorsoradial and deep anterior oblique Ligaments play a substantial role in stabilizing the trapeziometacarpal joint, and the deep anterior oblique ligament may function as a pivot for the first metacarpal during palmar abduction to allow rotation (pronation). The dorsal trapezio-second metacarpal, volar trapezio-second metacarpal, and trapezio-third metacarpal Ligaments function as tension bands and are required to prevent instability from cantilever bending forces on the trapezium.
Steven F Viegas - One of the best experts on this subject based on the ideXlab platform.
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three dimensional analysis of the ligamentous attachments of the first carpometacarpal joint
Journal of Hand Surgery (European Volume), 2006Co-Authors: Mitsuhiko Nanno, Rita M Patterson, William L Buford, Clark R Andersen, Steven F ViegasAbstract:PURPOSE: To show the ligamentous locations and attachments of the first carpometacarpal (CMC) joint on a 3-dimensional (3-D) surface model. METHODS: Ten fresh-frozen cadaver wrists were used to dissect and identify the first CMC Ligaments. Their ligamentous attachments and whole bone surfaces were digitized 3-dimensionally and their areas were calculated. The attachments of each ligament were represented in a model combining 3-D computed tomography surfaces overlaid by a digitized 3-D surface and also were shown visually by a specific color on 3-D bone images. The superimposed outlines of the ligamentous attachments on both the radial and ulnar base of the first metacarpal (MC) also are described. RESULTS: Seven Ligaments of the first CMC joint were identified: the dorsoradial ligament, the posterior oblique ligament, the superficial anterior oblique ligament, the deep anterior oblique ligament, the ulnar collateral ligament, the dorsal first MC ulnar base-second MC radial base intermetacarpal ligament, and the volar first MC ulnar base-second MC radial base intermetacarpal ligament. The detailed locations and areas of the ligamentous attachments of the first CMC joint were determined. The average locations of the centroid of the ligamentous attachments of the ulnar collateral and the dorsoradial Ligaments were located ulnovolar and dorsoradial on the first MC base, respectively. CONCLUSIONS: The anatomic 3-D attachment sites of the first CMC Ligaments were shown qualitatively and their areas were quantified. The results of this study improve the knowledge and understanding of the normal anatomy and its impact on the mechanics of the first CMC joint. This should help in making an accurate assessment of radiographic images and treating injuries and degenerative changes in the first CMC joint by ligament reconstruction, repair, and arthroscopy.
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the dorsal Ligaments of the wrist anatomy mechanical properties and function
Journal of Hand Surgery (European Volume), 1999Co-Authors: Steven F Viegas, Satoshi Yamaguchi, Nolan L Boyd, Rita M PattersonAbstract:The purpose of this study was to examine the anatomy and mechanical properties of the dorsal radiocarpal (DRC) and dorsal intercarpal (DIC) Ligaments of the wrist and to better understand the functional design of the dorsal Ligaments. The DRC ligament was consistently found to originate from the dorsal margin of the distal radius and extended ulnar obliquely and distally. Its radial fibers attached to the lunate and lunotriquetral interosseous ligament. The DRC ligament then inserted onto the dorsal tubercle of the triquetrum. The DIC ligament originated from the triquetrum and extended radially and attached onto the lunate, inserted into the dorsal groove of the scaphoid, and then extended to the trapezium. The DRC and DIC Ligaments together, in their lateral V configuration, act effectively as a dorsal radioscaphoid ligament that has the ability to vary its length by changing the angle between the 2 arms of the V. The DRC-DIC Ligaments' lateral V configuration allows normal carpal kinematics while maintaining its indirect dorsal stabilizing effect on the scaphoid throughout the range of motion of the wrist.
Christopher J Gottsegen - One of the best experts on this subject based on the ideXlab platform.
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cruciate ligament avulsion fractures anatomy biomechanics injury patterns and approach to management
Emergency Radiology, 2013Co-Authors: Eric A White, Dakshesh B Patel, George R Matcuk, Deborah M Forrester, Ryan B Lundquist, George Rick F Hatch, Thomas C Vangsness, Christopher J GottsegenAbstract:Injury to the ACL or PCL of the knee most commonly involves a tear of the collagenous fibers of the ligament. Less frequently, a cruciate ligament injury involves an avulsion fracture at the origin or insertion of the ligament, usually from the insertion site on the tibial surface. Avulsion fractures of the cruciate Ligaments are important, as they can be identified on radiographs, allowing a specific diagnosis. Although more common in children, when they occur in adults, they are more commonly associated with other injuries. The treatment of cruciate ligament avulsion fractures is different than the treatment of intrasubstance tears of the cruciate Ligaments. These injuries can be treated conservatively or surgically with good outcomes. Recently arthroscopic fixation of these injuries with various fixation devices has become more frequent. Treatment largely depends on the type of fracture, particularly, the size, displacement, comminution, and orientation of the avulsed fracture fragment, in addition to the integrity of the attached cruciate ligament. This review article covers the anatomy and biomechanics of the cruciate Ligaments, their injury patterns, and approach to management.