Comparison between Operative and Non-Operative Treatment of the Medial Collateral Ligament: Histological and Ultrastructural Findings during Early Healing in the Epiligament Tissue in a Rat Knee Model

2018 ◽  
Vol 206 (3) ◽  
pp. 165-182
Author(s):  
Georgi P. Georgiev ◽  
Georgi Kotov ◽  
Alexandar Iliev ◽  
Plamen Kinov ◽  
Jordanka Angelova ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Operative Treatment ◽  
Medial Collateral Ligament ◽  
Normal Function ◽  
Ultrastructural Changes ◽  
Vascular Bundles ◽  
Collateral Ligament ◽  
Electron Microscopic ◽  
Thin Sections ◽  
Significant Difference

The medial collateral ligament of the knee joint is one of the most commonly injured ligaments of the knee. Recent data have shown that the thin layer of connective tissue covering the ligament, known as the epiligament, is essential for its nutrition and normal function, as well as its healing after injury. The aim of the present study was to investigate and compare the changes in the epiligament of the medial collateral ligament which occurred during operative and non-operative treatment throughout the first month after injury. We used 27 male Wistar rats randomly allocated to three groups. In the 9 rats belonging to the first group, the medial collateral ligament was fully transected and left to heal spontaneously without suture. In the 9 rats belonging to the second group, the transected ends were marked with a 9–0 nylon monofilament suture. The 9 rats in the third group were used as normal controls. Three animals from each group were sacrificed on days 8, 16, and 30 after injury. Light microscopic analysis was performed on semi-thin sections stained with 1% methylene blue, azure II, and basic fuchsin. Transmission electron microscopy was used to study and compare the ultrastructural changes in the epiligament. The statistical analysis of the obtained data was performed using the Kruskal-Wallis H test and Mood’s median test. The normal structure of the epiligament of the medial collateral ligament was presented by fibroblasts, fibrocytes, adipose cells, mast cells, collagen fibers, and neuro-vascular bundles. On days 8 and 16 postinjury, the epiligament appeared hypercellular and returned to its normal appearance on the thirtieth day postinjury. The electron microscopic study revealed the presence of different types of fibroblasts with the typical ultrastructural features of collagen-synthetizing cells. The comparative statistical analysis on the respective day showed that there was no statistically significant difference in the number of cells between spontaneously healing animals and animals recovering with suture application. These data further prove that spontaneous healing of the medial collateral ligament yields similar results to surgical treatment and may be used as a basis for the development of treatment regimens with improved patient outcome.

scholarly journals Medial Collateral Ligament Reconstruction in Patients With Medial Knee Instability: A Systematic Review

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770392 ◽  
Author(s):  
Antonios N. Varelas ◽  
Brandon J. Erickson ◽  
Gregory L. Cvetanovich ◽  
Bernard R. Bach
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Medial Collateral Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Cruciate Ligament Reconstruction ◽  
Significant Difference ◽  
Ikdc Score

Background: The medial collateral ligament (MCL) is the most frequently injured ligament of the knee, but it infrequently requires surgical treatment. Current literature on MCL reconstructions is sparse and offers mixed outcome measures. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated MCL reconstruction and multiligamentous MCL reconstruction. Our hypothesis was that in selective patients, MCL reconstruction would significantly improve objective and subjective patient knee performance measures, those being baseline valgus laxity, range of motion, objective and subjective International Knee Documentation Committee (IKDC) scores, Tegner score, and Lysholm knee activity scores. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and utilizing 3 computer-based databases. Studies reporting clinical outcomes of patients undergoing MCL reconstruction due to chronic instability or injury with mean follow-up of at least 2 years and levels of evidence 1 to 4 were eligible for inclusion. All relevant subject demographics and study data were statistically analyzed using 2-sample and 2-proportion z tests. Results: Ten studies involving 275 patients met our inclusion criteria. Of these patients, 46 underwent isolated MCL reconstruction while another 229 underwent reconstruction of the MCL in addition to a variety of concomitant reconstructions. Overall outcomes for all patients were significant for (1) reducing the medial opening of the knee (8.1 ± 1.3 vs 1.4 ± 1.0 mm; P < .001), (2) improving the patient’s objective IKDC score (1.2% vs 88.4%; P < .001), (3) improving the patient’s subjective IKDC score (49.8 ± 6.9 vs 82.4 ± 9.6; P < .001), and (4) improving the Lysholm knee activity score (69.3 ± 5.9 vs 90.5 ± 6.6; P < .001). No differences existed between concomitant reconstruction groupings except that postoperative Lysholm scores were better for MCL/anterior cruciate ligament reconstruction than MCL/posterior cruciate ligament reconstruction (94.3 ± 4.5 vs 84.0 ± 11.7; P < .001). Normal or nearly normal range of motion was obtained by 88% of all patients. Conclusion: The systematic review of 10 studies and 275 knees found that the reported patient outcomes after MCL reconstruction were significantly improved across all measures studied, with no significant difference in outcomes between concomitant reconstructions.

scholarly journals Epidemiology of injuries in professional ice hockey: a prospective study over seven years

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Gregory Ornon ◽  
Jean-Luc Ziltener ◽  
Daniel Fritschy ◽  
Jacques Menetrey
Keyword(s):  
Prospective Study ◽  
Medial Collateral Ligament ◽  
Significant Risk ◽  
The Body ◽  
Ice Hockey ◽  
Collateral Ligament ◽  
Time Loss ◽  
Significant Difference ◽  
Ice Hockey Injuries ◽  
A Prospective Study

Abstract Background Ice hockey injuries epidemiology is still poorly understood and very few studies are focused on it, especially about professional players. Methods Our prospective study collected all injuries occurring on ice during practice and games over 7 years (2006–2013) in a professional hockey team playing in the 1st division championship in Switzerland. Results During the 7 seasons, we recorded a total of 525 injuries and 190 injuries with time loss (TL). Mean injuries incidence was 5.93 (95% CI 5.28 to 6.27) injuries/1000 h/player and with time loss 2.14 (95% CI 1.79 to 2.39) injuries/1000 h/player. The lower limb was the most affected part of the body, with a total of 40.4% of all injuries, mostly knee Medial Collateral Ligament tear and muscle adductors/abdominal sprain. For the upper limb, shoulder was the most affected joint with mostly acromioclavicular sprain and shoulder dislocation. Forwards had a significant (p < 0.05) higher risk than defensemen for knee Medial Collateral Ligament (MCL) tear. There was no significant difference in the concussion risk between forwards and defensemen, but defensemen had a significant higher risk (p < 0.05) to have a more severe concussion. Conclusion This study provides a better understanding about professional ice hockey epidemiology, which is still insufficiently researched and understood. We also found some significant risk factors, being a forward for knee MCL tear, being a defensemen for concussion severity. Concussion program prevention seems to be effective but it is crucial to continue the follow up of concussion on long term and expand the surveillance system to all the League.

Meniscus Graft Augmentation for a Midsubstance Tear of the Medial Collateral Ligament during Total Knee Arthroplasty

2020 ◽  
Author(s):  
Changjiao Sun ◽  
Wei Rong ◽  
Ruiyong Du ◽  
Sha Wu ◽  
Pu Liu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Control Group ◽  
Collateral Ligament ◽  
Impaired Wound Healing ◽  
Primary Tkas ◽  
Significant Difference ◽  
Total Knee

AbstractsMultiple surgical techniques exist to repair iatrogenic medial collateral ligament (MCL) injury during total knee arthroplasty (TKA). The objective of the study is to confirm the clinical effectiveness of meniscus transfer for treatment of iatrogenic MCL midsubstance transection in which remaining MCL is of poor quality, and there is a persistent gap between both ligament ends during TKA. From January 2015 to November 2019, we treated 11 patients with MCL injuries of 882 primary TKAs by meniscus transfer. Another 24 primary TKAs were recruited as a control group. The two groups of patients were comparable for age, gender, body mass index (BMI), Knee Society scoring (KSS), knee function score (KFS), and type of prosthesis comparison without significant difference (p > 0.05). We reviewed the patient's stability, as well as objective measures such as KSS and KFS scores, physical examinations, and radiographs. No patient of either group reported impaired wound healing, joint instability on physical examination, pain, radiographic changes, signs of loosening, and other complications. At the final follow-up, there was no significant difference in terms of KSS (p = 0.780) and KFS (p = 0.612) between the injury group and control group at last follow-up. X-ray image review showed no prosthesis loosening or subsidence for both groups. Based on these results, we are cautiously optimistic that midsubstance transections in which the quality of remaining tendon is weak, there is suspicion of stretching, or there is a persistent gap between both ligament ends that can be reconstructed with meniscus autograft transfer augmentation and an unconstrained implant.

Operative Treatment for a Painful Nonunion Avulsion Fracture of the Femoral Attachment of the Medial Collateral Ligament in a Teenager

2019 ◽  
Vol 9 (2) ◽  
pp. e0281-e0281 ◽  
Author(s):  
Jacob G. Calcei ◽  
Jensen K. Henry ◽  
Joash R. Suryavanshi ◽  
Jonathan M. Schachne ◽  
Peter D. Fabricant
Keyword(s):  
Operative Treatment ◽  
Medial Collateral Ligament ◽  
Avulsion Fracture ◽  
Collateral Ligament ◽  
Femoral Attachment

scholarly journals Extracoporeal shockwave treatment decreases pain, functional limitations and medial collateral ligament thickness in subjects aged 50-70 years with knee osteoarthritis

2021 ◽  
Vol 40 (2) ◽  
pp. 121-132
Author(s):  
Andwi Setiawan Kokok ◽  
Tirza Z Tamin ◽  
Nyoman Murdana ◽  
Indah Suci Widyahening
Keyword(s):  
Knee Osteoarthritis ◽  
Medial Collateral Ligament ◽  
Functional Limitations ◽  
Hip Osteoarthritis ◽  
Extracorporeal Shock Wave Therapy ◽  
Collateral Ligament ◽  
Topical Anesthetic ◽  
Knee Oa ◽  
Extracorporeal Shock Wave ◽  
Significant Difference

BackgroundPain from knee and hip osteoarthritis (OA) can have a significant impact on the physical function and quality of life of affected individuals worldwide. The objective of this study was to evaluate the effect of extracorporeal shockwave therapy (ESWT) on pain, flexibility, function, and medial collateral ligament (MCL) thickness in knee osteoarthritis (KOA). MethodsA study of quasi experimental design was performed involving 15 subjects aged 50 – 70 years with Kellgren-Lawrence grade 2-3 KOA. All subjects were evaluated regarding baseline -pain using visual analogue scale (VAS), range of motion (ROM), functional outcome using Western Ontario and McMaster Universities Arthritis Index (WOMAC), and MCL size. Extracorporeal shock wave therapy was given 3 times, at baseline, and 4 and 8 weeks after intervention. All subjects were given 4000 shocks at intensities of 1.5 – 4 Bar (raised gradually) per session. The shocks were given in the supine position, knee flexed 90o, without topical anesthetic. Statistical analyses were conducted using a dependent t-test. ResultsAfter 8 weeks of intervention, ESWT significantly improved pain score (p<0.01), WOMAC (p<0.01) and MCL thickness (p<0.01) in patients with OA of the knee. However, there was no significant difference in knee ROM, both for degree of flexion and extension (p>0.05). ConclusionThe use of ESWT for treatment of knee OA had a beneficial effect on pain relief, function outcome and MCL thickness. However, there remains a lack of clarity regarding the frequency and dosage levels of ESWT required to achieve maximum improvement.

scholarly journals Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty: a meta-analysis and systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jiahao Li ◽  
Zijian Yan ◽  
Yan Lv ◽  
Yijin Li ◽  
Pengcheng Ye ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Medial Collateral Ligament ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Collateral Ligament ◽  
Postoperative Function ◽  
Significant Difference ◽  
Total Knee ◽  
The Impact

Abstract Background As an uncommon but severe complication, medial collateral ligament (MCL) injury in total knee arthroplasty (TKA) may be significantly under-recognized. We aimed to determine whether MCL injury influences postoperative outcomes of patients undergoing TKA. Methods Two independent reviewers searched PubMed, Cochrane Library, and EMBASE from their inception to July 1, 2021. The main outcomes were postoperative function, and secondary outcomes included the incidences of revision and complications. Results A total of 403 articles yielded 15 studies eligible for inclusion with 10 studies used for meta-analysis. This study found that there was a statistically significant difference in postoperative functional scores, range of motion (ROM), complications, and revision rates, with adverse outcomes occurring more commonly in patients with MCL injury. Conclusions This meta-analysis highlights the complexity of MCL injury during TKA and shows the impact on postoperative function, joint mobility, complications, and revision. Surgeons need to prevent and put more emphasis on MCL injury during TKA.

Fine structure of sunflower crown gall tissue

1970 ◽  
Vol 48 (8) ◽  
pp. 1455-1458 ◽  
Author(s):  
M. S. Manocha
Keyword(s):  
Crown Gall ◽  
Electron Microscopic Examination ◽  
Mesophyll Cell ◽  
Ultrastructural Changes ◽  
Bacterial Inoculation ◽  
Electron Microscopic ◽  
Mesophyll Cells ◽  
Thin Sections ◽  
Gall Tissue ◽  
Crown Gall Tissue

Electron microscopic examination of thin sections from sunflower crown gall tissue, induced by Agrobacterium tumefaciens, revealed certain details about its intracellular organization not previously reported. Tumor tissue showed a marked increase in the number of ribosomes, endoplasmic reticulum, and Golgi dictyosomes, over that of normal mesophyll cells. Mitochondria and chloroplasts did not show any detectable change. Crystalline bodies, consisting of a lattice surrounded by a unit membrane, were frequently observed in tumorous cells. The nucleoli of tumor cells contained vacuoles and were clearly differentiated into two zones, pars amorpha and nucleolonema. The possible significance of these ultrastructural changes has been discussed. Small vesicle-like bodies were observed in the nuclei of mesophyll cells 4 days after bacterial inoculation. Whether or not these vesicle-like bodies are responsible for the transformation of a normal mesophyll cell to a fully autonomous tumor cell is not known, but the possibility is an intriguing one.

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