Disruption of the proximal tibiofibular joint in the setting of multi-ligament knee injury.

Instability of the proximal tibiofibular joint is a relatively uncommon condition when in isolation; however, instability of the proximal tibiofibular joint is far more frequent in those presenting with a severe multi-ligament injury of the knee. If this joint is left unstable, repair of a co-existent injury of the posterolateral corner may fail, regardless of the proficiency of the technique. We present two patients with disruption of the proximal tibiofibular joint, including the MRI appearance, who initially presented to our hospital for management of significant polytrauma, as well as multi-ligament injury of the ipsilateral knee.

The use of thermal shrinkage for scapholunate instability.

Scapholunate interosseous ligament (SLIL) instability is the most common form of carpal instability. There is a lack of consensus among hand surgeons as to the appropriate treatment of various stages. This article reviews the background and results of thermal treatment of predynamic instability of the SLIL. Case examples are discussed as well as a series of patients treated with our protocol for this injury.

Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament.

OBJECTIVE: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome (CTS). BACKGROUND DATA: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT. MATERIALS AND METHODS: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm(2), at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up. RESULTS: Before treatment, there were no significant differences between the two groups for all assessments (p > 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p < 0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p > 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p < 0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2-wk follow-up. CONCLUSIONS: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.

Anatomical ligament reconstruction for trapeziometacarpal osteroarthritis.

Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Previous studies have indicated that joint instability from ligament insufficiency is the pathological mechanism underlying the disease. Therefore, various ligament reconstruction techniques have been developed to improve both the stability and kinematics of the joint. However, none of them involve anatomical ligament reconstruction and are almost always used in combination with trapeziectomy. In order to restore joint stability as well as to save the trapezium, we developed a new technique for reconstructing the anterior oblique ligament of the TMC joint anatomically using the distal part of the transverse carpal ligament. In this article, we describe the technique in detail and report the clinical outcome of 9 patients. 6 of whom were treated by ligament reconstruction alone while the other 3 underwnet ligament reconstruction combined with surface joint replacement. All 9 patients maintained good stability and ROM of the joint at their final follow-up (3 years or longer). Although that follow-up period is admittedly short, we think anatomical ligament reconstruction with or without surface joint replacement is a rational alternative to ligament reconstruction tendon interposition (LITI) prodecures.

Radiofrequency energy effects on the mechanical properties of tendon and capsule.

PURPOSE: To compare the mechanical properties of tendon and capsule after radiofrequency (RF) energy treatment. TYPE OF STUDY: An in vitro study. METHODS: RF energy was applied to ovine extensor tendon and human cadaveric glenohumeral capsule varying in the treatment wattage and time (5, 10, or 20 W for 10 or 30 seconds). The associated tissue length changes and dynamic and failure properties of the tissues were investigated using a materials testing machine. RESULTS: Length changes in the 2 tissues were comparable across the range of treatment settings used with both increases in the treatment wattage and time increasing the amount of tissue shrinkage observed. However, tendon showed greater changes in its mechanical properties after RF treatment, with significant decreases in the failure properties of the tissue as well as the dynamic and static stiffness. CONCLUSIONS: RF treatment shrinks collagenous tissues in a progressive manner correlated to the treatment wattage. However, it has different effects on the mechanical properties of tendon and capsule with the properties of tendinous tissues dramatically reduced. CLINICAL RELEVANCE: RF treatment has been shown to effect the mechanical properties of different collagenous tissues differently; therefore, it must be used specifically and with caution around areas of mixed tissue origin.

Thermal profile of radiofrequency energy in the inferior glenohumeral ligament.

PURPOSE: Currently, two different methods of applying radiofrequency (RF) energy (monopolar and bipolar) are available to the surgeon for thermal shortening of the shoulder capsule. The objective of this study was to investigate the temperature changes and the thermal conduction across the human inferior glenohumeral ligament (IGHL) during radiofrequency energy application. METHODS: Thermistors were secured onto both the intra-articular and extra-articular surfaces of human IGHL. Monopolar RF energy and bipolar RF energy were delivered to the intra-articular surface at the manufacturer's recommended settings. Pre-treatment and post-treatment ligament lengths, widths, heating times, and temperatures were measured and compared. RESULTS: For the monopolar devices, temperature spikes to 89 degrees C were recorded for the set temperature of 67 degrees C, averaging 77 degrees C +/- 10 degrees C. Temperatures across the ligament averaged 48 degrees C +/- 3 degrees C. For both devices, the IGHL became thicker with higher RF settings. Recorded temperatures decreased as distance increased from the point of application. Maximum temperatures occurred at least 6 to 7 seconds after cessation of energy application. CONCLUSIONS: The bipolar and monopolar devices had similar conduction times across the ligament, suggesting that this occurs by simple diffusion of heat. Bipolar and monopolar devices were equally efficacious for capsular shrinkage if the extent of the shortening is tightly defined. CLINICAL RELEVANCE: The thermal probe should not rest in one position for an extended period of time during RF energy application because, as our study showed, the monitoring of temperature or the visualization of tissue change is not efficacious for determining the end point of thermal shrinkage of the shoulder capsule.

Electromagnetic stimulation of ligament healing in rabbits.

To evaluate the effect of a specific noninvasive method of electrical stimulation on ligament healing in rabbits, a solid core electromagnet energized by a square wave unidirectional current was applied to injured and repaired medial collateral ligaments seven hours per day, five days per week for intervals of up to six weeks. Healing was evaluated by gross, histologic, biochemical, and biomechanical parameters. Stimulation was shown to increase histologic maturity relatively, restore stiffness and failure strength earlier, and return collagen content toward normal unoperated values sooner in these healing ligaments. It is uncertain whether the end point of healing is affected by this technique, but at six weeks both histologic and biochemical evidence of acceleration remains. Further investigation into the effect of electromagnetic stimulation by this and other fields on non-osseous tissues and their components is indicated.