MyMedR

Fulltext Salvage of elbow function in chronic complex elbow fracture dislocation with total elbow arthroplasty: a case report

Muthu R, Foead AI, Ali A, Devadasan B

Med J Malaysia, 2013 Aug;68(4):353-5.

PMID: 24145266 MyJurnal

In patients with an elbow fracture dislocation the incidence of radial head fracture is 36%, where as coronoid process fractures occur in 13%, and olecranon fractures in 4% of patients. Combination of all these fractures with a 'terrible triad' is rarely reported in the literature. We describe a 40 year old lady involved in a polytrauma who had head injury, pnuemothorax and an open fracture dislocation of the left elbow. The Injury Severity Score initially on admission was 44. She presented with chronic elbow instability with pain 1 year later. A semi constrained total elbow arthroplasty (TEA) with a Coonrad-Morrey prosthesis was performed in this complex injury involving fractures of the coronoid, olecranon, proximal third of the ulna and radial head malunion with heterotrophic ossification around the elbow joint. Although the survivorship of total elbow replacements has improved, it is still a procedure reserved to older patients with low functional demand. At 1-year follow-up, the patient had full range in flexion and extension. The Mayo Elbow Performance Score (MEPS) was 100. TEA is a procedure which gains function and stability in a terrible triad elbow.

Matched MeSH terms: Collateral Ligaments*

Stylohyoid ossification with a case report

Pallie W, Hussein MA

Med J Malaya, 1970 Sep;25(1):61-4.

PMID: 4249499

Matched MeSH terms: Ligaments*

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

Lee JI, Jaffar MSA, Choi HG, Kim TW, Lee YS

J Knee Surg, 2022 Feb;35(3):299-307.

PMID: 32659817 DOI: 10.1055/s-0040-1713898

The purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to -0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18-74) preoperatively to 94.71 (range: 86-100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10-81) preoperatively to 94.14 (range: 86-100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT-TG distance, or valgus alignment. This is a Level 4, case series study.

Matched MeSH terms: Ligaments, Articular/surgery

Description of WALANT technique in open bone and ligament wrist surgery

Brutus JP, Chang MC, Ahmad AA, Apard T

Hand Surg Rehabil, 2024 Feb;43(1):101610.

PMID: 38393765 DOI: 10.1016/j.hansur.2023.10.004

The gold-standard for bone, ligament and joint surgery in the wrist is locoregional anesthesia in most countries. Wide-Awake Local Anesthesia No Tourniquet (WALANT) is commonly used for simple soft-tissue hand surgery procedures such as carpal tunnel or trigger finger release, and can now also be safely used in procedures such as proximal row carpectomy, scapholunate ligament repair or partial wrist fusion, to name but a few. This article describes the use of WALANT for complex surgery in the wrist. WALANT surgery offers many known benefits, such as enhanced patient safety and comfort, simplified perioperative process and avoidance of anesthesia-related risks, and also allows the surgeon to perform intraoperative testing of the repaired structures. Thus, the surgeon can tailor the rehabilitation program and shorten recovery time. We describe detailed guidelines for performing WALANT procedures safely and effectively, making it a favorable option for complex surgeries in the wrist.

Matched MeSH terms: Ligaments, Articular/surgery

Fulltext Difficult intubation stylohyoid ligament calcification

Aris AM, Elegbe EO, Krishna R

Singapore Med J, 1992 Apr;33(2):204-5.

PMID: 1621133

Intubation was difficult and traumatic in a 40-year-old patient presented for emergency oesophagoscopy because the diagnosis of stylohyoid ligament calcification was not suspected. High probability of stylohyoid ligament calcification should be suspected when there is difficulty in lifting the epiglottis and fibre-optic laryngoscopy is suggested as the best way to tackle this problem to prevent trauma and possible risk of regurgitation and aspiration especially in emergency situation.

Matched MeSH terms: Ligaments/pathology*; Ligaments/radiography

Cavernous hemangioma arising from the gastro-splenic ligament: a case report

Chin KF, Khair G, Babu PS, Morgan DR

World J Gastroenterol, 2009 Aug 14;15(30):3831-3.

PMID: 19673030

We present a rare case of a 45-year-old woman who presented with epigastric pain associated with early satiety and weight loss. Imaging revealed a large intra-abdominal mass in the epigastrium. Despite intensive investigations, including ultrasound scanning, computed tomography, upper gastrointestinal endoscopy, and percutaneous biopsy, a diagnosis could not be obtained. A histological diagnosis of cavernous hemangioma arising from the gastro-splenic ligament was confirmed after laparoscopic excision and histological examination of the intra-abdominal epigastric mass.

Matched MeSH terms: Ligaments/pathology*

Fulltext Acromioclavicular Reconstruction using Autogenous Semitendinosus Tendon Graft and the Importance of Postoperative Rehabilitation: A Case Report

Ho JP, Ahmad Faizal A, Sivapathasundaram N

Malays Orthop J, 2013 Nov;7(3):30-2.

PMID: 25674306 MyJurnal DOI: 10.5704/MOJ.1311.012

We present a case of chronic acromioclavicular joint dislocation (Rockwood type 5) in which the choice of acromioclavicular reconstruction using autogenous semitendinosus tendon graft was made due to its superiority in anatomical reconstruction of the coracoclavicular ligaments, and the impact of postoperative rehabilitation on the recovery of this patient. We also discuss the rationale behind this.

Matched MeSH terms: Ligaments, Articular

Long-term outcome of native tissue reconstructive vaginal surgery for advanced pelvic organ prolapse at 86 months: Hysterectomy versus hysteropexy

Lo TS, Pue LB, Hung TH, Wu PY, Tan YL

J Obstet Gynaecol Res, 2015 Jul;41(7):1099-107.

PMID: 25808989 DOI: 10.1111/jog.12678

To evaluate and compare the long-term outcome of sacrospinous ligament fixation (SSF) in combination with various other compartment defect native tissue repairs with hysterectomy or hysteropexy.

Matched MeSH terms: Ligaments

Graft and Button Modification of Technique of Coracoclavicular Joint Reconstruction in Treatment of Chronic Type V Acromioclavicular Joint Dislocation: A Case Report

Leong YC, Muhammad-Suhairi J

Malays Orthop J, 2019 Jul;13(2):45-48.

PMID: 31467652 DOI: 10.5704/MOJ.1907.009

Treatment of chronic Rockwood's type V Acromioclavicular (AC) joint dislocation remains controversial. We describe a surgical technique to reduce and maintain AC joint using a combination of gracilis autograft with GraftMax™ button (Conmed Inc, Utica, NY). Graft was prepared using running whip stitch technique with No. 5 Hi-Fi high strength suture (ConMed Linvatec, Largo, FL). Our technique reduces intraoperative clavicular and coracoid tunnel fracture and restores anatomical coracoclavicular ligament. At sixth week and third month postoperatively, the patient demonstrated good clinical and radiographic outcome.

Matched MeSH terms: Ligaments, Articular

Irreducible Dorsal Distal Interphalangeal Joint Dislocation of Finger: A Case Report and Perspectives on Management

Sem SH, Omar MF, Muhammad Nawawi RF

Cureus, 2019 May 02;11(5):e4588.

PMID: 31309013 DOI: 10.7759/cureus.4588

Irreducible closed dorsal dislocation of distal interphalangeal (DIP) joint of the finger is a rare injury. The causes of irreducibility of the DIP joint are volar plate interposition, entrapment of flexor digitorum profundus tendon behind the head of middle phalanx, and buttonholing of the middle phalanx head through the volar plate or flexor tendon. Open reduction with a volar approach is recommended with the advantages of better wound healing, ease of releasing entrapped structures, and possibilities of a volar plate, collateral ligaments, and/or flexor tendon repair. We report a case of irreducible dorsal dislocation of left ring finger DIP joint secondary to volar plate interposition treated successfully with open reduction.

Matched MeSH terms: Collateral Ligaments

Fulltext The Development of Eagle's Syndrome after Neck Trauma

Rahman SA, Singh J, Muthusamy R, Alam MK

Contemp Clin Dent, 2018 6 8;9(2):319-322.

PMID: 29875581 DOI: 10.4103/ccd.ccd_870_17

Eagle's syndrome (ES) refers to a group of various types and patterns of pain which spans over the head-and-neck region owing to an elongated styloid process or calcified stylohyoid ligament. These symptoms are often confused with those attributed to a wide variety of facial neuralgias. The diagnosis of ES is usually made through clinical exclusion which is then confirmed radiographically. Patients with ES are initially managed with nonsurgical therapy, but surgical resection seems to be the treatment of choice. The styloid process shortening can be achieved through an intraoral or extraoral approach. This clinical case report describes such a case of ES after sustaining neck trauma.

Matched MeSH terms: Ligaments

Long Term Follow-up of an Open Bicondylar Hoffa Fracture with a Disrupted Extensor Mechanism: A Case Report

Joseph CM, Rama-Prasad YS, Boopalan P, Jepegnanam TS

Malays Orthop J, 2019 Jul;13(2):59-62.

PMID: 31467656 DOI: 10.5704/MOJ.1907.013

This is the first report of a long-term follow-up of an open bicondylar Hoffa with patella fracture. It is interesting to note the radiological changes of osteoarthritis 15 years after global intra-articular injury of the distal femur. The good clinical outcome is possibly due to the integrity of the knee ligaments and reconstruction of the extensor mechanism in addition to stable anatomical reduction and fixation.

Matched MeSH terms: Ligaments

Fulltext First and Second Metatarsophalangeal Joint Open Dislocations: A Case Report

Sharma A, Dosajh R, Bedi GS, Gupta K, Jain A

Malays Orthop J, 2017 Mar;11(1):71-73.

PMID: 28435580 DOI: 10.5704/MOJ.1703.010

Dislocation of multiple metatarsophalangeal joint is an uncommon injury. The mechanism of injury is a high energy force distal to proximal with foot in hyperextension at the metatarsophalangeal (MTP) joint. The acute hyperextension of the toe at the moment of injury causes avulsion of the plantar part of the capsule from the junction of head and neck of the metatarsal. If the collateral ligaments remain intact, they maintain the locked fibrocartilaginous plate over the dorsum of the head of the metatarsal, making closed reduction impossible. We report a case of simultaneous 1st and 2nd MTP joint open dislocation. In the present case, we chose the plantar approach utilizing the already present plantar wound. At 18 months post-operative follow-up, there was no instance of redislocations or signs of avascular necrosis of head of metatarsal.

Matched MeSH terms: Collateral Ligaments

Fulltext Current Progress in Tendon and Ligament Tissue Engineering

Lim WL, Liau LL, Ng MH, Chowdhury SR, Law JX

Tissue Eng Regen Med, 2019 Dec;16(6):549-571.

PMID: 31824819 DOI: 10.1007/s13770-019-00196-w

BACKGROUND: Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. Damaged tendon and ligament can severely affect the normal body movement and might lead to many complications if not treated promptly and adequately. Current conventional treatment through surgical repair and tissue graft are ineffective with a high rate of recurrence.

METHODS: In this review, we first discussed the anatomy, physiology and pathophysiology of tendon and ligament injuries and its current treatment. Secondly, we explored the current role of tendon and ligament tissue engineering, describing its recent advances. After that, we also described stem cell and cell secreted product approaches in tendon and ligament injuries. Lastly, we examined the role of the bioreactor and mechanical loading in in vitro maturation of engineered tendon and ligament.

RESULTS: Tissue engineering offers various alternative ways of treatment from biological tissue constructs to stem cell therapy and cell secreted products. Bioreactor with mechanical stimulation is instrumental in preparing mature engineered tendon and ligament substitutes in vitro.

CONCLUSIONS: Tissue engineering showed great promise in replacing the damaged tendon and ligament. However, more study is needed to develop ideal engineered tendon and ligament.

Matched MeSH terms: Ligaments/anatomy & histology; Ligaments/pathology; Ligaments/physiology*

Tissue engineering techniques in tendon and ligament replacement

Goh JC, Ouyang HW, Toh SL, Lee EH

Med J Malaysia, 2004 May;59 Suppl B:47-8.

PMID: 15468812

Matched MeSH terms: Ligaments/cytology*; Ligaments/surgery

Fulltext Biochemical evaluation of the supporting structure of pelvic organs in selected numbers of premenopausal and postmenopausal Malaysian women

Aznal SS, Meng FG, Nalliah S, Tay A, Chinniah K, Jamli MF

Indian J Pathol Microbiol, 2012 Oct-Dec;55(4):450-5.

PMID: 23455778 DOI: 10.4103/0377-4929.107778

Pelvic organ prolapse (POP) is associated with menopause and changes in the proteins of the pelvic supporting system, but there is scant data on the precise alterations in Malaysian women.

Matched MeSH terms: Ligaments/pathology*; Ligaments/chemistry

Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery

Das S, Suri R, Kapur V

Sao Paulo Med J, 2007 Nov 01;125(6):351-3.

PMID: 18317606

CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP), which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP) by a ligament known as the caroticoclinoid ligament (CCL), which may be ossified, forming the caroticoclinoid foramen (CCF). Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons.

CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

Matched MeSH terms: Ligaments/abnormalities; Ligaments/anatomy & histology*

Fulltext Transoral surgical resection of bilateral styloid processes elongation (eagle's syndrome)

Baharudin A, Rohaida I, Khairudin A

Acta Inform Med, 2012 Jun;20(2):133-5.

PMID: 23322967 DOI: 10.5455/aim.2012.20.133-135

Eagle's syndrome represents a symptomatic styloid process elongation or calcification of stylohyoid or stylomandibular ligament. The symptoms include the throat pain radiating to ipsilateral ear or foreign body sensation in the pharynx causing odynophagia and dysphagia. It is commonly unilateral and bilateral cases are rare. We report a case of bilateral elongation of styloid processes treated surgically by transoral approach.

Matched MeSH terms: Ligaments

Osteochondritis Dissecans of the Lateral Femoral Trochlea Healing after Isolated Medial Patellofemoral Ligament Reconstruction: A Case Report

Barbosa NC, Carvalho L, Fernandes LR, Castro D, Lino T

Malays Orthop J, 2019 Jul;13(2):35-37.

PMID: 31467649 DOI: 10.5704/MOJ.1907.006

We report on a 12 years old female patient who had been diagnosed with patellofemoral instability - recurrent dislocation and anterior knee pain. Radiologic evaluation further revealed osteochondritis dissecans (OCD) of the lateral femoral trochlea. She underwent surgical procedure with isolated medial patellofemoral ligament reconstruction, no surgical procedure was done to the OCD lesion. Postoperatively, there was clinical improvement of patellofemoral instability, with radiological evidence of healing of the OCD lesion. Isolated realignment procedures such as medial patellofemoral ligament reconstruction may be associated with spontaneous healing of osteochondritis dissecans of the lateral femoral trochlea.

Matched MeSH terms: Ligaments, Articular

Efficacy and Safety of Functional Medial Ligament Balancing With Stepwise Multiple Needle Puncturing in Varus Total Knee Arthroplasty

Siong FT, Kim TW, Kim SC, Lee ES, Jaffar MSA, Lee YS

J Arthroplasty, 2020 02;35(2):380-387.

PMID: 31587980 DOI: 10.1016/j.arth.2019.09.005

BACKGROUND: The aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety.

METHODS: A total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups.

RESULTS: Fifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups.

CONCLUSION: Functional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability.

LEVEL OF EVIDENCE: Level II, Prospective cohort study.

Matched MeSH terms: Ligaments

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