DOCSLIB.ORG

A Guide to Ultrasound of the Shoulder, Part 3: Interventional and Procedural Uses

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
A Guide to Ultrasound of the Shoulder, Part 3: Interventional and Procedural Uses Orthopedic Technologies & Techniques A Guide to Ultrasound of the Shoulder, Part 3: Interventional and Procedural Uses Alan M. Hirahara, MD, FRCS(C), and Alberto J. Panero, DO for injections.3-12 Within the limitation of using a Abstract needle, second-generation procedures—hydrodis- Ultrasound is an extremely useful di- section of peripherally entrapped nerves, capsular agnostic tool for physicians, but recent distention, mechanical disruption of neovascu- advances have found that ultrasound’s larization, and needle fenestration or barbotage greatest utility is in interventional and in chronic tendinopathy—try to simulate surgical procedural uses. Numerous studies have objectives while minimizing tissue burden and demonstrated a significant improvement other complications of surgery.3 More advanced in outcome and patient satisfaction when procedures include needle fenestration/release of using ultrasound guidance for injections. the carpal ligament in carpal tunnel syndrome and Newer techniques are emerging to use A1 pulley needle release in the setting of trigger 3 ultrasound as an aid to surgery and finger. Innovative third-generation procedures in- interventional procedures. This allows volve the use of surgical tools such as hook blades the physician to use smaller incisions under ultrasound guidance to perform surgical and less invasive methods, which are procedures. Surgeons are now improving already also easier to use for the practitioner and established percutaneous, arthroscopic, and open 3 more cost-effective. surgical procedures with ultrasound assistance. Aside from better guidance, reducing cost and improving surgeon comfort may be additional benefits of ultrasound assisted surgery. ltrasound has classically been marketed and used as a diagnostic tool. Radiologists, Image-Guided Treatment Options U emergency physicians, and sports physi- Prior to image guidance, palpation of surface anat- cians used ultrasound units to rapidly and appro- omy helped physicians determine the anatomic priately diagnose numerous injuries and disorders, placement of injections, incisions, or portals. Joints in a timely and cost effective manner. Part 11 and and bursas that do not have any inflammation Part 22 of this series showed how to use ultra- or fluid can sometimes be difficult to identify or sound in the shoulder for diagnosis and how to locate by palpation alone. Palpation-guided joint code and get reimbursed for its use. Ultrasound injections often miss their target and cause signif- can also be used to help guide procedures and icant pain when the therapeutic agent is injected interventions performed to treat patients. Current- into a muscle, tendon, ligament, fat, or other ly, more physicians are beginning to recognize the tissue. Ultrasound-guided injections have proven to utility of this modality as an aid to interventional be more accurate and have better patient satisfac- procedures. tion when compared to blind injections.3-12 First-generation procedures use ultrasound to X-ray fluoroscopy has been the primary option improve accuracy of joint, bursal, tendon, and for surgeons to assist in surgery. This is a natural muscular injections.3 Recent studies have shown modality for orthopedic surgeons; their primary a significant improvement in accuracy, outcomes, use is for bone to help with fracture reduction and patient satisfaction using ultrasound guidance and fixation as the bone, instrumentation, and Authors’ Disclosure Statement: Dr. Hirahara reports that he receives support from Arthrex as a consultant, royalties, and research support. Dr. Panero reports no actual or potential conflict of interest in relation to this article. 440 The American Journal of Orthopedics ® November/December 2016 www.amjorthopedics.com fixation methods are usually radio-opaque. With and identification of pathology to treat these dis- the advancement in technology, many orthopedic ease processes. However, this is no different from surgeons are regularly using radiolucent fixation the use of arthroscopy or fluoroscopy to treat devices and working with soft tissue as opposed patients. Training is required, as well as an un- to bone. Fixation of tendons, ligaments, and mus- derstanding of the ultrasound machine, anatomy, cles would be done using a large incision, palpa- and sono-anatomy—identification of anatomy and tion of the anatomy, then fixation or repair. Many pathology as shown by the ultrasound machine.2 surgeons began looking for ways to minimize the In ultrasound, the long axis refers to looking incisions. Turning to fluoroscopy, a traditional and at a structure along its length, as in longitudinal. well-used modality, was a natural progression. The short axis refers to evaluating a structure in Guides and methods were developed to isolate cross-section, transverse, or along its shortest insertions and drill placements. However, fluoros- length. “In plane” refers to performing a procedure copy is limited by its difficulty in changing planes where the needle or object being used enters the and the large equipment required. Also, it is limited ultrasound field along the plane of the transducer, in its ability to image soft tissue. allowing visualization of the majority of the needle Computed tomography (CT) scans and magnetic as it crosses tissue planes. “Out of plane” has the resonance imaging (MRI) are far better at imaging needle entering perpendicular to the plane of the soft tissue but cannot be taken for use into the transducer, showing the needle on the monitor as office or surgical suite. These modalities are also a bright, hyperechoic dot. Some studies have sug- far more expensive and take up significant space. gested that novice ultrasonographers should start CT scans have significant radiation exposure, and in a long axis view and use the in plane technique MRIs prohibit the use of metal objects around when injecting, as doing so may decrease time them. Overall, ultrasound has far more advantages to identify the target and improve mean imaging over the other modalities as an adjunct for proce- quality during needle advancement.13 dures (Table). Anisotropy is the property of being directionally dependent. The ultrasound beam needs to be Ultrasound Procedural Basics perpendicular to the structure being imaged to give Appropriate use of ultrasound still remains highly the optimal image. When the beam hits a longitu- technician-dependent. Unlike other imaging mo- dinal structure like a needle at an angle <90°, the dalities, ultrasound requires a higher skill level by linear structure might reflect most of the beam the physician to implement the use of ultrasound away from the transducer. So when using a needle Table. Procedure Options Comparison Ultrasound X-ray CT Scan MRI Blind (None) Size of unit Small Medium Large Large N/A Portability Yes Yes No No Yes Mobility Very Medium None None Yes Cost Low Medium High High N/A Radiation No Yes Yes No No Metal limitations No No No Yes No Accuracy High Medium High High Low Multiplanar Yes Yes Yes Yes No User-dependent Yes Yes No No Yes Soft tissue imaging Excellent Poor Medium Excellent N/A Bony imaging Medium Excellent Excellent Medium N/A Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging; N/A, not applicable. www.amjorthopedics.com November/December 2016 The American Journal of Orthopedics ® 441 A Guide to Ultrasound of the Shoulder, Part 3: Interventional and Procedural Uses to localize or inject a specific area, maintaining the was 65% vs 70% for the subacromial space (P > probe as close to perpendicular as possible with .05); 86.7% vs 26.7% for the biceps tendon sheath the needle will give a better image. New technol- (P < .05); and 92.5% vs 72.5% for the glenohumer- ogy exists to better visualize needles even at high al joint (P = .025).18 acuity angles by using a multi-beam processing With cortisone, injecting into muscle, ligament, algorithm, which can significantly aid the physician or tendons could potentially harm the tissue or without the need for specialized needles. cause worsening of the disease process.19-20 With Despite better technology, advance planning the advent of orthobiologics, injecting into these is key to a successful procedure. Positioning structures is now desirable, instead of a potential the patient and ultrasound machine in a man- complication.19-20 Ultrasound has become even ner that is comfortable and makes the desired more important to the accurate delivery of these target accessible while being able to visualize the therapies to the disease locations. Multiple studies ultrasound monitor comes first. Identifying the using leukocyte-poor PRP for osteoarthritis show target, mapping the needle trajectory using depth significant differences in pain scores.21-23 Peer- markings, and scanning for nerves, vessels, and booms and colleagues24,25 also showed that PRP other structures that may be damaged along the reduced pain and increased function compared needle path comes next. Using the in plane ultra- to cortisone injections for lateral epicondylitis in sound technique with color Doppler and the nerve 1- and 2-year double-blind randomized controlled contrast setting can ensure that the physician trials. Centeno and colleagues26 performed a pro- has placed the therapeutic agent to the proper spective, multi-site registry study on 102 patients location while avoiding any nerves, arteries, or with symptomatic osteoarthritis and/or rotator veins. Marking the borders of the ultrasound probe cuff tears that were injected with bone marrow
Load more

Recommended publications
  • Anatomic Anterolateral Ligament Reconstruction of the Knee Leads to Overconstraint at Any Fixation Angle
    AJSM PreView, published on July 12, 2016 as doi:10.1177/0363546516652607 Winner of the 2016 Excellence In Research Award Anatomic Anterolateral Ligament Reconstruction of the Knee Leads to Overconstraint at Any Fixation Angle Jason M. Schon,* BS, Gilbert Moatshe,*yz MD, Alex W. Brady,* MSc, Raphael Serra Cruz,*§ MD, Jorge Chahla,* MD, Grant J. Dornan,* MSc, || # Travis Lee Turnbull,* PhD, Lars Engebretsen,y MD, PhD, and Robert F. LaPrade,*{ MD, PhD Investigation performed at the Department of Biomedical Engineering of the Steadman Philippon Research Institute, Vail, Colorado, USA Background: Anterior cruciate ligament (ACL) tears are one of the most common injuries among athletes. However, the ability to fully restore rotational stability with ACL reconstruction (ACLR) remains a challenge, as evidenced by the persistence of rotational instability in up to 25% of patients after surgery. Advocacy for reconstruction of the anterolateral ligament (ALL) is rapidly increasing because some biomechanical studies have reported that the ALL is a significant contributor to internal rotational stability of the knee. Hypothesis/Purpose: The purpose of this study was to assess the effect of ALL reconstruction (ALLR) graft fixation angle on knee joint kinematics in the clinically relevant setting of a concomitant ACLR and to determine the optimal ALLR graft fixation angle. It was hypothesized that all fixation angles would significantly reduce rotational laxity compared with the sectioned ALL state. Study Design: Controlled laboratory study. Methods: Ten nonpaired fresh-frozen human cadaveric knees underwent a full kinematic assessment in each of the following states: (1) intact; (2) anatomic single-bundle (SB) ACLR with intact ALL; (3) anatomic SB ACLR with sectioned ALL; (4) anatomic SB ACLR with 7 anatomic ALLR states using graft fixation angles of 0°, 15°, 30°, 45°, 60°, 75°, and 90°; and (5) sectioned ACL and ALL.
    [Show full text]
  • The Anterolateral Ligament of the Knee: What the Radiologist Needs to Know
    26 The Anterolateral Ligament of the Knee: What the Radiologist Needs to Know Pieter Van Dyck, MD, PhD1 ElineDeSmet,MD1 Valérie Lambrecht, MD2 Christiaan H. W. Heusdens, MD3 Francis Van Glabbeek, MD, PhD3 Filip M. Vanhoenacker, MD, PhD1,2,4 Jan L. Gielen, MD, PhD1 Paul M. Parizel, MD, PhD1 1 Department of Radiology, Antwerp University Hospital and Address for correspondence Pieter Van Dyck, MD, PhD, Department University of Antwerp, Edegem, Belgium of Radiology, Antwerp University Hospital and University of Antwerp 2 Department of Radiology, Ghent University Hospital, Ghent, Belgium Wilrijkstaat 10, 2650 Edegem, Belgium 3 Department of Orthopaedics, Antwerp University Hospital and (e-mail: [email protected]). University of Antwerp, Edegem, Belgium 4 Department of Radiology, AZ Sint-Maarten, Duffel, Belgium Semin Musculoskelet Radiol 2016;20:26–32. Abstract The anterolateral ligament (ALL) was recently identified as a distinct component of the anterolateral capsule of the human knee joint with consistent origin and insertion sites. Biomechanical studies revealed that the current association between the pivot shift and Keywords an injured anterior cruciate ligament (ACL) should be loosened and that the rotational ► anterolateral component of the pivot shift is significantly affected by the ALL. This may change the ligament clinical approach toward ACL-injured patients presenting with anterolateral rotatory ► anterior cruciate instability (ALRI), the most common instability pattern after ACL rupture. Radiologists ligament rupture should be aware of the importance of the ALL to ACL injuries. They should not overlook ► anterolateral rotatory pathology of the anterolateral knee structures, including the ALL, when reviewing MR instability images of the ACL-deficient knee.
    [Show full text]
  • Anterolateral Ligament Expert Group Consensus Paper on the Management of Internal Rotation and Instability of the Anterior Cruciate Ligament - Deficient Knee
    J Orthopaed Traumatol DOI 10.1007/s10195-017-0449-8 EMERGING TOPIC (REVIEW ARTICLE) Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee 1 2 1 Bertrand Sonnery-Cottet • Matthew Daggett • Jean-Marie Fayard • 3 4 5 3 Andrea Ferretti • Camilo Partezani Helito • Martin Lind • Edoardo Monaco • 6 1 7 Vitor Barion Castro de Pa´dua • Mathieu Thaunat • Adrian Wilson • 8 9 10 Stefano Zaffagnini • Jacco Zijl • Steven Claes Ó The Author(s) 2017. This article is published with open access at Springerlink.com Abstract Purpose of this paper is to provide an overview exchange of experiences during the ALL Experts Meeting of the latest research on the anterolateral ligament (ALL) (November 2015, Lyon, France). The ALL is found deep to and present the consensus of the ALL Expert Group on the the iliotibial band. The femoral origin is just posterior and anatomy, radiographic landmarks, biomechanics, clinical proximal to the lateral epicondyle; the tibial attachment is and radiographic diagnosis, lesion classification, surgical 21.6 mm posterior to Gerdy’s tubercle and 4–10 mm technique and clinical outcomes. A consensus on contro- below the tibial joint line. On a lateral radiographic view versial subjects surrounding the ALL and anterolateral the femoral origin is located in the postero-inferior quad- knee instability has been established based on the opinion rant and the tibial attachment is close to the centre of the of experts, the latest publications
    [Show full text]
  • MRI Evalua on of the Normal and Injured Anterolateral Ligament
    MRI evaluaon of the normal and injured anterolateral ligament Camilo Partezani Helito, MD Hospital Sírio Libanês Knee Surgery Division, Department of OrthopediC Surgery, University of São Paulo, São Paulo, Brazil • No finanCial disClosures reported 4 Anatomy of the ALL, S. Claes et al. the meniscus, the lateral inferior geniculate artery (LIGA) and vein were invariably found, situated in between the lateral meniscal rim and the ALL at the level of the joint line. More distally, the ALL inserted on the proximal tibia, thereby forming a thick capsular insertional fold. The tibial insertion of the ALL was always clearly situated posterior to Gerdy’s tubercle, with no connecting fibers to the ITB. Grossly, the tibial ALL insertion could be found in the mid- dle of the line connecting Gerdy’s tubercle and the tip of the fibular head. A graphic illustration of the ALL and its neighboring structures is provided in Figs 4 and 5. Quantitative ALL characterization The mean length of the ALL measured in neutral rotation and at 90º flexion was 41.5 6.7 and 38.5 6.1 mm in Æ Æ extension, illustrating some tensioning of the ligament dur- ing mid-flexion. This increase in length during flexion was Fig. 5 Anatomic drawing of the axial view of a right knee at a level significant (P < 0.001). During manipulation of the knee above the meniscal surface. The intra-capsular course of the ALL is joint, we observed a maximal tension of the ALL during appreciated, as well as the triple layered anatomy of the lateral knee.
    [Show full text]
  • The Anterolateral Ligament Is a Secondary Stabilizer in the Knee Joint
    811.BJBJR Follow us @BoneJointRes Freely available online OPEN ACCESS BJR KNEE The anterolateral ligament is a secondary stabilizer in the knee joint A VALidated COMPUtatiONAL MODEL OF THE BIOmechanicaL EFFects OF A DEFicient ANTERIOR crUciate LIGAMENT AND ANTEROLateraL LIGAMENT ON KNEE JOINT Kinematics K-T. Kang, Objectives Y-G. Koh, The aim of this study was to investigate the biomechanical effect of the anterolateral liga- K-M. Park, ment (ALL), anterior cruciate ligament (ACL), or both ALL and ACL on kinematics under C-H. Choi, dynamic loading conditions using dynamic simulation subject-specific knee models. M. Jung, Methods J. Shin, Five subject-specific musculoskeletal models were validated with computationally predicted S-H. Kim muscle activation, electromyography data, and previous experimental data to analyze effects of the ALL and ACL on knee kinematics under gait and squat loading conditions. Department of Orthopedic Surgery, Results Arthroscopy and Joint Anterior translation (AT) significantly increased with deficiency of the ACL, ALL, or both Research Institute, structures under gait cycle loading. Internal rotation (IR) significantly increased with defi- Yonsei University ciency of both the ACL and ALL under gait and squat loading conditions. However, the defi- ciency of ALL was not significant in the increase of AT, but it was significant in the increase College of Medicine, of IR under the squat loading condition. Seoul, South Korea Conclusion The results of this study confirm that the ALL is an important lateral knee structure for knee joint stability. The ALL is a secondary stabilizer relative to the ACL under simulated gait and squat loading conditions.
    [Show full text]
  • Anatomical Characteristics and Biomechanical Properties of The
    www.nature.com/scientificreports OPEN Anatomical Characteristics and Biomechanical Properties of the Oblique Popliteal Ligament Received: 18 August 2016 Xiang-Dong Wu1,2, Jin-Hui Yu2,3, Tao Zou2,4, Wei Wang2,5, Robert F. LaPrade6, Wei Huang1 & Accepted: 12 January 2017 Shan-Quan Sun1,7 Published: 16 February 2017 This anatomical study sought to investigate the morphological characteristics and biomechanical properties of the oblique popliteal ligament (OPL). Embalmed cadaveric knees were used for the study. The OPL and its surrounding structures were dissected; its morphology was carefully observed, analyzed and measured; its biomechanical properties were investigated. The origins and insertions of the OPL were relatively similar, but its overall shape was variable. The OPL had two origins: one originated from the posterior surface of the posteromedial tibia condyle, merged with fibers from the semimembranosus tendon, the other originated from the posteromedial part of the capsule. The two origins converged and coursed superolaterally, then attached to the fabella or to the tendon of the lateral head of the gastrocnemius and blended with the posterolateral joint capsule. The OPL was classified into Band-shaped, Y-shaped, Z-shaped, Trident-shaped, and Complex-shaped configurations. The mean length, width, and thickness of the OPL were 39.54, 22.59, and 1.44 mm, respectively. When an external rotation torque (18 N·m) was applied both before and after the OPL was sectioned, external rotation increased by 8.4° (P = 0.0043) on average. The OPL was found to have a significant role in preventing excessive external rotation and hyperextension of the knee.
    [Show full text]
  • At the Seashore 299 300 MRI of the Ankle: Trauma and Overuse Disclosure
    William J. Weadock, M.D. of the Presents The 18 th atRadiology the Seashore Friday, March 17, 2017 South Seas Island Resort Captiva Island, Florida Educational Symposia TABLE OF CONTENTS Friday, March 17, 2017 Ankle MRI: Trauma and Overuse (Corrie M. Yablon, M.D.) ............................................................................................ 299 Challenging Abdominal CT and MR Cases (William J. Weadock, M.D., FACR) ............................................................... 315 Knee MRI: A Pattern-Based Approach to Interpretation (Corrie M. Yablon, M.D.) ......................................................... 319 Complications of Aortic Endografts (William J. Weadock, M.D., FACR) ........................................................................... 339 SAVE THE DATE - 19 th Annual Radiology at the Seashore 299 300 MRI of the Ankle: Trauma and Overuse Disclosure Corrie M. Yablon, M.D. None Associate Professor Learning Objectives Introduction • Identify key anatomy on ankle MRI focusing on ligaments • MR protocol of the ankle • Discuss common injury patterns seen on ankle MRI • Ankle anatomy on MRI • Explain causes of ankle impingement • Case-based tutorial of pathology • Describe sites of nerve compression Protocol Planes Best to Evaluate… • Sag T1, STIR Axial Coronal • Ax T1, T2FS • Ankle tendons • Deltoid ligaments • Tibiofibular ligaments • Talar dome/ankle joint • Cor PDFS • Anterior, posterior talofibular • Plantar fascia • Optional coronal GRE for talar dome ligaments • Sinus tarsi cartilage
    [Show full text]
  • The Anterolateral Ligament of the Knee and the Lateral Meniscotibial
    Annals of Anatomy 226 (2019) 64–72 Contents lists available at ScienceDirect Annals of Anatomy jou rnal homepage: www.elsevier.com/locate/aanat Research Article The anterolateral ligament of the knee and the lateral meniscotibial ligament – Anatomical phantom versus constant structure within the anterolateral complex ∗ Stefanie Urban, Bettina Pretterklieber, Michael L. Pretterklieber Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Waehringer Strasse 13, Vienna 1090, Austria a r t i c l e i n f o a b s t r a c t Article history: Background: Concerning the ongoing controversy about the existence and nature of the anterolateral Received 18 March 2019 ligament (ALL) of the knee joint, we reinvestigated the formation of the anterolateral part of its fibrous Received in revised form 21 June 2019 capsule in anatomic specimens. Furthermore, we wanted to clarify if the lateral meniscus has established Accepted 23 June 2019 a constant anchoring to the lateral tibial condyle via a lateral meniscotibial ligament (lmtl). Methods: Forty paired embalmed lower extremities taken from 20 human body donors (15 men and five Keywords: women) underwent exact macroscopic dissection. For the detailed evaluation of the lmtl, additionally Knee joint fibrous capsule 12 specially dissected joint specimens were used. In two of these specimens, the lmtl underwent further Anterolateral ligament histological examination. Iliotibial tract Results: In all specimens, the anterolateral part of the knee joint fibrous capsule was established by the Biceps femoris aponeurosis Segond fracture iliotibial tract and the anterior arm of the aponeurosis of the biceps femoris muscle. According to their MR-imaging close connection and the fact that the anterolateral part of the fibrous capsule is exclusively assembled by these two aponeuroses, they do not leave any space for a distinct ALL connecting the lateral femoral epicondyle and the lateral tibial condyle.
    [Show full text]
  • The Relationship Between the Anterolateral Ligament and the Lateral Meniscus" (2016)
    Western University Scholarship@Western Masters of Clinical Anatomy Projects Anatomy and Cell Biology Department 2016 THE RELATIONSHIP BETWEEN THE ANTEROLATERAL IGL AMENT AND THE LATERAL MENISCUS Gillian Corbo Western University, [email protected] Follow this and additional works at: https://ir.lib.uwo.ca/mcap Part of the Anatomy Commons Citation of this paper: Corbo, Gillian, "THE RELATIONSHIP BETWEEN THE ANTEROLATERAL LIGAMENT AND THE LATERAL MENISCUS" (2016). Masters of Clinical Anatomy Projects. 13. https://ir.lib.uwo.ca/mcap/13 THE RELATIONSHIP BETWEEN THE ANTEROLATERAL LIGAMENT AND THE LATERAL MENISCUS Project format: Integrated Article by Gillian Corbo Graduate Program in Clinical Anatomy A project submitted in partial fulfillment of the requirements for the degree of Masters of Clinical Anatomy The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Gillian Corbo 2016 Abstract The anterolateral ligament (ALL) has recently been of interest due to the belief that it plays a role in controlling anterolateral rotational laxity. However, the relationship of the ALL and its attachment to the lateral meniscus has yet to be addressed. Firstly this investigation determined the effect that sectioning the ALL and lateral meniscus posterior root (LMPR) in an ACL deficient knee has on internal rotation. Secondly this research determined if differences exist in the mechanical properties of the supra- and infra- meniscal fibers of the ALL. The ALL was found to control internal rotation at higher degrees of knee flexion, while the LMPR acted closer to extension and the infra-meniscal fibers were shown to be stronger and stiffer than the supra-meniscal fibers.
    [Show full text]
  • Study of the Anterolateral Ligament of the Knee in Formalin-Embedded Cadavers Estudo Do Ligamento Anterolateral Do Joelho Em Cadáveres Formolizados
    DOI: http://dx.doi.org/10.1590/1413-785220172502162204 ORIGINAL ARTICLE STUDY OF THE ANTEROLATERAL LIGAMENT OF THE KNEE IN FORMALIN-EMBEDDED CADAVERS ESTUDO DO LIGAMENTO ANTEROLATERAL DO JOELHO EM CADÁVERES FORMOLIZADOS PALOMA BATISTA ALMEIDA FARDIN1, JULIANA HOTT DE FÚCIO LIZARDO2, JOSEMBERG DA SILVA BAPTISTA2 1. Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil. 2. Universidade Federal do Espírito Santo, Department of Morphology, Laboratory of Applied Morphology (LEMA), Vitória, ES, Brazil. ABSTRACT RESUMO Objective: To verify the incidence and characterize morpholog- Objetivo: Verificar a incidência e possivelmente caracterizar morfo- ically the anterolateral ligament of the knee (ALL) in cadaveric logicamente o ligamento anterolateral do joelho (LAL) em amostras samples of the collection of the Laboratory of Anatomy of the cadavéricas do acervo do Laboratório de Anatomia do Departamento Department of Morphology of the Universidade Federal do Espírito de Morfologia da Universidade Federal do Espírito Santo. Métodos: Santo. Methods: Dissections and cross sections were performed Foram realizadas dissecações e secções transversais para análise for mesoscopic analysis of the anterolateral region of 15 knees mesoscópica da região anterolateral de 15 joelhos conservados em preserved in 4% formalin solution in order to identify the ALL. solução de formalina a 4% a fim de identificar o LAL. Resultados: Após Results: After dissection of the skin and subcutaneous tissue a dissecação da pele e da tela subcutânea da região anterolateral dos of the knee anterolateral region, it was possible to identify the joelhos foi possível identificar o trato iliotibial (TIT), o ligamento patelar iliotibial tract (ITT), the patellar ligament and the femoral biceps e o tendão do músculo bíceps femoral.
    [Show full text]
  • Imaging Evaluation of the Multiligament Injured Knee
    Review Article Page 1 of 14 Imaging evaluation of the multiligament injured knee Paulo V. P. Helito1,2, Benjamin Peters3, Camilo P. Helito1,2, Pieter Van Dyck3 1Sírio Libanês Hospital, São Paulo, Brazil; 2Institute of Orthopedics and Traumatology, Hospital das Clínicas FMUSP, São Paulo, Brazil; 3Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium Contributions: (I) Conception and design: PV Helito, CP Helito, P Van Dyke; (II) Administrative support: PV Helito, CP Helito, P Van Dyke; (III) Provision of study materials or patients: PV Helito, B Peters, P Van Dyke; (IV) Collection and assembly of data: PV Helito, B Peters; (V) Data analysis and interpretation: PV Helito, B Peters, P Van Dyke; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Paulo V. P. Helito. R. Dr. Ovídio Pires de Campos, 333 - Cerqueira César, São Paulo - SP, 01246-000, Brazil. Email: [email protected]. Abstract: Knee dislocation (KD) is an uncommon and complex injury with potentially limb threatening outcome. Injury to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) rarely occurs in isolation and is often part of a multiligamentous knee injury. There is a growing interest in the diagnosis and treatment of injury to the secondary supporting structures of the knee. Magnetic resonance imaging (MRI) is invaluable for evaluating the knee joint and its peripheral corners. Therefore, detailed knowledge of the normal MRI knee anatomy and the patterns of injury are crucial for the correct diagnosis and appropriate management of KD. As low impact KD often resolve spontaneously, the radiologists can be the first to consider the diagnosis of KD in a patient.
    [Show full text]
  • Anterior Cruciate Ligament
    ANTERIOR CRUCIATE LIGAMENT Ce logo a pour objet d’alerter le lecteur sur la menace que représente pour l’avenir de l’écrit, tout particulièrement dans le domaine universitaire, le développement massif du « Photocopillage ». Cette pratique qui s’est généralisée, notamment dans les établissements d’enseignement, provoque une baisse brutale des achats de livres, au point que la possibilité même pour les auteurs de créer des œuvres nouvelles et de les faire éditer correctement est aujourd’hui menacée. Nous rappelons donc que la reproduction et la vente sans autorisation, ainsi que le recel, sont passibles de poursuites. Les demandes d’autorisation de photocopier doivent être adressées à l’éditeur ou au Centre français d’exploitation du droit de copie, 3, rue Hautefeuille, 75006 Paris. Téléphone : 01 43 26 95 35 Tous droits de traduction, d’adaptation et de reproduction par tous procédés réservés pour tous pays. Toute reproduction ou représentation intégrale ou partielle, par quelque procédé que ce soit, des pages publiées dans le présent ouvrage, faite sans autorisation de l’éditeur est illicite et constitue une contre- façon. Seules sont autorisées, d’une part, les reproductions strictement réservées à l’usage privé du copiste et non destinées à une utilisation collective, et d’autre part, les courtes citations justifiées par le caractère scientifique ou d’information de l’œuvre dans laquelle elles sont incorporées (art. L. 122-4, L. 122-5 et L. 335-2 du Code de la propriété intellectuelle). ©SAURAMPS MEDICAL, 2016 Sarl DT - 11, boulevard Henri IV - 34000 Montpellier Dépot légal : septembre 2016 I.S.B.N.
    [Show full text]