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Purpose To find out if there is an association between ligament laxity measured intraoperatively and functional outcome 1 year after total knee arthroplasty (TKA). Methods Medial and lateral ligament laxities were measured intraoperatively in extension and in 90° of flexion in 108 patients [122 knees; median age 70 (range 42–83) years]. Mechanical axes were measured preoperatively and at 1-year follow-up. Outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Knee Society Clinical Rating System, the Oxford Knee Score and patient satisfaction. The relationships between laxity and outcome scores were examined by median regression analyses. Results Post-operative mechanical axis had a significant effect on the association between ligament laxity and KOOS. Therefore, the material was stratified on post-operative mechanical axis. In perfectly aligned and valgus-aligned TKAs, there was a negative correlation between medial laxity and all subscores in KOOS. The most important regression coefficient (β) was recorded for the effect of medial laxity in extension on activities of daily living (ADLs) (β = −7.32, p

OBJECTIVE:: Ankle sprains are the most common injury in the active population. With high reinjury rates and complaints of the ankle "giving way," it has been suggested that laxity of ankle ligaments increases with repeated sprains. The objective of this study was to determine if a relationship exists between ligament laxity and the number of ankle sprains. DESIGN:: Cross-sectional study. SETTING:: Biomechanics laboratory. PARTICIPANTS:: A total of 203 Division I collegiate athletes (84 women; 119 men; age, 18.5 ± 1.1 years; height, 178.5 ± 10.8 cm; mass, 79.8 ± 18.7 kg) participated in the study. INTERVENTION:: Each participant reported the number of previous sprains on each ankle. Ligament laxity was measured using an instrumented ankle arthrometer. MAIN OUTCOME MEASURES:: Measurements for anterior displacement (AD), inversion (IV), and eversion (EV) rotation of the ankle were obtained using an instrumented ankle arthrometer. RESULTS:: There was no relationship between ligament laxity and the number of ankle sprains in either direction (AD, P = 0.86; IV, P = 0.64; EV, P = 0.81). In addition, comparing ligament laxity between previously sprained ankles and ankles that have never been sprained resulted in no differences in the direction of movement (AD, P = 0.98; IV, P = 0.96; EV, P = 0.67). CONCLUSIONS:: Despite anecdotal evidence suggesting repeated ankle sprains increase ligament laxity, this report involving a large data set and a reliable measurement analysis found no relationship between the two. The results of this study make it necessary to rethink the causes of ligament laxity. Therefore, further research is necessary to understand the causes of "giving way" of the ankle and their role in repeated ankle sprains. Language: en

We studied the healing response of a devitalized anterior cruciate ligament to a treatment of initial anterior-posterior joint translation in goats. Devitalization and devascularization were achieved by five successive freeze-thaw cycles. Anterior-posterior translation was surgically altered by an osteotomy of the tibial attachment of the devitalized ligament and its reattachment either in the anatomical position or in a position 5 mm posterior. Six weeks after the first surgery, the same procedure was performed on the contralateral limb, except that the ligament was reattached in the alternate position. Six months after the initial surgery, femur-anterior cruciate ligament-tibia specimens were tested to determine their structural and mechanical material properties. Anatomic ligament placement resulted in reduced anterior-posterior translation (p < 0.05) and greater anterior joint stiffness (p < 0.05). Maximum load (p < 0.05) and ligament stiffness (p < 0.01) also were greater for the anatomically placed anterior cruciate ligaments. The maximum load for anatomically placed ligaments averaged 1.625 +/- 211 N (SEM). The strength of the posteriorly placed anterior cruciate ligament, 895 +/- 164 N was similar to results of historical anterior cruciate autograft reconstructions. Ligament failure occurred near the tibial insertion in the posteriorly placed ligaments more often than in the anatomically placed ligaments (four of five times compared with one of five times). Ligament failure near the tibial insertion occurred with lower mean maximum load than failure at the midsubstance or by bone avulsion (796 compared with 1.592 N: p < 0.05). These data support the hypothesis that ligament laxity is important to the healing and remodeling of anterior cruciate ligament grafts.

We prospectively enrolled 160 consecutive patients with inversion trauma of the ankle in a diagnostic protocol that included physical examination within 2 days and at 5 days after trauma, arthrography, stress radiography, and ultrasonography. 135 patients had pathological lateral ligament laxity on the later physical examination or lateral ligament rupture diagnosed on arthrography and they were operated on 122 of these patients had ligament ruptures. At clinical follow-up after a minimum of half a year, all of the patients who were not operated on had stable joints without signs of previous ligament ruptures. Delayed physical examination at 5 days after the injury led to the highest overall sensitivity (96%) and specificity (84%) for the detection of a ligament rupture. Additional diagnostic procedures, at a considerable cost, yielded little additional information.

Objective This study aimed to analyze the evolution of the tibiofemoral anterior laxity during the return to sport after anterior cruciate ligament reconstruction. Patients and methods Twenty patients (11 women, 9 men) with mean age of 22.4 ± 5.1 years, operated for ACL reconstruction by a hamstring technique, competitors in a pivot-contact sport, were enrolled between September 2014 and March 2016. They were evaluated at 6 (n = 20), 9 (n = 13) and 12 (n = 13) months postoperatively by laximetry to 250 N using laximetre GnRB® (GenouROB, Laval, France). The differential between laxity uninjured side and operated side in mm, and the difference in slope of the curve laxity according to the force applied between the two sides percentage, on each testing time, were selected. The average values at each time were compared using a t-test of Student. Results The average differential laxity increases insignificantly by 1.4 ± 1 mm to 1.7 ± 1.3 mm between 6 and 9 months postoperatively (P = 0.17) and significantly decreased to 0.95 ± 0.5 mm at 12 months postoperatively (P = 0.02). The slope difference increased from 9% to 15% between 6 and 9 months after surgery (P = 0.05). Between 6 and 12 months postoperatively, the difference in slope (9% and 11%, respectively) was not significant (P = 0.1). Residual laxity was significantly greater in women at 6 months postoperatively, 1.9 mm vs. 0.9 mm (P = 0.002); this difference was no longer significant at 9 and 12 months postoperatively. Discussion/Conclusion Our study reported a significant change in the anterior-posterior laxity between 9 and 12 months postoperatively. These results suggest that the laxity is not only the result of isometric positioning of the transplant but probably also of the transplant ligamentisation phenomena by collagen remodeling to mechanical stress, but also the local muscle condition or exposure to hormonal factors. These results, which show a normalization of laximetry to 12 months postoperatively, make us cautious when a premature return to sport without satisfactory joint control. So, it seems that in sports recovery decision, the analysis of the ligament laxity is a relevant parameter to use.

Made available in DSpace on 2019-09-12T16:25:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2012 INTRODUÇÃO: A entorse de tornozelo é uma das lesões mais comuns em atletas. Uma forma de avaliar a frouxidão ligamentar pode ser através da medida da amplitude passiva dos movimentos de inversão e eversão do pé para estimar a resistência passiva das estruturas capsuloligamentares do tornozelo, o qual pode ser chamado de torque de resistência passiva. Existem poucos estudos que utilizam a avaliação do torque passivo do tornozelo para avaliar a resistência da cápsula e dos ligamentos. OBJETIVO: O objetivo deste estudo foi comparar o torque passivo dos movimentos de inversão e eversão do pé em atletas com e sem história de entorse de tornozelo. MÉTODO: Participaram do estudo 32 atletas de basquetebol e voleibol feminino (16,06 ± 0,8 anos, 67,63 ± 8,17kg, 177,8 ± 6,47cm). Seus tornozelos foram divididos em dois grupos: grupo controle (29), composto por tornozelos sem sintomas, e grupo entorse de tornozelo, composto por tornozelos que sofreram lesão (29). O torque dos movimentos passivos do tornozelo foi registrado por um dinamômetro isocinético, e a atividade dos músculos fibular longo e tibial anterior foi medida por um eletromiógrafo. As atletas realizaram duas repetições do movimento de inversão e eversão, nas velocidades de 5, 10 e 20°/s e, em seguida, o mesmo protocolo foi repetido apenas para o movimento de inversão máxima do pé. RESULTADOS: O torque de resistência passiva durante os movimentos de inversão e eversão do pé foi menor no grupo com entorse do tornozelo. Este grupo também mostrou menor torque durante o movimento de inversão máxima do pé. Não foram observadas diferenças entre o movimento de inversão e eversão. CONCLUSÕES: A entorse de tornozelo leva a um menor torque de resistência passiva, indicando redução da resistência dos ligamentos colaterais do tornozelo e uma frouxidão articular mecânica. INTRODUCTION: The ankle sprain is one of the most common injuries in athletes. Direct evaluation of the ligament laxity can be obtained through the objective measurement of extreme passive inversion and eversion movements, but there are few studies on the use of the evaluation of the passive resistive torque of the ankle to assess the capsule and ligaments resistance. OBJECTIVE: The aim of this study was to compare the inversion and eversion passive torque in athletes with and without ankle sprains history. METHOD: 32 female basketball and volleyball athletes (16.06 ± 0.8 years old; 67.63 ± 8.17 kg; 177.8 ± 6.47 cm) participated in this study. Their ankles were divided into two groups: control group (29), composed by symptom-free ankles, and ankle sprain group, composed by ankles which have suffered injury (29). The resistive torque at maximum passive ankle movement was measured by the isokinetic dynamometer and the muscular activity by electromyography system. The athletes performed 2 repetitions of inversion and eversion movement at 5, 10 and 20°/s and the same protocol only at maximum inversion movement. RESULTS: The resistive passive torque during the inversion and eversion was lower in the ankle sprain group. This group also showed lower torques at the maximum inversion movement. No differences were observed between inversion and eversion movement. CONCLUSIONS: Ankle sprain leads to lower passive torque, indicating reduction of the resistance of the lateral ankle ligaments and mechanical laxity. [Araujo, Rubens Correa] Universidade de Taubaté, Brazil Fernandes, Tulio Diniz; Hernandez, Arnaldo Jose] Universidade de São Paulo, Brazil Barbanera, Márcia] Universidade São Judas Tadeu, Brazil

The Integral Theory (1993) stated: “Stress, urge, and abnormal emptying are mainly caused by connective tissue laxity in the suspensory ligaments of vagina, a result of altered connective tissue”. More recently, the theory has been amended to include pelvic pain, fecal incontinence, and defecation difficulties. According to the theory, therefore, accurate diagnosis and reconstruction of the suspensory ligaments will cure such symptoms. Essential to understanding the theory are the following concepts: the organs are suspended by ligaments; the organs are opened or closed by neurologically coordinated muscle forces contracting against these ligaments; lax ligaments may invalidate the muscle forces causing organ prolapse, and dysfunctions in closure (incontinence) or opening (evacuation symptoms); a symptom-based diagnostic algorithm helps to locate ligament laxity; these are confirmed by a three-zone structured examination system; and organ prolapse and abnormal symptoms are both addressed by using tapes to reinforce damaged suspensory ligaments.

Anterior tibial tunnel placement contributed to the failure of two previous anterior cruciate ligament reconstructions. An allograft patellar bone-tendon-bone nonunion within the tibial tunnel caused dysfunctional ligament laxity. This is the first report of this type of reconstructive cruciate ligament failure.

SummaryThis paper reports on the early results obtained using the Acufex Knee Signature System (KSS) to study ligament laxity.

Aging population continuously grows up and being active in their lifestyle, they are more likely important to determine outcomes of Anterior Cruciate Ligament (ACL) reconstruction that can be achieve in older adults. The aim of this study was to compare with the knee functional scores and ligament laxity in 30’s and 50‘s years old patients following ACL reconstruction after 1 year. Fifteen subjects, greater than 50 years, had been operated for ACL reconstruction that selected for this retrospect study, and the results were compared with patients in 30 age groups. At follow up, patients were evaluated ligament instability used KT-2000 arthrometer and observed knee functional outcome used Lysholm score International Knee Documentation Committee (IKDC) score. Anterior knee translations (side-toside difference) measure by KT-2000 was 2.3±2.0㎜ for 50’s and 2.8±2.5㎜ for patient 30’s. Mean Lysholm score was 90.7±8.5 for 50’s and 93.6±6.5 for 30’s. In IKDC score was 85.7±14.2 for 50’s and 90.3±8.9 for 30’s However, no statistically significant difference between 30’s and 50’s age groups in the knee functional outcome and ligament laxity. This study showed that ACL reconstruction is a safe and valid option for patients over the age of 50 years with restoration of knee function and stability.

Correct ligamentous balancing is an important determinant of the clinical outcome in total knee arthroplasty (TKA). Many surgeons prefer a tight rather than a lax knee during implantation of a TKA. The hypothesis in this study was that patients with a slightly laxer knee joint might perform better than patients with a tight knee joint after implantation of a TKA.Twenty-two patients with bilateral knee arthroplasties were clinically and radiologically evaluated at a mean follow-up of 4.5 years, ranging from 2 to 7 years. There were 12 women and 10 men with an average age of 68.9 years (range 32-82 years) at the time of surgery. A modified HSS score (excluding laxity), varus and valgus stress X-rays in 30 degrees of knee flexion, and the subjective outcome of both knees were compared. A knee was considered tight when it opened less than 4 degrees and lax if it opened 4 degrees or more on stress X-ray.There was a trend towards improved range of motion and HSS score for the laxer knee joints. However, the difference did not achieve statistical significance. Eleven of the 22 patients considered one side subjectively better than the other side. In 10 out of these 11 TKA, the slacker knee joint was the preferred side ( p0.05).As the present study compared bilateral knee joints after TKA, the same patient could act as a control group, and subtle subjective differences were revealed which are not quantifiable. The results showed that patients with a preferred side felt significantly more comfortable on the laxer side, indicating that during intraoperative ligamentous tensioning, some varus and valgus laxity at 20-30 degrees of flexion might be preferable to an over-tight knee joint. Further biomechanical and prospective investigations will be necessary to establish the correct soft-tissue tensioning.

Heat has been used as a therapeutic form of treatment in the field of medicine since ancient times. Electrothermal energy delivered by radiofrequency has the advantages of being able to be used by even the casual arthroscopist and being relatively inexpensive. One of the expanded uses is treating ligament laxity, including the anterior cruciate.

Background: It is now generally accepted that the ligamentous structures of the knee not only act as mechanical restraints but also have a neurophysiological role in joint function and protection. A report that knee joint laxity increases with exercise raised the question as to whether there is any compensatory change in joint position appreciation. Objective: To test whether there is a compensatory mechanism for increased ligamentous laxity during normal levels of activity. Methods: Joint position appreciation was measured, using a previously reported technique, in the knees of sportsmen at rest and after warm up. Results: Joint position appreciation was found to be significantly more sensitive after warm up (p = 0.005). Conclusions: These findings indicate that joint position appreciation within the knee accommodates physiological changes within the ligaments and muscles after exercise.

Because the knee has no significant abduction or adduc-tion movement, joint contracture or compensatory joint movement in the frontal plane need not be considered. Considerations of ligament laxity and intraarticular deficiency, which cause some knee motion in the frontal plane, are discussed in Chaps. 14 and Chaps. 15. Frontal plane osteotomy considerations regarding the knee are discussed in Chap 5. Deformity considerations associated with monocompartmental arthritis of the knee are discussed in Chap. 16.

We implanted the total arthroplasty knee or TACK prosthesis in 40 patients with degenerative osteoarthritis. We used the same surgical technique in all patients. Full extension and flexion more than 90 degrees were achieved in all 40 knees. All patients obtained a HSS score of more than 88 points. The results confirm that the TACK prosthesis provides excellent results in patients with degenerative osteoarthritis if there is no significant bone loss, serious ligament laxity or extensive deformation.

This study was performed to assess the incidence of generalized ligament laxity (GLL) in patients undergoing hip arthroscopy for intraarticular hip pathology diagnosed by clinical examination and confirmed with magnetic resonance arthrography. Prospective data were collected for 27 patients between Feb and May 2013 under the care of a specialist hip surgeon including demographic details; mechanism of injury, operative diagnosis, surgical treatments performed and GLL by using the Beighton score. The mean age was 32 years (range 18–56). There were 14 male (52%) and 13 (48%) female patients. 81% patients were involved in sports and football was the most common sports in 55%. The mean duration of symptoms was 4 years (range 1–16). The mean Non-arthritic hip score was 30 (range 20–46). 80% patients denied hip injury, 8% had significant hip injury, 8% were involved in road traffic accidents and 4% had a trivial injury. 21% patients had bilateral, 67% had right and 12% had left sided symptoms. 54% patients had Femoroacetabular Impingement (FAI) and an associated labral tear, 31% had an isolated labral tear and 15% had only impingement. 42% patients had labral debridement and osteochondroplasty of the femoral neck, 19% had labral debridement, 15% had osteochondroplasty, 15% had labral repair and osteochondroplasty and 8% had only labral repair. The mean Beighton score for these patients was 2.7 (range 0–9). 10 patients (37%) in this group had a Beighton score of 4 or more indicating GLL. We found that there was a high incidence (37%) of GLL in patients undergoing hip arthroscopy. 54% patients had FAI and associated labral tear, 80% denied hip injury and 21% had bilateral symptoms. Further research to study the effect of GLL on intraarticular hip pathology in young athletic population is required for appropriate advice about the risk of injuries.

Collateral ligament laxity has recently been recognized as an important component of frontal plane malalignment. The authors have developed new surgical techniques to re-tension lax collateral ligaments. Twenty-three collateral ligament re-tensioning with bony alignment were carried out in 17 patients, with 19 knees being graded excellent, 2 fair, and 2 poor. Recurrence of significant laxity was noted in one patient.

Back pain is common in athletes and different risk factors are known to aggravate it. This study was performed to assess the incidence of generalised ligament laxity in patients admitted with severe back pain. Prospective data was collected for patients admitted with severe back pain between Jan 2011 and March 2011 including demographic details, MRI scan findings and generalised ligament laxity. Clinical examination was used to assess the ligament laxity using the Beighton score. Laxity is scored on a 0–9 scale. Scores of 4 or above are indicative of generalised ligament laxity. There were 11 patients with a mean age of 46 years (range 33–63). There were 8 female (73%) and 3 (27%) male patients. The average Beighton score for these patients was 2 with a range from 0 to 8. 4 patients (36%) were involved in sporting activities. 6 patients (55%) had nerve root compression (Group A) on the MRI scan as compared to 5 patients (45%) with normal MRI scan (Group B). All patients who played sport were in Group A and had nerve root compression on the MRI scan. 2 patients (33%) in Group A, who played sport, had a Beighton score of 4 or more indicating generalised ligament laxity as compared to no patient in Group B. We found that there was a high incidence (33%) of generalised ligament laxity in patients who played sport and were admitted with severe back pain due to nerve root compression on MRI scan. Appropriate advice should be given to athletes about the risks of back pain and nerve root compression in later life.

This study was performed to assess the incidence of generalised ligament laxity in patients presented with shoulder dislocations. Prospective data were collected for patients presented with shoulder dislocations between August 2008 and August 2009 under the care of a specialist shoulder surgeon including demographic details, types of dislocation, mechanism of injury and generalised ligament laxity. Clinical examination was used to assess the ligament laxity using the Beighton score. Laxity is scored on a 0-9 scale. Scores of 4 or above are indicative of generalised ligament laxity. Brighton criteria is used to diagnose benign joint hypermobility syndrome (BJHS) and use signs and symptoms along with Beighton score. There were 82 patients with a mean age of 30 years. There were 77 male (94%) and 5 (6%) female patients. 34 patients (41%) attended after first time shoulder dislocation, 37 (45%) after recurrent shoulder dislocations and 11 (13%) for revision shoulder stabilisation. The most common cause of shoulder dislocation was sports related injuries in 48 patients (68%). The most common sports involved was rugby in 22 (46%) patients followed by football in 15 (31%) patients. 75 (91%) patients had anterior shoulder dislocations and 6 (7%) had multidirectional instability. The average Beighton score for these patients was 3.1 with a range from 0 to 9. 35 patients (43%) in this group had a Beighton score of 4 or more indicating generalised ligament laxity. 15 patients (18%) fulfilled the Brighton criteria for BJHS. 12 patients (15%) had a first degree relative with generalised ligament laxity. The authors found that there is a high incidence (43%) of generalised ligament laxity in patients with shoulder dislocations after sports injuries. Appropriate advice should be given about the risk of shoulder dislocations in patients with generalised ligament laxity.

We analysed static footprints of 2300 children between the ages of four and 13 years to establish the influence of footwear on the prevalence of flat foot. The incidence among children who used footwear was 8.6% compared with 2.8% in those who did not (p less than 0.001). Significant differences between the predominance in shod and unshod children were noted in all age groups, most marked in those with generalised ligament laxity. Flat foot was most common in children who wore closed-toe shoes, less common in those who wore sandals or slippers, and least in the unshod. Our findings suggest that shoe-wearing in early childhood is detrimental to the development of a normal longitudinal arch.

A 24-year-old professional football player sustained an isolated rupture of the popliteus tendon. The injury was confirmed by arthroscopic examination. No clinical instability was present initially or during the recovery period. The injury was managed nonoperatively with the patient able to return to full sports participation. No residual ligament laxity or weakness on isokinetic testing resulted.

Purpose: To analyze the findings of midcarpal and radiocarpal arthroscopic examinations in the diagnosis of wrist trauma and pathology focusing on interosseous ligament laxity. Materials and Methods: Forty-one midcarpal arthroscopic examinations were performed in conjunction with radiocarpal arthroscopic examinations. Thirty-one wrists with distal radius fracture and ten wrists with triangular fibrocartilage complex tear were included. Scapholunate and lunotriquetral ligament laxity was graded by using the Geissler classification and radiocarpal and midcarpal arthroscopic findings were compared. Results: For scapholunate findings midcarpal arthroscopy confirmed radiocarpal findings in 14 cases and provided a diagnosis in 6 cases. For lunotriquetral findings midcarpal arthroscopy confirmed radiocarpal findings in 13 cases and provided a diagnosis in 6 cases. Conclusion: Midcarpal arthroscopy added more statistically significant information to the results of radiocarpal examination than wrist arthroscopy performed without a midcarpal examination.

Background: Prolotherapy is an effective treatment for pain due to ligament or tendon laxity. The purpose of this study was to determine the effects of prolotherapy on the relief of knee joint pain. Methods: Forty patients who complained of knee joint pain, considered ligament originated pain were investigated using a pain score system. Prolotherapy was performed using 15% dextrose to regions according to Hemwall's pattern. We recorded visual analog scale (VAS) pain scores just before prolotherapy and 1, 2, 4 and 8 weeks later. Results: For the 40 patients, prolotherapy proved to be effective and satisfactory in 82% (VAS; after prolotherapy). Conclusions: Prolotherapy with 15% dextrose resulted in a clinically significant improvement of knee joint pain due to ligamentopathy.

Asymptomatic spontaneous subluxation of C1 on C2 is common in Down's syndrome and can result in compression of the upper cervical cord. Symptomatic atlantoaxial dislocations developed in two such patients. The causes of the atlantoaxial dislocations were possibly due to the ligament laxity in one case and due to the osseous malformation in the other. Conditions in both patients were relieved by surgical stabilization of the first and second cervical vertebrae.

Measurements have been made on knee radiographs exposed during stress displacement by controlled hydraulic forces using a specially designed apparatus. This accurately records the amount of anterior and posterior tibial displacement (drawer sign) and the degree of medial and lateral collateral ligament laxity on radiographs. The findings in 25 patients have been analysed following the Jones' procedure for the repair of the anterior cruciate ligaments. The operative results were judged to be completely successful in 72 per cent of patients and the value of stress radiographic measurements is discussed.

After review of the first 209 polycentric total knee arthroplasties (in 159 patients) performed at the Mayo Clinic between July 1970 and November 1971, we found that the calculated probability of the arthroplasty remaining successful ten years postoperatively was 66 per cent. Actual results showed 42 per cent of the arthroplasties to be successful in patients who were still alive at review; another 24 per cent were successful but were in patients who had died or were lost to follow-up before ten years postoperatively. In 34 per cent failure occurred, which we defined as reoperation for any reason, unacceptable pain, or loss of function. The most common causes of failure were instability or ligament laxity (13 per cent), loosening of a component (7 per cent), infection (3 per cent), and patellofemoral joint pain (4 per cent). Prior knee surgery significantly decreased the probability of success, as did axial malalignment of the prosthetic components at operation.

Congential cutis laxa with ligamentous laxity and delayed development appears to be a distinct syndrome. Experience with six patients brings the total number of cases described to 13. Characteristics of the syndrome include congenital dislocation of the hips, wide patency and delayed closure of the anterior fontanel, and delayed intrauterine growth and extrauterine growth and development. Each of the 13 patients has been female. Inheritance may be as an autosomal recessive or an X-linked dominant lethal in the male.

Bilateral varus-valgus knee-stress roentgenograms were made in 208 patients with unilateral single tibial-plateau fracture. Martin's so-called clear space was used to measure the laxity of the collateral ligaments and statistical analysis showed no increased laxity in the possibility injured ligaments. A vacuum phenomenon was produced in 36 per cent and ligament calcification was noted in 16 per cent of the knees tested.

Linscheid and Dobyns (1972), in a classical article on post-traumatic instability of the wrist described two major types of instability, dorsal and volar. The dorsal intercalated segment instability (D.I.S.I.) was the more common and occurred with scapholunate dissociation and displaced scaphoid fractures. The instability occurred in these conditions as a result of the scaphoid losing its ability to support the carpus. They presented five cases of volar intercalated segment instability (V.I.S.I.) of which four were related to congenital ligament laxity and not to traumatic ligament disruption. In the one case of traumatic origin they felt that the capitolunate ligament was ruptured. However, more recent publications by Taleisnik, Prietto (1982) and Reagan, (1984) have proposed that for V.I.S.I. to occur the lunate triquetral interosseous ligament must be disrupted. We report this case as it demonstrates which ligamentous structures are torn for V.I.S.I. to occur. In addition, these ligament disruptions were pathological and occurred spontaneously as a result of longterm systemic steroid medication.

Of 45 consecutive knees undergoing Macintosh fascia lata anterior cruciate substitution, only five had accompanying collateral ligament laxity. Over a third of cases (16) had more than ten episodes of major instability causing falls to the ground pre-operatively. The initial injury caused haemarthrosis, usually without external trauma (36), was often accompanied by a sensation of knee disruption (18), and was always associated with immediate disability. The results of 26 lateral substitution operations with minimum 12 month follow-up show abolition of pivot shift jerk in all patients. Incomplete control of objective and functional instability postoperatively in four patients may have been related to soft tissue stretching associated with early mobilization in a cast-brace or generalized ligamentous laxity.

he proXimal interphalangeal (PIP) joint is par­ticularly susceptible to acute ligamentous in­jury, and such an injury can result in swelling without ligament laXity, collateral ligament laXity and disruption, or a partial or complete avulsion of the volar plate with or without bony involvement. Many articles have been written about methods for treat­ment of injuries to this joint (Bowers

1. Recurrent dislocation of the elbow is caused primarily by collateral ligament laxity with secondary damage to the capitulum and head of radius. 2. The pathological changes resemble those of recurrent dislocation of the shoulder. 3. Subluxation or instability of the radial head is often associated with capsular ossification and deserves wider recognition because it may be confused with osteochondritis dissecans. 4. A simple method of soft-tissue repair has successfully prevented redislocation of eight elbows.

A case with stress fracture of the body of the pubic bone which occurred in a 35-year-old pregnant woman is described. No underlying pathologic process was found and it would seem that the mechanical load acting on the pubic bone to cause stress fracture is brought about by both the muscle imbalance and ligament laxity. In a few weeks after delivery, the fracture showed a complete bony union.

All patients returning from skiing holidays who had sustained injuries of the knee ligaments were assessed. Thirteen patients had radiologically evident flake fractures around the knee. Of these, all had marked laxity when examined under anaesthetic. In ten cases the accident had occurred at low speed. It is concluded that all knee injuries following a skiing fall must be examined to exclude ligament laxity. The relevance of the bony flakes is discussed.

Forty-seven patients who had been treated by 63 total knee arthroplasties were assessed at 12-84 months after the operation. The data were analyzed to determine if collateral ligament laxity had a detrimental effect on the clinical outcome. The Hospital for Special Surgery (HSS) score was used to make the clinical assessment and a modified HSS score, which excluded points awarded for laxity, was also used. Unidirectional (varus or valgus) and total (varus and valgus) laxity were used as a basis of analysis. None of the examined parameters produced results suggesting that lax knees were worse than stable knees. Indeed, knees with increasing laxity through the categories of mild and moderate showed better statistically significant results in HSS score and pain than those with lesser degrees of laxity. Seventy-five percent of the knees with unidirectional laxity were classified as excellent; only 38.5% of the stable knees were graded as excellent (p less than 0.01). Only 9% of the lax knees had complaints of pain; 38% of the stable knees were painful (p less than 0.05). No significant difference in functional score and walking ability was noted between the lax and the stable knees. Seventy-eight percent of the lax knees had a range of motion over 100 degrees; 62.5% of the stable knees achieved this range.

Background Previous literature investigating the effect of exercise on ligament laxity at the knee found that basketball and distance running elicit a significant increase in knee laxity post exercise [1], whereas powerlifting [1] and cycling [2] do not change after exercise. This suggests that, to have an effect on ligament laxity, an activity must be weight bearing and repetitive in nature. We aimed to use a multidirectional exercise protocol to determine whether the ligaments responsible for controlling inversion/eversion at the ankle allowed greater rotation following dynamic movement. This will form the basis of future methodological decisions regarding the conditions under which laxity should be measured, and will help to describe the acute response of ligaments during exercise with applications to injury prevention.