The ligaments of the fingers. Anatomical study of the Cleland ligaments

The aim of this study was to establish a precise architecture of the retinacular ligaments of human digits. Sixty selected digits from human cadavers aged 40-70 years were used in this study. We were able to identify, under the dissecting microscope, two distinct ligamentous complexes: one proximal of greater importance and the other distal of lesser importance. Both structures extend from the periosteum as well as from the fibrous part of the digital sheath to the skin. There are many variations in size and in shape of these structures but they are not related to a particular digit. The role of these ligaments is to prevent the 'effet de doigt de gant', to stabilize and to maintain the neurovascular bundle of the digit at the moment of the digital flexion.     

Cutaneous ligaments of the human hand

A topographical study concerning the cutaneous ligaments of adult as well as human fetal hands was performed. In order to be able to preserve the cutaneous ligaments in their entirety two different methods, a careful dissection and a new histological technique, have been employed. The results of these methods are compared and the detailed topography of the different cutaneous ligaments is clarified. In addition to topographical details, the functional co-operation of the ligaments especially in regard to their clinical relevance is reported.     

The retaining ligaments of the cheek

The zygomatic ligaments (McGregor's patch) anchor the skin of the cheek to the inferior border of the zygoma just posterior to the origin of the zygomaticus minor muscle. The mandibular ligaments tether the overlying skin to the anterior mandible. Both these ligaments are obstacles to surgical maneuvers intended to advance the overlying skin. They also restrain the facial skin against gravitational changes, and they delineate the anterior border of the "jowl" area. The platysma-auricular ligament is a thin fascial sheet that extends from the posterosuperior border of the platysma and that is intimately attached to the periauricular skin; it serves as a surgical guide to the posterosuperior border of the platysma. The anterior platysma-cutaneous ligaments are variable fascial condensations that anchor the SMAS and platysma to the dermis. They can cause anatomic disorientation with dissection of false planes into the dermis. These four ligaments are useful as anatomic landmarks during facial dissections. The tethering effects of the zygomatic and mandibular ligaments must be interrupted if a maximum upward movement of the facial skin is desired.     

Paraterminal ligaments of the distal phalanx.

The paraterminal ligaments of the distal phalanges have been studied by dissection. They are a normal feature of all distal phalanges in both the hand and foot, and connect the paraterminal spines and paraterminal tubercles of the distal phalanx on both sides. Branches of the proper palmar digital artery and nerve pass under the ligament to reach the matrix of the nail, which they supply.     

Variable tensility of the ligaments in the stalk of a sea-lily

The stalk of isocrinid sea-lilies consists largely of skeletal plates linked by collagenous ligaments. Although lacking contractile tissue, it can bend in response to external stimuli. The stalk of Cenocrinus asterius was tested mechanically to determine whether the mechanical properties of its ligaments are under physiological control. In bending tests, ligaments at the mobile symplexal junctions showed a limited “slackening” response to high K⁺ concentrations which was blocked reversibly by the anaesthetic propylene phenoxetol. In bending tests and uniaxial loading tests, ligaments at the normally rigid synostosal junctions ruptured in response to high K⁺, confirming that these junctions are specialized for autotomy. It is concluded that the ligaments are mutable collagenous structures whose presence explains the mechanical versatility of the isocrinid stalk.     

Reflex from the ankle ligaments of the feline.

It was found that two to three articular branches of the tibial nerve innervate the medial ligament of the feline ankle. No innervation was found to the laterial ligament. Supramaximal electrical stimulation of the articular nerves was found to elicit electromyographic (EMG) activity in the intrinsic muscles of the foot. EMG activity was not found in any of the calf muscles which cross the ankle. The average time delay from stimulus to EMG activity was 3.8 ms, indicating that a fast, bisynaptic reflex is active, probably for purposes of preventing or correcting foot eversion to maintain joint stability.     

Recruitment of knee joint ligaments

On the basis of earlier reported data on the in vitro kinematics of passive knee-joint motions of four knee specimens, the length changes of ligament fiber bundles were determined by using the points of insertion on the tibia and femur. The kinematic data and the insertions of the ligaments were obtained by using Roentgenstereophotogrammetry. Different fiber bundles of the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments were identified. On the basis of an assumption for the maximal strain of each ligament fiber bundle during the experiments, the minimal recruitment length and the probability of recruitment were defined and determined. The motions covered the range from extension to 95 degrees flexion and the loading conditions included internal or external moments of 3 Nm and anterior or posterior forces of 30 N. The ligament length and recruitment patterns were found to be consistent for some ligament bundles and less consistent for other ligament bundles. The most posterior bundle of each ligament was recruited in extension and the lower flexion angles, whereas the anterior bundle was recruited for the higher flexion angles. External rotation generally recruited the collateral ligaments, while internal rotation recruited the cruciate ligaments. However, the anterior bundle of the posterior cruciate ligament was recruited with external rotation at the higher flexion angles. At the lower flexion angles, the anterior cruciate and the lateral collateral ligaments were recruited with an anterior force. The recruitment of the posterior cruciate ligament with a posterior force showed that neither its most anterior nor its most posterior bundle was recruited at the lower flexion angles. Hence, the posterior restraint must have been provided by the intermediate fiber bundles, which were not considered in the experiment. At the higher flexion angles, the anterior bundles of the anterior cruciate ligament and the posterior cruciate ligament were found to be recruited with anterior and posterior forces, respectively. The minimal recruitment length and the recruitment probability of ligament fiber bundles are useful parameters for the evaluation of ligament length changes in those experiments where no other method can be used to determine the zero strain lengths, ligament strains and tensions.     

Study of the hysteresis phenomenon in canine anterior cruciate ligaments

Preconditioning is now in common use in biomechanical testing of soft connective tissues. During the first few cycles the tissue behaviour is characterized by a decreasing hysteresis area. However, little is known about the changes occurring during the preconditioning process. The purpose of this study was to investigate the hysteresis phenomenon of ligaments as it is influenced by preconditioning and in vitro enzymatic treatment. Canine anterior cruciate ligament (ACL) was chosen because its mechanical properties and microstructure are relatively well known. A series of experiments were conducted to clarify some of the hysteresis features by combining mechanical testing, enzymatic digestions and pH variations. The area within the hysteresis loops (energy absorption, EA) was measured before and after each treatment. The results showed that the EA before preconditioning is not modified by elastase treatment, however, it was significantly reduced after preconditioning. The fractional EA lost during the preconditioning process increased significantly as compared to the controls. This may be explained by the destruction of elastin, which plays a significant role in the elasticity of ligaments. It was found that hyaluronidase treatment did not significantly affect the hysteresis of preconditioned ligaments. However, the EA during the first cycle decreased significantly as a result of uronic acid digestion leading probably to an exhaustion of the viscous component of the tissue. Hyaluronidase treatment seems to have the same effect as preconditioning on the hysteresis area.     

Rheological properties of the human lumbar spine ligaments

The purpose of this study is to provide a better understanding of the rheological properties of the lumbar spinal ligaments under subfailure physiological loads. Non-destructive tests including an hysteresis experiment, stress-relaxation and stepwise load-relaxation tests were used to investigate the time-dependent properties of the interspinous-supraspinous ligament complex. Using a reduced relaxation function, the viscoelastic behaviour over the experimental time-scale was described by a linear function of the logarithm of time. Internal damping of ligament substance dissipates about 36% of the mechanical energy applied during physiological loading. Local elastic stiffness is found to be two to four times global stiffness of the bone-ligament-bone complex. These physical parameters (stiffness, energy dissipation, hysteresis, relaxation, etc) can be used to improve computer models of the lumbar spinal column.     

Control exerted by ligaments

The function of the ligaments as local controllers, independent of the central nervous system, in maintaining the integrity of the joint is demonstrated by modelling the human knee in the sagittal plane, and studying its anterior-posterior motion. In addition to the ligaments, the model includes the characteristic geometry of the joint surface and some muscle groups. The connecting reaction forces at the point of contact between the tibia and the femur are considered to be constraint forces due to three different surface motions--gliding, rolling and combined gliding and rolling. It is demonstrated that the ligamentous structure maintains these holonomic and nonholonomic constraints that describe the joint motion, and that stability of the knee joint is provided mainly by ligaments. Muscular structures further stabilize and contribute to joint movement. Computer simulation of rolling movement of the knee is presented to illustrate the importance of the ligaments for joint integrity and stability.     

Trace elements in human tendons and ligaments

Tendons and ligaments are key structures in promoting joint movement and maintaining joint stability. Although numerous reviews have detailed their structure, molecular composition, and biomechanical properties, far less attention has been paid to their content of trace elements. Tendons and ligaments are generally rich in calcium, sulfur, and phosphorus, although there are intriguing differences between one tendon/ligament and another. Furthermore, there can be significant regional variations that correlate with the presence or absence of fibrocartilage in the “wraparound” regions of tendons or ligaments, where they change direction and press against bone. Here, their sulfate and calcium contents are particularly high. This is undoubtedly associated with the high levels of proteoglycans that are found in these cartilaginous tissues and the occasional presence of sesamoid bones within them.     

Stiffness of the ligaments of the human wrist joint.

In the present study the stiffness of the superficial ligaments of 14 human cadaver wrist joints have been determined. In these experiments the tested, fresh-frozen carpal joints are divided into a number of bone-ligament-bone complexes, which are loaded in a tensile testing machine at a rate of 66% of the ligaments' initial length per second to a maximal strain of 15%. From the force-elongation curves and ligament dimensions the tangent moduli for the ligament-bone strips are derived. The results show that, with regard to the tangent modulus, there is not a clear differentiation among ligament strips. Only the dorsal radiotriquetrum ligament (RTD) and the palmar radiocapitate ligament (RCP) appear to consist of a material of a relatively high tangent modulus, about 93 and 83 MPa, respectively. The other seven ligaments tested have similar tangent moduli, ranging from 25 to about 50 MPa.