Science topic

Ligaments - Science topic

Shiny, flexible bands of fibrous tissue connecting together articular extremities of bones. They are pliant, tough, and inextensile.
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Montezzia fractures
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In Monteggia fractures radial head usually reduced closely after reducing the ulnar fracture and annular ligament is rarely required.
In cases of neglected or chronic Monteggia fractures with chronic radial head dislocation, annular ligament reconstruction may be required to restore the radial head stability.
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Hello,
I have experienced in my private practice that intradermal injections of G5W (Glucose 5% in Water) can be beneficial in mild forms of localized neuropathic pain. I also found some articles on this subject, where Glucose 5% was injected perineurally, epidurally and into joints. I wonder if therea re any clinicains who have had interesting results with Glucose (or dextrose) 5% injections. I have used them also in muscular trigger pints and in ligaments.
Jan Kersschot, MD
PS I am not a researcher myself, I simply have put my experiences in a e-book you can download for free online on www.glucopuncture.com
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Dear Dr. Jan Kersschot, at no time have I said anything about control groups or similar; I wanted to refer, and sorry if I have not been able to explain myself well, that, since there is no scientific evidence about its analgesic efficacy, and I have read enough about it, its supposed efficacy - which I am not saying does not exist - can be explained by the Placebo effect that, as we all know, is universal ... but in the case of pain even more and precisely by the three dimensions, according to the Model of the key or gate, which interact in it: Sensory / Discriminatory, Motivational / Affective and Rational / Cognitive; In this sense, and more succinctly, I therefore share what Dr. Shalendra Singh. Thanks you.
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During arthroscopic release of frozen shoukder after capulotomy and subacromial examination we must release CA Ligament
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No. Not part of the pathology. But if you mean coracohumeral ligament, it is a must
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I was trying to add ligaments in cervical spine geometry. There it is mentioned in the existing literature to add the ligaments in the geometry as truss element with no effect of compression. However I am confused after creating these ligaments in specified positions as line bodies and implying material properties how to make the connections in the setup and then the compression free effect.
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Use the command:
et, matid,180
seccontrol,,1
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In literature, Anterior longitudinal ligament (ALL), Posterior longitudinal ligament (ALL), Supraspinous Ligament (SSL), Interspinous Ligament (ISL), Intertransverse Ligament (ITL), Facet Capsular Ligament (FCL), Ligamentum flavum (LFL) ligaments are modeled with the whole lumbar vertebrae. However, I couldn't reach the exact numbers of them in the model, repectively. Do you have any information about this? Could you give me a suggestion to solve this problem?
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hi
i hope this paper can help you:
1- BIOMECHANICAL PROPERTIES OF HUMAN LUMBAR SPINE
LIGAMENTS, J.Biomechanics. Vol 25 N.o. 11, pp.1351-1356, 1992.
Kind regards
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Dear All,
I'm trying to build a finite element model of the knee joint, but I'm having trouble applying the initial strain on the ligaments.
Data on initial strain is given in the literature, but I don't know how to apply the initial stress in ABAQUS, nor how to define the direction of the initial stress. I tried the predefined temperature field, but it didn't seem to work well.
Does anyone know how to set the initial strain and how to control the size and direction of the initial strain? Any answers will be appreciated. Thank you very much in advance.
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I used the method in the literature. It can also be solved by writing subroutines, but it is too difficult for me.
Alexander D. Orsi, Srinath Chakravarthy, Paul K. Canavan, Estefanía Peña, Ruben Goebel, Askhan Vaziri & Hamid Nayeb-Hashemi (2015): The effects of knee joint kinematics on anterior cruciate ligament injury and articular cartilage damage, Computer Methods in Biomechanics and Biomedical Engineering, DOI:10.1080/10255842.2015.1043626
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Respected professor,
I would like to know about Cervical spine ligament properties to study about the ROM, In particular stress strain graph. if possible May I get some suggestion/guidance from your about the FEM analysis of Cervical spine.
Thanking you
With Sincerely
Pugazhenthi S K
VIT University
Chennai
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Hi pugazh,
i hope the following literatures will help you.
1. John JD, Saravana Kumar G, Yoganandan N (2019) Cervical spine morphology and ligament property variations:
A finite element study of their influence on sagittal bending characteristics. J Biomech 85:18-26.
doi:10.1016/j.jbiomech.2018.12.044
2. Arun MW, Yoganandan N, Stemper BD, Zheng M, Masoudi A, Snyder B (2014) Sensitivity and stability
analysis of a nonlinear material model of cervical intervertebral disc under cyclic loads using the finite element
method. Biomed Sci Instrum 50:19-30
3. Wheeldon JA, Stemper BD, Yoganandan N, Pintar FA (2008) Validation of a finite element model of the young
normal lower cervical spine. Ann Biomed Eng 36 (9):1458-1469. doi:10.1007/s10439-008-9534-8
4. Wheeldon JA, Pintar FA, Knowles S, Yoganandan N (2006) Experimental flexion/extension data corridors for
validation of finite element models of the young, normal cervical spine. J Biomech 39 (2):375-380.
doi:10.1016/j.jbiomech.2004.11.014
Thank you!
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I was pleased to be informed that the American International Medical University in St Lucia trains its students in the causes, diagnosis, management and prevention of diseases caused by Fluoride bio-accumulation.
Listed problems include: calcification of ligaments, with resulting impairment of muscles and pain. Constriction of vertebral canal and intervertebral foramen exerting pressure on nerves, blood vessels leading to paralysis and pain. Neurological manifestation: Nervousness and depression, tingling sensation in fingers and toes, excessive thirst and tendency to urinate. Loss of muscle power, inability to carry out normal routine activities. Skin rashes, Perivascular inflammation. Effects on foetus: Abortions, still births and children with birth defects are common in endemic areas. Formation of echinocytes by damage to erythrocytes leading to low haemoglobin levels.
Can anyone add to the list of institutions covering this topic in their curricula?
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Geoff, you are asking a great question. Let me more specific, I think inclusion of fluoride toxicity is particularly important in pediatrics. Imagine what will be the situation if it is not taught in depth in the dental school.
J Public Health Dent. 1997 Summer;57(3):150-8.
Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age.
Shulman JD1, Wells LM.
Author information
1Texas A&M University System, Baylor College of Dentistry, Dallas 75266-0677, USA. jshulman@tambcd.edu
Abstract
OBJECTIVE:
This paper analyzes reports to the American Association of Poison Control Centers (AAPCC) of suspected overingestion of fluoride by children younger than 6 years of age between 1989 and 1994, and estimates the probably toxic amounts of various home-use fluoride products in children younger than 6 years of age.
METHODS:
Annual incidence rates of reported fluoride exposures attributed to dietary supplements, toothpaste, and rinses were calculated. Probably toxic amounts of each product were calculated using the frequently cited dose of 5 mg/kg.
RESULTS:
Children younger than 6 years of age accounted for more than 80 percent of reports of suspected overingestion. While the outcomes were generally not serious, several hundred children were treated at health care facilities each year. A 10 kg child who ingests 50 mg fluoride (10.1 g 1.1% NaF gel; 32.7 g 0.63% SnF2 gel; 33.3 g 1,500 ppm F toothpaste; 50 g 1,000 ppm F toothpaste; and 221 mL 0.05% NaF rinse) will have ingested a probably toxic dose.
CONCLUSIONS:
Overingestion of fluoride products in the home is preventable. Dentists and other health care providers should educate parents and child care providers about the importance of keeping fluoride products out of reach of children. Manufacturers should be encouraged by the ADA and the FDA to use child-resistant packaging for all fluoride products intended for use in the home.
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Tendons, ligaments, cartilage are composed of collagen. There are articles saying that collagen supplementation can help with tendon injuries. Where is the scientific evidence to support these claims? How is ingestion of collagen linked to an increase in collagen synthesis in the body?
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I thought I would describe in a bit more detail the nature of my tendon injury that I referred to early on in the discussion so as to give a bit more context and hopefully provide information that may be useful to others experiencing similar injuries.
How did my injury occur? I am not entirely sure. I keep racking my brain to remember where I was and what I was doing and the only thing that comes to mind is that I was walking home one morning after having gone to get a coffee and I thought I will sprint home.
I started to run and then something didn’t feel right, I’m not really sure what or how to describe it but I felt like I couldn’t run to the end of the street and I had to stop and walk home. I didn’t think anything of it, I just thought I am not fit, I am not warmed up, I probably have tight muscles.
In the subsequent weeks I had pain in the left thigh that felt like muscular pain, similar to when you exercise and get sore muscles, only that weeks passed and the pain didn’t go away and so I became suspicious that perhaps there was something more to it and lo and behold I go to see my GP and she orders an ultrasound and the report indicates a partial thickness defect in the deep fibers of the quadriceps tendon measured over 1.5cm in width, approximately 8cm above the insertion of the quadriceps tendon from the patella. Associated hyperemia is seen. A complex suprapatellar effusion is also noted.
This first ultrasound was done on the 11th of April 2019 and was maybe between 4-8 weeks after the injury. I followed my GPs advice and went to see a physiotherapist and this was a good move, the physio is much more knowledgeable in musculoskeletal injuries and adept at communicating and made me feel more at ease and that it was not the end of the world. I am grateful for meeting Chris.
On the road to recovery I began muscle strengthening exercises and approximately 3 months after the first ultrasound, I was curious to know what was going on with my tissue so I went back for a second ultrasound on the First of July 2019, 80 days after the first ultrasound, almost 3 months, to check the progress of my injury to know if it was improving or worsening. Thankfully the report came back saying that there is a partial thickness tear of the quadriceps mechanism at the musculotendinous junction which has decreased in size from the prior examination and that there is no new injury or fluid. In my case ultrasound was useful in showing that there was a reason for the pain I was experiencing.
Musculotendinous junction
The myotendinous junction (MTJ) is a complex specialized region located at the muscle-tendon interface that represents the primary site of force transmission.
Overall, I have normal range of motion, I am not debilitated in any way, I do not have any change in movement, however I am aware of my left quad tendon now and that it feels different and has changed. I would also like to mention that tendons heal slowly from what I have been reading in the literature and that healing doesn’t just stop it keeps on going. The various phases of healing have been documented scientifically and consist of inflammation in the early stages, followed by repair and tissue remodeling and this is another area that I have been reading about and that prompted me to look at tendon dynamics and nutritional intervention. In addition to the basic muscle strengthening exercises and walking that I do I have started using a skipping rope.
As Dr Jill Cook articulates exercise and provoking the tendon with load is the best intervention.
Loads in different parts of the tendon
Energy storage acts like a spring
Compressive load – tendons compressed against the bone
Friction load between tendon and surrounding tissue peritendon
The exercises I have been doing have mainly been strengthening the muscle and not really loading the tendon so this is where consulting with a physio is of benefit because they can help with exercise programs and recovery.
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Hi, I desperately need some medical advice. A doctor performed a ligament extracapsular surgery repair for my 5 years old cat and used a monofilament suture and a inox pin. 3 weeks after surgery she had a complication, a seroma with fibrin liquid was drained from her joint area. After that, we followed an antibiotic treatment for 9 days(amoxicillin). Now there are 7 weeks after surgery and the cat still have a lot of pain (is trembling most of the time), has difficulties in using the leg and walking and also have some fever episodes and a decreased appetite. What can be wrong? The doctor says that it doesn't have any drawer motion and that the RX is looking good. I don't know what to say... it might be a reaction to the suture or something else... what options do we have to heal her? Please help me :(
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I'm sorry..... I'm a nutritionist / dietist, so I can't help the problem you're facing.
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Hi , I am a PT at UC Health in Greeley, CO. We have 2 KT 1000's that we do not need or want anymore. If anyone would like to have one or both please contact me at 970-313-2775
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I regret to inform all those who were interested in the KT 1000's that corporate has decided to keep them for possible future use, even though they didn't know we had them. Sorry for any inconvenience this may have caused. This may change in the future but as of now they will not be given away.
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Hi all, I am new to Abaqus and currently are learning to model a human spine.
However, I faced trouble in setting up material. Does anybody know how to set up the material in the picture attached?
This is the properties to model capsular ligament in spine. I found it in one thesis. It shows that Capsular ligament is nonlinear material properties of non-linear stress-strain curve. Anyone know how to set up??
***This question may sound stupid to all the experts but I hope you guys can teach me how to do it****
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Dear Chun
I understand your problem in defining a material with different young’s modules(E). As seen in the attached figure, the E value is changed as the strain value reaches 0.25. First of all, make sure that the value of strain reaches 0.25 in your loading condition. I suggest to define a material with E=7.5, and run your analysis.Then check whether the value of strain reaches to 0.25 or not. If the amount of strain is more than 0.25 in the final increment, you have to use a "user subroutine" which is usually coded using a "Fortran compiler". You could find useful information about subroutines in Abaqus documentation.
As a useful guide, you can see a sample of subroutine which addresses the same issue in the following:
If using a subroutine seems a difficult way, you can try to find different data about your sample. I guess that capsular ligament can be considered as a hyperelastic material. If it is the case, you can define your material as a hyperelastic material:
property>create material>mechanical>elasticity>hyper elastic
However, for defining a hyper elastic material you need to have extra data, and I hope you would find them in other sources.
With best regards
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Hi everyone,
I already have an assembly CAE for the lumbar spine model. However, my project needs me to model out facet capsular ligament for future study.
Basically what I need to do is model CL using truss elements. But the problem is how to create that truss element?? (Sorry because I'm very new to Abaqus and the resources available is very limited)
Any recommendations or solutions??
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Personally I have used connector elements. Similar to truss elements they transmit force axially. I have found it easier implement these types of elements. They have an added advantage of allowing for tabular data so that you can model nonlinear properties. The downside of using connectors vs truss elements is that connectors don't have cross-sectional area, they are essentially springs.
If you want to use truss elements you will need to create a separate part for each ligament. The part would be a line, and when it is placed in the assembly the end points of the line will be need to have the tie boundary condition to a node on the corresponding facet joints. Alternatively you can merge your assembly into a single part and create wires directly on your merged part.
If you are using connector elements, go into the:
Interaction module
Connector > Geometry > Create Wire Feature and select two end points.
Create a connector section in:
Connector > Section > Create
I use the following settings
Connection Category - Basic
Transnational Type - Axial
Rotational Type - None
Good luck,
Aaron
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I am trying to section paraffin embedded human ligament at 20µm, but the tissue keeps breaking in the middle, with vertical lines throughout the tissue. Does anyone have any tips on how to resolve this issue?
I've tried a new blade, decalcifying in EDTA, a surface softener, and different temperatures.
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Try reembedding first.
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Model the behavior of Ligaments of carpal bones ?
Damping of these ligaments ?
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Due to the sensetivity of this issue, I strongly recommend to conduct actual test on spscimens to characterize its stress-strain diagram and elstic modulus; also for the damping there tests that can be run to obtain the damping ratio.
however, it is a good approximation to assume 5% for steel and concrete and 10-15% for wood. I think bones are brittle so I would not use more than 5%. A good approach in simulations is to conduct sensitivity analysis which means to run your simulation with 0 damping, 1%, 2%, 3%, 4%, and 5% to see if there is a major effect.
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The importance of analyzing the human walking gives huge information about the status of the human body. It represents the status of the neurological human system giving orders from the brain through the spinal cord and nerves, to move our limbs in a synchronized way using the muscles, bones, ligaments in an specific order to obtain the human displacement required, indicating a way to detect human movements disorders.
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I think there are many ways in which one could respond to you question, Jorge Garza-Ulloa , one viewpoint I would consider is related to the incumbent equations/models that may be used to theorize gait. this paper by Kuo and Donelan gives some nice information throughout the article, and demonstrates the idea of the inverted pendulum (and similar) models of human gait. I'm not sure how far that goes to answer your question, but hopefully helps in some small way. Best wishes, Cain
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Bones are stiffer and, therefore, potentially more powerful springs than ligaments. The ground reaction force of a bouncing creature would load its springy bones and the stored potential energy would best be utilized by elastic recoil making it a very energy efficient system.
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Yes
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I am wondering if collagen will be measured accurately in the total measure for protein content. In other words, will the triple helical structure of collagen fibers affect its ability to be read using NanoDrop?
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Thank you Subhash.
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I had much time struggling with Elastin powder, that can not be fully dissolved in different solvents which I have tried (1% acetic acid, PBS, distilled water, 2% formic acid )unless I used 98% formic acid. The powder completely dissolved but I'm not sure if that a true way to dissolve the powder, as the Elastin solution has to be mixed with other polymers to produce hydrogel for skin regeneration. I'm worry that high concentration of formic acid can damage the molecular structure of Elastin and other mixed polymers.
I will appreciate if you can supplement me with similar papers, as I can't find specific answer in literature.
Thank you!
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Hello Fatma,
What is your desired concentration as the process I guess is not quick and require multiple hours to see a complete dissolution. you may also increase the acid and temperature (up to about 40C) gradually. High % formic acid degrade the polymer chain.
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Looking for FEA software that can model dynamic joint kinematics over multiple cycles and has the ability to model elastic/viscoelastic materials in order to assess how tendon/ligaments in the simulation.
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Hi Madesh
To complete you list, Nastran (Nasa Structural Analysis), the old industry work horse, is now old enough to have become open source and freeware.
There is also a Nastran equivalent software that runs in Matlab
For Nastran and processing of Nastran generated data, take a look also at PyNastran
The above may be old but is still does come with serious teeth as Nastran's forte always has been speed and large model size, i.e. it is a good choice when one wants a fast and rugged software for multidisciplinary optimization. It does not hurt that it runs together with OpenMDAO.
Here's an OpenMDAO wrapper for Nastran
As side notes,
  • CalculiX is the Pre/Post - the almost Abaqus solver is called CrunchiX. For large problems, one needs a special SGI based solver.
  • Mystran needs an Intel based solver.
  • Nastran-95 should run out of the box if you find a version that is recompiled for your platform. It can outpput F06, Punch, OP4 and OP2 files that can be read by a bunch of Pre/Post processors. The major sign of age is that it uses the older suite of numerical solvers, e.g. SOL3 rather than the newer SOL103, which is not a big thing to overcome. Vibroacoustic has to be done old school as these functions started to appear in ~1997.
Sincerely
Claes
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Well, this time I have a personal problem. I am a sport physician but I spent my career in muscle research. Now, I think I have a rupture of my costoclavicular ligament.
During a powerful breaststroke swim I experienced sudden subluxation of the sternoclavicular joint left that quickly regained its normal position. Since then I avoid (cannot) swim breaststroke, since it dislocates immediately at about middle of the side stroke, jumps a bit out of the sternoclavicular joint and comes back quickly as I terminate the movement. But I can crawl without problem. Also if I want to pull something to the side with my arm stretched by about 30 degrees sideways – it quickly dislocates and immediately comes back. I did not do my MRI.
Do I have costoclavicular rupture? Is there a therapy apart from the figure of eight bandage that I tried for many months and it did not work probably because when sleeping, I cannot hold my shoulder in the backward position. As soon as I move the arm forward, the clavicle moves forward and the distance between clavicle and the first rib is too large for the repair to take place spontaneously.
I am a sports medicine physician, (30 years of muscle and circulation research and in vitro and in vivo - small animal surgery) and anesthesiologist, ICU physician (40 years of observing attentively surgeons by their valuable work). I believe to know, more or less, what the surgeons know and can do and what they do not know and cannot do. Well, nobody is perfect
Therefore I am looking for a surgeon who performed a series of exactly those operations and has experience of the exchange of ideas with the colleagues who performed longer series of similar operations. So if you know somebody, please give me the reference.
Do you have a solution? My literature research was quite unsuccessful.
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I think you need to see Orthopedic surgeon to evaluate the ligament damage and he will choose an approximation procedure suitable to your case. I think conservative procedure is too late.
Wish you luck
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Hello All,
 This is the image of Total RNA non- denaturing gel electrophoresis. I performed a total RNA extraction from dog (cartilage, blood, synovial fluid and knee ligament) tissue. Can someone please tell me what are the two bands intercalated between the 28s and 18s bands showing in the 3rd lane? Thanks
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Hello Gabriela,
Firstly i think if you further want to process your RNA then try to optimize your isolation procedure so that your band (28s and 18s) intensities correspond to 2:1 ratio. That will ensure you a good quality of your RNA. Also for RNA quality assessment you can use RIN.
Now as it appears from your gel image the 2 bands might correspond to 5s and 5.8s.
There are articles where you will find that it is being stated that when eukaryotic RNA isolation is done then along with 28 and 18s one might also observe 5 and 5.8s.
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Hello. I'm using the FX-4000 tension system with BioFlex plates to apply strain to different ligaments and tendons. The protocol that I have been using is 4% or 10% (0.5Hz- 30s rest, 10s strain). Seeding the plates has been successful for synovium, patellar tendon, medial collateral ligament, and meniscus but not for anterior cruciate ligament. When I try to start the protocol, the ACL cells start to detach. I have tried to seed the wells with different concentrations (1x10^5, 3x10^5, 1x10^6) and different media (with and without FBS) and is still not working. We are using Collagen I coated plates. Could you help me with some info to overcome this issue? Thank you!
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Thanks everyone for your help, I think I will try a different coated plate (maybe laminin), otherwise I can use platelet lysates instead of FBS for better attachment.
Here is the company feedback:
ACL cells are known to adhere differently in vitro than MCL cells and other cells types. A couple references that may be of interest:
Adhesiveness of human ligament fibroblasts to laminin. Sung KL, Steele LL, Whittermore D, Hagan J, Akeson WH. J Orthop Res. 1995 Mar;13(2):166-73.
Adhesion strength of human ligament fibroblasts. Sung KL, Kwan MK, Maldonado F, Akeson WH. J Biomech Eng. 1994 Aug;116(3):237-42.
You may want to try another coating, such as fibronectin or laminin. In addition, you could use 3D cell culture methods and grow the ACL cells in a collagen hydrogel and apply strain with the Tissue Train® System (seehttp://www.flexcellint.com/slideshow4.htm for more information on the products in this line).
Thanks everyone.
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What do you think about utility of platelet rich plasma (PRP) in treatment of tendon and ligament injuries?
What is your experience with this method and your preferred preparation methods.
Would you expect benefit of such treatment in heamophilia patients?
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Prolotherapy short for Proliferative Therapy has been shown to help heal tendon and ligament injuries with injection with PRP being more effective than Dextrose injection. However, PRP is much more costly.  I have attached an article which is a review of Prolotherapy with an algorithm for treatment.
For Hemophilia patients, there was a study performed  by Buda et al using Bone Marrow-Derived Cells (which is in the continuum of proliferative therapy) infused in the joint during Arthroscopic surgery which showed regeneration and stabilization of joint degeneration.  See reference below:
Cartilage. 2015 Jul; 6(3): 150-5.
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Specifically with regard to knee, hip and/or lower back pain.
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One relavent RCT from the PubMed:
Hashemi, M., Jalili, P., Mennati, S., Koosha, A., Rohanifar, R., Madadi, F., Sajad, S. & Taheri, F. (2015). The Effects of Prolotherapy With Hypertonic Dextrose Versus Prolozone (Intraarticular Ozone) in Patients With Knee Osteoarthritis. Anesthesiology and pain medicine, 5(5).
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Some sources explain there are 4 areas composing the ligament-to-bone or tendon-to-bone insertion, namely bone- calcified fibrocartilage - uncalcified fibrocartilage- ligament. I would like to know if someone knows about the gradation of the Young modulus across each of these sections and how it behaves under loading
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Hello Kenza,
The attached pdf may be of assistance.
Jeff
Guy M. Genin, Alistair Kent, Victor Birman, Brigitte Wopenka, Jill D. Pasteris, Pablo J. Marquez, and Stavros Thomopoulos.  Functional Grading of Mineral and Collagen in the Attachment of Tendon to Bone, Biophysical Journal Volume 97, Issue 4, 19 August 2009, Pages 976–985
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One example of each from real life scenario will be appreciated. 
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Hi Yasmin, an example of where the tendon experiences a high load, high strain rate may be the Achilles tendon during running, where loads of up to 5 times BW, and instantaneous loading rates of up to 121 x BW can be easily seen. See J Hum Kinet. 2014 Dec 9; 44: 155–159
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Round ligament forms covering of the sac in an inguinal hernia in female children. Should it be preserved or ligated / transfixed. What would be long term implications of cutting the round ligament since they lend some support  (false support of uterus)  in adult life?
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Dear Zahoor, in girls I will excise the distal sac. I find the sac can be separated easily by blunt dissection from it's attachments. I never use diathermy during inguinal surgery in children. I also always check for an ovary/Fallopian tube in a girl by opening the sac.
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Do you manage it conservatively or surgically (volar and/or dorsal approach)?
If only volar fracture is present, do you also perform a dorsal approach and repair the radiotriquetral ligament?
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Always combined approaches. Volarly, with extended carpal tunnel approach, to reconstruct the volar RC ligaments and check the integrity of the volar ulnocarpal ligaments. Dorsally, to reconstruct dorsal RC ligament, capsule and retinaculum. Immobilization with Ex Fix for 6 weeks 
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I have a patient with active ankylosing spondylitis(AS) and second (2007;2012) kidney transplantation (due to chronic glomerulonephritis). Ankylosing spondylitis is active with BASDAI . 5,5 -  6,0 during last 3 years, CRO changes from 11 - 25 mg/l (normal value 0 - 5 mg/l), spine ligament calcification has found in 3 cervical and lumbar spine ligaments  on X- ray. Due to kidney transplantation the patient use MMF and prednisolone. 
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I am unaware of any published reports on the concomitant use of a TNF inhibitor and mycophenolate mofetil in AS. It would seem reasonable to try this combination while monitoring closely for any potential adverse events in your patient. Before attempting this treatment regimen, I advise consulting with your local renal transplant colleagues.
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Can anyone tell me the cross-sectional area of semitendinosus and biceps femoris (short head) tendons please? I can't seem to find any information on the cross-sectional area of these 2 tendons for humans, only the muscles. Thank you for any help you can give me!
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Thank you for your reply. What I am actually looking for is some average values for the cross-sectional area of these tendons in humans. I can't seem to find any papers that give any actual values for these tendons and was wondering if anyone had any information? 
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I want to look at collagen breakdown and formation, what would be some markers that I could stain for?
Thank you!
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Hi Dr.Singh,
to have an overview of collagen turnover in ligaments and tendons I suggest to analyze collagen type I and III, lysyl hydroxylase (to evaluate collagen maturation) and then, in relation to collagen degradation, MMP-1. I suggest also to consider TIMP-1 to understand the eventual MMP-1 inhibition. If you want, you can use also sirius red to stain collagen in your samples.
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I want a standard protocol for measuring spring ligament
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I suggest using ultrasonographic based literature to start.
See Ultrasound of the Musculoskeletal System - Stefano Bianchi, Carlo Martinoli
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Hey,
I am searching for any reports stating the presence of costocoracoid ligament in cadavers, and if it is present can it cause such degree of occlusion/compression of the subclavian vessels, leading to the gangrene in patients? 
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I have found such ligament during dissection in a female cadaver left side today only,  a thickened band arising from first rib to coracoid orocess.
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They may have a similar look when they attain a huge size.
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I agree, and MRI can differentiate as well. The surgical problem is similar for both-- avoiding ureteral injury and avoiding uterine artery injury that (1) predisposes to ureteral injury; and (2) may result on transfusion and even hysterectomy. So, open the sidewall, identify the ureter early if possible, shell the fibroid out going from lateral to medial, and trace the ureter through the pelvis when resection and reconstruction are complete. Consider laparotomy with the patient in stirrups and a sound in the cervis. If yo do not do ureteral dissection frequently, consider a stent. 
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The TFCC with its discus, ulna-carpal joint and ligaments is crucial for stability and mobility of the wrist. Due to its anatomic complexity it is submitted to delayed generation when it is injured.
Expected lesions in the TFCC in young pregnant woman are due to overburden of extension-pronation stance of wrist after a long bicycle-trip.
 
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Hi,
I am aware this is not a forum that should be used to advocate a particular device, especially one that does not have any recognised research behind it, however I treat a lot of TFCC injuries and have been using a strap called the "Wrist Widget" with a lot of success. I do this having first ascertained through a weight bearing test that it is the TFCC that is damaged. The patient may also need a wrist brace initially to restrict wrist extension also.
Once symptoms have settled, I begin a program similar to the one David has mentioned. Please note that pronator quadratus is also an important ulnar stabilser and needs addressing in treatment also as appropriate. 
In the elite and not so elite sports people I see, I employ a taping protocol for sport that does not compress the ulnar head. Education is also vital, especially with reference to gripping, and activities that demand  forceful pronation.
Good luck,
Hamish