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1

Anterior tibial post impingement in a posterior stabilized total knee arthroplasty  

Microsoft Academic Search

Despite the numerous long-term success reports of posterior stabilized (PS) total knee arthroplasty (TKA), recent retrieval studies of various PS TKA designs revealed wear and deformation on the anterior side of the tibial post. This study investigated the mechanisms of anterior impingement of the post with the femoral component. Seven cadaveric knees were tested to study kinematics and tibial post

Guoan Li; Ramprasad Papannagari; Ephrat Most; Sang Eun Park; Todd Johnson; Linggawati Tanamal; Harry E. Rubash

2005-01-01

2

Anterior tibial striations.  

PubMed

Radiolucent horizontal striations of the anterior cortex of the tibia were seen in 10 athletes who were evaluated for "shin-splints." There were seven basketball players, two professional dancers, and one hurdler. Each patient's history included vigorous leaping in performance of athletic feats. All the lesions were similar in location and appearance and were accompanied by thickening of the anterior tibial cortex. These striations are considered stress fractures and were not observed in a group of runners who were evaluated for shin-splints. PMID:6331753

Daffner, R H

1984-09-01

3

[Entrapment of the anterior tibial artery in a distal tibial fracture after intramedullary nailing].  

PubMed

We present a patient with a closed displaced distal tibia fracture with entrapment of the anterior tibial vessels in the fracture after tibial nailing. This complication was initially not recognised. After several debridements of the forefoot on the same side due to open metatarsal fractures and severe soft tissue injury, a free latissimus dorsi flap was used for covering the dorsum pedis. Preoperative angiography showed occlusion of the anterior tibial artery at the fracture line which was interpreted as a secondary occlusion due to an intima lesion of the vessel after injury. The entrapment in the fracture line was recognised intra-operatively during the preparation of the anterior tibial vessel. PMID:16391935

Labler, L; Wedler, V; Mica, L; Trentz, O

2006-02-01

4

Combined anterior tibial tendon rupture and posterior tibial tendon dysfunction in advanced flatfoot.  

PubMed

The combination of spontaneous anterior tibial tendon rupture and posterior tibial tendon dysfunction has rarely been reported in the literature. This is a case report of a 78-year-old patient presenting with a history of longstanding, progressive flatfoot deformity, clinically grade III posterior tibial tendon dysfunction, and dropfoot gait. Radiographic films revealed severe flatfoot, and the clinical examination was consistent with a complete rupture of the anterior tibial tendon and severe posterior tibial tendon degeneration as well as rupture of the spring and deltoid ligaments. Treatment by triple arthrodesis and repair of the anterior tibial tendon affected pain relief and clinical as well as radiographic correction at the 4-month postoperative assessment. PMID:17145469

Frigg, Arno Martin; Valderrabano, Victor; Kundert, Hans-Peter; Hintermann, Beat

5

Anterior tibial artery aneurysm: Case report and literature review  

PubMed Central

INTRODUCTION We present a patient with a true anterior tibial artery aneurysm without any causative history. PRESENTATION OF CASE A 59 year old male was referred with a swelling on his left lateral ankle which he noticed 2 months ago, with symptoms of soaring pain. Additional radiological research showed a true arterial tibialis anterior aneurysm. True anterior tibial artery aneurysm is a rare condition. The aneurysm was repaired by resection and interposition of a venous bypass. DISCUSSION Patients may complain about symptoms like calf pain, distal ischemia, paresthesias due to nerve compression and the presence of a pulsating or increasing mass. Symptomatic aneurysms require surgical intervention, where bypass with a venous saphenous graft have shown good patency and endovascular treatment have shown good short term results. Asymptomatic and small aneurysm can be followed for several years with DUS. CONCLUSION Clinical features, radiographic findings, surgical management, and a review of the literature on true anterior tibial aneurysms are discussed.

Sigterman, Tim A.; Dolmans, Dennis E.J.G.J.; Welten, Rob J.Th.J.; Krasznai, Attila; Bouwman, Lee H.

2012-01-01

6

Bilateral anterior tibial compartment syndrome in association with hypothyroidism.  

PubMed Central

Local vascular and traumatic involvement are well-recognized causes of anterior tibial compartment syndrome (ATCS) terminating as myoneural ischaemia. However, in a large number of patients the cause of ATCS remains unidentified. We document the occurrence of bilateral ATCS in a patient of hypothyroidism, to our knowledge a previously unrecorded association.

Thacker, A. K.; Agrawal, D.; Sarkari, N. B.

1993-01-01

7

Blunt trauma of the anterior tibial artery in professional footballers.  

PubMed

Three cases of blunt trauma to the anterior tibial artery in professional footballers are described. Each case was managed conservatively, allowing the players to promptly return to competitive fixtures. We hope the outcomes of the cases described might be helpful for teams facing the challenge of managing similar injuries. PMID:21030392

Shalhoub, Joseph; English, Bryan; Byard, Matt; Franklin, Ian J

2010-10-27

8

The effect of the point of application of anterior tibial loads on human knee kinematics  

Microsoft Academic Search

Coupled axial tibial rotation in response to an anterior tibial load has been used as a common diagnostic measurement and as a means to load the ligamentous structures during laboratory tests. However, the exact location of the point of application of these loads as well as the corresponding sensitivity of the coupled tibial rotation to this point can have an

Theodore W Rudy; Masataka Sakane; Richard E. Debski; Savio L.-Y Woo

2000-01-01

9

Anterior opening wedge high tibial osteotomy: the effect of increasing posterior tibial slope on ligament strain  

PubMed Central

Background Although a previous study showed that anterior opening wedge high tibial osteotomy (HTO) for sagittal plane correction induced no increased strain in the anterior cruciate ligament (ACL), we hypothesized that other ligamentous restraints of the knee may be subjected to increased strain. Methods We mounted 6 cadaveric knees at 15° flexion in a testing apparatus that provided compressive and anterior loading. We measured the strain in the ACL, posterior (PCL), medial (MCL) and lateral (LCL) ligaments for 6 randomized loading combinations and 3 conditions: intact, after anterior opening wedge HTO with a 5-mm plate and with a 10-mm plate. Results The mean ACL strain decreased from 0.84% (standard deviation [SD] 1.50%) at baseline to ?6.28% (SD 5.40%) with a 5-mm anterior opening wedge osteotomy and to ?6.77% (SD 4.79%) with a 10-mm osteotomy. Stepwise regressions yielded no significant effect of compression, anterior loading or osteotomy on PCL, MCL or LCL strain. Conclusion Increasing the posterior slope via HTO did not increase strain in the PCL, MCL or LCL.

Martineau, Paul A.; Fening, Stephen D.; Miniaci, Anthony

2010-01-01

10

Fracture of the polyethylene tibial post in a NexGen posterior-stabilized knee prosthesis  

Microsoft Academic Search

We reported a case of fracture of a polyethylene tibial post in a 44-year-old woman after 3 years of NexGen posterior-stabilized total knee arthroplasty (Zimmer, Warsaw, IN). Burnishing and delamination of the polyethylene was found around the breakage site of the post, especially over the anterior aspect of the post base. It indicated that the possible failure mechanism was the

Yen-Shuo Chiu; Wei-Ming Chen; Ching-Kuei Huang; Chao-Ching Chiang; Tain-Hsiung Chen

2004-01-01

11

Pseudoaneurysm of the anterior tibial artery: a complication of ankle arthroscopy.  

PubMed

The authors describe a case of pseudoaneurysm of the anterior tibial artery after ankle arthroscopy that was undiagnosed for more then 10 weeks. The pseudoaneurysm was resected and postoperative recovery was uneventful. Anterior tibial artery pseudoaneurysm is a rare complication of ankle arthroscopy and should be considered when a patient presents with a local swelling of the anterolateral ankle joint. PMID:22299333

Verbrugghe, P; Vandekerkhof, J; Baeyens, I

12

Anterior tension band plating for anterior tibial stress fractures in high-performance female athletes - A report of 4 cases  

Microsoft Academic Search

Stress fracture of the anterior tibial cortex is an extremely challenging fracture to treat, especially in the high-performance female athlete who requires rapid return to competition. Previous reports have not addressed treating these fractures in the world-class athlete with anterior plating. We hypothesize that anterior plating is a biomechanically sound approach to treatment of these fractures, and will lead to

Olivier Borens; Milan K. Sen; Russel C. Huang; Jeffrey Richmond; Peter Kloen; Jesse B. Jupiter; David L. Helfet

2006-01-01

13

Non-union of a midshaft anterior tibial stress fracture: A frequent complication  

Microsoft Academic Search

We report a case of non-union of a midshaft anterior cortex tibial stress fracture and review the literature concerning this pathological entily. This is a relatively rare clinical form of tibial stress fracture which often results in delayed union, non-union or complete fracture. Initial management is as for a conventional stress fracture, associated in some cases, according to certain authors,

C. Mabit; C. Pécout

1994-01-01

14

Anterior cruciate ligament reconstruction using hamstring tendon graft without detachment of the tibial insertion  

Microsoft Academic Search

Introduction: We report results of the anterior cruciate ligament reconstruction using a four-strand hamstring graft without detachment of the tibial insertion of the tendons. Material and Methods: In 74 patients the hamstring graft was fixed using an endobutton on the femoral side and a barbed staple on the tibial side. There were 69 male and 5 female patients. The mean

M. Salman Ali; A. Kumar; S. Adnaan Ali; T. Hislop

2006-01-01

15

The Effects of Muscle Fatigue on Neuromuscular Function and Anterior Tibial Translation in Healthy Knees  

Microsoft Academic Search

We investigated the effect of quadriceps and hamstring muscle fatigue on anterior tibial translation and muscle reaction time in 10 healthy subjects. The six men and four women had an average age of 21.3 years and had no known pathologic knee conditions. Each patient underwent a knee examination, arthrometer measure ments of tibial translation, subjective functional assess ment, and an

Edward M. Wojtys; Bradford B. Wylie; Laura J. Huston

1996-01-01

16

Insufficiency fracture of the tibial plateau after anterior cruciate ligament reconstructive surgery: a case report and review of the literature  

PubMed Central

Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up.

Wong, Jessica J.; Muir, Brad

2013-01-01

17

The modified tibial tubercle osteotomy for anterior knee pain due to chondromalacia patellae in adults  

PubMed Central

Objectives To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae. Methods A total of 47 consecutive patients (51 knees) with arthroscopically proven chondromalacia, who had failed conservative management, underwent a modified Fulkerson tibial tubercle osteotomy. The mean age was 34.4 years (19.6 to 52.2). Pre-operatively, none of the patients exhibited signs of patellar maltracking or instability in association with their anterior knee pain. The minimum follow-up for the study was five years (mean 72.6 months (62 to 118)), with only one patient lost to follow-up. Results A total of 50 knees were reviewed. At final follow-up, the Kujala knee score improved from 39.2 (12 to 63) pre-operatively to 57.7 (16 to 89) post-operatively (p < 0.001). The visual analogue pain score improved from 7.8 (4 to 10) pre-operatively to 5.0 (0 to 10) post-operatively. Overall patient satisfaction with good or excellent results was 72%. Patients with the lowest pre-operative Kujala score benefitted the most. Older patients benefited less than younger ones. The outcome was independent of the grade of chondromalacia. Six patients required screw removal. There were no major complications. Conclusions We conclude that this modification of the Fulkerson procedure is a safe and useful operation to treat anterior knee pain in well aligned patellofemoral joints due to chondromalacia patellae in adults, when conservative measures have failed.

Jack, C. M.; Rajaratnam, S. S.; Khan, H. O.; Keast-Butler, O.; Butler-Manuel, P. A.; Heatley, F. W.

2012-01-01

18

Increased medial tibial slope in teenage pediatric population with open physes and anterior cruciate ligament injuries  

Microsoft Academic Search

Purpose  Variations in bony morphology have been associated with anterior cruciate ligament (ACL) injury risk. The primary aim of this\\u000a study was to compare the tibial slope in the teenage pediatric population with open physes, with and without ACL injury. The\\u000a secondary aims were to compare the notch width index (NWI) and determine the influence of gender and age on tibial

Shail Vyas; Carola F. van Eck; Nina Vyas; Freddie H. Fu; Norman Y. Otsuka

2011-01-01

19

Anterior Cruciate Ligament Reconstruction With a Quadrupled Hamstring Autograft Does Not Restore Tibial Rotation  

Microsoft Academic Search

Summary: As a result of the morbidity associated with anterior cruciate ligament (ACL) reconstruction with a bone-patellar-tendon-bone graft, many orthopaedic surgeons prefer hamstrings as the graft for ACL reconstruction. However, this selection is not based on solid scientific evidence. In vitro research shows that this graft cannot restore control of tibial rotation. Our recent in vivo research work has also

Anastasios D. Georgoulis; Stavros Ristanis; Vasilis Chouliaras; Constantina Moraiti; Nick Stergiou

2005-01-01

20

Operative treatment in case of a closed rupture of the anterior tibial tendon  

Microsoft Academic Search

Closed rupture of the tibial anterior tendon is a rare clinical entity. Case reports in the literature reveal a total of only 49 cases up to the year 2000. According to these reports, the age group affected is 50 to 70 years old, and there are more men than women affected. Although the functional limitation is quite considerable, late diagnosis

Stephanie Otte; Hans-Michael Klinger; Frank Lorenz; Thomas Haerer

2002-01-01

21

Relationship between Static Anterior Laxity Using the KT-1000 and Dynamic Tibial Rotation during Motion in Patients with Anatomical Anterior Cruciate Ligament Reconstruction.  

PubMed

The anterior cruciate ligament (ACL) plays an important role in controlling knee joint stability, not only by limiting tibial anterior translation but also by controlling knee axial rotation. The aim of ACL reconstruction is to reduce excessive anterior joint laxity, hoping to restore normal tibiofemoral kinematics including knee axial rotation. The purpose of this study was to investigate the relationship between static anterior instability and tibial rotation during several activities in an anterior cruciate ligament reconstructed knee. Seven patients with unilateral ACL injury performed plain walking, running, landing and side step cutting tasks after ACL reconstruction with a mean follow-up of 14 months. The kinematic data for the 4 motions was measured using a motion analysis system and the point cluster technique. The evaluation period was defined to be from the first contact to removal of the tested leg from the ground. Maximum tibial internal rotation during tasks was calculated using the point cluster technique (PCT). Passive anterior tibial translation was measured using a KT-1000 arthrometer. Regression analysis was used to determine the correlation of the maximum internal rotation with the side-to-side difference of static anterior tibial translation measured using a KT-1000 arthrometer. During side step cutting maneuvers, maximum tibial internal rotation significantly showed negative correlation with static anterior tibial translation (p<0.05, r=0.83). The anterior laxity contributed to the normal knee rotation kinematics. The normal anterior tibial translation obtained by ACL reconstruction is thought to be the key factor in successful restoration of normal knee kinematics. PMID:23925154

Sato, Koji; Maeda, Akira; Takano, Yoshio; Matsuse, Hiroo; Ida, Hirofumi; Shiba, Naoto

2013-08-07

22

Osgood Schlatter lesion: histologic features of slipped anterior tibial tubercle.  

PubMed

No study reports the histological features of the various zone of the anterior tubercle of the tibia in the different stages of the Osgood-Schlatter (O-S) lesion. For this reason we carried on an histological study. Specimens were taken from 13 patients with O-S lesion prior to surgery. In 4 cases in the apophyseal stage lesions were present in an altered fibrocartilage anterior to the ossification centre. In 9 cases in the epiphyseal stage varying degrees of reparative tissues were observed in the bed of the fragment of the secondary ossification centre. In 3 of them a zone of lesion was observed within the fibrocartilage anterior to the ossification centre. These results suggest that the slippage of the patellar tendon insertion may be progressive and caused by pathological fibrocartilage. PMID:21669134

Falciglia, F; Giordano, M; Aulisa, A G; Poggiaroni, A; Guzzanti, V

23

Arthroscopic reduction and fixation of avulsion fracture of the tibial attachment of the anterior cruciate ligament.  

PubMed

In treating avulsion fracture of the tibial attachment of the anterior cruciate ligament, surgical reduction and fixation of fractured bone is necessary for patients who have a wide displacement of bone fragment (i.e., types III and IV in the Meyers classification). Our arthroscopic technique allows the creation of bone tunnels on the medial and lateral sides of the bone fragment from the medial side of the tibial tubercle without using special equipment. At surgery, fixation wire is prepared into a loop, pulled into the joint space, and the loop is opened within the joint. This makes intra-articular manipulation easy, and the bone can be reduced more accurately. This arthroscopic technique decreases surgical invasion of the joint, allows good postoperative range of motion without problems, and is useful in preventing extension limitation due to dislocation of the anterior portion of the fragment. PMID:11694937

Hara, K; Kubo, T; Shimizu, C; Suginoshita, T; Hirasawa, Y

24

Surface EMG observation and isokinetic test on pressing-kneading manipulations for exercise fatigue of anterior tibial muscle  

Microsoft Academic Search

Objective  To observe the therapeutic effect of An-pressing and Rou-kneading manipulations for exercise fatigue of the anterior tibial\\u000a muscle.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Sixty healthy subjects were randomly divided into two groups, 30 in each group. Isokinetic test training was employed to induce\\u000a left anterior tibial muscle fatigue. After this, subjects in the observation group received 5 min of tuina treatment, while\\u000a subjects in the

Junfeng Zhang; Debin Sun

2011-01-01

25

Effects of denervation, immobilization and cachexia on fibre size in the anterior tibial muscle of the rat  

Microsoft Academic Search

The effects of denervation, immobilization and cachexia on the size of the various histochemical fibre types were studied in the anterior tibial muscle of male Wistar rats aged 60–100 days. Denervation was induced by unilateral sectioning of the sciatic nerve, immobilization by a plaster cast on one hindlimb and cachexia by restriction of food intake.

C. F. Lindboe; J. Presthus

1985-01-01

26

Arthroscopic treatment for tibial "Peel off" tears in anterior cruciate ligament-case report.  

PubMed

Anterior cruciate ligament (ACL) injury was very common, and its reconstruction is one of the most commonly performed orthopaedic surgeries. A standard treatment option for ACL complete rupture in active young patients is debridement of remnant tissue and reconstruction with various types of tendon graft. However, "A tibial peel off tear" of ACL without bony avulsion can be treated using preservation of original ACL and trans-osseous pullout suture repair. The IKDC subjective score was 90, the objective score was A, and the Lysholm score was 95 at 24 months after surgery. KT-2000 arthrometer showed 2 mm side-to-side difference. Pivot shift test and Lachman test were negative, and there was no limitation in range of motion. Patient returned to full activities including sports and satisfied with the surgical results. In the postoperative MRI at 6 months after the surgery, the continuity of ACL was well maintained without any Cyclops lesion. We believe that trans-osseous pullout suture repair could be included as an alternative method in this "tibial peel off" type ACL injury instead of the usual removal of remnant tissue and reconstruction with a graft. PMID:23412240

Ahn, Jin Hwan; Han, Kye Young; Yu, In Sang; Koh, Kyoung Hwan

2012-10-27

27

Double-concave deformity of the polyethylene tibial post in posterior stabilized total knee arthroplasty.  

PubMed

This report describes a unique case of bilateral total knee arthroplasty necessitating revision of the polyethylene insert, which showed prominent marks on the tibial post resulting from repeated seiza-style sitting. The patient presented 7 years postoperatively with knee pain and flexion disturbance due to continuous joint effusion persisting for more than 4 months. Proliferating synovia throughout the joint revealed reactive synovitis to polyethylene particles. The retrieved polyethylene inserts displayed double-concave deformity of the tibial post with burnishing and creep in tibiofemoral articulation. The damage pattern of retrieved polyethylene inserts reflected the data from tibiofemoral contact location obtained using a shape-matching technique in the early postoperative phase. This case provides an example of damage to the polyethylene tibial post caused by a floor-sitting lifestyle and the potential clinical sequelae. PMID:19261434

Niki, Yasuo; Matsumoto, Hideo; Yoshimine, Fumihiro; Toyama, Yoshiaki; Suda, Yasunori; Banks, Scott A

2009-03-04

28

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees  

Microsoft Academic Search

Background  The tibial post in posterior-stabilized total knees is a potential source of polyethylene wear debris, but the relationship\\u000a between the shape and location of the tibial post in relation to the tibiofemoral bearing surfaces and the subsequent wear\\u000a damage patterns remains unknown.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We used observations made on retrieved implant components from three contemporary posterior-stabilized knee designs to examine\\u000a how differences

Mark M. Dolan; Natalie H. Kelly; Joseph T. Nguyen; Timothy M. Wright; Steven B. Haas

2011-01-01

29

Post damage in contemporary posterior-stabilized tibial inserts: influence of implant design and clinical relevance.  

PubMed

The mechanisms of damage at the polyethylene post in 3 contemporary tibial insert designs were evaluated and compared with a historical standard (Insall-Burstein II; Zimmer, Warsaw, Ind). One hundred five gamma sterilized posterior-stabilized tibial inserts were revised after an average of 4.7 years (0.05-13.6 years). Retrievals were classified according to their designs: Insall-Burstein II (n = 28); PFC (Johnson & Johnson, Raynham, Mass; n = 30); NexGen (Zimmer; n = 32); and Scorpio (Stryker Orthopaedics, Mahwah, NJ; n = 15). Reasons for revision and patient details were available. Surface damage scoring and photogrammetry were performed on all the retrieved tibial inserts. Oxidation analysis was carried out for traceable historical, gamma air-sterilized and conventional, gamma inert-sterilized tibial inserts (n = 61) with the use of infrared spectroscopy. The posts for all 3 contemporary designs exhibited damage similar to the historical controls. Articular, post, and backside damage scores significantly increased with implantation time. Post damage was insensitive to design and patient factors but was exacerbated by oxidation. An association between damage at the post and articular surface was also confirmed. Logistic models suggested an interaction between post damage, backside surface damage, and implant loosening. PMID:21575793

Medel, Francisco J; Kurtz, Steven M; Sharkey, Peter F; Austin, Matthew S; Klein, Gregg R; Cohen, Alexis R; Patel, Hina; Goldberg, Victor M; Kraay, Matthew J; Rimnac, Clare M

2011-06-01

30

Post operative voiding efficacy after anterior colporrhaphy.  

PubMed

The aim of this study was to determine the most effective and suitable time to remove the urinary catheter (Foley) after anterior and posterior colporrhaphy surgery. Patients who experience anterior Colporrhaphy operation for genuine stress incontinency or pelvic organ prolapsed will have post operative voiding dysfunction. These patients need postoperative drainage. One of the methods preferred for this purpose is to apply Foley Catheter, but there is no particular regimen available for the exact time of catheter removal in these patients. We have tried to find out the best time to remove Foley catheter after which the repeated Foley catheter is not required or minimized. One hundred and eighty nine patients who have been undergone Colporrhaphy have been selected randomly and divided into three groups' as 1, 2 and 4 days of catheter removal. The number of patients in each group was 62, 63 and 64 respectively. In all three groups, before removing urinary catheter, it was clamped every 4 hrs, for 3 times. After removing of Foley, the patients were guided for urination; the voiding and residual volume was measured. In the patients with an increase of residual volume, the repeated Foley requirement was increased. However, 5.6 % of the patients with residual volume of < or = 33 percent and 23.9% of the patients with residual volume between 33 to 68 percent, and finally 64.8% of the patients with residual volume of > or = 68% had repeated Foley insertion. When considering the number of days, 85, 65 and 35.7 percent of the patients needed repeated Foley after 1, 2, and 4 days of catheter removal respectively. Interestingly, in the third group (4 days of the catheter removal) with residual volume of < or = 33% the repeated Foley requirement was nil, with no increase risk of urinary infection. We suggest that the best time to remove the urinary Foley catheter after anterior and posterior Colporrhaphy is the day four. PMID:21137666

Kokabi, Roya; Fereidouni, Zhila; Meshkibaf, Mohammad Hassan; Miladpoor, Behnoosh

31

Double-Concave Deformity of the Polyethylene Tibial Post in Posterior Stabilized Total Knee Arthroplasty  

Microsoft Academic Search

This report describes a unique case of bilateral total knee arthroplasty necessitating revision of the polyethylene insert, which showed prominent marks on the tibial post resulting from repeated seiza-style sitting. The patient presented 7 years postoperatively with knee pain and flexion disturbance due to continuous joint effusion persisting for more than 4 months. Proliferating synovia throughout the joint revealed reactive

Yasuo Niki; Hideo Matsumoto; Fumihiro Yoshimine; Yoshiaki Toyama; Yasunori Suda; Scott A. Banks

2010-01-01

32

Dorsal-plantar loop technique using chronic total occlusion devices via anterior tibial artery.  

PubMed

The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage. PMID:23364993

Kim, Seunghwan; Choi, Donghoon; Shin, Sanghoon; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Hong, Myeong-Ki; Jang, Yangsoo

2013-03-01

33

Dorsal-Plantar Loop Technique Using Chronic Total Occlusion Devices via Anterior Tibial Artery  

PubMed Central

The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage.

Kim, Seunghwan; Shin, Sanghoon; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Hong, Myeong-Ki; Jang, Yangsoo

2013-01-01

34

MRI evaluation of tibial tunnel wall cortical bone formation after platelet-rich plasma applied during anterior cruciate ligament reconstruction  

PubMed Central

Background After anterior cruciate ligament (ACL) reconstruction, formation of cortical sclerotic bone encircling the femoral and tibial tunnel is a part of intratunnel graft healing. During the physiological cascades of soft tissue healing and bone growth, cellular and hormonal factors play an important role. The purpose of this study was to non-invasively but quantitatively assess the effect of intraoperatively applied platelet-rich plasma (PRP) on the formation of cortical bone encircling the tibial tunnel. Patients and methods In fifty patients, standard arthroscopic ACL reconstructions were performed. The PRP group (n = 25) received a local application of PRP while the control group (n = 25) did not receive PRP. The proximal tibial tunnel was examined by MRI in the paraxial plane where the portion of the tibial tunnel wall circumference consisting of sclerotic cortical bone was assessed with testing occurring at one, two and a half and six months after surgery. Results At one month after surgery, differences between the groups in the amount of cortical sclerotic bone encircling the tunnel were not significant (p = 0.928). At two and a half months, the sclerotic portion of the tunnel wall in the PRP group (36.2%) was significantly larger than in the control (22.5%) group (p = 0.004). At six months, the portion of sclerotic bone in the PRP group (67.1%) was also significantly larger than in the control (53.5%) group (p = 0.003). Conclusions Enhanced cortical bone formation encircling the tibial tunnel at 2.5 and 6 months after ACL graft reconstruction results from locally applied platelet-rich plasma.

Rupreht, Mitja; Vogrin, Matjaz; Hussein, Mohsen

2013-01-01

35

The effect of the material property change of anterior cruciate ligament by ageing on joint kinematics and biomechanics under tibial varus/valgus torques.  

PubMed

It is known that the anterior cruciate ligament (ACL) plays a role in providing joint stabilities under tibial varus/valgus torques and the material behavior of the ACL has changed with ageing. However, the effect of this variation of the ACL material property on joint kinematics and biomechanics under tibial varus/valgus torques has still not been clarified.In this paper, three finite element (FE) models of an intact tibiofemoral joint were reconstructed with different ACL material properties, corresponding to the ACL on the younger, middle and older ages, respectively. The joint kinematics, the stress distribution and resultant force of the ACL were obtained under a tibial varus or valgus torque load. It was found that the variation in the ACL material property would result in great changes in some joint displacements (i.e., the tibial anterior translation and external rotation). The maximal stress value in the ACL had also altered while the stress distribution did not varied obviously. The great change in the tibial anterior translation illustrated that ACL played an important role against varus/valgus torques by controlling the coupled tibial anterior translation//external rotation rather than the corresponding varus/valgus rotation. PMID:24092114

Wan, Chao; Hao, Zhi-Xiu; Wen, Shi-Zhu

2013-01-01

36

Mid-Anterior Tibial Stress Fracture in a Female Elite Athlete  

Microsoft Academic Search

We report the case of an unusual tibial stress fracture and its successful surgical treatment in a female elite sprinter 2\\u000a years after complete consolidation of the same tibia following resection of an osteoid osteoma.

Patricia A. M. Netzer

2007-01-01

37

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma  

Microsoft Academic Search

Background  Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion.\\u000a Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have\\u000a been the standard treatment for foot drop.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to

Jennifer L. Giuffre; Allen T. Bishop; Robert J. Spinner; Bruce A. Levy; Alexander Y. Shin

38

Pullout strength of tibial graft fixation in anterior cruciate ligament replacement with a patellar tendon graft: interference screw versus staple fixation in human knees  

Microsoft Academic Search

The endoscopic single incision technique for anterior cruciate ligament (ACL) reconstruction with a femoral half-tunnel may\\u000a lead to a graft\\/tunnel mismatch and subsequent protrusion of the block from the tibial tunnel. The typical tibial fixation\\u000a with an interference screw is not possible in these cases. Fixation with staples in a bony groove inferior to the tunnel outlet\\u000a can be used

T. G. Gerich; A. Cassim; C. Lattermann; H. P. Lobenhoffer

1997-01-01

39

[A manifestation suggesting juvenile spondylarthropathy: anterior tibial enthesitis. Apropos of 3 cases].  

PubMed

The tibial tuberosity may be affected by enthesitis in seronegative spondylarthropathies, especially in childhood. Three personal cases illustrate this possibility. Data from the literature seem to confirm that enthesitis is more common in juvenile forms (where it may occur as the first manifestation) than in adult forms. Enthesitis is manifested mainly by clinical symptoms. Roentgenographic changes are inconsistent and variable; ossification may develop. Osgood Schlatter disease is the main differential diagnosis. Persistent enthesitis of the tibial tuberosity in a young boy should suggest spondylarthropathy. PMID:2029120

Wendling, D; Bertrand, A M

1991-02-01

40

A comparison of five tibial-fixation systems in hamstring-graft anterior cruciate ligament reconstruction  

Microsoft Academic Search

The weak point in an ACL reconstruction immediately after surgery is the tibial fixation of the graft. This factor will often limit the return to load-inducing activities. Many new hamstring-graft fixation devices have been introduced for cruciate ligament reconstruction, but there is little comparative data on their performance. This work tested the hypotheses that some of these devices will resist

Simon D. Coleridge; Andrew A. Amis

2004-01-01

41

Technical note: double tibial tunnel using quadriceps tendon in anterior cruciate ligament reconstruction.  

PubMed

To avoid complications related to the use of patellar tendon and hamstring (semitendinosus and gracilis) tendon and to create a more anatomic reconstruction, we present a new technique based on the use of quadriceps tendon placed in a single half femoral tunnel and double tibial tunnels. The graft, harvested by a central longitudinal incision, possesses the following characteristics: (1) a bone plug 20 mm long and 10 mm in diameter; (2) a tendon component 7 to 8 cm long, 10 mm wide, and 8 mm thick; and (3) division of the tendon longitudinally into 2 bundles while maintaining the patellar insertion. Every bundle has a width and thickness of approximately 5 mm and 8 mm, respectively. The total length of the graft is 9 to 10 cm. A 10-mm half femoral tunnel is drilled through a low anteromedial portal with the knee flexed at 120 degrees. A suture loop is left in place in the half tunnel. A double tibial tunnel is drilled in a convergent manner (from outside to inside) obtaining an osseous bridge between the 2 tunnels. Two suture loops are passed trough the tibial tunnels and retrieved in a plastic cannula (10 mm) positioned in the anteromedial portal to allow the passage of the 2 bundles in the tibial tunnels. The suture loop left in the half tunnel permits the transportation of the bone plug in the femoral tunnel. Fixation is achieved by an interference screw at the femoral side and by 2 absorbable interference screws (1 for each tunnel). The advantages of this technique are a more cross-sectional area (80 mm(2)), greater bone-tendon interface, and a more anatomic reconstruction. Theoretically, easier bone incorporation, decreased windshield wiper and bungee effect, fewer donor site problems, and less tunnel enlargement can also be possible. PMID:10882460

Pederzini, L; Adriani, E; Botticella, C; Tosi, M

2000-07-01

42

IS ELEVATED CONTACT STRESS PREDICTIVE OF POST-TRAUMATIC OSTEOARTHRITIS FOR IMPRECISELY REDUCED TIBIAL PLAFOND FRACTURES?  

PubMed Central

Despite the widely held belief that residual incongruities from intra-articular fractures subject the joint to contact stresses that predispose to post-traumatic osteoarthritis (PTOA), objective evidence has been lacking. This study tested the hypothesis that a metric of elevated contact stress exposure would predict the onset of PTOA. The ankles of ten tibial plafond fracture patients were treated initially using a spanning fixator, with subsequent screw fixation of the articular surface. Following up on an earlier report of finite element computed post-operative contact stress distributions in these patients’ ankles, Kellgren-Lawrence (KL) scores were assessed from minimum two-year follow-up radiographs to characterize the presence/severity of PTOA. At that time point, seven patients had developed PTOA (KL ? 2). Five different metrics of contact stress exposure were calculated, all of which exhibited excellent concordance with KL scores, ranging from 88% to 95%. When time of stress exposure was included, one metric was able to predict PTOA development (KL ? 2) with 100% reliability, and all metrics exhibited greater than 94% prediction reliability. These findings, albeit in a small population, support the existence of a contact stress exposure threshold above which incongruously reduced tibial plafond fractures are highly likely to develop PTOA.

Anderson, Donald D.; Van Hofwegen, Christopher; Marsh, J. Lawrence; Brown, Thomas D.

2010-01-01

43

Is there a correlation between posterior tibial slope and non-contact anterior cruciate ligament injuries?  

Microsoft Academic Search

Purpose  The purpose of this study was (1) to determine differences in posterior tibial slope (PTS) between subjects who underwent\\u000a ACL reconstruction following a non-contact ACL injury and a matched control uninjured group and (2) to investigate gender\\u000a differences between ACL-injured subjects and gender-matched controls.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A retrospective chart review was conducted of all 316 ACL-deficient patients at a large regional academic

Erik Hohmann; Adam Bryant; Peter Reaburn; Kevin Tetsworth

44

Restoring the anatomical tibial slope and limb axis may maximise post-operative flexion in posterior-stabilised total knee replacements.  

PubMed

The optimal management of the tibial slope in achieving a high flexion angle in posterior-stabilised (PS) total knee replacement (TKR) is not well understood, and most studies evaluating the posterior tibial slope have been conducted on cruciate-retaining TKRs. We analysed pre- and post-operative tibial slope differences, pre- and post-operative coronal knee alignment and post-operative maximum flexion angle in 167 patients undergoing 209 TKRs. The mean pre-operative posterior tibial slope was 8.6° (1.3° to 17°) and post-operatively it was 8.0° (0.1° to 16.7°). Multiple linear regression analysis showed that the absolute difference between pre- and post-operative tibial slope (p < 0.001), post-operative coronal alignment (p = 0.02) and pre-operative range of movement (p < 0.001) predicted post-operative flexion. The variance of change in tibial slope became larger as the post-operative maximum flexion angle decreased. The odds ratio of having a post-operative flexion angle < 100° was 17.6 if the slope change was > 2°. Our data suggest that recreation of the anatomical tibial slope appears to improve maximum flexion after posterior-stabilised TKR, provided coronal alignment has been restored. Cite this article: Bone Joint J 2013;95-B:1354-8. PMID:24078531

Singh, G; Tan, J H; Sng, B Y; Awiszus, F; Lohmann, C H; Nathan, S S

2013-10-01

45

Medial sixth of the patellar tendon at the tibial attachment is useful for the anterior reference in rotational alignment of the tibial component.  

PubMed

PURPOSE: The anteroposterior (AP) axis connecting the middle of the posterior cruciate ligament to the medial border of the patellar tendon at its attachment has been introduced as a reproducible and reliable reference perpendicular to the surgical epicondylar axis in healthy knees. A recent literature has reported that the AP axis of the tibia is, on average, almost perpendicular to the surgical epicondylar axis also in varus and valgus knees and can be used as a tibial rotational reference to minimize the risk for rotational mismatch between the femoral and tibial components in total knee arthroplasty (TKA). However, it is difficult to identify the AP axis after tibial resection. The purpose of the current study was to determine a modified AP axis that runs parallel to the AP axis and passes through the centre of the cut surface in osteoarthritic knees. METHODS: Preoperative computed tomography scans on 30 varus and 30 valgus knees undergoing TKA were studied using a three-dimensional software. The modified AP axis that runs parallel to the AP axis and passes through the centre of the cut surface was drawn. We investigated where the modified AP axis crossed the patellar tendon at its tibial attachment. RESULTS: The modified AP axis passed through the medial 1/6 of the patellar tendon (4 mm from medial edge) at its attachment in both varus and valgus knees. CONCLUSIONS: The AP axis of the tibia is useful as a tibial rotational reference in cutting the proximal tibia, but it is difficult to identify the AP axis after tibial resection. The clinical relevance of this study is that medial 1/6 of the patellar tendon at its attachment would be a useful landmark in aligning the tibial component. LEVEL OF EVIDENCE: IV. PMID:23479057

Kawahara, Shinya; Okazaki, Ken; Matsuda, Shuichi; Mitsuyasu, Hiroaki; Nakahara, Hiroyuki; Okamoto, Shigetoshi; Iwamoto, Yukihide

2013-03-12

46

Tibial Tunnel Placement in Anterior Cruciate Ligament Reconstructions and Graft Impingement  

Microsoft Academic Search

Fifty-six anterior cruciate ligament (ACL) reconstructions had a magnetic resonance scan of the ACL graft six months after operation. The impingement-free grafts (n = 26) had a low mag- netic resonance signal from origin to insertion. Impinged grafts (n = 30) had an increased mag- netic resonance signal confined to the distal two thirds of the graft. The location of

MAJ STEPHEN M. HOWELL; JAMES A. CLARK

1992-01-01

47

Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up  

PubMed Central

The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1–T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25–100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis.

Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schuttler, Karl Friedrich; Ziring, Ewgeni

2012-01-01

48

Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up.  

PubMed

The aim of the present study was to evaluate incidence, degree and impact of tibial tunnel widening (TW) on patient-reported long-term clinical outcome, knee joint stability and prevalence of osteoarthritis (OA) after isolated anterior cruciate ligament (ACL) reconstruction. On average, 13.5 years after ACL reconstruction via patella-bone-tendon-bone autograft, 73 patients have been re-evaluated. Inclusion criteria consisted of an isolated anterior cruciate ligament rupture and reconstruction, a minimum of 10-year follow-up and no previous anterior cruciate ligament repair or associated intra-articular lesions. Clinical evaluation was performed via the International Knee Documentation Committee (IKDC) score and the Tegner and Lysholm scores. Instrumental anterior laxity testing was carried out with the KT-1000™ arthrometer. The degree of degenerative changes and the prevalence of osteoarthritis were assessed with the Kellgren-Lawrence score. Tibial tunnel enlargement was radiographically evaluated on both antero-posterior and lateral views under establishment of 4 degrees of tibial tunnel widening by measuring the actual tunnel diameters in mm on the sclerotic margins of the inserted tunnels on 3 different points (T1-T3). Afterwards, a conversion of the absolute values in mm into a 4 staged ratio, based on the comparison to the results of the initial drill-width, should provide a better quantification and statistical analysis. Evaluation was performed postoperatively as well as on 2 year follow-up and 13 years after ACL reconstruction. Minimum follow-up was 10 years. 75% of patients were graded A or B according to IKDC score. The mean Lysholm score was 90.2±4.8 (25-100). Radiological assessment on long-term follow-up showed in 45% a grade I, in 24% a grade II, in 17% a grade III and in additional 12% a grade IV enlargement of the tibial tunnel. No evident progression of TW was found in comparison to the 2 year results. Radiological evaluation revealed degenerative changes in sense of a grade II OA in 54% of patients. Prevalence of a grade III or grade IV OA was found in 20%. Correlation analysis showed no significant relationship between the amount of tibial tunnel enlargement (P>0.05), long-term clinical results, anterior joint laxity or prevalence of osteoarthritis. Tunnel widening remains a radiological phenomenon which is most commonly observed within the short to midterm intervals after anterior cruciate ligament reconstruction and subsequently stabilises on mid and long- term follow-up. It does not adversely affect long-term clinical outcome and stability. Furthermore, tunnel widening doesn't constitute an increasing prevalence of osteoarthritis. PMID:22802989

Struewer, Johannes; Efe, Turgay; Frangen, Thomas Manfred; Schwarting, Tim; Buecking, Benjamin; Ruchholtz, Steffen; Schüttler, Karl Friedrich; Ziring, Ewgeni

2012-06-21

49

A comparison of five tibial-fixation systems in hamstring-graft anterior cruciate ligament reconstruction.  

PubMed

The weak point in an ACL reconstruction immediately after surgery is the tibial fixation of the graft. This factor will often limit the return to load-inducing activities. Many new hamstring-graft fixation devices have been introduced for cruciate ligament reconstruction, but there is little comparative data on their performance. This work tested the hypotheses that some of these devices will resist graft slippage under cyclic loads better than others, and that some will have higher ultimate strength than others. Five devices were tested: WasherLoc, Intrafix fastener; and RCI, Delta Tapered, and Bicortical interference screws. Cyclic loads representing normal walking activity (1000 cycles from 70 to 220 N) and ultimate strength tests were done, using calf tibiae (similar bone density to young human tibiae) and four-strand tendon grafts, with eight tests of each device for each of cyclic and ultimate tensile strength tests. A series of graft creep tests under cyclic loads was also done. The results showed that there was no significant difference in graft construct elongation under cyclic loads (range 0.7-1.3 mm) after allowing for 0.4 mm mean graft creep. The WasherLoc gave the highest ultimate strength (945 N, p<0.001, range 490-945 N). We concluded that all devices performed well under cyclic loads that represented normal walking activity, but the ultimate strengths differed. The performance under cyclic load was better than has been published for conventional interference screws. This evidence suggests that it may now be safe to mobilise younger patients less cautiously immediately after hamstring-graft ACL reconstruction. PMID:15024559

Coleridge, Simon D; Amis, Andrew A

2004-03-16

50

Anterior–posterior bending strength at the tibial shaft increases with physical activity in boys: evidence for non-uniform geometric adaptation  

Microsoft Academic Search

Summary  We investigated bone structural adaptations to a 16-month school-based physical activity intervention in 202 young boys using\\u000a a novel analytical method for peripheral quantitative computed tomography scans of the tibial mid-shaft. Our intervention\\u000a effectively increased bone bending strength in the anterior–posterior plane as estimated with the maximum second moment of\\u000a area (Imax).\\u000a \\u000a \\u000a \\u000a Introduction  We previously reported positive effects of a physical

H. M. Macdonald; D. M. L. Cooper; H. A. McKay

2009-01-01

51

Three-Dimensional Reconstruction Computed Tomography Evaluation of Tunnel Location during Single-Bundle Anterior Cruciate Ligament Reconstruction: A Comparison of Transtibial and 2-Incision Tibial Tunnel-Independent Techniques  

PubMed Central

Background Anatomic tunnel positioning is important in anterior cruciate ligament (ACL) reconstructive surgery. Recent studies have suggested the limitations of a traditional transtibial technique to place the ACL graft within the anatomic tunnel position of the ACL on the femur. The purpose of this study is to determine if the 2-incision tibial tunnel-independent technique can place femoral tunnel to native ACL center when compared with the transtibial technique, as the placement with the tibial tunnel-independent technique is unconstrained by tibial tunnel. Methods In sixty-nine patients, single-bundle ACL reconstruction with preservation of remnant bundle using hamstring tendon autograft was performed. Femoral tunnel locations were measured with quadrant methods on the medial to lateral view of the lateral femoral condyle. Tibial tunnel locations were measured in the anatomical coordinates axis on the top view of the proximal tibia. These measurements were compared with reference data on anatomical tunnel position. Results With the quadrant method, the femoral tunnel centers of the transtibial technique and tibial tunnel-independent technique were located. The mean (± standard deviation) was 36.49% ± 7.65% and 24.71% ± 4.90%, respectively, from the over-the-top, along the notch roof (parallel to the Blumensaat line); and at 7.71% ± 7.25% and 27.08% ± 7.05%, from the notch roof (perpendicular to the Blumensaat line). The tibial tunnel centers of the transtibial technique and tibial tunnel-independent technique were located at 39.83% ± 8.20% and 36.32% ± 8.10%, respectively, of the anterior to posterior tibial plateau depth; and at 49.13% ± 4.02% and 47.75% ± 4.04%, of the medial to lateral tibial plateau width. There was no statistical difference between the two techniques in tibial tunnel position. The tibial tunnel-independent technique used in this study placed femoral tunnel closer to the anatomical ACL anteromedial bundle center. In contrast, the transtibial technique placed the femoral tunnel more shallow and higher from the anatomical position, resulting in more vertical grafts. Conclusions After single-bundle ACL reconstruction, three-dimensional computed tomography showed that the tibial tunnel-independent technique allows for the placement of the graft closer to the anatomical femoral tunnel position when compared with the traditional transtibial technique.

Ahn, Jin Hwan; Ko, Chun-Suk; Ko, Taeg Su; Kim, Jang Hwan

2013-01-01

52

Magnetic resonance imaging of anterior cruciate ligament (ACL) tears: Diagnostic value of ACL-tibial plateau angle  

Microsoft Academic Search

Tears of the anterior cruciate ligament (ACL) are often difficult to diagnose on magnetic resonance imaging (MRI), as it is often difficult to interpret the images. We developed a quantitative method for diagnosing ACL tears on MRI; the method involves measuring the angle formed by the intersection between a straight line drawn along the anterior border of the ACL and

Hiroshi Murao; Shinobu Morishita; Mikio Nakajima; Muneaki Abe

1998-01-01

53

Gait analysis post anterior cruciate ligament reconstruction: knee osteoarthritis perspective.  

PubMed

Individuals with anterior cruciate ligament (ACL) reconstruction are at increased risk to develop knee osteoarthritis (OA). Gait analysis describing kinetics of the lower extremity during walking and stair use (stair ascent and stair descent) can provide insight to everyday dynamic knee joint loading. In this study, we compared lower extremity gait patterns of those with ACL reconstruction (>1 year) to a control group. Fifteen ACL reconstructed individuals and 17 healthy controls participated in this study. Knee extensor and flexor strength were assessed. Using inverse dynamics, lower extremity moments were calculated during the stance phase of walking and during two steps of stair ascent and descent. Univariate ANOVA was used to test for main effects between (1) injured leg and control group and (2) non-injured leg and control group. Student paired t-tests were used to determine differences between the injured and non-injured leg. Those with ACL reconstruction exhibited reduced initial knee flexion angles during stair descent, reduced knee extension moments during stair descent and stair ascent (second step), and increased hip extension moments during stair ascent (second step) and walking as compared to controls. Knee flexor strength was significantly reduced in the ACL group, but no differences were found in knee extensor strength. No kinematic or kinetic differences were observed between the injured and non-injured leg of the ACL group. Walking and stair ambulation highlight altered joint loading in those with ACL reconstruction surgery. Individuals appeared to compensate for lower knee extension moments by increasing hip extension moments. Furthermore, the load distribution on the articular cartilage is likely shifted as evidenced by reduced knee flexion angles in the ACL reconstructed leg. PMID:22310303

Hall, Michelle; Stevermer, Catherine A; Gillette, Jason C

2012-02-05

54

Comparison of fixation methods of double-bundle double-tibial tunnel ACL reconstruction and double-bundle single-tunnel technique  

PubMed Central

An experimental study was conducted in order to evaluate biomechanical methods of single-bundle reconstruction in ACL and compare it with a new double-bundle double-tibial tunnel technique. Twenty-four porcine cadaver knees, divided into 4 groups of 6 knees each and 48 proper extensors of the fourth toe tendons, were used for the fixation techniques. In groups A and B, a double-bundle technique with a single femoral and tibial tunnel was used, fixed to a femoral and tibial post with screws and with buttons, respectively. In groups C and D, a double-bundle technique (technique ?) with two separate tibial tunnels was used, fixed to a femoral and tibial post with screws and with buttons, respectively. A material testing system (Instron) was used for anteriorly translating the tibia until failure. The femoral and tibial post as a fixation method is superior to the conventional buttons technique. The more anatomical double-bundle reconstruction technique provided significantly higher structural properties and smaller loss of fixation compared with the single-bundle reconstruction technique. The comparison of the two techniques gave superior results to the femoral and tibial screws over the buttons. The double-bundle technique attempts to restore the anterior stability of the knee joint.

Kalliakmanis, Alkiviadis; Papachristou, Konstantinos; Magnissalis, Evangelos; Sourlas, John; Plessas, Spyros

2007-01-01

55

Reconstruction of anterior teeth using an aesthetic post-and-core and all-ceramic material.  

PubMed

Ceramic post-and-core systems offer biocompatibility, aesthetics, reinforcement of the remnant root, and prosthesis retention. Aesthetic posts-and-cores contribute to the optical properties of the overlying restorations when metal-free crowns are used. This article illustrates the use of these materials to provide strength and aesthetics during the restoration of endodontically treated teeth. The case presentation detailed herein demonstrates the rehabilitation of anterior dentition following substantial structural loss and exhibits the biomechanical treatment of these structures using contemporary restorative materials. PMID:13677836

Francischone, Carlos E; D'Alpino, Paulo H; Garcia, Fernanda C; Pereira, José C

2003-07-01

56

A Case-Control Study Of Anterior Cruciate Ligament Volume, Tibial Plateau Slopes and Intercondylar Notch Dimensions In ACL-Injured Knees  

PubMed Central

The role played by anatomic factors in ACL injury remains elusive. In this study, objective methods were used to characterize ACL volume, tibial slopes, and notch geometry from ACL-injured and matched control subjects. The study tested four hypotheses: 1) the medial tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, 2) the lateral tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, 3) the femoral intercondylar notch dimensions are smaller in the injured group compared to the non-injured group and 4) the ACL volume, tibial plateau slopes and intercondylar notch dimensions are all independent of each other. Fifty-four subjects were divided into two groups, those who had suffered a non-contact ACL injury and those who still had two healthy ACLs, matched to the injured subjects by gender, age, height and weight. The lateral tibial plateaus in the uninjured contralateral knees of the injured subjects had a significantly steeper posterior slope (1.8° vs. ?0.3°), a factor that potentially contributed to the ACL injury in the opposite knee. The intercondylar notch dimensions were found to be smaller in the injured subjects, potentially putting the ACL at risk of impingement, and intercondylar notch volume was correlated to ACL volume (r=0.58). Discriminant analysis showed that the notch width at the inlet was the best single predictor of ACL injury.

Simon, RA; Everhart, J; Nagaraja, HN; Chaudhari, AM

2010-01-01

57

Tensile bond strength of intracanal posts in primary anterior teeth: an in vitro study.  

PubMed

The aim of this study was to measure in vitro; the tensile bond strength of three intracanal posts used in anterior primary teeth. A total of 45 single rooted primary anterior teeth were selected for the study and the crowns sectioned leaving 1mm above the cement-enamel junction. The roots were then assigned to three groups according the type of retention used. All roots were endodonticaly treated, a 4-mm of the canal was cleansed and a base of glass ionomer cement was put at the bottom of the prepared canal. The roots were then prepared to receive intracanal posts using a # 4137 diamond bur (KG Sorensen) used in a depth of 3-mm of the length of the canal All the prepared roots were acid etched with a 37% phosphoric acid gel for 15 seconds, rinsed, dried and the dentin adhesive Single Bond (3M) was applied. Group I received intracanal posts and cores made of composite resin (Filtek Z 250, 3M). Group II intracanal posts were made from a 0.6mm orthodontic wire bent as a Greek letter type (gamma), fixed with the Z 250 composite resin and cores were built with the same composite. Finally Group III received intracanal retention made of a fiber glass post (Fibrekor Post, Generic/Pentron) with 1.25 mm diameter, fixed with Z 250 and cores were made like the other groups. The samples were submitted to tension in a universal-testing machine (Instron, model 4444). Statistical analysis (ANOVA) revealed that there were no statistically significant differences between the groups. On the basis of the results of this in vitro study it was concluded that the type of intracanal post did not interfere with the tensile strength and the most frequent type of failure was of adhesive type, corresponding to 74% of the sample. PMID:12413170

Pithan, Silvia; Vieira, Ricardo de Sousa; Chain, Marcelo Carvalho

2002-01-01

58

Increased left anterior insular and inferior prefrontal activity in post-stroke mania  

PubMed Central

Background Post-stroke mania is an infrequent complication after stroke, and the mechanisms underlying this disorder remain unclear. Although a contralesional release phenomenon has been implicated in post-stroke mania, empirical findings are lacking. Case presentation We present a case report of post stroke mania. Single photon emission tomography (SPECT) was performed twice, during the manic state and during the remitted euthymic state. The first SPECT study performed during the manic state demonstrated hypoperfusion in the right temporal and frontal regions due to right putaminal hemorrhage. It also showed hyperperfusion in the inferior lateral prefrontal lobe, the temporal lobe, and the medial and lateral parts of the parietal lobe in the left hemisphere. The second SPECT study performed during the euthymic state demonstrated moderate improvement in the hypoperfusion in the right fronto-temporal regions. Furthermore, compared to the findings on the first SPECT study, the second study showed that the focal hyperperfusion in the anterior insular cortex, inferior lateral prefrontal lobes, and superior-middle temporal gyrus in the left hemisphere had vanished. Conclusion Increased left inferior prefrontal and anterior insular activity and reduced extensive right fronto-temporal lobe activity are involved in the development of post-stroke mania.

2012-01-01

59

The 'Pomeroy procedure': a new method to correct post-mitral valve repair systolic anterior motion.  

PubMed

Systolic anterior motion (SAM), a recognized complication of mitral valve repair, is often associated with left ventricular outflow gradient and mitral regurgitation. Current surgery to prevent these conditions is to perform sliding annuloplasty to reduce the posterior mitral leaflet (PML) height and to oversize the annuloplasty ring. However, these techniques do not consistently eliminate post-repair SAM, and removal of excess tissue and reduction of anterior mitral leaflet (AML) height may be more effective; this is the 'Pomeroy procedure'. Here, we report a patient in whom all standard procedures to prevent SAM were performed, but the condition still developed. This was corrected on a second pump run, using the Pomeroy procedure. PMID:11380092

Raney, A A; Shah, P M; Joyo, C I

2001-05-01

60

Assessing post-anterior cruciate ligament reconstruction ambulation using wireless wearable integrated sensors.  

PubMed

Abstract A hardware/software co-design for assessing post-Anterior Cruciate Ligament (ACL) reconstruction ambulation is presented. The knee kinematics and neuromuscular data during walking (2-6?km?h(-1)) have been acquired using wireless wearable motion and electromyography (EMG) sensors, respectively. These signals were integrated by superimposition and mixed signals processing techniques in order to provide visual analyses of bio-signals and identification of the recovery progress of subjects. Monitoring overlapped signals simultaneously helps in detecting variability and correlation of knee joint dynamics and muscles activities for an individual subject as well as for a group. The recovery stages of subjects have been identified based on combined features (knee flexion/extension and EMG signals) using an adaptive neuro-fuzzy inference system (ANFIS). The proposed system has been validated for 28 test subjects (healthy and ACL-reconstructed). Results of ANFIS showed that the ambulation data can be used to distinguish subjects at different levels of recuperation after ACL reconstruction. PMID:24117351

Arosha Senanayake, S M N; Ahmed Malik, Owais; Mohammad Iskandar, Pg; Zaheer, Dansih

2013-10-14

61

How to read post-operative radiographs and CT scans after single-bundle anterior cruciate ligament reconstruction.  

PubMed

Reconstruction of the anterior cruciate ligament (ACL) is a well-established surgical procedure. However, post-operative imaging in the early phase is not routinely performed. The rationale for performing such imaging is to provide a baseline examination for future controls, to provide immediate feedback to surgeons regarding tunnel placement, and to assess placement of fixation devices. The purpose of this paper is to enable the reader to accurately read post-operative radiographs and CT scans after single-bundle ACL reconstruction. PMID:23857421

Parkar, Anagha P; Adriaensen, Miraude Eamp; Strand, Torbjørn; Inderhaug, Eivind; Harlem, Thomas; Solheim, Eirik

2013-07-16

62

Tibial nerve dysfunction  

MedlinePLUS

... nerve dysfunction is a loss of movement or sensation in the foot from damage to the tibial ... the leg. The tibial nerve supplies movement and sensation to the calf and foot muscles. A problem ...

63

Optic nerve infarction and post-ischemic inflammation in the rodent model of anterior ischemic optic neuropathy (rAION)  

PubMed Central

Nonarteritic anterior ischemic optic neuropathy (NAION) results from isolated anterior optic nerve (ON)-axonal ischemia near the retina–optic nerve junction. We utilized a rodent model of NAION (rAION) to study the in vivo inflammatory response after pure axonal ischemic infarct. ON ischemia was generated using laser-coupled rose Bengal dye photoactivation, and the infarct localized using tetrazolium red and histology. ON inflammation was evaluated following infarct using extrinsic macrophage (ED1) and microglial (isolated Iba1) cell markers. In naive ONs, some ED1(+)/Iba1(+) cells, representing extrinsic macrophages, were present in intraretinal ON region, but not in the retroscleral (isolated ON) region. Numerous ED1(?)/Iba1(+) cells, likely representing intrinsic microglia, were present throughout the entire ON. One day post-stroke, slight increases in both ED1(+) and Iba1(+) cells were apparent in the eye region immediately surrounding the anterior ON. Three days post-stroke, there was marked infiltration and aggregates of ED1(+)/Iba1(+) cells, with axon structural disruption in the region of the ischemic infarct. ED1(+) and Iba1(+) cells were present in the portion of the ON surrounding the infarct, possibly representing a penumbral region similar to that seen in ischemic brain infarcts. Although ED1(+) cells decreased by 7–14 days post-stroke, large numbers of Iba1(+) cells persisted in the anterior ON. Similar to other CNS ischemic strokes, pure axonal ischemia results in the early recruitment of extrinsic macrophages to the ischemic region. Manipulation of the inflammatory response may be an important variable that could potentially improve visual outcome.

Zhang, Cheng; Guo, Yan; Miller, Neil R.; Bernstein, Steven L.

2009-01-01

64

Optic nerve infarction and post-ischemic inflammation in the rodent model of anterior ischemic optic neuropathy (rAION).  

PubMed

Nonarteritic anterior ischemic optic neuropathy (NAION) results from isolated anterior optic nerve (ON)-axonal ischemia near the retina-optic nerve junction. We utilized a rodent model of NAION (rAION) to study the in vivo inflammatory response after pure axonal ischemic infarct. ON ischemia was generated using laser-coupled rose Bengal dye photoactivation, and the infarct localized using tetrazolium red and histology. ON inflammation was evaluated following infarct using extrinsic macrophage (ED1) and microglial (isolated Iba1) cell markers. In naive ONs, some ED1(+)/Iba1(+) cells, representing extrinsic macrophages, were present in intraretinal ON region, but not in the retroscleral (isolated ON) region. Numerous ED1(-)/Iba1(+) cells, likely representing intrinsic microglia, were present throughout the entire ON. One day post-stroke, slight increases in both ED1(+) and Iba1(+) cells were apparent in the eye region immediately surrounding the anterior ON. Three days post-stroke, there was marked infiltration and aggregates of ED1(+)/Iba1(+) cells, with axon structural disruption in the region of the ischemic infarct. ED1(+) and Iba1(+) cells were present in the portion of the ON surrounding the infarct, possibly representing a penumbral region similar to that seen in ischemic brain infarcts. Although ED1(+) cells decreased by 7-14 days post-stroke, large numbers of Iba1(+) cells persisted in the anterior ON. Similar to other CNS ischemic strokes, pure axonal ischemia results in the early recruitment of extrinsic macrophages to the ischemic region. Manipulation of the inflammatory response may be an important variable that could potentially improve visual outcome. PMID:19401181

Zhang, Cheng; Guo, Yan; Miller, Neil R; Bernstein, Steven L

2009-01-15

65

Do pre-operative knee laxity values influence post-operative ones after anterior cruciate ligament reconstruction?  

PubMed

The objective of this study was to verify whether pre-reconstruction laxity condition effects post-reconstruction outcome. A total of 100 patients who underwent navigated Anterior Cruciate Ligament (ACL) reconstruction were included in the study and knee laxity analysed retrospectively. The knee was assessed in six different laxity tests before and after ACL reconstruction, namely antero-posterior (AP) and internal-external (IE) at 30° and 90°, and varus-valgus (VV) rotations at 0° and 30° of flexion. For each test, the least square (LS) fitting line based on pre-operative-to-post-operative laxity value was calculated. To what degree the post-operative laxity value is explainable by the corresponding pre-operative condition was evaluated by the LS line slope. Post-operatively, for each single patient, the grade of laxity decreased at any evaluated test. The strongest influence of pre-operative-to-post-operative laxity values was found during IE30 and IE90 tests. While AP30 and VV0 tests seem to be those in which the post-reconstruction laxity was barely affected by the pre-surgery condition. The analysis of the global laxity reduction confirms the previous results. Following this hypothesis, our study remarks on the importance of combined lesions to secondary restraints and the importance of fully understanding the residual laxity to optimize the surgical technique. PMID:23438253

Signorelli, C; Bonanzinga, T; Lopomo, N; Marcheggiani Muccioli, G M; Bignozzi, S; Filardo, G; Zaffagnini, S; Marcacci, M

2013-02-26

66

Bone Tunnel Enlargement After Anterior Cruciate Ligament Replacement  

Microsoft Academic Search

Radiographic increase in the size of tibial and femoral tunnels has been observed. This retrospective study compared tibial tunnel diameter in 56 autograft and 87 allograft patellar tendon bone-tendon-bone anterior cru ciate ligament replacements whose observed tunnel changes were correlated with clinical results at 1 year postoperatively. Tibial tunnel sclerotic margins were measured approximately 1 cm below the joint line.

Mark Fahey; Peter A. Indelicato

1994-01-01

67

"The non-ischemic repair" as a safe alternative method for repair of anterior post-infarction VSD  

PubMed Central

Patient's myocardium with post-infarction ventricular septum defect (VSD) is characterized by severe dysfunction. The "additive ischemia" caused by the operating process of cross-clamp ischemia and reperfusion injury, has a significant aggravation to the myocardium and overall negative impact to patient's outcome. We present a useful, safe and advantageous methodology in order to abolish "the toxic phase" of ischemia-reperfusion which is adopted by most as the "classic repair method" of myocardial protection. This abolition is in our opinion, particularly beneficial in order to reverse postoperatively the Low Cardiac Output Syndrome (LOS) and achieve better short and long term results. By using this method we avoid the aortic occlusion, the use of systematic hypothermia and any cardioplegic arrest. Furthermore, the total cardio-pulmonary bypass (CPB) time is significantly reduced, tissue debridement and stitching is much easier and safer. We think the method is applicable for every anterior and apical case of post-infarction septum rupture. After application of method in 3 patients with anterior post-myocardial infarction VSD, we are convinced that the patient will have a better postoperative haemodynamic condition and therefore a better outcome.

2010-01-01

68

Tibial tuberosity fractures in adolescents  

PubMed Central

Background Tibial tuberosity fractures in adolescents are uncommon. We retrospectively reviewed all tibial tuberosity fractures in adolescents (10–19) who presented to our level 1 pediatric trauma center over a 7-year period to review fracture morphology, mechanism of injury, fracture management including return to play, as well as complications. Additionally, we present a review of the literature and treatment algorithm. Methods We reviewed the clinical charts and radiographs of consecutive patients with tibial tuberosity fractures between 01 January 2000 and 01 January 2007. Data parameters included the following: patients age and gender, involved side, injury classification, co-morbidities, mechanism of injury, treatment, return to activity and complications. Data were extracted and reviewed, and a treatment algorithm is proposed with some additional insights into the epidemiology of the injury. Nineteen patients met the inclusion criteria. Results There were 19 patients with 20 tibial tuberosity fractures. The mean age was 13.7 years. There were 18 males and 1 female patient. There were nine left-sided injuries and eleven right-sided including one patient with bilateral fractures. Mechanism of injuries included basketball injury (8), running injury (5), football injury (3), fall from a scooter (2), high jump (1) and fall (1). Co-morbidities included three patients with concurrent Osgood–Schlatter disease and one with osteogenesis imperfecta. All were treated with ORIF, including arthroscopic-assisted techniques in two cases. Complications included four patients with pre-operative presentation of compartment syndrome all requiring fasciotomy, one post-operative stiffness and one painful hardware requiring removal. Range of motion was started an average of 4.3 weeks post-operatively and return to play was an average of 3.9 months post-operatively. Conclusion Although uncommon, tibial tuberosity fractures in adolescents are clinically important injuries. Early recognition and treatment (closed or open as appropriate) gives good results. All the patients in our series had surgical fixation as per different indications that have been elaborated. It is important for clinicians to recognize that compartment syndrome remains a significant concern post-injury and in the perioperative period. Close monitoring and timely intervention is recommended. A simple treatment algorithm is presented for clinicians to help manage these injuries.

Frey, Steven; Hosalkar, Harish; Cameron, Danielle B.; Heath, Aaron; David Horn, B.

2008-01-01

69

Stemmed knee replacement in a patient with an irremovable tibial nail.  

PubMed

A patient with a cemented centrally located intramedullary tibial nail that occluded the proximal tibial canal underwent knee reconstruction with a total knee design utilizing a custom hollow tibial stem. In this oncology case, a rotating-hinge knee design was used that incorporates an intra-articular inverted post-in-channel central rotational post design. This design allowed for a rather straightforward reconstruction that functioned well for 3 years. Although rarely encountered, utilization of a hollow-stemmed tibial total knee component may allow salvage of an extremity with central occlusion of the proximal tibial canal. PMID:24063801

Ward, William G; Cooper, Joshua M

2013-01-01

70

Ceramic coating improves tibial component fixation in total knee arthroplasty  

Microsoft Academic Search

Forty uncemented total knee arthroplasties (36 patients) were randomly allocated to a Miller-Galante II prosthesis with or without hydroxyapatite\\/tricalcium phosphate (HA\\/TCP) coating on the titanium fiber mesh on the undersurface of the tibial component. The patients were followed for 2 years with repeated radiostereometric examinations. After 2 years, the HA\\/TCP tibial components displayed smaller anterior-posterior tilt and less subsidence. The

Lars Regnér; Lars Carlsson; Johan Kärrholm; Peter Herberts

1998-01-01

71

Longitudinal Tear of the Medial Meniscus Posterior Horn in the Anterior Cruciate Ligament–Deficient Knee Significantly Influences Anterior Stability  

Microsoft Academic Search

Background: Longitudinal tears of the medial meniscus posterior horn (MMPH) are commonly associated with a chronic anterior cruciate ligament (ACL) deficiency. Many studies have demonstrated the importance of the medial meniscus in terms of limiting the amount of anterior-posterior tibial translation in response to anterior tibial loads in ACL-deficient knees.Hypothesis: An MMPH tear in an ACL-deficient knee increases the anterior-posterior

Jin Hwan Ahn; Tae Soo Bae; Ki-Ser Kang; Soo Yong Kang; Sang Hak Lee

2011-01-01

72

Tibial collateral ligament bursitis  

Microsoft Academic Search

In 91 patients evaluated between 1982 and 1985, tibial collateral ligament bursitis was diagnosed. This entity has not been described since the work of Brantigan and Voshell in 1943. The diagnosis was based on the findings of tenderness over the tibial collateral ligament at the joint line, without a history of mechanical symp toms. With a nonsurgical program, 62% of

Robert K. Kerlan; Ronald E. Glousman

1988-01-01

73

Smaller amygdala volume and reduced anterior cingulate gray matter density associated with history of post-traumatic stress disorder.  

PubMed

Although post-traumatic stress disorder (PTSD) may be seen to represent a failure to extinguish learned fear, significant aspects of the pathophysiology relevant to this hypothesis remain unknown. Both the amygdala and hippocampus are necessary for fear extinction occur, and thus both regions may be abnormal in PTSD. Twenty-five people who experienced the Tokyo subway sarin attack in 1995, nine who later developed PTSD and 16 who did not, underwent magnetic resonance imaging (MRI) with manual tracing to determine bilateral amygdala and hippocampus volumes. At the time of scanning, one had PTSD and eight had a history of PTSD. Results indicated that the group with a history of PTSD had significantly smaller mean bilateral amygdala volume than did the group that did not develop PTSD. Furthermore, left amygdala volume showed a significant negative correlation with severity of PTSD symptomatology as well as reduced gray matter density in the left anterior cingulate cortex. To our knowledge, this is the first observation of an association between PTSD and amygdala volume. Furthermore the apparent interplay between amygdala and anterior cingulate cortex represents support at the level of gross brain morphology for the theory of PTSD as a failure of fear extinction. PMID:19914045

Rogers, Mark A; Yamasue, Hidenori; Abe, Osamu; Yamada, Haruyasu; Ohtani, Toshiyuki; Iwanami, Akira; Aoki, Shigeki; Kato, Nobumasa; Kasai, Kiyoto

2009-11-13

74

Tunnel enlargement after anterior cruciate ligament reconstruction in patients with post-operative septic arthritis  

Microsoft Academic Search

Tunnel enlargement is a frequent issue after ACL reconstruction and the “synovial bathing effect” is thought to be among the\\u000a biological factors contributing to this phenomenon. Since the amount and the pressure of the synovial fluid inside the knee\\u000a joint are higher and the length of its presence is longer in patients with post-operative septic arthritis after ACL reconstruction,\\u000a we

R. Iorio; I. Di Vavo; A. De Carli; F. Conteduca; G. Argento; A. Ferretti

2008-01-01

75

Comparison of bioabsorbable interference screws and posts for distal fixation in anterior cruciate ligament reconstruction.  

PubMed

Comparison of the results of bioabsorbable interference screws and posts for hamstring graft distal fixation in ACL reconstructions are presented. The results of 20 patients with bioabsorbable screws were compared to 22 patients with posts. The assessement was based on Lysholm-Gillquist and Marshall scores and the KT-1000 device. In the study group the points gained were 38.9 in the Lysholm-Gillquist and 12.89 in the Marshall scale. The average KT-1000 difference was 2.46 mm. In the control group the points gained were 32.93 in the Lysholm-Gillquist and 11.47 in the Marshall scale. The average KT-1000 difference was 2.5 mm. There were 14 patients in the study group with interference screw problems; in 2 the implants were removed. (1) There are no differences in outcome using bioabsorbable interference screws and posts for distal fixation of hamstring ACL grafts. (2) The lack of bioabsorbtion with poly L-lactide interference screws is frequent and causes problems. PMID:18064457

Gaweda, Krzysztof; Walawski, Jacek; Weg?owski, Robert; Krzyzanowski, Wojciech

2007-12-07

76

Anterior cruciate ligament- specialized post-operative return-to-sports (ACL-SPORTS) training: a randomized control trial  

PubMed Central

Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317

2013-01-01

77

Knee Valgus During Drop Jumps in National Collegiate Athletic Association Division I Female AthletesThe Effect of a Medial Post  

Microsoft Academic Search

Background: Female athletes land from a jump with greater knee valgus and ankle pronation\\/eversion. Excessive valgus and pronation have been linked to risk of anterior cruciate ligament injury. A medially posted orthosis decreases component motions of knee valgus such as foot pronation\\/eversion and tibial internal rotation.Hypothesis: We hypothesized a medial post would decrease knee valgus and ankle pronation\\/eversion during drop-jump

Michael Joseph; David Tiberio; Jennifer L. Baird; Thomas H. Trojian; Jeffrey M. Anderson; William J. Kraemer; Carl M. Maresh

2008-01-01

78

Tibial plateau stress fracture  

Microsoft Academic Search

Unicompartmental knee arthroplasty has gained popularity recently as a treatment for unicompartmental tibiofemoral non inflammatory arthritis. Tibial plateau stress fracture after unicompartmental knee arthroplasty (UKA) through guide pin holes placed in the proximal tibia has not been previously reported. In each case in this report, the compressive strength of the proximal tibia was reduced by the drilling of multiple holes

Scott A Brumby; Richard Carrington; Shay Zayontz; Tim Reish; Richard D Scott

2003-01-01

79

Cartilage Pressure Distributions Provide a Footprint to Define Female Anterior Cruciate Ligament Injury Mechanisms  

PubMed Central

Background Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/Hypothesis (1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains. Study Design Descriptive laboratory study. Methods Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons. Results Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°. Conclusion The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations. Clinical Relevance Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury.

Quatman, Carmen E.; Kiapour, Ali; Myer, Gregory D.; Ford, Kevin R.; Demetropoulos, Constantine K.; Goel, Vijay K.; Hewett, Timothy E.

2012-01-01

80

Increased external tibial torsion in Osgood-Schlatter disease.  

PubMed

We studied the relationship between Osgood-Schlatter disease and torsional abnormalities of the lower limb in 21 boys with this condition and 20 age- and sex-matched controls. 3 groups of knees (20 control knees, 21 symptomatic and 21 asymptomatic or less symptomatic knees) were subjected to clinical, radiographic and CT evaluation. We found no statistically significant differences between patients and controls, as regards femoral anteversion, patellar congruence angle, patellar tilt angle and anterior tibial tuberosity-trochlear groove distance, but the condylomalleolar angle and tibial torsion angle were greater in patients. We found no differences between symptomatic and asymptomatic or less symptomatic knees in any of the parameters. All the symptomatic knees were on the side preferentially involved in jumping and sprinting. This increase in external tibial torsion may play a role as a predisposing mechanical factor in the onset of Osgood-Schlatter disease in male athletes. PMID:14521294

Gigante, Antonio; Bevilacqua, Claudia; Bonetti, Massimo G; Greco, Francesco

2003-08-01

81

Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial.  

PubMed

Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for radiculopathy resulting from degenerative cervical spine conditions. Post-surgical cervical collar use is believed to reduce post-operative pain, provide the patient with a sense of security during activities of daily living and even reduce rates of non-fusion. This prospective randomized controlled pilot trial investigates trial design feasibility in relation to prospective physical, functional, and quality of life-related outcomes of patients undergoing ACDF with interbody cage, with (n?=?17) and without (n?=?16) post-operative cervical collar usage. Results show that the sample provides sufficient statistical power to show that the use of a rigid cervical collar during 6 post-operative weeks is associated with significantly lower levels of neck disability index after 6 weeks and significantly lower levels of prospective neck pain. To investigate causal quality of life or fusion rate outcomes, sample size needs to be increased at least fourfold and optimally sixfold when accounting for data loss in prospective follow-up. The study suggests that post-surgical cervical collar usage may help certain patients cope with initial post-operative pain and disability. PMID:23074995

Abbott, Allan; Halvorsen, Marie; Dedering, Asa

2012-10-17

82

[Tibial torsion deformities].  

PubMed

Tibial torsion defects are usually not clinically evident and, hence, are often overlooked. Clinical examination and CT scan have proved to be the best ways of measuring static tibial torsion, whereas dynamic measurements are usually performed in the clinic and the "gait laboratory." Only few studies have determined there to be a connection between a torsion defect in the lower leg and expected pathological conditions of the knee and ankle joints. However, patellofemoral instability, Osgood-Schlatter disease, osteochondrosis dissecans are increasingly being found in cases of increased external tibial torsion and arthrosis in reduced torsion. Although spontaneous correction may occur in certain cases, in others the only way to correct the condition is by employing physiologic torsion. Conservative treatment methods such as bandages or orthosis have been shown to not have any effect on torsion; thus, surgical treatment is the only successful way to correct a pathologic angle of rotation of the tibia. For this, supramalleolar osteotomy with fixation using Kirscher wires and plaster or an external fixator are the most common treatments. PMID:11092002

Lampert, C; Thomann, B; Brunner, R

2000-09-01

83

The Effect of Tibial Tuberosity Realignment Procedures on the Patellofemoral Pressure Distribution  

PubMed Central

Purpose The study was performed to characterize the influence of tibial tuberosity realignment on the pressure applied to cartilage on the patella in the intact condition and with lesions on the lateral and medial facets. Methods Ten knees were loaded in vitro through the quadriceps (586 N) and hamstrings (200 N) at 40°, 60° and 80° of flexion while measuring patellofemoral contact pressures with a pressure sensor. The tibial tuberosity was positioned 5 mm lateral of the normal position to represent lateral malalignment, 5 mm medial of the normal position to represent tuberosity medialization, and 10 mm anterior of the medial position to represent tuberosity anteromedialization. The knees were tested with intact cartilage, with a 12 mm diameter lesion created within the lateral patellar cartilage, and with the lateral lesion repaired with silicone combined with a medial lesion. A repeated measures ANOVA and post-hoc tests were used to identify significant (p < 0.05) differences in the maximum lateral and medial pressure between the tuberosity positions. Results Tuberosity medialization and anteromedialization significantly decreased the maximum lateral pressure by approximately 15% at 60° and 80° for intact cartilage and cartilage with a lateral lesion. Tuberosity medialization significantly increased the maximum medial pressure for intact cartilage at 80°, but the maximum medial pressure did not exceed the maximum lateral pressure for any testing condition. Conclusions The results indicate that medializing the tibial tuberosity by 10 mm reduces the pressure applied to lateral patellar cartilage for intact cartilage and cartilage with lateral lesions, but does not overload medial cartilage.

Saranathan, Archana; Kirkpatrick, Marcus S.; Mani, Saandeep; Smith, Laura G.; Cosgarea, Andrew J.; Tan, Juay Seng; Elias, John J.

2011-01-01

84

Is there an influence of the tibial slope of the lateral condyle on the ACL lesion?  

Microsoft Academic Search

This study examines the effect of the tibial slope on the anterior cruciate ligament lesion (separately on the lateral and\\u000a medial tibial condyle). The study consisted of 33 matched pairs of patients divided into two groups: an examined group with\\u000a a diagnosed ACL lesion, and a control group with diagnosed patellofemoral pain. The patients were matched on the basis of

Lazar Stijak; Richard F. Herzog; Pascal Schai

2008-01-01

85

Radiographic guided drilling of bony tibial tunnels for fixation of meniscus transplants using percentage references.  

PubMed

The objective of our investigation was to evaluate the precision of radiographic-guided tibial tunnel drilling for anatomical anchoring of meniscus transplants at the tibial insertion areas. In 20 cadaveric proximal tibiae, the meniscal insertions were dissected and their circumferences outlined. Standardized photographs of the tibial plateau were obtained. Applying established percentage values for radiographic determination of the meniscus insertion midpoints, tibial tunnels were drilled using a standard ACL-guide. Guide positioning was performed by using the midpoints as determined on standard AP and lateral radiographs. After tibial tunnel drilling, a second set of standardized photographs of the tibial plateau was obtained. Digital imaging permitted the superposition of pre- and postoperative images. Overlapping between the anatomical insertion areas and the tibial tunnel exit was determined, as well as the distance between the borders of the insertion areas and the tunnel exit. Insertion area and tunnel exit showed a mean overlapping of 59.8 ± 34.8% (anterior horn), respectively 62.4 ± 32.0% (posterior horn) for the lateral meniscus and of 88.4 ± 15.5% (anterior horn), respectively 60.3 ± 31.6% (posterior horn) for the medial meniscus. Mean distance between the borders of insertion area and tunnel exit was 2.0 ± 1.5 mm (anterior horn), respectively 2.0 ± 1.7 mm (posterior horn) for the lateral meniscus and 0.9 ± 0.9 mm (anterior horn), respectively 2.1 ± 1.4 mm (posterior horn) for the medial meniscus. Thus, a precise drilling of tibial tunnels at the anatomical insertions of the menisci can be obtained by positioning a standard ACL-guide under radiographic control in a cadaver setting. In advanced day-by-day clinic, this knowledge could facilitate the surgical technique for anatomical fixation of lateral and medial meniscus transplants. PMID:20130834

Wilmes, Philippe; Lorbach, O; Weth, C; Kohn, D; Seil, R

2010-02-04

86

Can a tibial tunnel in ACL surgery be placed anatomically without impinging on the femoral notch? A risk factor analysis.  

PubMed

PURPOSE: To analyze anatomical risk factors and surgical technique dependent variables, which determine the risk for femoral notch impingement in anatomically correct placed tibial tunnels for anterior cruciate ligament (ACL) surgery. METHODS: Twenty fresh frozen adult human knee specimens under the age of 65 years were used. Digital templates mimicking a tibial tunnel aperture at the tibia plateau were designed for different tibial tunnel diameters and different drill-guide angles. The centres of these templates were placed over the geometric centre of the native tibial ACL footprint. The distances between the anterior borders of the templates and the anterior borders of the footprints (graft free zone) were measured and compared. Furthermore, anatomic risk factors for femoral notch impingement were determined. RESULTS: The graft free zone was statistically significantly longer for larger drill-guide angles compared to smaller drill-guide angles (p < 0.00001). Furthermore, 8 mm diameter tibial tunnels had a statistically significant larger graft free zone compared to 10-mm-diameter tibial tunnels (p < 0.00001). For the 10 mm diameter tibial tunnels with drill-guide angle of 45°, 9 out of 20 knees (45 %) were "at risk" for notching and 4 out of 20 knees (20 %) had "definite" notching. For 10-mm tunnels with drill-guide angle of 45°, a risk for notching was associated with smaller tibial ACL footprint (p < 0.05). CONCLUSION: If a perfect centrally positioned tibial tunnel is drilled, a real risk for femoral notch impingement exists depending on the size of the tibial ACL footprint and surgery-related factors. Therefore, in anatomical tibial tunnel placement in single bundle ACL reconstruction surgery, particular attention should be paid to size of the tunnel and drill-guide angle to minimize the risk of femoral notch impingement. PMID:23338664

Van der Bracht, H; Bellemans, J; Victor, J; Verhelst, L; Page, B; Verdonk, P

2013-01-23

87

Smaller amygdala volume and reduced anterior cingulate gray matter density associated with history of post-traumatic stress disorder  

Microsoft Academic Search

Although post-traumatic stress disorder (PTSD) may be seen to represent a failure to extinguish learned fear, significant aspects of the pathophysiology relevant to this hypothesis remain unknown. Both the amygdala and hippocampus are necessary for fear extinction occur, and thus both regions may be abnormal in PTSD. Twenty-five people who experienced the Tokyo subway sarin attack in 1995, nine who

Mark A. Rogers; Hidenori Yamasue; Osamu Abe; Haruyasu Yamada; Toshiyuki Ohtani; Akira Iwanami; Shigeki Aoki; Nobumasa Kato; Kiyoto Kasai

2009-01-01

88

Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study  

Microsoft Academic Search

The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site\\u000a morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore,\\u000a we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the\\u000a graft–fixation-device complex than does traditional extraction drilling

O. G. Sørensen; B. W. Jakobsen; S. Kold; T. B. Hansen; K. Søballe

2010-01-01

89

Anteroposterior positioning of the tibial component and its effect on the mechanics of patellofemoral contact.  

PubMed

The biomechanics of the patellofemoral joint can become disturbed during total knee replacement by alterations induced by the position and shape of the different prosthetic components. The role of the patella and femoral trochlea has been well studied. We have examined the effect of anterior or posterior positioning of the tibial component on the mechanisms of patellofemoral contact in total knee replacement. The hypothesis was that placing the tibial component more posteriorly would reduce patellofemoral contact stress while providing a more efficient lever arm during extension of the knee. We studied five different positions of the tibial component using a six degrees of freedom dynamic knee simulator system based on the Oxford rig, while simulating an active knee squat under physiological loading conditions. The patellofemoral contact force decreased at a mean of 2.2% for every millimetre of posterior translation of the tibial component. Anterior positions of the tibial component were associated with elevation of the patellofemoral joint pressure, which was particularly marked in flexion > 90°. From our results we believe that more posterior positioning of the tibial component in total knee replacement would be beneficial to the patellofemoral joint. PMID:20884990

Didden, K; Luyckx, T; Bellemans, J; Labey, L; Innocenti, B; Vandenneucker, H

2010-10-01

90

Navigated anterior cruciate ligament reconstruction: radiographic validation of a nonimage-based system.  

PubMed

The authors compared the intraoperative navigated measurements of the location of the tibial and femoral tunnels during arthroscopic-assisted anterior cruciate ligament reconstruction to the postoperative measurements performed on standard plain radiographs in 56 patients. The position of the center of the tibial and femoral tunnels was measured intraoperatively with the OrthoPilot (B. Braun Aesculap, Tuttlingen, Germany) and postoperatively on plain anteroposterior and lateral radiographs. The center of the tibial tunnel was located at 43% of the mediolateral tibial dimension intraoperatively and at 41% of the mediolateral tibial dimension postoperatively (P=.14). The center of the tibial tunnel tibial was located at 40% of the anteroposterior tibial dimension intraoperatively and at 35% of the anteroposterior tibial dimension postoperatively (P=.01). The center of the femoral tunnel was located at 85% of the anteroposterior femoral dimension intraoperatively and at 76% of the anteroposterior femoral dimension postoperatively (P<.001). A significant correlation was found between intraoperative navigated and postoperative radiographic measurements only at the femur. Good agreement existed between all navigated and radiographic measurements. The OrthoPilot navigation system allows an accurate measurement of the location of the tibial and femoral tunnels during anterior cruciate ligament reconstruction. PMID:23026247

Jenny, Jean-Yves; Abane, Lamine

2012-10-01

91

THE RELIABILITY OF THE PREOPERATIVE CLASSIFICATION OF OPEN TIBIAL FRACTURES IN CHILDREN A PROPOSAL FOR A NEW CLASSIFICATION  

Microsoft Academic Search

The purpose of this observational study was to eval- uate the accuracy of Gustilo's classification of open tibial fractures in children. Pre- and post-debride- ment (using the parameters of Gustilo's classifica- tion) wound gradings in 27 children with a mean age of 10 years (3 to 15 years) who had sustained an open tibial fracture were compared. Pre-operative Polaroid photographs

A. A. FARAJ

2002-01-01

92

RhoA activity and post-ischemic inflammation in an experimental model of adult rodent anterior ischemic optic neuropathy.  

PubMed

Activation of inflammatory cells and the RhoA signaling pathway may contribute to optic nerve damage following non-arteritic anterior ischemic optic neuropathy (NAION). We induced an optic nerve infarct with a photothrombotic mechanism in a rat model of AION (rAION). Immunohistochemistry and Western blot were performed to detect activation of RhoA signaling and inflammation. The extent of Rho activity, inflammation, retinal ganglion cell (RGC) loss and extent of axon regeneration were determined at 8 and 14 days after infarct. Eight days after stroke, we observed significant inflammation and RhoA activity at the site of infarction as well as loss of cells in the RGC layer. RhoA activity had decreased and inflammation had decreased at day 14 compared with day 8; however, loss of RGCs was greater at 14 days than at 8 days. Stroked eyes showed minor axon regeneration around the optic nerve lesion site at both 8 and 14 days. These results demonstrate that inflammation and RhoA activation occur in rAION at the site of infarction. PMID:23973747

Fard, Masoud Aghsaei; Ebrahimi, Katayoon Baradaran; Miller, Neil R

2013-08-21

93

Delayed diagnosis of post-traumatic C7 vertebra anterior subluxation with an unusual neurological pattern: a case report  

PubMed Central

Introduction Post-traumatic subluxations are potentially devastating injuries to the axial skeleton. Of utmost priority are an expedient and timely diagnosis and realignment because of its association with spinal cord and nerve root trauma, which lead to progressive deleterious neurological deficits. A good radiological study of the occipitocervical joint and first thoracic vertebra is key to a successful early diagnosis. However, cases might still fail to be diagnosed, leading to trouble. A case of post-traumatic subluxation at the C7 vertebral level with an unusual neurological pattern is presented here. Case presentation A 35-year-old farmer from the Sindh province of Pakistan presented to our neurology department after a fall 2 months earlier and complained of lower limb pain and difficulty in walking. He had numbness in both of his lower limbs up to his umbilical region, with sparing of bladder function along with intact strength in the upper extremities bilaterally. Conclusions Our case highlights the unusual sparing of upper limbs and intact urinary continence with severe lower limb deficits in a 70% subluxation. Our case is unusual because highly detrimental effects such as quadriplegia are expected with such extreme subluxation, but our patient presented with only lower limb deficits. This case serves as a reminder to emergency medicine doctors, spine surgeons, and even radiologists (a) to evaluate spine injuries by using computed tomography in trauma patients to identify artifact around a suspected injury and (b) to be mindful of negative conventional radiographs.

2013-01-01

94

Tibial Tunnel Aperture Irregularity After Drilling With 5 Reamer DesignsA Qualitative Micro-Computed Tomography Analysis  

Microsoft Academic Search

Background: There is limited information in the literature on comparisons of antegrade versus retrograde reaming techniques and the effect on the creation of anterior cruciate ligament (ACL) tibial tunnel entry and exit apertures.Hypothesis: Proximal and distal apertures of ACL tibial tunnels, as created with different reamers, will be affected by type of reamer design.Study Design: Controlled laboratory study.Methods: Forty skeletally

Andrew G. Geeslin; Kyle S. Jansson; Coen A. Wijdicks; Mark A. Chapman; Alex S. Fok; Robert F. LaPrade

2011-01-01

95

Ossicles anterior to the proximal tibia.  

PubMed

Ossicles anterior to the anterior tibia are most usually seen in relation to the tibial tuberosity. While these are usually taken to represent sequelae of previous Osgood-Schlatter disease, they may, on occasion, represent normal variants in ossification of the tuberosity. Ossicles superior to the tuberosity may have similar origins. Representative examples are presented, as is a very large ossicle separated from the anterior tibia by a prolongation of the knee joint space. Theories of causation of such ossicles are discussed. PMID:8348404

Bloom, R A; Gomori, J; Milgrom, C

96

Total knee arthroplasty for neuropathic joint disease after severe bone destruction eroded the tibial tuberosity.  

PubMed

This article describes a patient in whom total knee arthroplasty was performed for neuropathic joint disease secondary to diabetes mellitus after severe bone destruction eroded the tibial tuberosity. At initial examination, radiographs of the knee showed bone destruction in the medial and anterior regions of the tibia, and fine bone fragments were seen in the joint. Conservative therapy was performed using a brace. However, bone destruction gradually advanced, and 10 months after the initial examination, radiographs of the knee showed bone destruction in the lateral condyle of the femur and advanced bone destruction of the anterior tibia; the tibial tuberosity was missing. It is rare for the tibial tuberosity in the anterior tibia to disappear. If this happens, reconstruction is difficult and total knee arthroplasty becomes complicated. For the bone defect in the tibia, cement was used to recreate the shape of the anterior surface of the tibia. It was possible to minimize the volume of bone resection and morphologically reconstruct the tibial tuberosity. The patient recovered quickly. At postoperative week 5, the patient was able to walk using a cane. Thirty-six months after total knee arthroplasty, knee extension was 0°, flexion was 120°, extension lag was 5°, knee score improved from 40 points to 94 points, and functional score improved from 20 points to 75 points. However, long-term implant stability needs to be carefully monitored. PMID:22784910

Sugitani, Kazuya; Arai, Yuji; Takamiya, Hisatake; Minami, Ginjiro; Higuchi, Tetsuo; Kubo, Toshikazu

2012-07-01

97

Mycobacterium fortuitum infection after anterior cruciate ligament reconstruction using a polylactic acid bioabsorbable screw: Case report.  

PubMed

We report a case of pretibial sinus and abscess after anterior cruciate ligament reconstruction using a polylactic acid tricalcium phosphate bioabsorbable screw for tibial fixation. Mycobacterium fortuitum was identified as the pathogen after specific mycobacterial cultures were obtained from operative specimens. M. fortuitum is a known but rare cause of periprosthetic infection. Diagnosis is often delayed as routine microbiological cultures do not utilise specific culture requirements for mycobacterial growth. There have been several reports in the literature of sterile abscesses associated with bioabsorbable screws. To our knowledge, this is the first case report of a non-tuberculous mycobacterial infection associated with a bioabsorbable implant. This case illustrates that post-operative Mycobacterium infection can occur as a complication of ACL reconstruction with bioabsorbable screw fixation and should be considered in the differential diagnosis of post-operative periprosthetic infection. PMID:19744856

Oh, Horng Lii; Chen, Darren B; Seeto, Bradley G; Macdessi, Samuel J

2009-09-09

98

Micromotion analysis of the fixation of total knee tibial component  

Microsoft Academic Search

Immediate post-operative stability is critical for the long-term success of biological implant fixations. Excessive motion at the bone-prosthesis interface is known to inhibit bone ingrowth and thereby cause failure of the fixation. In the present study, relative displacements between the host bone and the tibial component of total knee implants were evaluated, and the effect of the method on the

M. Tissakht; H. Eskandari; A. M. Ahmed

1995-01-01

99

The Function of the Human Anterior Cruciate Ligament and Analysis of Single- and Double-Bundle Graft Reconstructions  

PubMed Central

Context: There exists controversy on the ability of a single or double anterior cruciate ligament graft technique to restore anterior cruciate ligament function. This article examines the published experimental and clinical data supporting these surgical procedures in the ability to restore knee stability. Evidence Acquisition: An analysis of anterior cruciate ligament function and single- and double-graft reconstructions defined by selected biomechanical, robotic, kinematic, anatomical, and clinical studies. Results: The anterior cruciate ligament resists the combined motions of anterior tibial translation and internal tibial rotation, which defines the concept of rotational stability. This function prevents anterior tibial subluxation of the lateral and medial tibiofemoral compartments that accounts for the pivot-shift phenomena. The placement of single anterior cruciate ligament grafts high and proximal at the femoral attachment and posterior at the tibial attachment results in a vertical graft orientation. This graft placement results in a limited ability to provide rotational stability and is inferior when compared to a double-bundle graft procedure. Studies show that a more oblique single-graft orientation, in the sagittal and coronal plane, achieved from a central anatomic femoral and tibial location provides rotational stability similar to a double-bundle anterior cruciate ligament graft. Conclusion: There exists insufficient experimental and clinical data to recommend the more complex double-bundle anterior cruciate ligament graft technique over a well-placed central anatomic single graft in terms of restoring knee rotational stability. Meticulous surgical technique for anterior cruciate ligament graft placement is necessary to avoid failure.

2009-01-01

100

Is there an influence of the tibial slope of the lateral condyle on the ACL lesion? A case-control study.  

PubMed

This study examines the effect of the tibial slope on the anterior cruciate ligament lesion (separately on the lateral and medial tibial condyle). The study consisted of 33 matched pairs of patients divided into two groups: an examined group with a diagnosed ACL lesion, and a control group with diagnosed patellofemoral pain. The patients were matched on the basis of four attributes: age, sex, type of lesion (whether it was profession-related), and whether the lesion was left- or right-sided. Measurements were carried out by radiography and MRI. In the examined group, the lateral tibial plateau was significantly greater than in the control group (P < 0.001), and the medial tibial plateau had lower tibial slope values than the control group; however, the difference was not statistically significant (P = 0.066). In both groups, the difference between the slopes on the lateral and medial plateaus was statistically significant (P < 0.001). In relation to ACL intact patients, population with ACL rupture have greater tibial slope of the lateral condyle. The greater tibial slope of the lateral tibial plateau may be the factor that leads to the injury of the anterior cruciate ligament. Compared to the medial plateau, the population with ACL rupture have a greater tibial slope on the lateral plateau, while the population of the intact ACL have greater tibial slope on the medial plateau. The tibial slope of the medial and lateral condyle should be compared separately because the values obtained from the two sets of data were different, revealing apparently opposing effects on the ACL lesion. PMID:18239948

Stijak, Lazar; Herzog, Richard F; Schai, Pascal

2007-11-16

101

Evidence for Acquired Pregenual Anterior Cingulate Gray Matter Loss from A Twin Study of Combat-Related Post-Traumatic Stress Disorder  

PubMed Central

Background Controversy exists over the nature and origin of reduced regional brain volumes in post-traumatic stress disorder (PTSD). At issue is whether these reductions represent pre-existing vulnerability factors for developing PTSD upon traumatic exposure or acquired PTSD signs due to the traumatic stress that caused the PTSD and/or the chronic stress of having PTSD. We employed a case-control design in monozygotic twin pairs discordant for combat exposure to address the pre-existing vs. acquired origin of brain morphometric abnormalities in this disorder. Method We used voxel-based morphometry to search for gray matter density reductions in magnetic resonance imaging (MRI) data obtained in a previous study of combat-exposed Vietnam veteran twins with (n=18) vs. without (n=23) PTSD and their “high-risk” vs. “low-risk” (respectively), identical, combat-unexposed co-twins. Results Compared to the combat-exposed twins without PTSD, the combat-exposed twins with PTSD showed significant gray matter density reductions in four predicted brain regions: right hippocampus, pregenual anterior cingulate cortex (ACC), and left and right insulae. There was a significant PTSD Diagnosis × combat Exposure interaction in pregenual ACC, in which combat-exposed PTSD twins had lower gray matter density than their own combat-unexposed co-twins as well as than the combat-exposed twins without PTSD and their co-twins. Conclusion The results point to gray matter volume diminutions in limbic and paralimbic structures in PTSD. The pattern of results obtained for pregenual ACC suggests that gray matter reduction in this region represents an acquired sign of PTSD that is consistent with stress-induced loss.

Kasai, Kiyoto; Yamasue, Hidenori; Gilbertson, Mark W.; Shenton, Martha E.; Rauch, Scott L.; Pitman, Roger K.

2009-01-01

102

Two-bundle, four-tunnel anterior cruciate ligament reconstruction.  

PubMed

We reviewed 33 patients who underwent anterior cruciate ligament (ACL) reconstruction using a two-bundle, four-tunnel technique. The posterolateral bundle (PLB) and anteromedial bundle (AMB) were individually reconstructed with gracilis and semitendinosus tendon auto-grafts, respectively, using separate tibial and femoral tunnels. At final follow-up (24 months post surgery, range 18-31) the International Knee Documentation Committee's (IKDC) objective final evaluation scores were 69 A, 19 B, 12% C. The mean global subjective IKDC score was 86+/-12 points. Ninety-four percent of the patients had returned to sport after an average of 9 months following surgery and 75% returned to their preinjury sporting level. One patient had suffered a graft rupture as a result of a further sports injury. Eighty-four percent of the patients had a negative pivot shift (IKDC A), 9% a glide (IKDC B), and 6% a "clunk" (IKDC C). The mean postoperative side-to-side laxity, measured with KT1000 arthrometry at manual maximum, was 0.9 mm (SD 1.9). Eighty-one percent of the patients had less than 3 mm difference, with only one patient having greater than 5 mm. Our early experience with this new technique appears to demonstrate satisfactory results that are at least equivalent to other techniques and show an apparent trend towards improved control of anterior laxity. PMID:16341690

Colombet, Philippe; Robinson, James; Jambou, Stéphane; Allard, Michel; Bousquet, Vincent; de Lavigne, Christophe

2005-12-09

103

Biomechanical Comparison of Single-Tunnel-Double-Bundle and Single-Bundle Anterior Cruciate Ligament Reconstructions  

PubMed Central

Background Anatomic double-bundle reconstruction has been thought to better simulate the anterior cruciate ligament anatomy. It is, however, a technically challenging procedure, associated with longer operation time and higher cost. Hypothesis Double-bundle anterior cruciate ligament reconstruction using a single femoral and tibial tunnel can closely reproduce intact knee kinematics. Study Design Controlled laboratory study. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system to investigate the kinematic response of the knee joint under an anterior tibial load (130 N), simulated quadriceps load (400 N), and combined torques (5 N·m valgus and 5 N·m internal tibial torques) at 0°, 15°, 30°, 60°, and 90° of flexion. Each knee was tested sequentially under 4 conditions: (1) anterior cruciate ligament intact, (2) anterior cruciate ligament deficient, (3) single-bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon, and (4) single-tunnel–double-bundle anterior cruciate ligament reconstruction using the same tunnels and quadrupled hamstring tendon graft as in the single-bundle anterior cruciate ligament reconstruction. Results Single-tunnel–double-bundle anterior cruciate ligament reconstruction more closely restored the intact knee kinematics than single-bundle anterior cruciate ligament reconstruction at low flexion angles (?30°) under the anterior tibial load and simulated muscle load (P < .05). However, single-tunnel–double-bundle anterior cruciate ligament reconstruction overconstrained the knee joint at high flexion angles (?60°) under the anterior tibial load and at 0° and 30° of flexion under combined torques. Conclusion This double-bundle anterior cruciate ligament reconstruction using a single tunnel can better restore anterior tibial translations to the intact level compared with single-bundle anterior cruciate ligament reconstruction at low flexion angles, but it overconstrained the knee joint at high flexion angles. Clinical Relevance This technique could be an alternative for both single-bundle and double-tunnel–double-bundle anterior cruciate ligament reconstructions to reproduce intact knee kinematics and native anterior cruciate ligament anatomy.

Gadikota, Hemanth R.; Seon, Jong Keun; Kozanek, Michal; Oh, Luke S.; Gill, Thomas J.; Montgomery, Kenneth D.; Li, Guoan

2013-01-01

104

Tibial anatomy and functional axes.  

PubMed

Articular geometry of the tibia has been studied in relation to the functional axis and extra-articular bone landmarks, using a Cartesian coordinate system. Thirty-one cadaver limbs were used, 26 of them paired. The donor age range was 61 to 89 years (17 females, 14 males), none of whom showed evidence of significant arthritic deterioration. Most linear parameters were greater in males than females (p less than 0.005), and correlations between these parameters were noted, e.g., tibial length versus plateau width (r = 0.7, p less than 0.01) with both genders combined. Gender differences occurred in only two of the angular parameters--tibial torsion (p less than 0.025) and foot rotation (p less than 0.005). For the latter, mean rotation was internal (-5 degrees) for males, and external (11 degrees) for females. No correlations between angular parameters were found. In the paired limbs, there was asymmetrical distribution of just two parameters--varus tilt of the tibial plateau margins (p less than 0.005) and lateral deviation of the tuberosity (p less than 0.025). The data complement a previous report on the femur. These studies are relevant to the kinematics of the lower limb, design and sizing of resurfacing components, and possibly to the pathogenesis of osteoarthritis. PMID:2908904

Yoshioka, Y; Siu, D W; Scudamore, R A; Cooke, T D

1989-01-01

105

Functional knee braces increase intramuscular pressures in the anterior compartment of the leg  

Microsoft Academic Search

The effect of three different functional knee braces on intramuscular pressures in the anterior compartment of the leg was investigated in 8 healthy subjects. Pres sures were recorded with the microcapillary infusion technique while the subjects were either supine, sitting, or standing. Pressures at rest in the anterior tibial muscle increased significantly following application of each of the three knee

Jorma R. Styf; Manoutch Nakhostine; David H. Gershuni

1992-01-01

106

Effect of knee flexion on the in situ force distribution in the human anterior cruciate ligament  

Microsoft Academic Search

This study was conducted to evaluate the effect of applied load on the magnitude, direction, and point of tibial intersection of the in situ forces of the anteromedial (AM) and posterolateral (PL) bands of the human anterior cruciate ligament (ACL) at 30° and 90° of knee flexion. An Instron was used to apply a 100 N anterior shear force to

J. W. Xerogeanes; Y. Takeda; G. A. Livesay; Y. Ishibashi; H. S. Kim; F. H. Fu; S. L.-Y. Woo

1995-01-01

107

Ischemic Necrosis of Tibialis Anterior Muscle in Burn Patients: Report of Three Cases.  

National Technical Information Service (NTIS)

The anterior tibial compartment syndrome is described in three patients with full-thickness burns of the legs. Loss of the tibialis anterior muscle and deep peroneal nerve deficit were seen in all patients. The anatomic and pathophysiological aspects of t...

M. J. Asch R. J. Flemma B. A. Pruitt

1969-01-01

108

Patellar tracking after total knee arthroplasty. The effect of tibial tray malrotation and articular surface configuration.  

PubMed

The effect of total knee arthroplasty (TKA) with neutrally aligned and malrotated tibial trays was studied in five fresh anatomic specimen knees. Patellar shift, tilt, and rotation, and the rotational position of the tibia were measured in normal knees and after TKA with the Ortholoc Modular knee system. Both semiconstrained and unconstrained articular surfaces were assessed in the neutral position and at anatomic, 15 degrees internal, and 15 degrees external rotation of the tibial tray. After TKA, the patellae shifted slightly medially in the early phase of knee flexion because the anterior lateral flange of the femoral component was longer than the lateral trochlea of the femur and because the tibia rotated internally. The raised lateral flange on the femoral component tilted the patella medially at full extension after TKA. The semiconstrained tray allowed minimal tibial rotation because of its articular configuration. As much as 15 degrees malrotation of the unconstrained tibial tray did not affect patellar tracking. The semiconstrained tibial tray in the neutral position had almost the same patellar tracking as the unconstrained tray, but at 15 degrees external rotation, the semiconstrained tray internally rotated the tibia, leading to medial shift of the patella. Although 15 degrees internal rotation caused external rotation of the tibia, the patella did not shift as much laterally, despite the increase in the Q angle. PMID:8020227

Nagamine, R; Whiteside, L A; White, S E; McCarthy, D S

1994-07-01

109

Intramedullary tibial nailing in distal third tibial fractures: distal locking screws and fracture non-union.  

PubMed

Distal third tibial fractures are prone to non-union following tibial nail insertion. The purpose of this study was to assess the union of distal third tibial fractures in patients who have undergone intra-medullary (IM) tibial nailing with one versus two distal locking screws. Sixty-five patients who had intramedullary tibial nail fixation were retrospectively analysed. Our results showed that 80% of non-unions in distal third fractures had only one distal locking screw compared to 20% who had two distal locking screws. This is statistically significant (p<0.01). We therefore conclude that two distal locking screws are essential for distal third fractures. PMID:17410364

Mohammed, Aso; Saravanan, Ramaswamy; Zammit, Jason; King, Richard

2007-04-05

110

Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results  

Microsoft Academic Search

Patellar tendon graft has been the most frequently used material in anterior cruciate ligament (ACL) reconstruction, but the\\u000a hamstring tendons have been increasingly used as well; however, which graft is to be preferred is not adequately supported\\u000a by existing clinical studies. In this prospective randomized clinical trial, the study hypothesis was that the hamstring tendons\\u000a are equally good graft material

Arsi Harilainen; Eric Linko; Jerker Sandelin

2006-01-01

111

Effect of tibial positioning on the diagnosis of posterolateral rotatory instability in the posterior cruciate ligament-deficient knee  

PubMed Central

Objective To determine whether positioning of the tibia affects the degree of tibial external rotation seen during a dial test in the posterior cruciate ligament (PCL)–posterolateral corner (PLC)?deficient knee. Design Laboratory investigation. Setting Biomechanics laboratory. Hypothesis An anterior force applied to the tibia in the combined PCL–PLC?deficient knee will yield increased tibial external rotation during a dial test. Methods The degree of tibial external rotation was measured with 5?N?m of external rotation torque applied to the tibia at both 30° and 90° of knee flexion. Before the torque was applied, an anterior force, a posterior force, or neutral (normal, reduced control) force was applied to the tibia. External rotation measurements were repeated after sequential sectioning of the PCL, the posterolateral structures and the fibular collateral ligament (FCL). Results Baseline testing of the intact specimens demonstrated a mean external rotation of 18.6° with the knee flexed to 30° (range 16.1–21.0°), and a mean external rotation of 17.3° with the knee flexed to 90° (range 13.8–20.0°). Sequential sectioning of the PCL, popliteus and popliteofibular ligament, and the FCL led to a significant increase in tibial external rotation compared with the intact knee for all testing scenarios. After sectioning of the popliteus and popliteofibular ligament, the application of an anterior force during testing led to a mean tibial external rotation that was 5° greater than during testing in the neutral position and 7.5° greater than during testing with a posterior force. In the PCL, popliteus/popliteofibular ligament and FCL?deficient knee, external rotation was 9° and 12° greater with the application of an anterior force during testing compared with neutral positioning and the application of a posterior force, respectively. Conclusion An anterior force applied to the tibia during the dial test in a combined PCL–PLC?injured knee increased the overall amount of observed tibial external rotation during the dial test. The anterior force reduced the posterior tibial subluxation associated with PCL injury, which is analogous to what is observed when the dial test is performed with the patient in the prone position. Reducing the tibia with either an anterior force when the patient is supine or performing the dial test with the patient in the prone position increases the ability of an examiner to detect a concomitant PLC injury in the setting of a PCL?deficient knee.

Strauss, Eric J; Ishak, Charbel; Inzerillo, Christopher; Walsh, Michael; Yildirim, Gokce; Walker, Peter; Jazrawi, Laith; Rosen, Jeffrey

2007-01-01

112

Posterior tibial tendon rupture in athletic people  

Microsoft Academic Search

We present our findings in six athletic patients with a ruptured or partially ruptured posterior tibial tendon. Pain in the midarch region, difficulty pushing off while running, and a pronated flattened longitudinal arch are the usual symptoms and physical findings of this injury. Surgical treatment, including reattachment of the rup tured posterior tibial tendon, is effective in restoring some but

Lee Woods; Robert E. Leach

1991-01-01

113

Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy  

PubMed Central

Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2?cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity.

Beslikas, Theodoros; Christodoulou, Andreas; Chytas, Anastasios; Gigis, Ioannis; Christoforidis, John

2012-01-01

114

Post-training disruption of Arc protein expression in the anterior cingulate cortex impairs long-term memory for inhibitory avoidance training  

Microsoft Academic Search

The activity-regulated-cytoskeletal-associated protein (Arc) has a well established role in memory consolidation and synaptic plasticity in the hippocampus and amygdala. However the role of Arc within the anterior cingulate cortex (ACC), an area of the brain involved in processing memory for pain, has yet to be examined. Here we sought to determine if Arc protein within neurons of the rat

Crystal M. Holloway; Christa K. McIntyre

2011-01-01

115

Chronic Anterior Midtibial Stress Fractures in Athletes Treated With Reamed Intramedullary Nailing  

Microsoft Academic Search

Background: A chronic anterior midtibial stress fracture is a serious, difficult-to-treat injury that can adversely affect an athlete’s career.Hypothesis: The use of a reamed intramedullary nail for a chronic anterior tibial stress fracture is a safe and effective treatment for an athlete.Study Design: Case series; Level of evidence, 4.Methods: Seven collegiate-level athletes with 11 chronic anterior midtibial stress fractures were

Kevin E. Varner; Shiraz A. Younas; David M. Lintner; John V. Marymont

2005-01-01

116

Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing.  

PubMed

The purpose of this study was to determine differences in insertional articular trauma in infrapatellar tibial portal and suprapatellar portal intramedullary tibial nail insertion techniques. A cadaveric study was performed on 10 matched pairs of fresh-frozen adult cadaver lower extremities with intact extensor mechanisms. Two study groups with 10 limbs each were created: left lower limbs were treated with a standard medial parapatellar nailing portal and right lower limbs were treated with a suprapatellar tibial nailing portal. Start points were created under fluoroscopic guidance in anteroposterior and mediolateral planes. A start wire was placed and opening reaming was performed on the specimens using instrumentation specific to the nailing portal. Specimens were then dissected by medial parapatellar arthrotomy, revealing the intra-articular condition of the knee structures. The border of the tibial entry reamer hole was measured to the anterior horns of the menisci, anterior cruciate ligament root, and intermeniscal ligament using a digital caliper accurate to 0.02 mm. The structure was considered damaged if the structure was obviously damaged on visual inspection or if a measurement was less than 1 mm. Impact to intra-articular structures was numerically lower in the suprapatellar group (2/10) compared with the infrapatellar group (4/10), but the difference was not statistically significant between the 2 groups (P=.629). The suprapatellar portal approach to the tibial start point demonstrated a lower overall incidence of damage to intra-articular structures, but no significant statistical difference existed between the 2 treatment groups. PMID:24025006

Gaines, Robert J; Rockwood, Jason; Garland, Joshua; Ellingson, Christopher; Demaio, Marlene

2013-09-01

117

No early tibial tray loosening after surface cementing technique in mobile-bearing TKA.  

PubMed

Controversy still exists regarding which cementation technique of the tibial component is preferable. Full cementation showed excellent long-term outcomes, and surface cementation with fixed-bearing designs provided excellent mid-term results. Concerns have been expressed about possible rotary forces to the tibial rotating platform, when the tibial stem remains cementless, with the risk of early loosening. The purpose of this study was to evaluate the rate of early loosening and radiolucency lines in 70 consecutive unidirectional rotating platform, posterior stabilized, total knee arthroplasties, using surface cementation. Multivariate analysis was performed to identify any correlations between early loosening or radiolucency lines and clinically relevant covariates: age, sex, BMI, follow-up time, cement penetration, radiolucencies, tibial slope, femoral flexion, frontal alignment, pre-operative and post-operative Knee Scores. The tibial plateau was divided into four zones in antero-posterior view and into two zones in lateral view, and the cement penetration was evaluated in each zone. The mean follow-up was 43 months (SD 14), and the average patients' age was 73 (SD 7). The Knee Score averaged 91 (SD 8) and the Function score 86 (SD 17) at last follow-up visit. The cement penetration was >2 mm in all zones. No early loosening was detected, but in five asymptomatic patients (7%) radiolucency was noted around the tibial stem. The presence of radiolucent lines was not correlated with any of the covariates. The rate of early loosening and radiolucency lines with mobile tibial tray and surface cementation is comparable to other studies using different cementation techniques or surface cementation combined with fixed platform total knee arthroplasties. PMID:20535448

Rossi, Roberto; Bruzzone, Matteo; Bonasia, Davide Edoardo; Ferro, Andrea; Castoldi, Filippo

2010-06-10

118

Effect of tibial tuberosity advancement on femorotibial contact mechanics and stifle kinematics.  

PubMed

Objective- To evaluate the effects of tibial tuberosity advancement (TTA) on femorotibial contact mechanics and 3-dimensional kinematics in cranial cruciate ligament (CrCL)-deficient stifles of dogs. Study Design- In vitro biomechanical study. Animals- Unpaired pelvic limbs from 8 dogs, weighing 28-35 kg. Methods- Digital pressure sensors placed subjacent to the menisci were used to measure femorotibial contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135 degrees . Three-dimensional static poses of the stifle were obtained using a Microscribe digitizing arm. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Repeated measures analysis of variance with a Tukey post hoc test (P<.05) was used for statistical comparison. Results- Significant disturbances to all measured contact mechanic parameters were evident after CrCL transection, which corresponded to marked cranial tibial subluxation and internal tibial rotation in the CrCL-deficient stifle. No significant differences in any contact mechanic and kinematic parameters were detected between normal and TTA-treated stifles. Conclusion- TTA eliminates craniocaudal stifle instability during simulated weight-bearing and concurrently restores femorotibial contact mechanics to normal. Clinical Relevance- TTA may mitigate the progression of stifle osteoarthritis in dogs afflicted with CrCL insufficiency by eliminating cranial tibial thrust while preserving the normal orientation of the proximal tibial articulating surface. PMID:19152615

Kim, Stanley E; Pozzi, Antonio; Banks, Scott A; Conrad, Bryan P; Lewis, Daniel D

2009-01-01

119

Open wedge high tibial osteotomy: cause of patellar descent.  

PubMed

This was a retrospective review of the nine open wedge high tibial osteotomy (HTO) done in a regional hospital in Hong Kong from 2006 to 2008. The mechanical hip-knee-ankle angle improved from average 169.5°(164°-175°) to average 183.9° (179°-187°). Patellar descent was noted in all patients postoperatively, with Blackburne-Peel (BP) index significantly changing from 0.78 (0.64-0.93) to 0.59 (0.38-0.78) (p < 0.05). This change was strongly correlated with the size of anterior bone graft (r = -0.766; p = 0.016). The patellar tendon length as measured by Insall-Salvati index was not changed (pre-operative: 1.02 (0.88-1.25), final: 1.09 (0.8-1.22) (p = 0.683)), inferring that scarring contracture of patellar tendon was not related to patellar descent. PMID:22240018

Fan, Jason C H

2012-01-12

120

Open wedge high tibial osteotomy: cause of patellar descent  

PubMed Central

This was a retrospective review of the nine open wedge high tibial osteotomy (HTO) done in a regional hospital in Hong Kong from 2006 to 2008. The mechanical hip-knee-ankle angle improved from average 169.5°(164°-175°) to average 183.9° (179°-187°). Patellar descent was noted in all patients postoperatively, with Blackburne-Peel (BP) index significantly changing from 0.78 (0.64-0.93) to 0.59 (0.38-0.78) (p < 0.05). This change was strongly correlated with the size of anterior bone graft (r = -0.766; p = 0.016). The patellar tendon length as measured by Insall-Salvati index was not changed (pre-operative: 1.02 (0.88-1.25), final: 1.09 (0.8-1.22) (p = 0.683)), inferring that scarring contracture of patellar tendon was not related to patellar descent.

2012-01-01

121

Tibial tuberosity transfer for episodic patellar dislocation.  

PubMed

Numerous surgical techniques have been described to address episodic patellar dislocations. Some of them involve the soft tissues whereas others primarily address a bony correction. Four principal anatomic factors have been identified that increase the risk for episodic patellar dislocations: trochlear dysplasia, patella alta, patellar tilt, and an excessive tibial tubercle-trochlear groove distance. A treatment algorithm has been proposed to correct each of these factors. It includes the tibial tuberosity transfer, which is able to correct both a patella alta and an excessive tibial tubercle-trochlear groove distance. The tibial tuberosity can be transferred distally or medially or more frequently a combination of both. It will realign the extensor mechanism and increase patellofemoral stability. This procedure may be associated with a medial patellofemoral ligament reconstruction in case of excessive patellar tilt or rarely with a trochleoplasty for major abnormal patellar maltracking. PMID:17505319

Servien, Elvire; Verdonk, Peter C; Neyret, Philippe

2007-06-01

122

Atypical tibial tuberosity fracture in an adolescent.  

PubMed

Avulsion fractures of the tibial tuberosity are typically sustained by adolescent males during sporting activities. Tibial tuberosity avulsions with simultaneous proximal tibial epiphyseal fractures are rare injuries. We present an unusual case of Ogden type IIIA avulsion fracture of tibial tuberosity with a Salter Harris type IV posterior fracture of proximal tibial epiphysis in a 13-year-old boy. We believe that the patient sustained the tibial tuberosity avulsion during the take-off phase of a jump while playing basketball due to sudden violent contraction of the quadriceps as the knee was extending. This was then followed by the posterior Salter Harris type IV fracture of proximal tibial physis as he landed on his leg with enormous forces passing through the knee. Although standard radiographs were helpful in diagnosing the complex fracture pattern, precise configuration was only established by computed tomography (CT) scan. The scan also excluded well-recognized concomitant injuries including ligament and meniscal injuries. Unlike other reported cases, our patient did not have compartment syndrome. Anatomic reduction and stabilization with a partially threaded transepiphyseal cannulated screw and a metaphyseal screw followed by early mobilization ensured an excellent recovery by the patient.Our case highlights the importance of vigilance and a high index of suspicion for coexisting fractures or soft tissue injuries when treating avulsion fractures of tibial tuberosity. A CT scan is justified in such patients to recognize complex fracture configurations, and surgical treatment should be directed appropriately to both the fractures followed by early rehabilitation. Patients with such injuries warrant close monitoring for compartment syndrome during the perioperative period. PMID:21667912

Jalgaonkar, Azal A; Dachepalli, Sunil; Al-Wattar, Zaid; Rao, Sudhir; Kochhar, Tony

2011-06-14

123

Intravitreal implant migration into anterior chamber in a post-vitrectomy eye with central retinal vein occlusion and persistent macular edema.  

PubMed

The authors report the case of a 76-year-old man with a history of central retinal vein occlusion with persistent macular edema in the pseudophakic left eye, which was vitrectomized after complicated retinal detachment surgery. Two weeks after treatment with an intravitreal dexamethasone implant, the implant migrated into the anterior chamber. Visual acuity was hand motion in the right eye and 20/40 in the left eye with corneal edema. One week later, the implant relocated back into the vitreous cavity without surgical intervention, with a marked decrease in corneal edema and improved visual acuity (20/30) in the left eye. Weak zonules and posture change may have caused implant migration in this patient. PMID:23402344

Turaka, Kiran; Kwong, Henry M; De Souza, Stephen

2013-02-12

124

Do Capacity Coupled Electric Fields Accelerate Tibial Stress Fracture Healing.  

National Technical Information Service (NTIS)

To determine the effect of capacitively coupled electric field stimulation on tibial stress fracture healing in men and women. Methods: A convenience sample of 20 men and 24 women with posteromedial tibial stress fractures was recruited. Subjects were ran...

A. R. Hoffman B. Beck G. Matheson G. Bergman

2006-01-01

125

Tibial stress injuries: decisive diagnosis and treatment of 'shin splints'.  

PubMed

Tibial stress injuries, commonly called 'shin splints,' often result when bone remodeling processes adapt inadequately to repetitive stress. Physicians who care for athletic patients need a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are implications for appropriate diagnosis, management, and prevention. PMID:20086529

Couture, Christopher J; Karlson, Kristine A

2002-06-01

126

Tibial Stress Injuries: Decisive Diagnosis and Treatment of "Shin Splints."  

ERIC Educational Resources Information Center

|Tibial stress injuries, commonly called shin splints, often result when bone remodeling processes adopt inadequately to repetitive stress. Physicians who are caring for athletic patients must have a thorough understanding of this continuum of injuries, including medial tibial stress syndrome and tibial stress fractures, because there are…

Couture, Christopher J.; Karlson, Kristine A.

2002-01-01

127

Tendoscopy of the posterior tibial tendon.  

PubMed

Posteromedial ankle complaints are most often caused by a disorder of the posterior tibial tendon. Two predominant groups of patients can be distinguished: the first involves younger patients who have some form of systemic inflammatory disease; the second involves older patients whose dysfunction is caused by chronic overuse. This article illustrates endoscopy of the posterior tibial tendon in a group of patients who had diverse pathology. None of the patients showed postoperative complications. All showed a quick recovery, early mobilization, none or mild postoperative pain, and nice wound healing. Although not all patients were free of complaints, all were satisfied with the intervention itself. Tendoscopy of the poterior tibial tendon offers the advantage of less morbidity, reduction of the postoperative pain, early mobilization, no wound healing problems and outpatient treatment. PMID:16798520

Bulstra, Gythe H; Olsthoorn, Paul G M; Niek van Dijk, C

2006-06-01

128

Osteochondritis of the Distal Tibial Epiphysis  

PubMed Central

Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.). Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment.

EL Hajj, Firass; Sebaaly, Amer; Kharrat, Khalil; Ghanem, Ismat

2012-01-01

129

Syndrome de loge tibiale antérieure secondaire à une myosite purulente chez un patient atteint de polyarthrite rhumatoïde  

Microsoft Academic Search

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared

Osman Aynaci; Cetin Onder; Ahmet Kalaycioglu

2003-01-01

130

Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL replacement  

Microsoft Academic Search

The aim of this study was to evaluate tibial bone tunnel enlargement following four-strand hamstring tendon anterior cruciate ligament (ACL) reconstruction, using a new method of magnetic resonance imaging (MRI) assessment. Correlation with clinical outcome was also examined. In a prospective study following ACL reconstruction, 24 patients underwent MRI and clinical assessment, at a mean follow-up of 6.5 months. A

Peter J. Fules; Rohit T. Madhav; Richard K. Goddard; Anthony Newman-Sanders; Michael A. S. Mowbray

2003-01-01

131

Insufficiency fractures of the tibial plateau  

SciTech Connect

An insufficiency fracture of the tibial plateau may be the cause of knee pain in patients with osteoporosis. The diagnosis is usually not suspected until a bone scan is done, as initial radiographs are often negative or inconclusive and clinical findings are nonspecific and may simulate osteoarthritis or spontaneous osteonecrosis. In five of 165 patients referred for bone scans due to nontraumatic knee pain, a characteristic pattern of intense augmented uptake of radionuclide confined to the tibial plateau led to a presumptive diagnosis of insufficiency fracture, later confirmed on radiographs.

Manco, L.G.; Schneider, R.; Pavlov, H.

1983-06-01

132

Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons.  

PubMed

We retrospectively reviewed 87 anterior cruciate ligament reconstructions using autogenous hamstring tendons with the Endobutton technique to investigate the relationship between bone tunnel enlargement and clinical outcome and to identify factors that contribute to the enlargement. The clinical outcome was evaluated using the Lysholm score and KT-1000 arthrometer. The location of the femoral tunnel with respect to Blumensaat's line, the tibial tunnel with respect to the tibial plateau, and the angle between the femoral tunnel and Blumensaat's line (femoral tunnel angle) were measured. Bone tunnel enlargement was observed in 32 patients (37%). Enlargement occurred in 22 of the femoral tunnels and 26 of the tibial tunnels. Enlargement of both tunnels occurred in 16 knees. There was no statistical difference in Lysholm scores or KT-1000 arthrometer measurements between the enlarged group and the unenlarged group. The femoral tunnel was placed more anteriorly in the enlarged femoral tunnel group than in the unenlarged femoral tunnel group. The tibial tunnel was placed more anteriorly in the enlarged tibial tunnel group than in the unenlarged tibial tunnel group. The femoral tunnel angle was significantly smaller in the enlarged femoral tunnel group than in the femoral unenlarged group. Gender, patient age, intraoperative isometricity, and graft size were not significant factors. Bone tunnel enlargement was not correlated with the clinical outcome measures. We conclude that the main factor associated with tunnel enlargement are the locations and angles of the tunnels. The windshield-wiper motion of the graft may be enhanced by changing tension in the graft due to tunnel malposition. An acute femoral tunnel angle may increase the mechanical stress on the anterior margin of the femoral tunnel. PMID:11522075

Segawa, H; Omori, G; Tomita, S; Koga, Y

2001-07-01

133

Electromyographic and biomechanic analysis of anterior cruciate ligament deficiency and functional knee bracing  

Microsoft Academic Search

Objective. Examine the neuromuscular response to functional knee bracing relative to anterior tibial translations in vivo.Design. During randomised brace conditions, electromyographic data with simultaneous skeletal tibiofemoral kinematics were recorded from four anterior cruciate ligament deficient subjects to investigate the effect of the DonJoy Legend functional brace during activity.Background. Knee braces do not increase knee stability but may influence afferent inputs

Dan K Ramsey; Per F Wretenberg; Mario Lamontagne; Gunnar Németh

2003-01-01

134

Growth factors in human serum during operative tibial lengthening with the ilizarov method.  

PubMed

Despite the widespread clinical use of distraction osteogenesis for limb lengthening, the cellular and molecular mechanisms by which this surgical treatment promotes new bone formation in humans are not well understood. The aim of the research was to study the levels of growth factors (GFs) in the serum of patients that were undergoing tibial lengthening with the Ilizarov method of distraction osteogenesis. Those were patients with unilateral congenital discrepancy of the tibia (n?=?12), unilateral posttraumatic tibial shortening (n?=?7), and healthy patients that underwent cosmetic bilateral tibial lengthening (n?=?10). The study established that unlike the congenital group, the posttraumatic group and healthy subjects showed a significantly evident increase in the levels of angiogenic GFs in their serum on day 10 of distraction. In the congenital group, the changes were not significant at this time point. The levels of TGF-?, TGF-?1, and TGF-?2 tended to decrease on day 10 of distraction and on day 30 of the post-distraction period in the cosmetic and posttraumatic groups while they grew in the congenital group. Most dynamic changes in the GFs levels during tibial lengthening were noted in the subjects undergoing cosmetic lengthening, and the least ones were in the congenital group. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31:1966-1970, 2013. PMID:23893880

Stogov, Maksim V; Luneva, Svetlana N; Novikov, Konstantin I

2013-07-24

135

Graft isometricity in unitunnel anterior cruciate ligament reconstruction: analysis of influential factors using a radiographic model  

Microsoft Academic Search

A radiographic model was developed to investigate the influence of three surgical variables on the change in attachment point distance (CAPD) of a hypothetical graft using the unitunnel technique of anterior cruciate ligament (ACL) reconstruction. Using three different femoral target points, we tested the hypothesis that varying the angle of knee flexion between 70° and 110° and varying the tibial

J. A. Feller; R. R. Glisson; A. V. Seaber; J. A. Feagin; W. E. Garrett

1993-01-01

136

Failure of Reconstruction of the Anterior Cruciate Ligament Due to Impingement by the Intercondylar Roof  

Microsoft Academic Search

The relationship between impingement of the roof of the intercondylar notch on a reconstructed anterior cruciate ligament, and the subsequent stability and range of extension of the joint, was analyzed in forty- seven knees. The extent of the impingement was deter- mined by analysis of the relationship of the tibial tunnel to the intersection of the line of slope of

MAJOR STEPHEN M. HOWELL; CAPTAIN MICHAEL A. TAYLOR

137

Tunnel placement in anterior cruciate ligament (ACL) reconstruction: quality control in a teaching hospital  

Microsoft Academic Search

Correct placement of the femoral and tibial bone tunnels is decisive for a successful anterior cruciate ligament (ACL) reconstruction. Our method of tunnel placement was evaluated as part of quality control at a teaching hospital. The emphasis was placed mainly on investigating the influence of surgical experience on tunnel placement, and the effect of tunnel position on the clinical outcome.

H. Behrend; G. Stutz; M. A. Kessler; A. Rukavina; K. Giesinger; M. S. Kuster

2006-01-01

138

The Effect of Anterior Cruciate Ligament Injury on the Biomechanical Behavior of Human Knee Joint  

Microsoft Academic Search

Based on the magnetic resonance imaging (MRI) data, a 3-dimentional finite element model of knee joint was developed using the reverse modeling technology. The model includes bone, all the four main ligaments, menisci and cartilages with consideration of the transversely isotropic constitutive behavior of menisci and hyperelasticity of ligaments. The biomechanics of tibiofemoral joint under an anterior tibial force and

Tianfu Wang; Zhixiu Hao; Chao Wan

2009-01-01

139

Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques  

PubMed Central

Background Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design Controlled laboratory study. Hypothesis Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation (P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations (P <.05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation (P > .05) at 0° of flexion but could not do so at 30° of flexion (P <.05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques (P <.05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique.

Sim, Jae Ang; Gadikota, Hemanth R.; Li, Jing-Sheng; Li, Guoan; Gill, Thomas J.

2013-01-01

140

Tantalum is a good bone graft substitute in tibial tubercle advancement  

Microsoft Academic Search

Background  Porous tantalum is reportedly a good substitute for structural bone graft in several applications. So far, its use has not\\u000a been reported in tibial tuberosity anteriorization (TTA) for treatment of isolated degenerative chondral lesions of the patellofemoral\\u000a joint.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/Purposes  We asked whether the use of this material would produce similar standardized functional scores, pain (VAS), fusion rates,\\u000a complications, and patient satisfaction

Mariano Fernandez-Fairen; Virginia Querales; Alexander Jakowlew; Antonio Murcia; Jorge Ballester

2010-01-01

141

Biomechanical Factors in Tibial Stress Fractures.  

National Technical Information Service (NTIS)

The overall aim of this research is to gain insight into the etiology of tibial stress fractures. Three dimensional motion analysis data along with structural data will be collected from 40 subjects (200 at each site) over a 3- year period. 30 of the subj...

I. S. McClay

2003-01-01

142

Biomechanical Factors in Tibial Stress Fractures.  

National Technical Information Service (NTIS)

The overall aim of this research is to gain insight into the etiology of tibial stress fractures. Three dimensional motion analysis data along with structural data will be collected from 400 subjects (200 at each site) over a 3-year period. 30 of the subj...

I. S. McClay

2004-01-01

143

Tibial plateau levelling osteotomy in an alpaca.  

PubMed

In this report, a case of cranial cruciate ligament (CrCL) rupture treated by tibial plateau levelling osteotomy (TPLO), in a 36-month-old male breeding alpaca, is described. The alpaca was presented with the complaint of acute onset of right pelvic limb lameness. The findings of our clinical and radiographic examinations were consistent with CrCL insufficiency of the right stifle joint. The right tibial plateau angle measured prior to surgery was 19 degrees . A TPLO was performed and this eliminated cranial tibial thrust. Culture of a swab taken from the surgical site prior to wound closure was positive for Pseudomonas aeruginosa . Enrofloxacin was administered parenterally for two weeks postoperatively. There were not any clinical signs of infection noted. Outcome assessments included veterinary examination (two and six weeks) and owner assessment (28 months). At two weeks the animal walked with a grade 2/5 lameness, and at six weeks radiographic examination showed progression of bone healing at the site of tibial osteotomy. A return to full breeding fitness occurred by eight weeks after the surgery. The alpaca remained free from lameness 28 months later, according to the owner. PMID:19597639

Smith, T; Girard, N; O'Riordan, J; Fitzpatrick, N

2009-06-23

144

Linkage Analyses in Tibial Muscular Dystrophy  

Microsoft Academic Search

Tibial muscular dystrophy (TMD) is a recently described muscular disease first discovered in a highly consanguineous family in Finland. The pedigree also included patients whose symptoms resembled another phenotype, classical limb-girdle muscular dystrophy. Extensive linkage analysis was carried out in this complex pedigree using 157 highly polymorphic DNA markers. Because of the presence of two phenotypes, several inheritance models were

P. Nokelainen; B. Udd; H. Somer; L. Peltonen

1996-01-01

145

Tibial osteotomy in a young, active patient.  

PubMed

High tibial osteotomies are valuable treatment options in the young, active patient with single-compartment arthritis who wishes to return to high load-bearing sports. Patients with limited areas of degenerative wear should be referred to an orthopedic surgeon. PMID:24069671

Webb, Chris

2013-09-01

146

Heterogeneity of tibial plateau cartilage in response to a physiological compressive strain rate.  

PubMed

Knowledge of the extent to which tibial plateau cartilage displays non-uniform mechanical topography under physiologically relevant loading conditions is critical to evaluating the role of biomechanics in knee osteoarthritis. Cartilage explants from 21 tibial plateau sites of eight non-osteoarthritic female cadaveric knees (age: 41-54; BMI: 14-20) were tested in unconfined compression at 100% strain/s. The elastic tangent modulus at 10% strain (E(10%) ) was calculated for each site and averaged over four geographic regions: not covered by meniscus (I); covered by meniscus-anterior (II); covered by meniscus-exterior (III); and covered by meniscus-posterior (IV). A repeated-measures mixed model analysis of variance was used to test for effects of plateau, region, and their interaction on E(10%) . Effect sizes were calculated for each region pair. E(10%) was significantly different (p<0.05) for all regional comparisons, except I-II and III-IV. The regional pattern of variation was consistent across individuals. Moderate to strong effect sizes were evident for regional comparisons other than I-II on the lateral side and III-IV on both sides. Healthy tibial cartilage exhibits significant mechanical heterogeneity that manifests in a common regional pattern across individuals. These findings provide a foundation for evaluating the biomechanical mechanisms of knee osteoarthritis. PMID:22952052

Deneweth, Jessica M; Newman, Kelly E; Sylvia, Stephen M; McLean, Scott G; Arruda, Ellen M

2012-09-05

147

Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study.  

PubMed

The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore, we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the graft-fixation-device complex than does traditional extraction drilling of the tibial tunnel. In 20 bovine tibiae, the bone tunnels were created with either extraction drilling (group 1) or compaction by serial dilation (group 2). Twenty bovine digital extensor tendons were fixated in the bone tunnel with an Intrafix tibial fastener. The graft-fixation-device complexes were mounted in a hydraulic test machine. The fixation strength was evaluated after cyclic loading. The difference between the serial dilation group and the extraction drilling group ranged from a mean slippage of 0 mm at 70-220 N, to a mean slippage of 0.1 mm at 70-520 N. We found no significant difference in slippage of the graft-fixation-device complex after 1,600 cycles. This study failed to show a significant difference between compaction by serial dilation and extraction drilling of the tibia bone tunnel in anterior cruciate ligament reconstruction. PMID:19784628

Sørensen, O G; Jakobsen, B W; Kold, S; Hansen, T B; Søballe, K

2009-09-26

148

The influence of tibial component fixation techniques on resorption of supporting bone stock after total knee replacement.  

PubMed

Periprosthetic bone resorption after tibial prosthesis implantation remains a concern for long-term fixation performance. The fixation techniques may inherently aggravate the "stress-shielding" effect of the implant, leading to weakened bone foundation. In this study, two cemented tibial fixation cases (fully cemented and hybrid cementing with cement applied under the tibial tray leaving the stem uncemented) and three cementless cases relying on bony ingrowth (no, partial and fully ingrown) were modelled using the finite element method with a strain-adaptive remodelling theory incorporated to predict the change in the bone apparent density after prosthesis implantation. When the models were loaded with physiological knee joint loads, the predicted patterns of bone resorption correlated well with reported densitometry results. The modelling results showed that the firm anchorage fixation formed between the prosthesis and the bone for the fully cemented and fully ingrown cases greatly increased the amount of proximal bone resorption. Bone resorption in tibial fixations with a less secure anchorage (hybrid cementing, partial and no ingrowth) occurred at almost half the rate of the changes around the fixations with a firm anchorage. The results suggested that the hybrid cementing fixation or the cementless fixation with partial bony ingrowth (into the porous-coated prosthesis surface) is preferred for preserving proximal tibial bone stock, which should help to maintain post-operative fixation stability. Specifically, the hybrid cementing fixation induced the least amount of bone resorption. PMID:21236431

Chong, Desmond Y R; Hansen, Ulrich N; van der Venne, Rene; Verdonschot, Nico; Amis, Andrew A

2011-01-14

149

The location of nuclei of different labelling intensities in autoradiographs of the anterior forebrain of postnatial mice injected with [3H]thymidine on the eleventh and twelfth days post-conception.  

PubMed Central

The location of neuron nuclei of different labelling intensities in autoradiographs of the anterior forebrain of two 22 day old mice which had been injected with [3H]thymidine at 11 and 12 days post-conception respectively was charted on photocollages of sections enlarges 175 times. The pattern of distribution of the heavily labelled nuclei, i.e. those nuclei belonging to cells most likely to have been born shortly after the time of [3H]thymidine injection, indicated that the inner two thirds of the neocortex is laid down along a ventro-dorsal gradient, i.e. the lateral neocortex starts to form before the dorsal; and that cells born at a particular time lie in cortical layer VI at the dorsal edge of the gradient is traced ventrally. Progressively more weakly labelled cells formed intermediate steps in this migration. A model or cortical growth fitting these findings is presented. Some inferences are also made about the possible role of the ganglionic eminences in providing cortical cells, at least during the initial stages of cortical histogenesis. Images Fig. 1 Figs. 14 and 15

Smart, I H; Smart, M

1977-01-01

150

Prior anterior cruciate ligament reconstruction complicating intramedullary nailing of a tibia fracture.  

PubMed

As the number of patients with anterior cruciate ligament reconstructions continues to grow, a subpopulation of patients with displaced tibia-fibula fractures will emerge who have had prior anterior cruciate ligament reconstructions. Previous cruciate ligament surgery can complicate the operative treatment of tibia-fibula fractures by intramedullary nailing. Technical complications arise because the tibial tunnel-graft-screw is in the path of insertion of the intramedullary implant. We present a case in which we traced the path of the patellar tendon autograft, adjusted our entry point for the tibial intramedullary canal, and removed the interference screw to facilitate the fracture surgery. This technical note provides an approach to planning intramedullary nailing of the tibia in patients with prior anterior cruciate ligament surgery. PMID:9788381

Roberts, C; John, C; Seligson, D

1998-10-01

151

'Diabetic tibial disease': the case for revascularisation.  

PubMed Central

Diabetic patients with critical ischaemia of the lower limb are frequently considered to have unreconstructable vascular disease. In the presence of a palpable popliteal pulse they are often labelled as having 'small vessel disease'. In nine patients (mean age 69 years) with 'diabetic tibial disease' and critical ischaemia we have avoided major amputation using short vein bypasses. All revascularisations remained patent at a mean follow-up of 32 months (range 12-60 months). Diabetic patients with critical ischaemia should at the very least undergo arteriography to ensure that the possibility of successful distal revascularisation is not feasible before amputation is performed. However, if arteriography fails to demonstrate patent distal vessels and limb salvage is considered practical, Doppler insonation of the tibial and pedal vessels should be performed. Images Figure 1 Figure 2

Stephenson, B. M.; Shandall, A. A.; Shute, K.

1993-01-01

152

Anatomical Variations of the Popliteal Artery and its Tibial Branches: Analysis in 1242 Extremities  

SciTech Connect

The purpose of this study was to analyze the variations in branching of the popliteal artery by reviewing femoral arteriograms. Between 2004 and 2006, digital subtraction angiographies of both lower extremities were performed in 621 patients. We reviewed these 1242 arteriograms retrospectively in order to analyze the branching pattern of the popliteal artery. Of the 1242 extremities, 1108 extremities (89.2%) had normal branching pattern of the popliteal artery. The remaining 134 extremities (10.8%; 65 right, 69 left) in 105 patients (66 men, 39 women; 76 unilateral, 29 bilateral) showed seven variant branching patterns: hypoplastic or aplastic posterior tibial artery (PT) (n = 63, 5.1%); hypoplastic or aplastic anterior tibial artery (AT) (n = 21, 1.7%); trifurcation (n = 19, 1.5%); high origin of AT (n = 15, 1.2%); hypoplastic or aplastic PT and AT (n = 10, 0.8%); high origin of PT (n = 5, 0.4%); and anterior tibioperoneal trunk (n = 1, 0.1%). When the branching pattern of the popliteal artery is normal in one extremity, there is a 13% probability the other side will be a variant pattern. When the branching pattern is variant in one extremity, there is a 28% probability the opposite side will also contain a variation. Variations in branching of the popliteal artery are not uncommon. Awareness of these variations is important for evaluation of the lower extremity arteriograms and has clinical implications for vascular surgeons and interventional radiologists.

Kil, Sung-Won [Dankook University College of Medicine, Department of Radiology (Korea, Republic of); Jung, Gyoo-Sik, E-mail: gsjung@medimail.co.k [Kosin University College of Medicine, Department of Radiology (Korea, Republic of)

2009-03-15

153

Intraneural ganglion cyst of the tibial nerve  

Microsoft Academic Search

Summary  Intraneural ganglion cyst of the tibial nerve is very rare. To date, only 5 cases of this entity in the popliteal fossa have\\u000a been reported. We report a new case and review the previously reported cases. A 40-year-old man experienced a mild vague pain\\u000a in the medial half of his right foot for 3 years. Magnetic resonance imaging scan demonstrated

M. Adn; A. Hamlat; X. Morandi; Y. Guegan

2006-01-01

154

Cigarette smoking and open tibial fractures.  

PubMed

Complication rates were compared in 140 smoking and 133 non-smoking patients with open tibial fractures. Both the groups were evenly matched demographically and in terms of primary fracture treatment. Flap failure complicated 7 (20%) patients in the smoking group and 4 (14%) in the non-smoking group. The mean time to union was 32 weeks for smokers and 28 weeks for non-smokers (P<0.05). Bone grafting to stimulate union was required in 36 (26%) smoking patients compared with 24 (18%) non-smoking patients. In patients treated by intramedullary nailing exchange, nailing to achieve union was carried out in 24 (38%) smoking cases compared with 13 (26%) of non-smoking cases. Smoking is associated with an increased risk of complications in patients with open tibial fractures. There is an increased rate of flap failure, delayed union and non-union. We recommend patients with open tibial fractures should be advised to stop smoking to minimise these complications. PMID:11164405

Adams, C I; Keating, J F; Court-Brown, C M

2001-01-01

155

Comparative Study on Anterior Cruciate Ligament Reconstruction: Determination of Isometric Points with and Without Navigation  

PubMed Central

OBJECTIVES: To compare the accuracy of tunnel placement and graft isometry for anterior cruciate ligament reconstruction performed using a computer-assisted navigation system (Orthopilot) and using traditional instruments. METHODS: The anterior cruciate ligament was removed intact from 36 pairs of human cadaver knees. From each pair, one knee was randomized to Group 1 (conventional) and the other to Group 2 (Orthopilot). An inelastic suture was then passed through the central points of the tibial and femoral tunnels. Neither of the tunnels was drilled. All knees were then dissected, and six parameters were obtained: distances from the tibial tunnel center to the 1) posterior cruciate ligament, 2) anterior horn of the lateral meniscus and 3) medial tibial spine; 4) distance from the femoral tunnel center to the posterior femoral cortex; 5) femoral tunnel coronal angle; and 6) variation of the distance from the femoral to the tibial tunnel with the knee extended and at 90 degrees of flexion. RESULTS: The variation of the distance from the femoral to the tibial tunnel during flexion and extension was smaller in the Orthopilot group (better isometry) compared to the conventional group. There were no statistical differences in any other parameters between the groups, and all tunnels were considered to be in satisfactory positions. DISCUSSION: The results obtained for anterior cruciate ligament reconstruction depend on precise isometric point positioning, and a navigation system is a precision tool that can assist surgeons in tunnel positioning. CONCLUSION: No differences in tunnel position were observed between the groups. Nonetheless, better isometry was achieved in the Orthopilot group than with conventional instruments.

Angelini, Fabio J.; Albuquerque, Roberto F. M.; Sasaki, Sandra U.; Camanho, Gilberto L.; Hernandez, Arnaldo J.

2010-01-01

156

Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border  

Microsoft Academic Search

BACKGROUND: Correct rotational alignment of the femoral and tibial component is an important factor for successful TKA. The transepicondylar axis is widely accepted as a reference for the femoral component. There is not a standard reference for the tibial component. CT scans were used in this study to measure which of 2 tibial landmarks most reliably reproduces a correct femoro-tibial

Jörg Lützner; Frank Krummenauer; Klaus-Peter Günther; Stephan Kirschner

2010-01-01

157

Pathology of the posterior tibial tendon in posterior tibial tendon insufficiency.  

PubMed

Gross and histologic examinations of 15 normal cadaver and 15 surgical posterior tibial tendons from patients with posterior tibial tendon insufficiency were performed. All surgical specimens were abnormal with enlargement distal to the medial malleolus and a dull white appearance. At histologic examination, 12 of 15 cadaver tendons displayed normal tendon structure characterized by linear orientation of collagen bundles, normal fibroblast cellularity, low vascular density, and insertional chondroid metaplasia. The surgical specimens displayed a degenerative tendinosis characterized by increased mucin content, fibroblast hypercellularity, chondroid metaplasia, and neovascularization. This resulted in marked disruption of the linear orientation of the collagen bundles. PMID:9728698

Mosier, S M; Lucas, D R; Pomeroy, G; Manoli, A

1998-08-01

158

Anterior Cruciate Ligament Injuries in Growing Skeleton  

PubMed Central

Anterior cruciate ligament (ACL) injuries in the adult patients are thoroughly studied and published in orthopedic literature. Until recently, little was known about similar injuries in skeletally growing patients. The more frequent involvement of this age group in various athletic activities and the improved diagnostic modalities have increased the awareness and interest of ACL injuries in skeletally immature patients. ACL reconstruction in growing skeleton is controversial and carries some risks to the tibial and femoral growth plate. A guarded approach to ACL reconstruction is recommended in skeletally immature patients. Modification of activity of ACL injured young patient, proper rehabilitation and prudent planning of adolescent age ACL reconstruction carries the least risks of growth plate violation.

AlHarby, Saleh W.

2010-01-01

159

A rationale for predicting anterior cruciate graft impingement by the intercondylar roofA magnetic resonance imaging study  

Microsoft Academic Search

This study was designed to analyze how anterior tibial tunnel placement can result in graft impingement by the intercondylar roof. The relationship of the ACL to the intercondylar roof was studied using magnetic reso nance scans. An attempt was made to predict the amount of bone that may need to be removed from the intercondylar roof to prevent impingement on

Stephen M. Howell; James A. Clark; Timothy E. Farley

1991-01-01

160

Stress avulsion of the tibial tuberosity after tension band wiring of a patellar fracture: a case report  

PubMed Central

Introduction To the best of our knowledge there is no other report of an elderly patient who was surgically treated for a patellar fracture with tension band wiring and who subsequently suffered from an avulsion fracture of the tibial tuberosity. The combination of a patellar fracture and avulsion of the patellar ligament has only been described as complication after bone-patellar tendon-bone anterior cruciate ligament reconstructions. However, due to demographic changes and more elderly patients treated this injury may become more frequent in future. Case presentation We present the case of an 81 year old female who sustained an oblique patellar fracture after a direct contact injury of the left knee when falling on ice. Consequently the patellar fracture was openly reduced and stabilized with tension band wiring. The follow-up was uneventful till three months after surgery when the patient noticed a spontaneous avulsion fracture of the tibial tuberosity (Ogden type 3). The tibial tuberosity fragment was reattached with two non-resorbable sutures looped around two modified AO cortical 3.5 mm long neck screws. Intraoperatively multiple bone cysts were seen. Biopsies were not taken to prevent further fragmentation of the tibial tuberosity. The patient was followed up with anteroposterior and lateral full weight bearing radiographs and clinical assessment at 6, 12 weeks and 6 months after surgery. Recovery was completely pain free with full satisfaction. Conclusion In conclusion in elderly patients with a patella fracture a possible associated but not obvious fracture of the tibial tuberosity should be ruled out and the postoperative rehabilitation protocol after tension band wiring of the patella might have to be individually adjusted to bone quality and course of the fracture.

2009-01-01

161

Análise da translação anterior da tíbia, pico de torque e atividade eletromiográfica do quadríceps e isquiotibiais em indivíduos com lesão do ligamento cruzado anterior em cadeia cinética aberta  

Microsoft Academic Search

SUMMARY The aim of this study was to evaluated the anterior tibial translation (ATT), isometric peak torque and EMG activity in individuals with acl rupture performing isometric contraction in open kinetic chain in angle that provoke substantial ATT. It was evaluated 20 male subjects (31.1± 7.45 years) with acl total rupture and 20 control subjects (22.2 ± 3.15 years). Electromyography,

Rodrigo Antunes de Vasconcelos; Juliano Coelho Arakaki; Adriano P. Simão; Anamaria Siriani de Oliveira; Cleber Jansen Paccola; Débora Bevilaqua-Grossi

2007-01-01

162

The effect of progressive degrees of medial meniscal loss on stability after anterior cruciate ligament reconstruction.  

PubMed

Previous studies report conflicting results on whether loss of the medial meniscus compromises knee stability after reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to determine whether the degree of medial meniscus deficiency affects the stability of the ACL-reconstructed knee. Six cadaveric knees were arthroscopically reconstructed with bone-patellar tendon-bone autografts using an anatomic "footprint" technique. Knees tested were ACL-deficient and after reconstruction under three different meniscal states: with partial medial meniscectomy, subtotal meniscectomy, and meniscal root transection. Biomechanical testing was performed at 30 and 60 degrees of flexion under two loading conditions: (1) 134-N anterior tibial load termed anterior tibial translation (ATT) and (2) 10-Nm valgus load combined with 5 Nm of internal tibial torque termed provocative pivot maneuver (PPM). Knee kinematics was measured using a custom activity simulator, motion analysis system, and three-dimensional CT reconstructions. During both ATT and PPM loading, ACL deficiency resulted in a significant increase in anterior translation compared with knees with an intact ACL or those that had undergone ACL reconstruction (p < 0.05). Neither the addition of a partial nor subtotal medial meniscectomy led to increased instability. Only after medial meniscal root transection was increased instability of the ACL-deficient knee detected compared with intact, partial, or subtotal meniscectomy states (p < 0.01). In all states of meniscal deficiency, ACL reconstruction restored internal tibial rotation and anterior translation at 30 degrees to that of the intact knee (p > 0.05). Anatomic single bundle ACL reconstruction was able to restore knee stability in all conditions of medial meniscal deficiency. PMID:23512542

McCulloch, Patrick C; Shybut, Theodore B; Isamaily, Sabir K; Durrani, Salim; Gold, Johnathan E; Noble, Philip C; Lintner, David M

2013-03-19

163

Simultaneous management of ipsilateral gonarthritis and ununited tibial stress fracture  

Microsoft Academic Search

Nonunion of a proximal tibial stress fracture is rare and can be difficult to manage, especially if associated with ipsilateral gonarthritis. Three patients with nonunion of a proximal tibial stress fracture adjacent to an arthritic knee joint were managed by performing simultaneous total knee arthroplasty and internal fixation of the fracture site. The technique involved performing a total knee arthroplasty

Joseph T Moskal; John W Mann

2001-01-01

164

Change in tibial rotation of barefoot versus shod running  

Microsoft Academic Search

Tibial rotation during foot pronation has been proposed as a key factor in running related injuries. Precise analysis of knee motion during running, including the analysis of motion in the coronal plane, is difficult, and the effect of the wearing shoes on tibial rotation during running is unknown. Therefore, we aimed to determine the effect of wearing shoes in reducing

M. Fukano; Y. Nagano; H. Ida; T. Fukubayashi

2009-01-01

165

Optimal alignment of the distal screws in the tibial nailing  

Microsoft Academic Search

Serious stress concentration around the regions near the distal nail?holes and the distal screws in conventional tibial interlocking nails has been reported in previous studies. A three?dimensional finite element model was used to study the interlocking nail, the fractured tibia and the locking screws. The distal screws were inserted into the tibial nail in different configurations. We found that the

2003-01-01

166

Stability of the elevated fragment in tibial plateau fractures  

Microsoft Academic Search

Five cases of fracture of the lateral tibial condyle of the split-depression type were treated by elevation of the depressed fragment, bone grafting and cancellous bone screws. During the operation, tantalum markers were inserted into the depressed fragment and the tibial metaphysis for radiographic stereophotogrammetric analysis. Postoperatively a plaster cast was applied for one month and weightbearing was not allowed

L. Ryd; S. Toksvig-Larsen

1994-01-01

167

In vivo oxidation in retrieved highly crosslinked tibial inserts.  

PubMed

The current study determined (I) the environment where oxidation in a series of retrieved, HXL UHMWPE tibial inserts occurred (in vivo or postexplant); and (II) the effect of fabrication variables (irradiation source, irradiation dose) and thermal processing after irradiation (annealing or remelting) on oxidation resistance. Hypotheses examined are (1) HXL UHMWPE tibial inserts have potential to oxidize in vivo, and (2) annealed HXL UHMWPE oxidizes at a higher rate in vivo than remelted HXL UHMWPE. Highly crosslinked UHMWPE tibial inserts (87), received by an IRB-approved retrieval laboratory from 20 surgeons at 10 institutions across the U.S., were analyzed from 2005 to 2011. Fourier transform infrared spectroscopy was used to determine oxidation and trans-vinylene index for each retrieved insert. Measured oxidation that was maximum subsurface was found in 56% of all HXL tibial inserts. This maximum oxidation correlated significantly with in vivo time, trans-vinylene index, and thermal processing after irradiation. Articular oxidation rate correlated with crosslinking irradiation dose and thermal processing after irradiation. Retrieved below-melt annealed tibial inserts had significantly higher articular oxidation rates than remelted tibial inserts (p < 0.001). Articular oxidation rates correlated positively with cross-linking irradiation dose and postirradiation thermal processing. Edge oxidation correlated with postirradiation thermal processing. Oxidation of HXL UHMWPE may have clinical implications for tibial inserts, since loss of UHMWPE toughness resulting from oxidation has led to fatigue damage in gamma-sterilized tibial inserts. PMID:22997097

Currier, B H; Van Citters, D W; Currier, J H; Carlson, E M; Tibbo, M E; Collier, J P

2012-09-21

168

High tibial osteotomy in young adults with constitutional tibia vara.  

PubMed

Frontal plane malalignment of the lower extremity results in abnormal load distribution across the knee joint. Consequences of this increased stress may lead to compartmental osteoarthritis. High tibial osteotomy is well established for early osteoarthritis of the knee joint in middle-aged patients. We hypothesize that earlier realignment of the varus knee can be performed without undue risks and debilitation toward the young active patient and with good results in short-term follow-up. Open-wedge high tibia osteotomy using the Puddu plate was performed on eleven patients (19 knees) under 25 years of age for constitutional high tibia vara. The mechanical femorotibial angle (FTA) and Knee Society Knee Score (KSKS) were compared pre-operatively and 24 months post-operatively. The average FTA improved from +8.8 degrees (+5 - +16) to -0.1 (-2 - +5). The average KSKS improved from 74 (50-100) to 93 (60-100) and the function score improved from 84 (50-100) to 95 (60-100). Special concerns in this age group include unsightly cosmesis, and kneeling pain and discomfort. Open-wedge high tibia osteotomy provides a satisfactory solution for constitutional high tibia vara with minor morbidity on behalf of the patient in the short-term follow-up period. PMID:20411373

Masrouha, Karim Z; Sraj, Shafic; Lakkis, Suhail; Saghieh, Said

2010-04-22

169

Malrotation following reamed intramedullary nailing of closed tibial fractures  

PubMed Central

Background: Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures. Materials and Methods: Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation. Results: Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°. Conclusions: Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem.

Jafarinejad, Adel Ebrahimpour; Bakhshi, Hooman; Haghnegahdar, Maryam; Ghomeishi, Nima

2012-01-01

170

Full versus surface tibial baseplate cementation in total knee arthroplasty.  

PubMed

The use of a keel in the tibial component during modern primary total knee arthroplasty (TKA) has become common, and its cementation may affect the future performance of the prosthesis. Although proponents of cementing the entire tibial component argue that this technique provides better initial fixation and may prevent aseptic loosening, reasons exist to apply cement only to the tibial baseplate. In this study, 232 patients who underwent TKA using full or surface cementation of the tibial baseplate were evaluated at an average 5.6-year follow-up to assess survivorship and clinical results. The cumulative survival rate at 8 years was 97.1%. With revision of either component for any reason considered the endpoint, no significant difference was noted between full and surface cemented groups. Knee Society Score, range of motion, and femoro-tibial mechanical angle significantly increased postoperatively. Multivariate analysis revealed that good preoperative range of motion and Knee Society Scores were related to good postoperative range of motion and Knee Society Scores. Follow-up length was a negative predictor of postoperative Knee Society Score. The use of full or surface cementation of the baseplate was unrelated to the postoperative clinical outcomes. Clinical outcomes did not differ according to the tibial component cementation technique. The results of this study suggest that cementing the keel of the tibial component during primary TKA has no advantage for patients. Longer-term follow-up and proper patient randomization are required to confirm these findings. PMID:23379926

Galasso, Olimpio; Jenny, Jean-Yves; Saragaglia, Dominique; Miehlke, Rolf K

2013-02-01

171

Anatomical sector analysis of load-bearing tibial bone structure during 90-day bed rest and 1-year recovery.  

PubMed

The aim of this study was to investigate whether the bone response to long bed rest-related immobility and during subsequent recovery differed at anatomically different sectors of tibial epiphysis and diaphysis. For this study, peripheral quantitative tomographic (pQCT) scans obtained from a previous 90-day 'Long Term Bed Rest' intervention were preprocessed with a new method based on statistical approach and re-analysed sector-wise. The pQCT was performed on 25 young healthy males twice before the bed rest, after the bed rest and after 1-year follow-up. All men underwent a strict bed rest intervention, and in addition, seven of them received pamidronate treatment and nine did flywheel exercises as countermeasures against disuse-related bone loss. Clearly, 3-9% sector-specific losses in trabecular density were observed at the tibial epiphysis on average. Similarly, cortical density decreased in a sector-specific way being the largest at the anterior sector of tibial diaphysis. During recovery, the bed rest-induced bone losses were practically restored and no consistent sector-specific modulation was observed in any subgroup. It is concluded that the sector-specific analysis of bone cross-sections has potential to reveal skeletal responses to various interventions that cannot be inferred from the average analysis of the whole bone cross-section. This approach is considered also useful for evaluating the bone responses from the biomechanical point of view. PMID:21672131

Cervinka, Tomas; Rittweger, Jörn; Hyttinen, Jari; Felsenberg, Dieter; Sievänen, Harri

2011-02-06

172

Unicompartmental knee replacement after high tibial osteotomy: Invalidating a contraindication.  

PubMed

The outcome of high tibial osteotomy (HTO) deteriorates with time, and additional procedures may be required. The aim of this study was to compare the clinical and radiological outcomes between unicompartmental knee replacement (UKR) and total knee replacement (TKR) after HTO as well as after primary UKR. A total of 63 patients (63 knees) were studied retrospectively and divided into three groups: UKR after HTO (group A; n = 22), TKR after HTO (group B; n = 18) and primary UKR (group C; n = 22). The Oxford knee score (OKS), Knee Society score (KSS), hip-knee-ankle angles, mechanical axis and patellar height were evaluated pre- and post-operatively. At a mean of 64 months (19 to 180) post-operatively the mean OKS was 43.8 (33 to 49), 43.3 (30 to 48) and 42.5 (29 to 48) for groups A, B and C, respectively (p = 0.73). The mean KSS knee score was 88.8 (54 to 100), 88.11 (51 to 100) and 85.3 (45 to 100) for groups A, B and C, respectively (p = 0.65), and the mean KSS function score was 85.0 (50 to 100) in group A, 85.8 (20 to 100) in group B and 79.3 (50 to 100) in group C (p = 0.48). Radiologically the results were comparable for all groups except for patellar height, with a higher incidence of patella infra following a previous HTO (p = 0.02). Cite this article: Bone Joint J 2013;95-B:1348-53. PMID:24078530

Valenzuela, G A; Jacobson, N A; Buzas, D; Korecki, T D; Valenzuela, R G; Teitge, R A

2013-10-01

173

Anthropometry of the medial tibial condyle to design the tibial component for unicondylar knee arthroplasty for the Korean population.  

PubMed

Unicondylar knee arthroplasty (UKA) has gained popularity in the recent years for treating medial compartment osteoarthritis of the knee joint in the Asian population. There is little information about the anthropometry of the resected bony surfaces of the knee joint in these population groups for designing the appropriate size-matched UKA components. We studied the anthropometry of the resected medial tibial condyles in 50 male and 50 female Korean cadavers by using three-dimensional computer tomography. We measured the anteroposterior dimension, the mediolateral dimension at defined points and the condylar aspect ratio. These measurements were compared with similar dimensions of the tibial components from five conventionally used UKA designs. Statistical analysis was performed using Student's t-test, Paired t-test and Pearson's correlation coefficient. We found that three of the tibial component designs showed mediolateral overhang for the whole range of measured anteroposterior dimensions of the resected medial tibial condyles, whereas one of the designs (DePuy) showed mediolateral undersizing for the smaller AP dimensions and overhang for the larger AP dimensions of the resected medial tibial condyles. Another design (Smith and Nephew) showed mediolateral undersizing for the whole range of measured anteroposterior dimensions of the resected medial tibial condyle. We found a decrease in the condylar aspect ratio with increasing AP dimension for our cadaver population data. However, the majority of the conventional tibial prosthesis showed either a constant condylar aspect ratio or an increasing aspect ratio (DePuy) with the increasing AP dimension of the resected medial tibial condyle. Our study may provide guidelines for designing appropriate tibial UKA components for a majority of Asian sub-populations and encourage similar studies in other population groups. PMID:16964513

Surendran, Sibin; Kwak, Dai Soon; Lee, U Young; Park, Sang Eun; Gopinathan, Patinharayil; Han, Seung Ho; Han, Chang Whan

2006-09-09

174

High tibial osteotomy: does navigation improve results?  

PubMed

Between January 2003 and March 2006, the authors performed 67 open-wedge high tibial osteotomies (HTO) for treatment of genu varum and osteoarthritis. Through comparison of two groups, the study sought to answer whether computed tomography (CT)-free navigation is feasible for HTO and will provide a more accurate correction angle without giving rise to additional complications. The results showed a significantly higher accuracy in achieving the proper leg axis correction (P< .016) when HTO was performed with navigation. Navigation in HTO, which allows intraoperative calculation of the leg axis, seems to be a reliable and safe procedure. Knowing that clinical results of HTO in varus deformity of the leg axis are closely connected to correct postoperative valgus alignment and avoiding overcorrection and undercorrection, the study lead to the conclusion that the use of navigation will contribute to better clinical outcomes. PMID:17407938

Maurer, Franz; Wassmer, Günther

2006-10-01

175

Stage IV posterior tibial tendon rupture.  

PubMed

Adult acquired flatfoot deformity progresses through well defined stages as set out by Johnson and Strom. Myerson modified this classification system with the addition of a fourth, more advanced stage of the disease. This stage describes the involvement of the tibiotalar joint in addition to the hindfoot malalignment seen in stages II and III. This most advanced stage is comprised of a hindfoot valgus deformity, resulting from degeneration of the posterior tibial tendon, with associated valgus tilting of the talus within the mortise. The deformity at the tibiotalar joint may or may not be rigid. Although rigid deformities are still best treated with fusions of the ankle and hindfoot, supple tibiotalar deformity may be treated with joint sparing procedures involving reconstructive procedures of the foot and deltoid ligaments. PMID:17561206

Bluman, Eric M; Myerson, Mark S

2007-06-01

176

[Tibial head fractures: role of MRI?].  

PubMed

Tibial head fractures are the consequences of a direct compression mechanism. There are many classification systems but the most common are the Schatzker and the AO classification. Standard X-Rays of the knee (anteroposterior and lateral) are required. A CT-scan is useful when understanding the fracture morphology is difficult, thus helping with the choice of treatment (either conservative or by surgery). MRI allows detecting occult fractures and concomitant soft tissue injuries. The rate of false positive is not negligible, especially for meniscal lesions. Undoubtedly, it would be of great help for the surgeon to associate a kind of fracture with a typical soft tissue injury pattern. But, this is not reliable as yet. PMID:18277767

Miozari, Hermes H; Pagano, François; Hoffmeyer, Pierre

2007-12-19

177

Posterior tibial nerve lesions in ankle arthroscopy.  

PubMed

Ankle arthroscopy provides a minimally invasive approach to the diagnosis and treatment of certain ankle disorders. Neurological complications resulting from ankle arthroscopy have been well documented in orthopaedic and podiatric literature. Owing to the superficial location of the ankle joint and the abundance of overlying periarticular neurovascular structures, complications reported in ankle arthroscopy are greater than those reported for other joints. In particular, all reported neurovascular injuries following ankle arthroscopy have been the direct result of distractor pin or portal placement. The standard posteromedial portal has recognized risks because of the proximity of the posterior neurovascular structures. There can be considerable variability in the course of these portals and their proximity to the neurovascular structures. We found one report of intra-articular damage to the posterior tibial nerve as a result of ankle arthroscopy in the English-language literature and we report this paper as a second case described in the literature. PMID:17618442

Cugat, Ramon; Ares, Oscar; Cuscó, Xavier; Garcia, Montserrat; Samitier, Gonzalo; Seijas, Roberto

2007-07-06

178

Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study.  

PubMed

BACKGROUND: This study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90[degree sign] below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique. METHODS: The two reconstruction techniques were tested using a porcine model (n = 40). Fracture was simulated using a defined osteotomy of the lateral tibial plateau. Load-to-failure and multiple cyclic loading tests were conducted using a material testing machine. Twenty tibias were used for each reconstruction technique, ten of which were loaded in a load-to-failure protocol and ten cyclically loaded (5000 times) between 200 and 1000 N using a ramp protocol. Displacement, stiffness and yield load were determined from the resulting load displacement curve. Failure was macroscopically documented. RESULTS: In the load-to-failure testing, the jail technique showed a significantly higher mean maximum load (2275.9 N) in comparison to the conventional reconstruction (1796.5 N, p < 0.001). The trend for better outcomes for the novel technique in terms of stiffness and yield load did not reach statistical significance (p > 0.05). In cyclic testing, the jail technique also showed better trends in displacement that were not statistically significant. Failure modes showed a tendency of screws cutting through the bone (cut-out) in the conventional reconstruction. No cut-out but a bending of the lag screws at the site of the additional third screw was observed in the jail technique. CONCLUSIONS: The results of this study indicate that the jail and the conventional technique have seemingly similar biomechanical properties. This suggests that the jail technique may be a feasible alternative to conventional screw osteosynthesis in the minimally invasive reconstruction of lateral tibial plateau fractures. A potential advantage of the jail technique is the prevention of screw cut-outs through the cancellous bone. PMID:23557098

Weimann, Andre; Heinkele, Thomas; Herbort, Mirco; Schliemann, Benedikt; Petersen, Wolf; Raschke, Michael J

2013-04-01

179

Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: a biomechanical study  

PubMed Central

Background This study described a novel, minimally invasive reconstruction technique of lateral tibial plateau fractures using a three-screw jail technique and compared it to a conventional two-screw osteosynthesis technique. The benefit of an additional screw implanted in the proximal tibia from the anterior at an angle of 90° below the conventional two-screw reconstruction after lateral tibial plateau fracture was evaluated. This new method was called the jail technique. Methods The two reconstruction techniques were tested using a porcine model (n?=?40). Fracture was simulated using a defined osteotomy of the lateral tibial plateau. Load-to-failure and multiple cyclic loading tests were conducted using a material testing machine. Twenty tibias were used for each reconstruction technique, ten of which were loaded in a load-to-failure protocol and ten cyclically loaded (5000 times) between 200 and 1000 N using a ramp protocol. Displacement, stiffness and yield load were determined from the resulting load displacement curve. Failure was macroscopically documented. Results In the load-to-failure testing, the jail technique showed a significantly higher mean maximum load (2275.9 N) in comparison to the conventional reconstruction (1796.5 N, p??0.05). In cyclic testing, the jail technique also showed better trends in displacement that were not statistically significant. Failure modes showed a tendency of screws cutting through the bone (cut-out) in the conventional reconstruction. No cut-out but a bending of the lag screws at the site of the additional third screw was observed in the jail technique. Conclusions The results of this study indicate that the jail and the conventional technique have seemingly similar biomechanical properties. This suggests that the jail technique may be a feasible alternative to conventional screw osteosynthesis in the minimally invasive reconstruction of lateral tibial plateau fractures. A potential advantage of the jail technique is the prevention of screw cut-outs through the cancellous bone.

2013-01-01

180

Experimental and Numerical Analysis of Screw Fixation in Anterior Cruciate Ligament Reconstruction  

NASA Astrophysics Data System (ADS)

This paper reports the results of an experimental and finite element analysis of tibial screw fixation in anterior cruciate ligament (ACL) reconstruction. The mechanical properties of the bone and tendon graft are obtained from experiments using porcine bone and bovine tendon. The results of the numerical study are compared with those from mechanical testing. Analysis shows that the model may be used to establish the optimum placement of the tunnel in anterior cruciate ligament reconstruction by predicting mechanical parameters such as stress, strain and displacement at regions in the tunnel wall.

Chizari, Mahmoud; Wang, Bin; Snow, Martyn; Barrett, Mel

2008-09-01

181

Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing.  

National Technical Information Service (NTIS)

An average of three months rest is generally recommended for resolution of tibial stress fractures. Such an extended absence from athletic or military training reduces the ability to perform optimally and the likelihood of successful return to activity up...

R. Marcus

1999-01-01

182

Küntscher nailing of the tibia--a new tibial jig.  

PubMed

This paper illustrates the use of a new tibial jig which facilitates closed Küntscher nailing of the tibia. A brief history of medullary nailing is given, followed by a description of the jig. PMID:7364476

King, R

1980-02-01

183

Fatigue bone injuries causing anterior lower leg pain.  

PubMed

Shin splints, or stress-related anterior lower leg pain, seem to arise from numerous causes, including stress fractures. We retrospectively reviewed 154 consecutive military patients who had magnetic resonance imaging during a 5-year period for stress-related anterior lower leg pain. Using magnetic resonance imaging, 143 bone stress injuries were diagnosed in 86 of the 154 (56%) patients. The incidence of bone stress injury requiring orthopaedic consultation and magnetic resonance imaging among recruits during the 5 years was 117 per 100,000 person years in military service. The bone stress injury was located in the tibia in 141 (99%) patients. Of these injuries, 80 (57%) were located in the distal (1/3) of the tibial shaft, 42 (30%) in the middle (1/3), 14 (10%) in the proximal (1/3), and five (3%) in the medial condyle. The locations of tibial stress injuries related to the magnetic resonance imaging grades. Almost all lower leg fatigue bone stress injuries were located in the tibia, and the distal lateral shaft was affected most often. When used early after onset of symptoms, magnetic resonance imaging provides accurate diagnosis to ensure appropriate treatment, especially when dealing with exercise-induced lower leg pain in physically active patients. Level of Evidence: Diagnostic study, Level II (development of diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See the Guidelines for Authors for a complete description of levels of evidence. PMID:16523142

Ruohola, Juha-Petri S; Kiuru, Martti J; Pihlajamäki, Harri K

2006-03-01

184

Posterior tibial tendon dysfunction and MR imaging in rheumatoid arthritis.  

PubMed

We present the case of a patient with long-standing rheumatoid arthritis and an acute onset of total dysfunction of the posterior tibial tendon. On MRI, a rupture of the tendon was apparent. Intraoperatively, however, massive tenosynovitis with stricture of the tendon was identified as the cause of posterior tibial tendon dysfunction. This case illustrates a pitfall in MRI imaging with potential diagnostic and therapeutic consequences. PMID:12120910

Hasler, Paul; Hintermann, Beat; Meier, Monika

2002-05-01

185

Biomechanical Factors Associated with Tibial Stress Fracture in Female Runners  

Microsoft Academic Search

MILNER, C. E., R. FERBER, C. D. POLLARD, J. HAMILL, and I. S. DAVIS. Biomechanical Factors Associated with Tibial Stress Fracture in Female Runners. Med. Sci. Sports Exerc., Vol. 38, No. 2, pp. 323-328, 2006. Purpose: Tibial stress fractures (TSF) are among the most serious running injuries, typically requiring 6-8 wk for recovery. This cross-sectional study was conducted to determine

CLARE E. MILNER; REED FERBER; CHRISTINE D. POLLARD; JOSEPH HAMILL; IRENE S. DAVIS

2006-01-01

186

Kinematic Evaluation of the Step-up Exercise in Anterior Cruciate Ligament Deficiency  

PubMed Central

Background Step-up exercise is one of the most commonly utilized exercises during rehabilitation of patients after both ACL injury and reconstruction. Currently, insurance providers increasingly required a trial of intensified rehabilitation before surgical reconstruction is attempted. The purpose of this study was to investigate whether this “safe” rehabilitation exercise in the setting of ACL deficiency can cause altered knee kinematics. Methods Thirty patients with unilateral ACL rupture were recruited for this study. The mean time from injury was 3.3 months. Tibiofemoral kinematics were determined during a step-up exercise using a combination of MRI, dual fluoroscopy and advanced computer modeling. Findings The ACL-injured knee displayed an average 5° greater external tibial rotation than the uninjured knee (p<0.05), during the last 30% of step-up. The ACL-injured knee also demonstrated on average 2.5 mm greater anterior tibial shift during the last 40% of stance phase (p<0.01). In addition, during the last 30% of stance the tibia of the ACL-deficient knee tended to shift more medially (~1 mm) as the knee approached full extension (p<0.01). Interpertation The data confirmed the initial hypothesis as it was found that ACL deficient knees demonstrated significantly increased anterior tibial translation, medial tibial translation and external tibial rotation towards the end of the step-up as the knee approached full extension. Intensive rehabilitation utilizing the step-up exercise in the setting of ACL deficiency can potentially introduce repetitive microtrauma by way of altered kinematics.

Kozanek, Michal; Hosseini, Ali; Van de Velde, Samuel K.; Moussa, Mohamed E.; Gill, Thomas J.; Li, Guoan

2011-01-01

187

Results of Transphyseal Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft in Tanner Stage 3 or 4 Adolescents with Clearly Open Growth Plates  

Microsoft Academic Search

Background: Drilling across the physes for intra-articular anterior cruciate ligament reconstruction is considered risky for skeletally immature patients.Hypothesis: Skeletally immature patients with clearly open growth plates can safely undergo intra-articular anterior cruciate ligament reconstruction with patellar tendon autograft without suffering growth plate disturbance.Study Design: Retrospective review of prospectively collected data.Methods: Surgery involved drilling tunnels through the tibial and femoral physes,

K. Donald Shelbourne; Tinker Gray; Bryan V. Wiley

2004-01-01

188

Anterior cruciate ligament arthroplasty  

Microsoft Academic Search

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes an serine transfers. This coincided with a proposed patho logic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate

David A. Kieffer; Robert J. Curnow; Richard B. Southwell; William F. Tucker; Katherine K. Kendrick

1984-01-01

189

Anterior femoroacetabular impingement  

Microsoft Academic Search

Anterior femoroacetabular impingement is a mechanical hip disorder defined as abnormal contact between the anterior acetabular rim and the proximal femur. The typical patient is a young man who practices a martial art that involves kicking. Mechanical groin pain is the main presenting symptom. Passive flexion and internal rotation of the hip replicates the pain. The range of internal rotation

Frédéric Laude; Thierry Boyer; Alexis Nogier

2007-01-01

190

Anterior bony ankle impingement  

Microsoft Academic Search

Anterior bony ankle impingement results from osteophyte formation on the anterior edge of the distal tibia and\\/or neck of the talus, secondary to direct trauma during extreme or repetitive ankle dorsiflexion. It is common in ballet dancers, gymnasts, soccer players, football players, runners, and high jumpers. Typically, patients will complain of painful limitation of dorsiflexion, catching, and swelling in the

Brian G. Donley; Manuel Leyes

2001-01-01

191

Eight years' clinical experience with the Orthofix tibial nailing system in the treatment of tibial shaft fractures.  

PubMed

Intramedullary nailing has become a popular and effective procedure for the treatment of most tibial fractures. However, concerns regarding difficulties with reduction, the use and extent of intramedullary reaming, and hardware failure are probably the only constraints to its widespread use. In this prospective study, we present the clinical and radiographic results of the Orthofix tibial nailing system used in the treatment of tibial shaft fractures. One hundred and fifteen fresh tibial fractures in the same number of patients with a mean age of 37.5 years (17-85 years) were treated with operative stabilisation using the Orthofix tibial nailing system. All of the operations took place in a conventional operating theatre, on a simple tranlucent operating table and with manual reduction of the fracture. In the majority of the cases closed reduction and conventional reaming were performed and the mean duration of the operation was 38 min. Fracture healing occurred at 16 weeks (11-30 weeks) and was confirmed both clinically and radiographically. In six cases (two severely comminuted and four segmental fractures) delayed union occurred, however there were no tibial non-unions necessitating re-operation. There were no substantial differences in time to fracture union or in the rate of complications related to minimal open reduction. In addition, there seem to be more benefits than risks in the use of power intramedullary reaming during intramedullary fixation of tibial shaft fractures. In conclusion, most tibial shaft fractures can effectively and safely be treated using this type of locking intramedullary nailing device, with relatively few complications, and with satisfactory long-term clinical results. PMID:17054957

Babis, George C; Benetos, Ioannis S; Karachalios, Theofilos; Soucacos, Panayotis N

2006-10-18

192

A comparison of plate versus staple-and-cast fixation in maintaining femoral tibial alignment after valgus tibial osteotomy  

PubMed Central

Purpose To compare 2 methods of fixation for maintenance of alignment during healing of valgus tibial osteotomies. Methods We performed a retrospective chart and radiographic review of valgus tibial osteotomy cases of staple fixation supplemented by a postoperative cast and of blade plate fixation for maintenance of femoral–tibial alignment during healing of the osteotomy. Results Both groups (staple-and-cast, n = 16; plate, n = 28) were similar in terms of age, preoperative alignment, extent of osteoarthritis and degree of intra-operative correction. Between-group differences in the maintenance of femoral–tibial alignment during healing were not significant. In both groups there was a strong correlation between degree of bone contact at the osteotomy site and maintenance of alignment (p < 0.005). In cases done with the plate, 90% of osteotomies with good or excellent bone contact maintained alignment during healing; with poor or fair bone contact, 75% had loss of alignment > 5° during healing. There was a trend toward a greater incidence of delayed or non-union with plate fixation compared with staple fixation that did not reach statistical significance. All of these cases of delayed/non-union had loss of femoral–tibial alignment > 5° during healing. Conclusion As a result of this study, we have modified our surgical technique. We now use intra-operative fluoroscopy for optimizaiton of bone contact, and we have reverted to the less invasive staple method for fixation of tibial osteotomies.

Harrison, Mark M.; Waddell, James P.

2005-01-01

193

Vascularized fibular graft in infected tibial bone loss  

PubMed Central

Background: The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials and Methods: 15 male patients with mean age 33.7 years (range 18 - 56 years) of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 – 20 cm). The mean length of the graft was 16.7 cm (range 11.5 – 21 cm). The osteoseptocutaneous flap (bone flap with attached overlying skin flap) from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 – 164 months). The Pearson correlation coefficient (r) was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture. Results: Graft union occurred in all patients in a mean time of 3.3 months, at both ends. At a minimum followup of 24 months the mean hypertrophy noted was 63.6% (30 – 136%) in the vascularized fibular graft. Ten stress fractures occurred in seven patients. The mean duration of the occurrence of a stress fracture in the graft was 11.1 months (2.5 – 18 months) postoperatively. The highest incidence of stress fractures was when the graft hypertrophy was less than 20%. The incidence of stress fractures reduced significantly after the graft hypertrophy exceeded 20%. Conclusion: In most cases hypertrophy of the vascularized fibular graft occurs in response to mechanical loading by protected weight bearing, and the amount of hypertrophy is variable. The presence or absence of an intact fibula has no bearing on the hypertrophy or incidence of stress fracture. The length of the fibular graft has no bearing on the hypertrophy or stress fracture.

Kovoor, C Cheriyan; Jayakumar, R; George, VV; Padmanabhan, Vinod; Guild, AJ; Viswanath, Sabin

2011-01-01

194

The impact of platelet-rich plasma on the prevention of tunnel widening in anterior cruciate ligament reconstruction using quadrupled autologous hamstring tendon: a randomised clinical trial.  

PubMed

The use of platelet-rich plasma (PRP) as an adjuvant to tissue repair is gaining favour in orthopaedic surgery. Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a recognised phenomenon that could compromise revision surgery. The purpose of this study was to determine whether PRP might prevent tunnel widening in ACL reconstruction.Patients undergoing ACL reconstruction using a hamstring graft were randomly allocated either to have PRP introduced into the tunnels peri-operatively or not. CT scanning of the knees was carried out on the day after surgery and at three months post-operatively and the width of the tunnels was measured. Patients were also evaluated clinically at three months, when laxity was also measured.Each group comprised 25 patients, and at three months post-operatively all were pain-free with stable knees, a negative Lachman test and a good range of movement. Arthrometric results had improved significantly in both groups (p < 0.001). Despite slightly less tunnel widening in the PRP group, there was no significant difference between the groups at the femoral opening or the mid-tunnel (p = 0.370 and p = 0.363, respectively) nor at the tibial opening or mid-tunnel (p = 0.333 and p = 0.177, respectively).We conclude that PRP has no significant effect in preventing tunnel widening after ACL reconstruction. PMID:23307675

Mirzatolooei, F; Alamdari, M T; Khalkhali, H R

2013-01-01

195

Bilateral anterior shoulder dislocation  

PubMed Central

Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side. Prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome.

Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek

2013-01-01

196

Anatomic assessment of femoral tunnel by transtibial drilling technique in double-bundle anterior cruciate ligament reconstruction: an in vivo study.  

PubMed

Objective: To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction. Methods: Two tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45?and 55?to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. After the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached against the lateral wall of intercondylar notch. The position that the reamer shaft can reach was marked and recorded. Results: Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation through the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24%) the femoral AM tunnel opening and in 10 cases (20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel. Conclusion: The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized. PMID:24103819

Xu, Hu; Zhang, Chun-Li; Li, Guang-Zheng; Wang, Ying-Chun; Fan, Hong-Bin; Zhu, Qin-Sheng

2013-10-01

197

A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures.  

PubMed

The objective of this study was to determine whether clinical outcomes were superior and complication rates were lower in dogs that had had a cranial cruciate ligament rupture treated by tibial plateau levelling osteotomy (TPLO), compared to those dogs that had been treated using the original cranial tibial wedge osteotomy (CTWO) procedure. Thirty-seven client-owned dogs with cranial cruciate ligament rupture were included in the study: 19 dogs underwent a TPLO procedure, and 18 dogs underwent a CTWO procedure. The study was retrospective, with the data being obtained from medical records and a review of radiographs. The long-term outcome was assessed by means of an owner questionnaire using a visual analogue scale. For the majority of factors that were reviewed, there was not a significant difference in outcome between the dogs that had a TPLO or those that had undergone a CTWO. All of the dogs showed a rapid return to weight bearing after surgery, and at the six week re-examination, the majority of the dogs did not have any pain on stifle palpation. They displayed a good stifle range of motion and significantly lower lameness scores than those prior to surgery. The complication rates did not differ between the procedures, however, within this small sample of dogs, complications following a CTWO were more likely to require revision surgery. PMID:18038011

Corr, S A; Brown, C

2007-01-01

198

21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.  

Code of Federal Regulations, 2010 CFR

...Drugs 8 2009-04-01 2009-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. ...ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590 Knee joint tibial (hemi-knee) metallic...

2009-04-01

199

High tibial osteotomy with use of the Taylor Spatial Frame external fixator for osteoarthritis of the knee  

PubMed Central

Background High tibial osteotomy (HTO) is used to treat medial compartment osteoarthritis of the knee in active patients with varus alignment. In this study we review the clinical and radiographic outcomes associated with the Taylor Spatial Frame (Smith & Nephew), and its use in HTOs, and we include an illustrative case report. Methods In 7 patients with medial compartment osteoarthritis of the knee and varus alignment, the Taylor Spatial Frame was applied to the tibia in the operating room and a proximal tibial osteotomy was performed. Patients followed a computer-generated turning schedule until the desired correction was achieved. The frame was removed when the osteotomy site had healed. The lower extremity measure (LEM) was used to assess physical function. Clinical outcome measures relating to the Taylor Spatial Frame included latency, time to correction, time in the frame, number of residual corrections and complications. Radiographic outcomes included preoperative Resnick grades of osteoarthritis, pre-and post-correction limb alignment and tibial slope measurements. Results Average (and standard deviation) LEM grade at a mean 41 (14) months follow-up after correction was 94% (5%). Average latency was 8 days, time to correction was 15 days, time in the frame was 23 weeks and number of residual corrections was 1.3. Complications were similar to those for external fixators. Radiographic correction goals were met in all patients. Conclusion The Taylor Spatial Frame is a valuable asset when using HTO to treat medial compartment osteoarthritis of the knee.

Viskontas, Darius G.; MacLeod, Mark D.; Sanders, David W.

2006-01-01

200

Effect of Muscle Loads and Torque Applied to the Tibia on the Strain Behavior of the Anterior Cruciate Ligament: An In Vitro Investigation  

PubMed Central

Background Very little is known about the effects of applied torque about the long axis of the tibia in combination with muscle loads on anterior cruciate ligament biomechanics. The purpose of this study was to determine the effect of muscle contraction and tibial torques applied about the long axis of the tibia on anterior cruciate ligament strain behavior. Methods Six cadaver knee specimens were used to measure the strain behaviour of the anterior cruciate ligament. Internal and external axial torques were applied to the tibia when the knee was between 30° and 120° of flexion in combination with the conditions of no muscle load, isolated quadriceps load, and simultaneous quadriceps and hamstring loading. Findings The highest anterior cruciate ligament strain values were measured when the muscles were not loaded, when the knee was at 120° of flexion, and when internal tibial torques were applied to the knee. During muscle loading the highest anterior cruciate ligament strain values were measured at 30° of flexion and then the strain values gradually decreased with increase in knee flexion. During co-contraction of the quadriceps and hamstring muscles the anterior cruciate ligament was unstrained or minimally strained at 60°, 90° and 120° of knee flexion. Intepretation This study suggests that quadriceps and hamstring muscle co-contraction has a potential role in reducing the anterior cruciate ligament strain values when the knee is in deep flexion. These results can be used to gain insight into anterior cruciate ligament injury mechanisms and to design rehabilitation regimens.

Fujiya, Hiroto; Kousa, Petteri; Fleming, Braden C; Churchill, David L; Beynnon, Bruce D

2011-01-01

201

Ultrasound evaluation of gravity induced anterior drawer following anterior cruciate ligament lesion.  

PubMed

Ultrasound is not so far a standard procedure to visualize the anterior drawer following anterior cruciate ligament (ACL) lesions. This is because the described techniques are either technically difficult or depend on the experience of the performer and are not standardized. The purpose of this prospective analysis on ACL intact, ACL deficient and ACL reconstructed knees was to compare the diagnostic accuracy of prone ultrasonographic Lachman testing with KT-1000 measurements in the same study population. Our technique is based on a prone position of the patient. The thigh lies on the table surface such that the patella has no contact. The lower leg is placed on a roll in the ankle area and flexed to 30 degrees . The transducer (5 MHz) is positioned over the medial aspect of the popliteal fossa to visualize the femoral condyle as well as the tibial head. Under ultrasound control the lower leg is manually lifted as far the thigh stays in contact with the surface defining the start position. The lower leg is then released and drawn by gravity into the anterior drawer position, the final position. The distance between the posterior tangent from the medial femoral condyle to the medial tibial plateau was registered by three independent ultrasound measurements of the injured knee. The uninvolved opposite knee served as an internal control. The same procedure was done using a KT-1000 device (89 and 133 Newton and manual maximum force). The patients were split into two groups: acute injury (A), and (B) 6 months following ACL repair with a patellar tendon graft. All patients then underwent arthroscopy. In group A with acute ACL lesions the anterior drawer resulted in 14.1 mm (+/- 3.5) and was significantly (P < 0.001) different from the contralateral knee (7.7 mm +/- 2.9). The KT 1000 showed a comparable difference with 14.4 mm (+/- 3.9) for the injured knee and 8.3 mm (+/- 3.4) for the uninjured (P < 0.001). Sonometrically, group B patients showed no clear difference between the repaired (9.9 mm +/- 2.7) knee and its control (8.1 mm +/- 2.5). This was found for the KT-1000 results as well. The results derived from the ultrasound evaluation of the anterior drawer correlated well with those from the KT-1000 (r = 0.46). Based on a minimum intra-individual difference of 5 mm in the ultrasound measured anterior drawer, the sensitivity of the test in group A resulted in 0.96, and the specificity in 0.98. The described technique is reproducible, painless and easy to perform in order to evaluate acute ACL tears using any commercially available ultrasound device. The reproducibility is similar to the KT-1000 device. We recommend this technique for use in cases of acute ACL tears as well as in the follow-up of ACL repair. PMID:10401653

Gebhard, F; Authenrieth, M; Strecker, W; Kinzl, L; Hehl, G

1999-01-01

202

An accessory flexor digitorum longus muscle with high division of the tibial nerve  

Microsoft Academic Search

An accessory flexor digitorum longus muscle associated with a high division of the tibial nerve was encountered during routine dissection in the right leg of a newborn cadaver. The tibial nerve divided into its two terminal branches at a higher level than normal with a small branch from the tibial nerve contributing to one of the terminal branches. In addition,

Z. Kurtoglu; M. H. Uluutku; M. A. Çan; S. Önderoglu

2001-01-01

203

Photoperiodic responses of broilers. III. Tibial breaking strength and ash content  

Microsoft Academic Search

1.?A total of 7960 Cobb and Ross broiler males were reared on various photoperiods or continuous illumination in two trials to 35 or 40 d. Tibial breaking strength was measured in both, and tibial ash content determined in the first of the two trials.2.?Tibial breaking strength was significantly affected by photoperiod, body weight, testicular weight, and genotype. Although peak bone

P. D. Lewis; R. Danisman; R. M. Gous

2009-01-01

204

Are knee mechanics during early stance related to tibial stress fracture in runners?  

Microsoft Academic Search

BackgroundTibial stress fractures are a serious overuse injury in runners. Greater vertical loading rates and tibial shock have been found in runners with previous tibial stress fracture compared to controls. The timing of these variables occurs very early in the stance phase and suggests that conditions shortly after footstrike may be important in determining injury risk. The purpose of this

Clare E. Milner; Joseph Hamill; Irene Davis

2007-01-01

205

Proximal medial tibial biplanar retrotubercle open wedge osteotomy in medial knee arthrosis.  

PubMed

The patellar tendon length changes and patella infera occurs in medial open wedge osteotomies. We hypothesized that patellar tendon length in the sagittal plane would not change in a proximal medial tibial biplanar retrotubercle open wedge osteotomy. Proximal medial tibial biplanar retrotubercle open wedge osteotomies were conducted on 23 knees of 22 patients; the mean patient age was 59 ± 7 years (range, 53-69 years). The surgical procedure used had some technical distinctions from those used in literature. The mean follow-up was 37 ± 11 months (range, 19-58 months). Preoperative and postoperative Hospital for Special Surgery Scoring System (HSS) scores, radiological tibial slope, Insall-Salvati, Blackburne-Peel, and Caton indices, femoro-tibial anatomical axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axis were measured and compared statistically. Postoperative HSS scores were statistically higher than the preoperative HSS scores. The femoro-tibial axis angle, the angle between the femoral condyle and tibial plateau, and the angle between the tibial plateau and tibial axes decreased significantly. No statistical difference was observed between the preoperative and postoperative Insall-Salvati, Blackburne-Peel, or Caton indices. When we performed proximal medial tibial biplanar retrotubercle open wedge osteotomy, clinical and radiological recovery was observed but patellar height did not change. PMID:21561777

Esenkaya, Irfan; Unay, Koray

2011-05-10

206

[Anatomic anterior cruciate ligament reconstruction with hamstrings using press-fit fixation without hardware: operative technique and long-term results of a prospective and randomized study].  

PubMed

An innovative technique for anterior cruciate ligament (ACL) reconstruction has been developed in 1998 which allows the grafts to be fixed by press-fit to the femoral and tibial tunnel without any hardware. The semitendinosus (ST) and gracilis tendons (GT) are built into a sling by tying a knot with the tendon ends and securing the knot after conditioning by sutures. For the femoral tunnel the anteromedial porta is used. The correct anatomic position of the single femoral tunnel is checked using intraoperative lateral fluoroscopy by placing the tip of a K-wire to a point between the anteromedial and posterolateral bundle insertion sites. A femoral bottleneck tunnel is drilled to receive the knot of the tendons. The tendon loops filled the tibial tunnel without any suture material. The loops are fixed at the tibial tunnel outlet with tapes over a bone bridge. Between 1998 and 1999 a prospective randomized study (level 1) was conducted comparing this technique with a technique using bone-patellar-tendon graft and press-fit fixation without hardware. In conclusion it was found that implant-free press-fit ACL reconstruction using bone-patella-tendon (BPT) and hamstring tendon (HT) grafts proved to be an excellent procedure to restore stability and function of the knee. Using hamstring tendons (ST and GT) significantly lower donor site morbidity was noted. Kneeling and knee walking pain persisted to be significantly more intense in the BPT up to 9 years after the operation. Re-rupture rates, subjective findings, knee stability and isokinetic testing showed similar results for both grafts. This is the first level I study which demonstrates cartilage protection by ACL reconstruction as long as the meniscus is intact at index surgery, shown by bilateral MRI analysis 9 years post-operation. There was no significant difference in the average grade of chondral and meniscus lesions between BPT and HT and in comparison of the operated to the intact knee, except for grade 3-4 lesions found at the 9 year follow-up, which were significantly higher in the BPT group. PMID:20607509

Pässler, H H

2010-07-01

207

Anterior cruciate ligament surgery in the rabbit  

PubMed Central

Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery.

2013-01-01

208

Assessment of functional knee bracing: an in vivo three-dimensional kinematic analysis of the anterior cruciate deficient knee  

Microsoft Academic Search

Objective. To describe three-dimensional tibial and femoral movements in vivo and examine the effect of a brace on knee kinematics during moderate to intense activity.Design. Skeletal kinematics of anterior cruciate ligament deficient knees was measured with and without braces during moderate to intense activity.Background. Invasive markers implanted into the tibia and femur are the most accurate means to directly measure

Dan K Ramsey; Mario Lamontagne; Per F Wretenberg; Anders Valentin; Björn Engström; Gunnar Németh

2001-01-01

209

A knee-specific finite element analysis of the human anterior cruciate ligament impingement against the femoral intercondylar notch  

Microsoft Academic Search

This work presents a finite element analysis of anterior cruciate ligament (ACL) impingement against the intercondylar notch during tibial external rotation and abduction, as a mechanism of noncontact ACL injuries. Experimentally, ACL impingement was measured in a cadaveric knee in terms of impingement contact pressure and six degrees-of-freedom tibiofemoral kinematics. Three-dimensional geometries of the ACL, femur and tibia were incorporated

Hyung-Soon Park; Chulhyun Ahn; David T. Fung; Yupeng Ren; Li-Qun Zhang

2010-01-01

210

Does the Taylor Spatial Frame Accurately Correct Tibial Deformities?  

PubMed Central

Background Optimal leg alignment is the goal of tibial osteotomy. The Taylor Spatial Frame (TSF) and the Ilizarov method enable gradual realignment of angulation and translation in the coronal, sagittal, and axial planes, therefore, the term six-axis correction. Questions/purposes We asked whether this approach would allow precise correction of tibial deformities. Methods We retrospectively reviewed 102 patients (122 tibiae) with tibial deformities treated with percutaneous osteotomy and gradual correction with the TSF. The proximal osteotomy group was subdivided into two subgroups to distinguish those with an intentional overcorrection of the mechanical axis deviation (MAD). The minimum followup after frame removal was 10 months (average, 48 months; range, 10–98 months). Results In the proximal osteotomy group, patients with varus and valgus deformities for whom the goal of alignment was neutral or overcorrection experienced accurate correction of MAD. In the proximal tibia, the medial proximal tibial angle improved from 80° to 89° in patients with a varus deformity and from 96° to 85° in patients with a valgus deformity. In the middle osteotomy group, all patients had less than 5° coronal plane deformity and 15 of 17 patients had less that 5° sagittal plane deformity. In the distal osteotomy group, the lateral distal tibial angle improved from 77° to 86° in patients with a valgus deformity and from 101° to 90° for patients with a varus deformity. Conclusions Gradual correction of all tibial deformities with the TSF was accurate and with few complications. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Segal, Kira; Ilizarov, Svetlana; Fragomen, Austin T.; Ilizarov, Gabriel

2009-01-01

211

Anterior opening wedge osteotomy of the proximal tibia for anterior knee pain in idiopathic hyperextension knees  

PubMed Central

We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and the mean Knee Society score score was 94.6 (70–100) for function and 87.7 (47–100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42–100), for stiffness 82.8 (25–100) and for pain 87.3 (55–100). Radiographs showed a significant increase in posterior tibial slope of 9.4 deg and a significant decrease of patellar height according to the Blackburne–Peel method of 0.16 postoperatively. No cases of non-union, deep infection or compartment syndrome were seen. No osteoarthritic changes in the lateral or medial knee compartment were found with more than 5 years’ follow-up in 16 patients with 19 affected knees. Three out of the four dissatisfied patients had a patella infera which led to patellofemoral complaints. One patient in the study underwent a secondary superior displacement of the patella with excellent results. We conclude that in a selected group of patients with idiopathic genu recurvatum and anterior knee pain an opening wedge osteotomy of the proximal tibia can be beneficial.

van Raaij, T. M.

2006-01-01

212

Bilateral Tibial Tubercle Sleeve Fractures in a Skeletally Immature Patient  

PubMed Central

Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sleeve fractures with suture anchor fixation. At the final followup, 3 years after his initial injury, the patient demonstrated full knee function bilaterally without radiographic evidence of growth disturbances.

Desai, Rasesh R.; Parikh, Shital N.

2013-01-01

213

Tibial tuberosity excision for symptomatic Osgood-Schlatter disease.  

PubMed

A modified Ferciot procedure was used to excise the tibial tubercle in patients with persistently symptomatic Osgood-Schlatter disease. Forty-two knees in 35 patients were reviewed at a mean follow-up of 5 years to assess outcome. The results revealed relief of pain in 95% of patients and reduction of prominence in 85.5% with minimal complication, in particular no evidence of genu recurvatum. The pathogenesis of the condition is outlined, and some of the theories and treatment modalities discussed. Tibial tubercle excision is recommended as the treatment of choice in those few cases that fail with conservative treatment. PMID:7790481

Flowers, M J; Bhadreshwar, D R

214

Luxation of the long digital extensor tendon as a complication to Tibial Plateau Levelling Osteotomy. A presentation of four cases.  

PubMed

Cranial cruciate ligament disease in dogs is frequently treated with Tibial Plateau Levelling Osteotomy (TPLO). Herein we describe four cases of dogs presenting with sudden lameness in the operated leg one to 12 months post TPLO surgery. On examination, all of the dogs had a luxation of the long digital extensor tendon (LDE) resulting from the TPLO surgery. All of the dogs underwent revision surgeries. The LDE tendon was either secured in its normal position or transected, and a tenodesis was performed. The dogs recovered well after surgery and lameness was resolved in all four cases. PMID:17846690

Haaland, P J; Sjöström, L

2007-01-01

215

An In Vitro Biomechanical Comparison of Anterior Cruciate Ligament Reconstruction: Single Bundle Versus Anatomical Double Bundle Techniques  

PubMed Central

INTRODUCTION Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction). OBJECTIVES To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study. METHODS Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle) and group B (anatomical reconstruction). Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion. RESULTS There were no differences between the two techniques for any of the measurements by ANOVA tests. CONCLUSION The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.

Sasaki, Sandra Umeda; Albuquerque, Roberto Freire da Mota e; Pereira, Cesar Augusto Martins; Gouveia, Guilherme Simoes; Vilela, Julio Cesar Rodrigues; de Lima Alcaras, Fabio

2008-01-01

216

Alendronate reduced peri-tunnel bone loss and enhanced tendon graft to bone tunnel healing in anterior cruciate ligament reconstruction.  

PubMed

Peri-tunnel bone loss after anterior cruciate ligament (ACL) reconstruction is commonly observed, both clinically and experimentally. We aimed to study the effect and mechanisms of different doses of alendronate in the reduction of peri-tunnel bone loss and promotion of graft-bone tunnel healing in ACL reconstruction. Eighty-four ACL-reconstructed rats were divided into 4 groups. Alendronate at different dosages, or saline, were injected subcutaneously weekly, for 2 or 6 weeks post-reconstruction, for vivaCT (computed tomography) imaging, biomechanical tests, histology and immunohistochemistry. Alendronate significantly increased bone mass and density of tissue inside bone tunnels except at the epiphyseal region of tibial tunnel. The femoral tunnel diameter decreased significantly in the mid-dose and high-dose alendronate groups compared to that in the saline group at week 6. Alendronate significantly increased the peri-tunnel bone mass and density along all tunnel regions at week 6. Better graft-bone tunnel integration and intra-tunnel graft integrity were observed in the alendronate groups. The ultimate load was significantly higher in the mid-dose and high-dose alendronate groups at week 2, but not at week 6. There was a reduction in matrix metalloprotein (MMP)1, MMP13 and CD68-positive cells at the peri-tunnel region and graft-bone interface in the alendronate-treated group compared to the saline group. Alendronate reduced peri-tunnel bone resorption, increased mineralised tissue inside bone tunnel as well as histologically and biomechanically promoted graft-bone tunnel healing, probably by reducing the expression of MMP1, MMP13 and CD68-positive cells. Alendronate might be used for reducing peri-tunnel bone loss and promoting graft-bone tunnel healing at early stage post-ACL reconstruction. PMID:23325540

Lui, P P Y; Lee, Y W; Mok, T Y; Cheuk, Y C; Chan, K M

2013-01-16

217

Hamstrings Stiffness and Landing Biomechanics Linked to Anterior Cruciate Ligament Loading.  

PubMed

Context : Greater hamstrings stiffness is associated with less anterior tibial translation during controlled perturbations. However, it is unclear how hamstrings stiffness influences anterior cruciate ligament (ACL) loading mechanisms during dynamic tasks. Objective : To evaluate the influence of hamstrings stiffness on landing biomechanics related to ACL injury. Design : Cross-sectional study. Setting : Research laboratory. Patients or Other Participants : A total of 36 healthy, physically active volunteers (18 men, 18 women; age = 23 ± 3 years, height = 1.8 ± 0.1 m, mass = 73.1 ± 16.6 kg). Intervention(s) : Hamstrings stiffness was quantified via the damped oscillatory technique. Three-dimensional lower extremity kinematics and kinetics were captured during a double-legged jump-landing task via a 3-dimensional motion-capture system interfaced with a force plate. Landing biomechanics were compared between groups displaying high and low hamstrings stiffness via independent-samples t tests. Main Outcome Measure(s) : Hamstrings stiffness was normalized to body mass (N/m·kg(-1)). Peak knee-flexion and -valgus angles, vertical and posterior ground reaction forces, anterior tibial shear force, internal knee-extension and -varus moments, and knee-flexion angles at the instants of each peak kinetic variable were identified during the landing task. Forces were normalized to body weight, whereas moments were normalized to the product of weight and height. Results : Internal knee-varus moment was 3.6 times smaller in the high-stiffness group (t22 = 2.221, P = .02). A trend in the data also indicated that peak anterior tibial shear force was 1.1 times smaller in the high-stiffness group (t22 = 1.537, P = .07). The high-stiffness group also demonstrated greater knee flexion at the instants of peak anterior tibial shear force and internal knee-extension and -varus moments (t22 range = 1.729-2.224, P < .05). Conclusions : Greater hamstrings stiffness was associated with landing biomechanics consistent with less ACL loading and injury risk. Musculotendinous stiffness is a modifiable characteristic; thus exercises that enhance hamstrings stiffness may be important additions to ACL injury-prevention programs. PMID:23768123

Blackburn, J Troy; Norcross, Marc F; Cannon, Lindsey N; Zinder, Steven M

2013-06-14

218

Comparison of tibial rotation in fixed and mobile bearing total knee arthroplasty using computer navigation  

PubMed Central

Tibial rotation is an important aspect of knee function and can be altered after total knee arthroplasty (TKA). These alterations include decreased internal rotation with knee flexion as compared to the normal state and paradoxical external rotation with flexion. Mobile bearing total knee prostheses may allow greater unconstrained tibial rotation. I compared tibial rotation after fixed bearing or mobile bearing total knee arthroplasty in 82 patients who underwent TKA with the tibia cut first technique to ascertain any differences. Using intraoperative imageless computer navigation, measurements included the determination of tibial rotation from extension to 90° flexion before and after prosthetic implantation with non-weight-bearing range of motion. I found that tibial rotation was significantly reduced after fixed bearing total knee replacement as compared to mobile bearing. In addition, the tibial position compared to the distal femur in extension was more external in fixed bearings compared to mobile bearings. Placing the fixed tibial tray with increased internal rotation could explain this difference.

2008-01-01

219

Outcomes of total knee arthroplasty following high tibial osteotomy  

PubMed Central

Background: Total knee arthroplasty (TKA) following high tibial osteotomy (HTO) is a technically demanding procedure with varying results. The purpose of our study was to analyze the clinicoradiological results of TKA following HTO and to identify the factors that may influence the final outcome. Materials and Methods: 55 patients (58 knees) who had undergone a previous HTO were treated with a TKA from 1991 to 2009. There were 34 female and 21 male patients. The average age was 61.9 years (range 52-82 years) and the average weight was 79.5 kg (range 54-106 kg), with an average body mass index of 29.6 (range 21.8-34.6) at the time of TKA. The knee society scores (KSSs) and knee society functional scores were evaluated for every patient pre and postoperatively and the results evaluated. Results: The mean period of followup was 11.2 years (range 3-18 years) and the patients were followed up every year. The average KSS score at final followup improved from 38.5 (range 0-80 points) preoperatively to 88.5 postoperatively (range 35-95 points) (P < 0.05). The mean femorotibial angle corrected from 6.8 degrees (range 5-12°) varus preoperatively to a valgus of 4.4 (2-8°) degrees postoperatively. The average joint line height improved to an average of 9.6 mm (range 4.4-22 mm) (P < 0.01) at the last followup. The average Insall Salvatti Ratio also improved (average 1.11 preoperative - 1.21 average postoperative) (P < 0.05). The average range of motion improved to 108° (range 85°-125°) from 76° preoperative (range 55°-100°) (P < 0.01). Conclusion: Although TKA postHTO is a demanding surgery however, with newer component designs, results are comparable to primary TKA. Technical difficulties in exposure can sometimes lead to component malpositioning, which can affect the final outcome. Inadequate soft tissue balancing and limb malalignment should always be kept in mind. Regular followup to look for evidences of loosening is advised in such patients].

Gupta, Himanshu; Dahiya, Vivek; Vasdev, Attique; Rajgopal, Ashok

2013-01-01

220

Biomechanical Factors in the Etiology of Tibial Stress Fractures.  

National Technical Information Service (NTIS)

The overall aim of this research is to gain insight into the etiology of tibial stress fractures. Three dimensional motion analysis data along with structural data will be collected from 400 subjects (200 at each site) over a 3-year period. 30 of the subj...

I. S. Davis

2006-01-01

221

Changes in serum protein profiles of chickens with tibial dyschondroplasia  

Technology Transfer Automated Retrieval System (TEKTRAN)

Differences in serum protein profiles were analyzed to identify biomarkers associated with a poultry leg problem named tibial dyschondroplasia (TD) that can cause lameness. We used a bead-based affinity matrix containing a combinatorial library of hexapeptides (ProteoMinerTM) to deplete high abundan...

222

Proximal tibial physis fracture and popliteal artery injury.  

PubMed

A case of fracture about the proximal tibial physis with associated popliteal artery injury is presented. These fractures are not common, but their complications can be disastrous. The radiologist should draw attention to the possibility of vascular injury when these fractures are recognized. PMID:6691091

Rivero, H; Bolden, R; Young, L W

1984-02-01

223

Popliteal artery injury after tibial osteotomy: report of two cases.  

PubMed

Operative injury to the popliteal artery after meniscal surgery on the knee has been described previously, but its occurrence after tibial osteotomy has not been reported. The authors describe two cases of the latter condition, both involving the formation of a false aneurysm at the site of injury. The pathogenesis of this condition, its clinical sequelae and its subsequent repair are discussed. PMID:2383838

Rubens, F; Wellington, J L; Bouchard, A G

1990-08-01

224

Total knee arthroplasty in the management proximal tibial stress fractures  

Microsoft Academic Search

Five patients with stress fractures of the proximal tibia adjacent to an arthritic knee joint were treated by resurfacing arthroplasty with intramedullary fixation of the fracture. All five fractures healed and limb realignment was achieved. The literature concerning proximal tibial stress structures in relation to the arthritic knee and the management of this condition is reviewed.

M. P. W. Tomlinson; I. M. Dingwall; H. Phillips

1995-01-01

225

Biomechanical predictors of retrospective tibial stress fractures in runners  

Microsoft Academic Search

Both kinematics and kinetics of the lower limb have been shown separately to be related with a history of tibial stress fractures (TSFs) in female runners. However, it is likely that these factors interact together to increase the risk of a TSF. This study was conducted to determine which combination of kinematic and kinetic factors are the best predictors of

Michael B. Pohl; David R. Mullineaux; Clare E. Milner; Joseph Hamill; Irene S. Davis

2008-01-01

226

Comparison of techniques for tibial dyschondroplasia assessment in broiler chickens  

Microsoft Academic Search

This study was carried out at Faculdade de Medicina VeterinÆria e Zootecnia, Universidade Estadual Paulista, Botucatu, SP, Brazil, with the objective of evaluating the efficacy of four techniques in the assessment of tibial dyschondroplasia lesions in broiler chickens. Four hundred Cobb male chicks were reared from 1 to 39 days of age. At 39 days, forty birds were selected and

ICL Almeida Paz; AA Mendes; TS Takita; LC Vulcano; PC Guerra; FS Wechsler; RG Garcia; SE Takahashi; J Moreira; K Pelícia; CM Komiyama; RR Quinteiro

2005-01-01

227

CARTILAGE RESORPTION IN THE TIBIAL EPIPHYSEAL PLATE OF GROWING RATS  

Microsoft Academic Search

An electron microscopic study of the tibial epiphyseal plates of growing rats reveals that the resorption of unmineralized and mineralized cartilage occurs by two different mechanisms. During resorption the unmineralized transverse cartilaginous walls between chondrocytes are invaded by capillary sprouts. At the resorption zone, numerous cytoplasmic processes derived primarily from the perivascular cells and, to a lesser extent, from the

ROBERT K. SCHENK; DAVID SPIRO; JOSEPH WIENER

1967-01-01

228

Total Knee Arthroplasty Following High Tibial Osteotomy - a Radiological Evaluation  

PubMed Central

ABSTRACT The purpose of this study was to evaluate the results of total knee arthroplasty (TKA) following a closed wedge high tibial osteotomy (HTO). A total of 16 TKAs were performed in 16 pacients who had previously undergone a closed wedge (HTO) as a treatement for knee osteoarthritis. The radiographic results were evaluated with respect to the femurotibial angle (FTA), joint line height (JLH), tibial bone resection and Insall-Salvati ratio. The FTA improved in average, from 6.5 degree of varus preoperatively at 5.7 degree of valgus postoperatively. The JLH averaged 14.34 mm preop and 13.81 mm at the last follow-up. The amount of tibial bone resection averaged 5.98 mm, face to 7.5 mm for knees without HTO. The Insall-Salvati ratio was 1.127 preop and 1.172 postop. A meticulous surgical technique may lead to satisfactory results in TKA after HTO, considering the correction of the deformity, the re-estabilish of JLH and the amount of the tibial bone resection.

ORBAN, Horia; MARES, Emil; DRAGUSANU, Mihaela; STAN, Gabriel

2011-01-01

229

Arthroscopically assisted percutaneous osteosynthesis of lateral tibial plateau fractures  

PubMed Central

Background The aim of our study was to evaluate the results of lateral tibial plateau fractures treated with arthroscopically assisted percutaneous osteosynthesis (AAPO). Methods Twenty-one patients (14 men and 7 women) with a mean age of 41 years underwent AAPO to repair low-energy Schatzker I–III tibial plateau fractures. Under pneumatic tourniquet, we reduced and fixed the fracture with 1 or 2 subchondral cannulated screws. Accompanying lesions included 10 meniscus tears, which we partially excised in 9 patients and repaired in 1 patient. On the second postoperative day, patients began range-of-motion exercises. We encouraged partial and full weight-bearing by the sixth and tenth weeks, respectively. The mean follow-up period was 38 (range 12–96) months, and we evaluated the patients using Rasmussen's clinical and radiologic criteria. We used a t test for statistical analysis. Results There were 13 excellent (62%), 6 good (28%) and 2 fair (10%) clinical results, and 11 excellent (52%), 7 good (33%) and 3 fair (14%) radiologic results. We observed mild or moderate arthritic changes in 5 patients (24%). There were no infection or wound problems, but we removed hardware in 4 patients. Conclusion Arthroscopically assisted treatment of lateral tibial plateau fractures yields satisfactory results and can be accepted as an alternative and effective method for the treatment of low-energy tibial plateau fractures.

Kayali, Cemil; Ozturk, Hasan; Altay, Taskin; Reisoglu, Ali; Agus, Haluk

2008-01-01

230

Induction of Tibial Dyschondroplasia by Carbamate and Thiocarbamate Pesticides  

Technology Transfer Automated Retrieval System (TEKTRAN)

Tibial dyschondroplasia (TD) is a major poultry leg problem the natural etiology of which is unknown. Certain dithiocarbamate pesticides such as tetramethyl thiuram disulfide (thiram) have been shown to induce the disease in chickens. Since many different carbamate and thiocarbamate chemicals are ...

231

Anterior internal impingement  

Microsoft Academic Search

Purpose: The source of pain in patients with a stable shoulder and clinical signs of impingement is traditionally thought to be subacromial or outlet impingement, as popularized by Neer. This report introduces the concept of anterior internal impingement in patients with signs and symptoms of classic impingement syndrome and arthroscopic evidence of articular-side partial rotator cuff tear. Contact that occurs

Steven Struhl

2002-01-01

232

Delayed union stress fractures of the anterior tibia: conservative management  

PubMed Central

Introduction—A conservative method of treating four delayed union stress fractures of the anterior mid-tibia is described, with an illustrative case history. Methods—Once diagnosed each of the patients was treated in a pneumatic lower leg brace with modified rest. The mean (range) age of the patients was 28 (24–32) years and all were involved in professional or amateur sports. The mean (range) duration of symptoms before diagnosis and definitive treatment of the four fractures was 9 (3–14) months. Results—Use of this technique avoided the need for surgery in this group of patients and allowed return to unrestricted activity an average of 12 months from presentation. Conclusion—The treatment is cost effective and avoids the often uncertain results and morbidity associated with surgery for these difficult stress fractures. Key Words: overuse injury; leg; tibial; imaging; treatment; pneumatic brace

Batt, M; Kemp, S; Kerslake, R

2001-01-01

233

Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking.  

PubMed

Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment. PMID:22939754

Watanabe, Kota; Kitaoka, Harold B; Fujii, Tadashi; Crevoisier, Xavier; Berglund, Lawrence J; Zhao, Kristin D; Kaufman, Kenton R; An, Kai-Nan

2012-08-29

234

The reliability of the pre-operative classification of open tibial fractures in children a proposal for a new classification.  

PubMed

The purpose of this observational study was to evaluate the accuracy of Gustilo's classification of open tibial fractures in children. Pre- and post-debridement (using the parameters of Gustilo's classification) wound gradings in 27 children with a mean age of 10 years (3 to 15 years) who had sustained an open tibial fracture were compared. Pre-operative Polaroid photographs of the wound were taken of all these patients in the accident and emergency department. In every case, the fracture was treated with prophylactic intravenous antibiotic administration, wound debridement and lavage. Following wound exploration in the operating theater, the wound was classified using Gustilo's parameters again; this was different from the initial grading. We compared post-debridement classification according to Gustilo to the new classification which we propose. The latter classification is a peroperative assessment of the extent of soft tissue damage and it addresses bone stability. According to this classification, the majority of open tibial fractures were stable, requiring no skin graft or flap and had a good outcome. Only five patients were treated by initial external fixation of the tibia; the remainder were treated by cast immobilization. Wounds were treated as appropriate. The clinical outcome study included the assessment of wound and fracture healing and the incidence of complications. The mean period for follow-up was 8 months (6 to 24 months). There were no cases of nonunion or deep wound infection and the wounds healed in all these patients. We conclude that Gustilo's classification is not specific and does not reflect the extent of soft tissue and skeletal damage. Factors such as the degree of soft tissue damage and periosteal stripping that are noticed following wound debridement and velocity of injury are far more important than the wound size. Our proposed peroperative classification covers the extent of soft tissue injury and skeletal stability, thus predicting the outcome more than the Gustilo classification. PMID:11915459

Faraj, A A

2002-02-01

235

Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction.  

PubMed

The native anterior cruciate ligament (ACL) consists of 2 bundles, which have distinct biomechanical yet synergistic functions with respect to anterior tibial translation and combined rotatory loads. Traditionally, most ACL reconstruction techniques have primarily addressed the restoration of the anteromedial bundle, and less consideration was given to the posterolateral bundle. Recently, various ACL double-bundle reconstruction techniques have been described. With most of these techniques, however, an indirect extra-anatomic fixation far from the articular surface was performed. Because extra-anatomic fixation techniques, rather than aperture fixation techniques, are associated with graft tunnel motion, windshield wiper action, and suture stretch-out, concerns may arise regarding delayed biological incorporation, tunnel enlargement, and secondary rotational and anterior instability. We, therefore, present a novel arthroscopic technique that reapproximates the footprints of native ACL with the use of double-strand semitendinosus and gracilis autografts for reconstruction of the anteromedial and posterolateral bundles, respectively. A separate femoral and tibial tunnel is drilled for each double-strand autograft. The femoral tunnel for the anteromedial bundle is drilled primarily through a transtibial technique, and the femoral tunnel for the posterolateral bundle is drilled via an accessory anteromedial portal with the use of a 4-mm offset drill guide in the anteroinferior aspect of the femoral tunnel for the anteromedial bundle. Bioabsorbable interference screws are used in aperture fixation for anatomic fixation of each bundle. This technique attempts to reproduce closely the native ligament and its biomechanical function. PMID:17084308

Brucker, Peter U; Lorenz, Stephan; Imhoff, Andreas B

2006-09-11

236

The anterior pituitary gland: lessons from livestock.  

PubMed

There has been extensive research of the anterior pituitary gland of livestock and poultry due to the economic (agricultural) importance of physiological processes controlled by it including reproduction, growth, lactation and stress. Moreover, farm animals can be biomedical models or useful in evolutionary/ecological research. There are for multiple sites of control of the secretion of anterior pituitary hormones. These include the potential for independent control of proliferation, differentiation, de-differentiation and/or inter-conversion cell death, expression and translation, post-translational modification (potentially generating multiple isoforms with potentially different biological activities), release with or without a specific binding protein and intra-cellular catabolism (proteolysis) of pituitary hormones. Multiple hypothalamic hypophysiotropic peptides (which may also be produced peripherally, e.g. ghrelin) influence the secretion of the anterior pituitary hormones. There is also feedback for hormones from the target endocrine glands. These control mechanisms show broadly a consistency across species and life stages; however, there are some marked differences. Examples from growth hormone, prolactin, follicle stimulating hormone and luteinizing hormone will be considered. In addition, attention will be focused on areas that have been neglected including the role of stellate cells, multiple sub-types of the major adenohypophyseal cells, functional zonation within the anterior pituitary and the role of multiple secretagogues for single hormones. PMID:15905067

Scanes, C G; Jeftinija, S; Glavaski-Joksimovic, A; Proudman, J; Arámburo, C; Anderson, L L

2005-07-01

237

Anterior Cervical Arachnoid Cyst  

PubMed Central

This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome.

Sharifi, Give

2013-01-01

238

Anterior cervical arachnoid cyst.  

PubMed

This report is composed of two patients with anteriorly located cervical intradural arachnoid cyst and review of 24 cases in Englishlanguage literature. Both of our patients were in the first two decades of life with neck pain and motor weakness. With suspicious diagnosis of anterior arachnoid cyst surgery was carried out in both cases, though laminectomy in one and laminoplasty in the other. The cyst wall was widely fenestrated with subsequent subtotal excision of the cyst. Both cases had good long-term outcome. The review disclosed male predominance. 73% of the patients were diagnosed within the first two decades of life. Neck pain and motor weakness were the dominant signs and symptoms of this pathology. Magnetic resonance imaging showing a cerebrospinal fluid (CSF) containing cyst was the best mode of diagnosis. Wide cyst fenestration with waying CSF into subarachnoid cyst was the most appropriate and applied surgery with optimal outcome. PMID:23741550

Rahimizadeh, Abolfazl; Sharifi, Give

2013-05-22

239

Tibial torsion in non-arthritic Indian adults: A computer tomography study of 100 limbs  

PubMed Central

Background: Knowledge of normal tibial torsion is mandatory during total knee replacement (TKR), deformity correction and fracture management of tibia. Different values of tibial torsion have been found in different races due to biological and mechanical factors. Value of normal tibial torsion in Indian limbs is not known, hence this study to determine the norm of tibial torsional value in normal Indian population. Materials and Methods: Computer tomography (CT) scans were performed in 100 non-arthritic limbs of 50 Indian adults (42 males, eight females; age 26-40 years). Value of tibial torsion was measured using dorsal tangent to tibial condyles proximally and bimalleolar axis distally. Results: Normal tibial torsion was found to be 21.6 ± 7.6 (range 4.8 to 39.5) with none of the values in internal rotation. Right tibia was externally rotated by 2 degrees as compared to the left side (P 0.029). No significant difference was found in male and female subjects. Value of tibial torsion was less than in Caucasian limbs, but was comparable to Japanese limbs when studies using similar measurement technique were compared. Conclusions: Indian limbs have less tibial torsion than Caucasian limbs but the value of tibial torsion is comparable to Japanese limbs.

Mullaji, Arun B; Sharma, Amit K; Marawar, Satyajit V; Kohli, AF

2008-01-01

240

Arthroscopic management of tibial plateau fractures: special techniques.  

PubMed

Arthroscopic assessment and treatment of tibial plateau fractures has gained popularity in recent years. This article describes some maneuvers to facilitate the management of these fractures with the arthroscope. We use a 14-mm rounded curved periosteal elevator to manipulate fragments within the joint instead of using a probe. To facilitate visualization of fractures, we describe the use of loop sutures around the meniscus to retract the meniscus when there is a tear in the meniscus. We suggest the use of the arthroscope for directly viewing the interosseous space to be sure that any internal fixation devices remain outside the articular space. The use of these tactics will allow a faster, more accurate reduction with less radiation exposure in patients with displaced tibial plateau fractures. PMID:9127091

Perez Carro, L

1997-04-01

241

Tibial plateau fractures treated with the less invasive stabilisation system  

PubMed Central

Thirty-six tibial plateau fractures in 35 patients were treated with the less invasive stabilisation system (LISS). Patients’ mean age was 42 years. There were 27 type C fractures and nine type B fractures according to AO/OTA classification. The average time to healing was 4.2 months (3–7 months). Deep infection developed in two cases. One patient healed in 6° of varus, and seven patients had an increased articular angulation of 6° (4–8°) in the sagittal plane. There were no cases of loss of reduction, non-union, or deep vein thrombosis. The LISS system could be considered for the management of tibial plateau fractures.

Lee, Jackson A.; Moon, Charles; Zalavras, Charalampos G.

2006-01-01

242

Expandable intramedullary nails for fixation of tibial shaft fractures.  

PubMed

Interlocking intramedullary nailing is currently the preferred treatment for most tibial fractures requiring operative treatment, with good results and a relatively low complication rate as reported in large clinical series. However, vascular and neurological complications caused by interlocking screws have been reported. In addition, insertion of distal interlocking screws can be technically demanding and may entail substantial exposure. We present the results with an expandable self-locking nail in the management of 52 AO type A and B tibial shaft fractures. The mean time to union was 15.8 weeks and the rate of union was 98%. The average surgical time was 60 minutes. Complications were those usually seen in diaphysis nailing and no complication was noted during nail expansion. Interlocking screws are not necessary, which reduces the risk of iatrogenic lesions. The expandable nail allows effective management of AO type A and B diaphyseal fractures of the tibia, a lower radiation exposure and shorter operative time. PMID:23409575

Ghafil, Dior; Ackerman, Pieter; Baillon, Renaud; Verdonk, Rene; Delince, Philippe

2012-12-01

243

Case report: bipartite tibial epiphysis: radiologic and arthroscopic presentation.  

PubMed

We report the case of a bilateral bipartite ossification center of the proximal tibia in a 15-year-old boy with a history of knee injury. The presence of the duplicated ossific centers was an incidental finding on radiography and computed tomography performed after injury. Arthroscopy showed continuous hyaline cartilage between the two ossific centers confirming the diagnosis of a developmental abnormality; however, the articular surface was depressed in the region overlying the smaller ossific center. We presume the presence of an accessory center in the posteromedial aspect of the tibial plate could be a source of instability for the corresponding capsular and meniscal structures. This is, to our knowledge, the first report of tibial bipartite epiphysis. PMID:18663548

Negri, Giacomo; Zappia, Marcello; De Filippo, Massimo; Rotondo, Antonio

2008-07-29

244

[Plate osteosynthesis in complex fractures of the tibial plateau].  

PubMed

The authors report their experience in the treatment of complex fractures of the tibial plateau (epi-metaphyseal and comminuted bicondylar and spinotuberosity fractures) using the Kerboull epiphyseal plate and autogenous cancellous bone grafts if sinking occurs. It is not always possible to perfectly restore joint anatomy and stability. Plate fixation ensures solidity by not exposing the load-bearing axis, eliminating the risk that the tibial plate will later give way and thereby allowing early mobilization and rapid functional recovery of the knee. The authors emphasize the importance of both consensual treatment of possible ligament tears and preservation, when possible, of the meniscus. They claim that the frequent complications can only be prevented by careful preliminary assessment of general and local conditions which may absolutely or relatively contraindicate this type of surgery. PMID:1843066

Fama, G; Turra, S; Bonaga, S

1991-01-01

245

The impact of tensioning device mal-positioning on strand tension during Anterior Cruciate Ligament reconstruction  

PubMed Central

Background In order to confer optimal strength and stiffness to the graft in Anterior Cruciate Ligament (ACL) reconstruction, the maintenance of equal strand tension prior to fixation, is desired; positioning of the tensioning device can significantly affect strand tension This study aimed to determine the effect of tensioning device mal-positioning on individual strand tension in simulated cadaveric ACL reconstructions. Methods Twenty cadaveric specimens, comprising bovine tibia and tendon harvested from sheep, were used to simulate ACL reconstruction with a looped four-strand tendon graft. A proprietary tensioning device was used to tension the graft during tibial component fixation with graft tension recorded using load cells. The effects of the tensioning device at extreme angles, and in various locking states, was evaluated. Results Strand tension varied significantly when the tensioning device was held at extreme angles (p < 0.001) or in 'locked' configurations of the tensioning device (p < 0.046). Tendon position also produced significant effects (p < 0.016) on the resultant strand tension. Conclusion An even distribution of tension among individual graft strands is obtained by maintaining the tensioning device in an unlocked state, aligned with the longitudinal axis of the tibial tunnel. If the maintenance of equal strand tension during tibial fixation of grafts is important, close attention must be paid to positioning of the tensioning device in order to optimize the resultant graft tension and, by implication, the strength and stiffness of the graft and ultimately, surgical outcome.

2011-01-01

246

Triple positioning of tibial tubercle osteotomy for patellofemoral disorders.  

PubMed

BACKGROUND AND PURPOSE: Patellofemoral disorders are often associated with patellofemoral malalignment. Tibial tubercle transfer is an effective method to correct the patellofemoral malalignment. This study evaluated the long-term results of triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders with 10-year follow-up. PATIENTS AND METHODS: Fifty-six patients with 62 knees underwent triple positioning of tibial tubercle osteotomy for refractory patellofemoral disorders. All patients received standard rehabilitation protocol postoperatively. The average length of follow-up was 128.5±9.8months (range 116 to 149). The evaluations included pain score, Kujala patellofemoral score, Lysholm score and radiograph of the knee. RESULTS: The overall clinical results were excellent in 41.9%, good in 37%, fair in 12.9% and poor in 5% at 1year; and 29% excellent, 41% good, 18.3% fair and 9.3% poor at 10years. Satisfactory results were 78.9% and 70.9%, and unsatisfactory results 21.1% and 29.1% at 1year and 10years respectively. There was no correlation of clinical outcomes with age, sex, body weight and height and preoperative pain score. However, there was a positive correlation of clinical outcomes with the improvement of the congruence angle on postoperative X-rays of the knee, and a negative correlation of clinical outcome with the severity of articular cartilage damage assessed in arthroscopy. The complications included 1 non-union and 1 infection with non-union. CONCLUSION: Triple positioning of tibial tubercle osteotomy is effective and long lasting in patients with patellofemoral disorders with 70.9% satisfactory results at 10-year follow-up. LEVEL OF EVIDENCE: IV (refer to instructions for detailed description on the level of evidence). PMID:23200598

Wang, Ching-Jen; Wong, To; Ko, Jih-Yang; Siu, Ka-Kit

2012-11-28

247

The medial tibial syndrome. The role of surgery.  

PubMed

Among authors over the past 35 years, medial tibial syndrome, or "shin splints," has been interpreted to mean many different things. We present a review of the literature to attempt to ascribe one definition to this clinical entity, and to clearly define its symptoms, signs, pathophysiology, biomechanics, and treatment. In addition, we describe our results with five patients whose seven affected limbs eventually required surgery for this condition, and we compare them to the results in the literature. PMID:7854840

Abramowitz, A J; Schepsis, A; McArthur, C

1994-11-01

248

Pigmented villonodular synovitis after TKA associated with tibial component loosening.  

PubMed

There is no known causal link between total knee arthroplasty (TKA) and pigmented villonodular synovitis (PVNS). There also is no known relationship between PVNS and implant loosening after TKA in the literature. This article presents a case of PVNS in a patient undergoing revision TKA for tibial component loosening. A 74-year-old woman who had undergone cemented bilateral TKA 5 years earlier presented with painful swelling in her right knee. At the time of the primary TKA, no abnormal signs were found in the synovial membrane. Routine follow-up radiographs did not indicate implant loosening. At the patient's final follow-up examination before revision surgery, a radiolucent lesion was found below the tibial component. During revision surgery, there was focal proliferation of the synovial tissue with heavy pigmentation around the anteromedial part of the tibial component. The abnormal tissue was removed, and the tibial component was exchanged. The articular surface of the polyethylene was not damaged, and backside wear was not found. For the revision surgery, 5-mm thick medial metal block and extension stem were used. Histological analysis of the resected tissue revealed the typical appearance of PVNS. We present a typical case of PVNS found during revision TKA 5 years after primary TKA. It is hoped this report will encourage surgeons to consider PVNS in the differential diagnosis of patients who present with painful swelling of the knee and to consider PVNS as one of the causes of implant loosening after TKA. Further research about causal factors between PVNS and implant loosening are needed. PMID:21815587

Chung, Byung June; Park, Yong Bum

2011-08-08

249

Tibial stress fracture after computer-navigated total knee arthroplasty  

Microsoft Academic Search

A correct alignment of the tibial and femoral component is one of the most important factors determining favourable long-term\\u000a results of a total knee arthroplasty (TKA). The accuracy provided by the use of the computer navigation systems has been widely\\u000a described in the literature so that their use has become increasingly popular in recent years; however, unpredictable complications,\\u000a such as

F. Massai; F. Conteduca; A. Vadalà; R. Iorio; L. Basiglini; A. Ferretti

2010-01-01

250

Combined medial meniscal transplantation and high tibial osteotomy  

Microsoft Academic Search

This study describes a new surgical technique for combined medial meniscal transplantation and opening wedge high tibial osteotomy\\u000a for meniscal-deficient knees with malalignment. The technique allows wider medial joint opening, better visualization of the\\u000a medial compartment as well as easier meniscal graft positioning and suturing. This is achieved by transplanting the meniscus\\u000a after superficial medial collateral ligament release and before

Davide Edoardo Bonasia; Annunziato Amendola

2010-01-01

251

Posterior tibial nerve stimulation and faecal incontinence: a review  

Microsoft Academic Search

Purpose  Faecal incontinence is a common and important multifactorial disorder with a range of treatment options. Over the last two\\u000a decades, neuromodulation via sacral nerve stimulators has been shown to be effective for both faecal and urinary incontinence,\\u000a although associated with complications. Peripheral neuromodulation, via the posterior tibial nerve, is widely used in urinary\\u000a incontinence; however, its use in faecal incontinence,

John M. Findlay; Charles Maxwell-Armstrong

2011-01-01

252

High tibial osteotomy in young adults with constitutional tibia vara  

Microsoft Academic Search

Frontal plane malalignment of the lower extremity results in abnormal load distribution across the knee joint. Consequences\\u000a of this increased stress may lead to compartmental osteoarthritis. High tibial osteotomy is well established for early osteoarthritis\\u000a of the knee joint in middle-aged patients. We hypothesize that earlier realignment of the varus knee can be performed without\\u000a undue risks and debilitation toward

Karim Z. Masrouha; Shafic Sraj; Suhail Lakkis; Said Saghieh

2011-01-01

253

Popliteal arteriovenous fistula after corrective upper tibial osteotomy  

Microsoft Academic Search

Injuries to the popliteal artery or vein are rare complications of knee arthroscopy or osteosynthesis at the distal femur or the proximal tibia. We report a case of iatrogenic arteriovenous fistula after proximal tibial osteotomy for varus deformity. A 71-year-old woman complained of pain and swelling of the foot 9 weeks after a corrective barrel-vault osteotomy of the left tibia.

W. Lang; R. Ott; P. Haas; H. Schweiger

1993-01-01

254

Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus  

Microsoft Academic Search

Between 2003 and 2006, we used an extraarticular, cannulated, fully threaded posterior calcaneotibial screw to prevent equinus\\u000a contracture in 10 patients (four male and six female patients, 14 limbs) undergoing tibial lengthening with the intramedullary\\u000a skeletal kinetic distractor. Diagnoses were fibular hemimelia (two), mesomelic dwarfism (two), posteromedial bow (one), hemihypertrophy\\u000a (one), poliomyelitis (one), achondroplasia (one), posttraumatic limb-length discrepancy (one), and

Mohan V. Belthur; Dror Paley; Gaurav Jindal; Rolf D. Burghardt; Stacy C. Specht; John E. Herzenberg

2008-01-01

255

Clinical assessment following tibial tuberosity advancement in 28 stifles at 6 months and 1 year after surgery  

PubMed Central

This prospective study evaluated the effect of tibial tuberosity advancement (TTA) on lameness, thigh circumference, range of motion (ROM), and radiographic osteoarthritis (OA) scores at 6 wk, 6 mo, and 1 y after surgery in 24 client-owned dogs with cranial cruciate ligament (CrCL) deficiency. Complications associated with TTA were also assessed. A significant improvement in lameness score and thigh circumference was observed in CrCL deficient limbs that received TTA, but no significant overall change in range of motion occurred in the affected limbs over the course of the study. Post-operative complications were identified in 33.3% of the dogs. This study demonstrates that TTA results in significant clinical improvement in patients up to 1 y after surgery. However, 21% of the dogs had post-operative recurrent lameness.

MacDonald, Tamara L.; Allen, David A.; Monteith, Gabrielle J.

2013-01-01

256

Effect of Early and Delayed Mechanical Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Background: Modulation of the mechanical environment may profoundly affect the healing tendon graft-bone interface. The purpose of this study was to determine how controlled axial loading after anterior cruciate ligament reconstruction affects tendon-to-bone healing. Our hypothesis was that controlled cyclic axial loading after a period of immobilization would improve tendon-to-bone healing compared with that associated with immediate axial loading or prolonged immobilization. Methods: One hundred and fifty-six male Sprague-Dawley rats underwent anterior cruciate ligament reconstruction with use of a flexor digitorum longus autograft. A custom-designed fixture was used to apply an external fixator across the knee parallel to the anterior cruciate ligament graft. Animals were randomly assigned to be treated with immobilization (n = 36) or controlled knee distraction along the long axis of the graft to achieve approximately 2% axial strain beginning (1) immediately postoperatively (n = 36), (2) on postoperative day 4 (“early delayed loading,” n = 42), or (3) on postoperative day 10 (“late delayed loading,” n = 42). The animals were killed at fourteen or twenty-eight days postoperatively for biomechanical testing, micro-computed tomography, and histomorphometric analysis of the bone-tendon-bone complex. Data were analyzed with use of a two-way analysis of variance followed by a post hoc Tukey test with p < 0.05 defined as significant. Results: Delayed initiation of cyclic axial loading on postoperative day 10 resulted in a load to failure of the femur-anterior cruciate ligament-tibia complex at two weeks that was significantly greater than that resulting from immediate loading or prolonged immobilization of the knee (mean and standard deviation, 9.6 ± 3.3 N versus 4.4 ± 2.3 N and 4.4 ± 1.5 N, respectively; p < 0.01). The new-bone formation observed in the tibial tunnels of the delayed-loading groups was significantly increased compared with that in the immediate-loading and immobilization groups at both two and four weeks postoperatively (1.47 ± 0.11 mm3 [postoperative-day-10 group] versus 0.89 ± 0.30 mm3 and 0.85 ± 0.19 mm3, respectively, at two weeks; p < 0.003). There were significantly fewer ED1+ inflammatory macrophages and significantly more ED2+ resident macrophages at the healing tendon-bone interface in both delayed-loading groups compared with the counts in the immediate-loading and immobilization groups at two and four weeks (2.97 ± 0.7 [postoperative day 10] versus 1.14 ± 0.47 and 1.71 ± 1.5 ED2+ cells, respectively, per high-power field at two weeks; p < 0.02). The numbers of osteoclasts in the delayed-loading groups were significantly lower than those in the immediate-loading and immobilization groups at two and four weeks postoperatively (0.35 ± 0.15 [postoperative-day-10 group] versus 1.02 ± 0.08 and 1.44 ± 0.2 cells, respectively, per high-power field at two weeks; p < 0.01), and the delayed-loading groups also had significantly reduced interface tissue vascularity compared with the other groups (p < 0.003). Conclusions: Delayed application of cyclic axial load after anterior cruciate ligament reconstruction resulted in improved mechanical and biological parameters of tendon-to-bone healing compared with those associated with immediate loading or prolonged postoperative immobilization of the knee. Clinical Relevance: This study of anterior cruciate ligament reconstruction may have important implications for rehabilitation after soft-tissue reconstructive procedures in the knee. Controlled mechanical loads after a delay to allow resolution of acute postoperative inflammation may be most favorable to the healing enthesis.

Bedi, Asheesh; Kovacevic, David; Fox, Alice J.S.; Imhauser, Carl W.; Stasiak, Mark; Packer, Jonathan; Brophy, Robert H.; Deng, Xiang-Hua; Rodeo, Scott A.

2010-01-01

257

Relevance of anterior mandibular body ostectomy in mandibular prognathism  

PubMed Central

Purpose: We tried to find out the relevance of anterior mandibular body ostectomy in deformities of the mandible specially prognathism, which is primarily limited to anterior part only. Patients and Methods: Ten patients with skeletal deformity along with malocclusion, which was limited to anterior body of mandible were selected. Selected patients had proper molar interdigitation (even if class 3) and in general had anterior crossbite (except one). All patients had crossed their growth spurts and had no hormonal influence on facial deformity. Specific protocol, including cephelometric analysis cephalometry for orthognathic surgery, prediction tracing and model surgeries were devised. Pre and post-surgical orthodontics and body ostectomy were performed in all patients along with 18-month post-op follow-up. Results: There was significant reduction in prognathism and horizontal dysplasia in all ten patients. Anterior crossbite as well as axis of incisiors over mandibular plane was corrected in all patients due to decrease in length of mandibular body. All patients showed decreased facial height and better lip competence with intact posterior occlusion and no (negligible or transient) sensory loss. Conclusions: Our study could confirm that people whose deformity is limited to the anterior part of mandible with reasonable occlusion posteriorly can get satisfactory cosmetic and functional results through body ostectomy alone rather than going for surgical procedure in the ramal area, which is liable to cause sensory and occlusal disturbances.

Bansal, Pankaj; Singh, Virender; Anand, S. C.; Bansal, Sumidha

2013-01-01

258

Radiographic guided drilling of bony tibial tunnels for fixation of meniscus transplants using percentage references  

Microsoft Academic Search

The objective of our investigation was to evaluate the precision of radiographic-guided tibial tunnel drilling for anatomical\\u000a anchoring of meniscus transplants at the tibial insertion areas. In 20 cadaveric proximal tibiae, the meniscal insertions\\u000a were dissected and their circumferences outlined. Standardized photographs of the tibial plateau were obtained. Applying established\\u000a percentage values for radiographic determination of the meniscus insertion midpoints,

Philippe Wilmes; O. Lorbach; C. Weth; D. Kohn; R. Seil

2011-01-01

259

A pair of sibs with tibial hemimelia born to phenotypically normal parents  

Microsoft Academic Search

  \\u000a Tibial hemimelia is a rare congenital anomaly characterized by deficiency of the tibia with relatively intact fibula. Tibial\\u000a hemimelia is identified as a solitary disorder, or a part of more complex malformation syndromes. Although the majority of\\u000a cases with tibial hemimelia are sporadic, affected families with possible autosomal dominant or autosomal recessive inheritance\\u000a have been reported. Here we report

Juntaro Matsuyama; Akihiko Mabuchi; Junwei Zhang; Aritoshi Iida; Toshiyuki Ikeda; Mamori Kimizuka; Shiro Ikegawa

2003-01-01

260

Case report: comprehensive management of medial tibial stress syndrome  

PubMed Central

Abstract Activity or exercise-induced leg pain is a common complication among competitive and “weekend warrior” athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of “shin splints,” one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. “Active” rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness.

Krenner, Bernard John

2002-01-01

261

Case report: comprehensive management of medial tibial stress syndrome.  

PubMed

Activity or exercise-induced leg pain is a common complication among competitive and "weekend warrior" athletes. Shin splints is a term that has been used to describe all lower leg pain as a result of activity. There are many different causes of "shin splints," one of which is medial tibial stress syndrome, and the treating clinician must be aware of potentially serious causes of activity related leg pain. Restoring proper biomechanics to the entire kinetic chain and rehabilitation of the injured area should be the primary aim of treatment to optimize shock absorption. The role inflammation plays in medial tibial stress syndrome is controversial, but in this case, seemed to be a causative factor as symptomatology was dramatically decreased with the addition of proteolytic enzymes. Medial tibial stress syndrome can be quite difficult to treat and keeping athletes away from activities that will slow healing or aggravate the condition can be challenging. "Active" rest is the best way in which to allow proper healing while allowing the athlete to maintain their fitness. PMID:19674573

Krenner, Bernard John

2002-01-01

262

Morphogenesis of Fusarium sp-induced tibial dyschondroplasia in chickens.  

PubMed

Tibial dyschondroplasia was induced in female broiler chicks by the incorporation of 2% Fusarium roseum "Alaska" culture into their starter ration. Chicks were placed on this diet at one day of age and maintained until they were killed at four days or one week. Proximal tibial physes were grossly thickened into cone-shaped masses of cartilage by one week of age. Microscopically, lesions were in both ages of treated chickens and were characterized by thickening of the transitional zone which was especially prominent in the center of the growth plate. This zone was unmineralized, avascular, and contained chondrocytes which were crenated and densely eosinophilic. The cartilage matrix was pale and contained some patchy eosinophilic foci. Four growth plates with tibial dyschondroplasia and four normal growth plates from each of the four-day and one-week-old age groups were evaluated based on the following parameters: number of metaphyseal vascular sprouts, distance between the proliferative/transitional junction and the tip of the metaphyseal vascular sprouts, width of the tips of the metaphyseal sprouts, distance between tips of adjacent metaphyseal vascular sprouts, and number of perforating vessels in the proliferative zone. The distance between the proliferative/transitional junction and the metaphyseal sprout tips was greatly increased (p less than 0.01) in the affected four-day and one-week-old chickens compared to age-matched controls.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4082389

Haynes, J S; Walser, M M; Lawler, E M

1985-11-01

263

A qualitative and quantitative analysis of autologous human multipotent adult stem cells derived from three anatomic areas by marrow aspiration: tibia, anterior ilium, and posterior ilium.  

PubMed

Purpose: The purpose of this article was to compare the yields of stromal multipotent stem cells (CD34+ and CD105+) and hematopoetic multipotent stem cells (CD44+) obtained from different areas via bone marrow aspiration (BMA). Materials and Methods: Sixty 60-mL bone marrow aspirates were taken from the tibial plateau, the anterior ilium, and the posterior ilium using a single point-of-care BMA technique and a single BMA concentration (BMAC) device. A 1-mL portion of each sample was used to determine CD stem cell concentrations and the nucleated cell count. The remaining BMA was centrifuged to separate the more mature red blood cell precursors from the stem cells and then concentrate the latter into a BMAC. The BMAC yield of 10 mL was analyzed with flow cytometry and nucleated cell counts to derive a concentration factor for the BMAC. Results: The yield of total nucleated cells was equal between the anterior and posterior ilium and more than twice that obtained from the tibial plateau. The CD44+ and CD105+ cell yields were also nearly equal between the anterior and posterior ilium but more than twice that of the tibial plateau; however, the ratios between the three different stem cell types in BMAC obtained from the different areas suggest varying potentials for tissue development. Conclusions: The ilium is the preferred donor site for obtaining autologous stem cells at the point of care. The tibial plateau yielded only half as much bone marrow multipotent/progenitor stem cells as did the anterior and posterior ilium. The composition of the BMAC from each site suggests that the potential for differentiation into various cell types changes depending on the source of bone marrow, but that BMAC represents 6.5 ± 1.0 concentration factor from BMA. PMID:24066346

Marx, Robert E; Tursun, Ramzey

264

Is the Segond’s fracture a reliable sign of anterior cruciate ligament (ACL) tear? A case report without associated ACL rupture  

Microsoft Academic Search

Segond’s fracture is an avulsion fracture of the lateral rim of the tibial plateau. It is described as a “capsular sign” of\\u000a associated anterior cruciate ligament (ACL) tears. The clinical examination of a traumatically painful knee is often difficult.\\u000a For this reason the Segond’s fracture is considered a helpful sign for the diagnosis of ACL ruptures. We report an uncommon

D. Ollat; J. P. Marchaland; L. Mathieu; O. Barbier; G. Versier

2009-01-01

265

Surgical results of anterior corpectomy in the aged patients with cervical myelopathy  

Microsoft Academic Search

Retrospective study on the results of anterior corpectomy for the treatment of cervical myelopathy in patients over 70 years\\u000a old. To evaluate the surgical results of anterior corpectomy in aged patients with multilevel cervical myelopathy and to investigate\\u000a the probable pathomechanism by radiographic study. There are few data focused on the surgical results and post-operative complications\\u000a of anterior corpectomy in aged

Jun Lu; Xiaotao Wu; Yonggang Li; Xiangfei Kong

2008-01-01

266

The effect of stifle angle on cranial tibial translation following tibial plateau leveling osteotomy: An in vitro experimental analysis  

PubMed Central

This study was designed to determine the ability of tibial plateau leveling osteotomy (TPLO) to eliminate cranial tibial translation (CTT) through a loaded range of motion. Twenty-four large-breed canine cadaver limbs were compared. Each limb was placed in a custom designed jig at 120° of stifle extension under an axial load of 20% body weight. A force of approximately 10 N/s mimiced the action of the quadriceps muscle and allowed the limb to move from 120° to maximal extension. Positional data were acquired using electromagnetic motion-tracking sensors. Each limb was tested under normal, cranial cruciate ligament (CrCL)-deficient, and TPLO-treated conditions. Cranial tibial translation significantly increased after transection of the CrCL. The TPLO failed to normalize CTT within the CrCL deficient stifle; however, values trended towards intact values throughout the range of motion. The TPLO was more effective at higher angles of flexion. These altered biomechanics may help explain the continued progression of osteoarthritis in TPLO repaired stifles. This loaded model may serve as a method for future evaluation of other surgical techniques.

Johnson, Kelly; Lanz, Otto; Elder, Steven; McLaughlin, Ron; Werre, Stephen; Harper, Tisha

2011-01-01

267

The effect of stifle angle on cranial tibial translation following tibial plateau leveling osteotomy: an in vitro experimental analysis.  

PubMed

This study was designed to determine the ability of tibial plateau leveling osteotomy (TPLO) to eliminate cranial tibial translation (CTT) through a loaded range of motion. Twenty-four large-breed canine cadaver limbs were compared. Each limb was placed in a custom designed jig at 120° of stifle extension under an axial load of 20% body weight. A force of approximately 10 N/s mimiced the action of the quadriceps muscle and allowed the limb to move from 120° to maximal extension. Positional data were acquired using electromagnetic motion-tracking sensors. Each limb was tested under normal, cranial cruciate ligament (CrCL)-deficient, and TPLO-treated conditions. Cranial tibial translation significantly increased after transection of the CrCL. The TPLO failed to normalize CTT within the CrCL deficient stifle; however, values trended towards intact values throughout the range of motion. The TPLO was more effective at higher angles of flexion. These altered biomechanics may help explain the continued progression of osteoarthritis in TPLO repaired stifles. This loaded model may serve as a method for future evaluation of other surgical techniques. PMID:22379194

Johnson, Kelly; Lanz, Otto; Elder, Steven; McLaughlin, Ron; Werre, Stephen; Harper, Tisha

2011-09-01

268

Study to prospectively evaluate reamed intramedually nails in patients with tibial fractures (S.P.R.I.N.T.): Study rationale and design  

PubMed Central

Background Surgeons agree on the benefits of operative treatment of tibial fractures – the most common of long bone fractures – with an intramedullary rod or nail. Rates of re-operation remain high – between 23% and 60% in prior trials – and the two alternative nailing approaches, reamed or non-reamed, each have a compelling biological rationale and strong proponents, resulting in ongoing controversy regarding which is better. Methods/Design The objective of this trial was to assess the impact of reamed versus non-reamed intramedullary nailing on rates of re-operation in patients with open and closed fractures of the tibial shaft. The study to prospectively evaluate reamed intramedullary nails in tibial fractures (S.P.R.I.N.T) was a multi-center, randomized trial including 29 clinical sites in Canada, the United States and the Netherlands which enrolled 1200 skeletally mature patients with open (Gustilo Types I-IIIB) or closed (Tscherne Types 0–3) fractures of the tibial shaft amenable to surgical treatment with an intramedullary nail. Patients received a statically locked intramedullary nail with either reamed or non-reamed insertion. The first strategy involved fixation of the fracture with an intramedullary nail following reaming to enlarge the intramedullary canal (Reamed Group). The second treatment strategy involved fixation of the fracture with an intramedullary nail without prior reaming of the intramedullary canal (Non-Reamed Group). Patients, outcome assessors, and data analysts were blinded to treatment allocation. Peri-operative care was standardized, and re-operations before 6 months were proscribed. Patients were followed at discharge, 2 weeks post-discharge, and at 6 weeks, 3, 6, 9, and 12 months post surgery. A committee, blinded to allocation, adjudicated all outcomes. Discussion The primary outcome was re-operation to promote healing, treat infection, or preserve the limb (fasciotomy for compartment syndrome after nailing). The primary outcome was a composite comprising the following re-operations: bone grafts, implant exchanges, and dynamizations, in patients with fracture gaps less than 1 cm post intramedullary nail insertion. Infections and fasciotomies were considered events irrespective of the fracture gap. We planned a priori to conduct a subgroup analysis of outcomes in patients with open and closed fractures. S.P.R.I.N.T is the largest collaborative trial evaluating alternative orthopaedic surgical interventions in patients with tibial shaft fractures. The methodological rigor will set new benchmarks for future trials in the field and its results will have important impact on patient care. The S.P.R.I.N.T trial was registered [ID NCT00038129] and received research ethics approval (REB#99-077).

2008-01-01

269

Experimental and finite element analysis of tibial stress fractures using a rabbit model  

PubMed Central

AIM: To determine if rabbit models can be used to quantify the mechanical behaviour involved in tibial stress fracture (TSF) development. METHODS: Fresh rabbit tibiae were loaded under compression using a specifically-designed test apparatus. Weights were incrementally added up to a load of 30 kg and the mechanical behaviour of the tibia was analysed using tests for buckling, bone strain and hysteresis. Structural mechanics equations were subsequently employed to verify that the results were within the range of values predicted by theory. A finite element (FE) model was developed using cross-sectional computer tomography (CT) images scanned from one of the rabbit bones, and a static load of 6 kg (1.5 times the rabbit's body weight) was applied to represent running. The model was validated using the experimental strain gauge data, then geometric and elemental convergence tests were performed in order to find the minimum number of cross-sectional scans and elements respectively required for convergence. The analysis was then performed using both the model and the experimental results to investigate the mechanical behaviour of the rabbit tibia under compressive load and to examine crack initiation. RESULTS: The experimental tests showed that under a compressive load of up to 12 kg, the rabbit tibia demonstrates linear behaviour with little hysteresis. Up to 30 kg, the bone does not fail by elastic buckling; however, there are low levels of tensile stress which predominately occur at and adjacent to the anterior border of the tibial midshaft: this suggests that fatigue failure occurs in these regions, since bone under cyclic loading initially fails in tension. The FE model predictions were consistent with both mechanics theory and the strain gauge results. The model was highly sensitive to small changes in the position of the applied load due to the high slenderness ratio of the rabbit’s tibia. The modelling technique used in the current study could have applications in the development of human FE models of bone, where, unlike rabbit tibia, the model would be relatively insensitive to very small changes in load position. However, the rabbit model itself is less beneficial as a tool to understand the mechanical behaviour of TSFs in humans due to the small size of the rabbit bone and the limitations of human-scale CT scanning equipment. CONCLUSION: The current modelling technique could be used to develop human FE models. However, the rabbit model itself has significant limitations in understanding human TSF mechanics.

Franklyn, Melanie; Field, Bruce

2013-01-01

270

Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique  

PubMed Central

There is growing evidence that anatomic placement of the femoral tunnel in anterior cruciate ligament reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic anterior cruciate ligament reconstruction has many well-described technical challenges. This article describes the translateral all-inside technique, which produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and outside-in drilling. All work is carried out through the lateral portal with all viewing through the medial portal. Thus there is no need for an accessory medial portal or hyperflexion of the knee during femoral socket preparation. A single quadrupled hamstring graft is used with cortical fixation at both the femoral and tibial tunnels.

Wilson, Adrian J.; Yasen, Sam K.; Nancoo, Tamara; Stannard, Roger; Smith, James O.; Logan, James S.

2013-01-01

271

Does Lateral Knee Geometry Influence Bone Bruise Patterns after Anterior Cruciate Ligament Injury? A Report of two Cases  

PubMed Central

Bone bruise patterns are commonly seen after acute anterior cruciate ligament injuries; they represent a subchondral impaction injury that occurs in the lateral knee joint between the mid-lateral femoral condyle and the posterior lateral tibial plateau. These contusion patterns are present in the majority of noncontact ACL injuries. These injury patterns vary significantly in severity and this aspect is poorly understood. Edema patterns have gained increased interest in the literature of late; they may indicate the severity of the initial injury. They also may be correlated with the development of subsequent osteochondral defects and osteoarthritis. Given the location of this subchondral injury, it is plausible to assume that the geometry of the lateral femorotibial joint may play a role in ACL injury mechanism and severity of injury. We are reporting two cases of clinically identical ACL injuries. A patient with a flat lateral tibial plateau was noted to have a much larger bone edema pattern than a second patient with the highly convex lateral tibial plateau. This may shed light on the pathomechanics of ACL injury and suggests that an individual with a relatively flat tibial plateau has a stable lateral knee joint. Therefore, we hypothesize that much greater force is required to dislocate a flat and stable lateral femorotibial joint in a pivot shift pattern to produce an ACL injury. The greater force required results in a large bone edema pattern. Conversely, the individual with a relatively short and convex tibial plateau has an inherently unstable lateral joint and relatively smaller amounts of force would be needed to produce the identical injury to the ACL. As less force is required, smaller bone edema patterns result.

Westermann, Robert W; Wolf, Brian R; Wahl, Christopher J

2013-01-01

272

Scheimpflug imaging in anterior megalophthalmos  

PubMed Central

We report an anterior megalophthalmos case with decreased corneal thickness and show the findings using Scheimpflug imaging. A 25-year-old male was diagnosed with anterior megalophthalmos. In both eyes, enlarged corneal length was measured. Beside a comparatively good visual acuity, a thin but clear cornea, a fairly deep anterior chamber, and central lens opacity were found. Scheimpflug images were taken using Pentacam HR. Scheimpflug-based imaging can provide us new data at the examination of this syndrome affecting the whole anterior segment.

Nemeth, Gabor; Hassan, Ziad; Berta, Andras; Modis, Laszlo

2013-01-01

273

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics  

PubMed Central

Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom.

Van de Velde, Samuel K.; Gill, Thomas J.; Li, Guoan

2009-01-01

274

Tibial fractures after tibial tubercle osteotomies for patellar instability: a comparison of three osteotomy configurations  

PubMed Central

Purpose Tibial tubercle osteotomies (TTOs) are a seemingly straightforward technique; however problems with bony union, implant failure, wound infections, and fractures have been reported in the literature. Methods A database search identified all patients who had a TTO performed for patellofemoral instability between 1 March 2000 and 30 July 2008 by a single surgeon. The TTO technique was modified twice during the study period (December 2003 and June 2007, respectively), thereby creating three similar patient cohorts. Results TTOs were performed in 101 knees (90 patients), in which 34 knees (29 patients) received the blunt technique (TTO-B), 32 knees (30 patients) the sloped technique (TTO-S), and 35 knees (31 patients) the greenstick technique (TTO-G). Mean age of the patients (75 females, 15 males) was 16.0 years (range 12.2–20.2 years). Overall, six patients had complications, namely, six tibia fractures and no nonunions, for an overall complication rate of 5.9%. In the TTO-B group, four patients had four tibia fractures for an overall bony complication rate of 11.8%. In the TTO-S group, two patients had two delayed unions which developed into tibia fractures for an overall bony complication rate of 6.2%. There were no complications (0%) in the TTO-G group. No correlation was identified between TTO screw size and complications. The caudal aspect of the osteotomy was the location of the tibia fracture in five knees and the caudal screw in 1 knee, at a mean of 11 weeks postoperatively. All fractures were treated only with splint or cast immobilization and protected weight-bearing. Conclusion The overall bony complication rate was 5.9% for the TTOs in this study. Utilizing the TTO-G technique with rigid two-screw, bicortical fixation the complication rate could be lowered to 0%. Avoidance of periosteal stripping, and secondary cortical devascularization at the caudal aspect of the TTO appears to optimize bony consolidation, thereby minimizing fractures. Clinical relevance Bony complications are an infrequent problem after TTO. Greensticking the distal end of the TTO can minimize postoperative tibia fractures. Running and sports should not be permitted until complete cortical healing is documented on the lateral radiograph.

Fuhrhop, Sara; O'Donnell, June C.; Gordon, J. Eric

2010-01-01

275

Radiographic findings in revision anterior cruciate ligament reconstructions from the Mars cohort.  

PubMed

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature. PMID:23404491

2013-02-12

276

Anteroposterior Stability of the Knee during the Stance Phase of Gait after Anterior Cruciate Ligament Deficiency  

PubMed Central

Quadriceps avoidance and higher flexion strategy have been assumed as effects of ACL deficiency on knee joint function during gait. However, the effect of ACL deficiency on anteroposterior stability of the knee during gait is not well defined. In this study, ten patients with unilateral acute ACL ruptures and the contralateral side intact performed gait on a treadmill. Flexion angles and anteroposterior translation of the ACL injured and the intact controlateral knees were measured at every 10% of the stance phase of the gait (from heel strike to toe-off) using a combined MRI and dual fluoroscopic image system (DFIS). The data indicated that during the stance phase of the gait, the ACL-deficient knees showed higher flexion angles compared to the intact contralateral side, consistent with the assumption of a higher flexion gait strategy. However, the data also revealed that the ACL-deficient knees had higher anterior tibial translation compared to the intact contralateral side during the stance phase of the gait. The higher flexion gait strategy was not shown to correlate to a reduction of the anterior tibial translation in ACL deficient knees. These data may provide indications for conservative treatment or surgical reconstruction of the ACL injured knees in restoration of the knee kinematics during daily walking activities.

Chen, CH; Li, JS; Hosseini, A; Gadikota, HR; Gill, TJ; Li, G

2011-01-01

277

Loading response following anterior cruciate ligament reconstruction during the parallel squat exercise  

Microsoft Academic Search

Objective. To determine if individuals 1.5–15 months post-anterior cruciate ligament reconstruction demonstrated an equal loading response on their involved and uninvolved lower extremity during a parallel squat exercise versus a control group.Design. Four-group repeated measures design with one between-subject factor (time post-anterior cruciate ligament reconstruction) and two within-subject factors (knee angle and added weight).Background. It has been a clinical observation

Jennifer A. Neitzel; Thomas W. Kernozek; George J. Davies

2002-01-01

278

A predictive factor for acquiring an ideal lower limb realignment after opening-wedge high tibial osteotomy.  

PubMed

Obtaining a correct postoperative limb alignment is an important factor in achieving a successful clinical outcome after an opening-wedge high tibial osteotomy (OWHTO). To better predict some of the aspects that impact upon the clinical outcomes following this procedure, including postoperative correction loss and over correction, we examined the changes in the frontal plane of the lower limb in a cohort of patients who had undergone OWHTO using radiography. Forty-two knees from 33 patients (23 cases of osteoarthritis and 10 of osteonecrosis) underwent a valgus realignment OWHTO procedure and were radiographically assessed for changes that occurred pre- and post-surgery. The mean femorotibial angle (FTA) was found to be 182.1 +/- 2.0 degrees (12 +/- 2.0 anatomical varus angulation) preoperatively and 169.6 +/- 2.4 degrees (10.4 +/- 2.4 anatomical valgus angulation) postoperatively. These measurements thus revealed significant changes in the weight bearing line ratio (WBL), femoral axis angle (FA), tibial axis angle (TA), tibia plateau angle (TP), tibia vara angle (TV) and talar tilt angle (TT) following OWHTO. In contrast, no significant change was found in the weight bearing line angle (WBLA) after these treatments. To assess the relationship between the correction angle and these indexes, 42 knees were divided into the following three groups according to the postoperative FTA; a normal correction group (168 degrees < or = FTA < or = 172 degrees ), an over-correction group (FTA < 168 degrees ), and an under-correction group (FTA > 172 degrees ). There were significant differences in the delta angle [DA; calculated as (pre FTA - post FTA) - (pre TV - post TV)] among each group of patients. Our results thus indicate a negative correlation between the DA and preoperative TA (R(2) = 0.148, p < 0.05). Hence, given that the correction errors in our patients appear to negatively correlate with the preoperative TA, postoperative malalignments are likely to be predictable prior to surgery. PMID:19183959

Bito, Haruhiko; Takeuchi, Ryohei; Kumagai, Ken; Aratake, Masato; Saito, Izumi; Hayashi, Riku; Sasaki, Yohei; Aota, Yoichi; Saito, Tomoyuki

2009-01-29

279

Inducible displacements of cemented tibial components during weight-bearing and knee extension  

Microsoft Academic Search

The inducible displacements of the tibial component caused by active extension were studied in 16 knees 1 yr after an AMK total knee arthroplasty with either flat, concave or posterior-stabilised (PS) designs of the joint area. Continuous change of the position of the tibial component occurred with proceeding extension. Rocking, subsidence and lift-off at different localisations were observed. In 3

J. Uvehammer; J. Kärrholm

2001-01-01

280

Intra-articular tibial plateau stress fracture associated with osteoarthrosis and valgus knee deformity  

Microsoft Academic Search

Severe valgus deformity of the knee secondary to osteoarthritis can predispose to stress fracture of the lateral tibial plateau. Described herein is a case of severe valgus knee deformity that was complicated by an intra-articular tibial plateau stress fracture and treated by a fully constrained Guepar hinge prosthesis with a satisfactory end result. The etiology and mechanism of this complication

David Hendel; Gad J. Velan; Moshe Weisbort

1997-01-01

281

The relationship between the clinical performance and large deformation mechanical behavior of retrieved UHMWPE tibial inserts  

Microsoft Academic Search

Many aspects of the proposed relationship between material properties and clinical performance of UHMWPE components remain unclear. In this study, we explored the hypothesis that the clinical performance of tibial inserts is directly related to its large-deformation mechanical behavior measured near the articulating surface. Retrieval analysis was performed on three conventional UHMWPE and three Hylamer™-M tibial components of the same

S. M Kurtz; C. M Rimnac; L Pruitt; C. W Jewett; V Goldberg; A. A Edidin

2000-01-01

282

How Three Methods for Fixing a Media Meniscal Autograft Affect Tibial Contact  

Microsoft Academic Search

We evaluated three methods for fixing a medial menis- cal autograft to determine which method restored tibial contact mechanics closest to normal. The contact me- chanics (maximum pressure, mean pressure, contact area, and location of the center of maximum pressure) of the medial tibial articular surface were determined using pressure-sensitive film while knee specimens were loaded in compression to 1000

Mohammad M. Alhalki; Stephen M. Howell; Maury L. Hull

283

The Effect of Tibial Curvature and Fibular Loading on the Tibia Index  

Microsoft Academic Search

The tibia index (TI) is commonly used to predict leg injury based on measurements taken by an anthropomorphic test device (ATD). The TI consists of an interaction formula that combines axial loading and bending plus a supplemental compressive force criterion. Current ATD lower limbs lack geometric biofidelity with regard to tibial curvature and fibular load-sharing. Due to differences in tibial

JAMES R. FUNK; RODNEY W. RUDD; JASON R. KERRIGAN; JEFF R. CRANDALL

2004-01-01

284

Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament.  

PubMed

Thirty-five patients with documented absence of the anterior cruciate ligament were tested on the University of California, Los Angeles, instrumented clinical knee-testing apparatus and we measured the response curves for the following testing modes: anterior-posterior force versus displacement at full extension and at 20 and 90 degrees of flexion; varus-valgus moment versus angulation at full extension and 20 degrees of flexion; and tibial torque versus rotation at 20 degrees of flexion. Absolute values of stiffness and laxity and right-left differences for these injured knees were compared with identical quantities measured previously for a control population of forty-nine normal subjects with no history of treatment for injury to the knee. For both the uninjured knees and the knees without an anterior cruciate ligament, at 20 and 90 degrees of flexion the anterior-posterior laxity was greatest at approximately 15 degrees of external rotation of the foot. The injured knees demonstrated significantly increased total anterior-posterior laxity and decreased anterior stiffness when compared with the uninjured knees in all tested positions of the foot and knee. The mean increase in paired anterior-posterior laxity for the injured knees in this group of patients at +/- 200 newtons of applied anterior-posterior force was 3.1 millimeters (+39 per cent) at full extension, 5.5 millimeters (+57 per cent) at 20 degrees of flexion, and 2.5 millimeters (+34 per cent) at 90 degrees of flexion. The mean reduction in anterior stiffness for injured knees was also greatest (-54 per cent) at 20 degrees of knee flexion. Only slight reduction in posterior stiffness (-16 per cent) was measured at 20 degrees of flexion, and this probably reflected the presence of associated capsular and meniscal injuries. In the group of anterior cruciate-deficient knees, the patients with an absent medial meniscus showed greater total anterior-posterior laxity in all three positions of knee flexion than did the patients with an intact or torn meniscus. Varus-valgus laxity at full extension increased an average of 1.7 degrees (+36 per cent) for the injured knees, while varus and valgus stiffness decreased 21 per cent and 24 per cent. Absence of the medial meniscus (in a knee with absence of the anterior cruciate ligament) increased varus-valgus laxity at zero and 20 degrees of flexion.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6693451

Markolf, K L; Kochan, A; Amstutz, H C

1984-02-01

285

Anterior uveitis associated with latanoprost  

Microsoft Academic Search

Purpose: To report the association of anterior uveitis with the use of latanoprost.Methods: We studied four patients with complicated open-angle glaucoma who had anterior uveitis associated with the use of latanoprost. The uveitis was unilateral and occurred only in the eye receiving latanoprost in three patients. In one patient, latanoprost was used in both eyes, and the uveitis was bilateral.

Robert D. Fechtner; Albert S. Khouri; Thom J. Zimmerman; John Bullock; Robert Feldman; Prasad Kulkarni; Andrew J. Michael; Tony Realini; Ronald Warwar

1998-01-01

286

Prevalence, association with stifle conditions, and histopathologic characteristics of tibial tuberosity radiolucencies in dogs.  

PubMed

A tibial tuberosity radiolucency is sometimes identified on lateral radiographs of canine stifle joints, however little is known about the cause or significance. The purpose of this study was to describe the prevalence, association with other stifle conditions, and histopathologic characteristics of tibial tuberosity radiolucencies in a group of dogs. Radiographs of all canine stifle joints over 5 years were evaluated. Presence or absence of a tibial tuberosity radiolucency was recorded by an observer who was unaware of clinical status. Patient signalment and presence of other stifle joint conditions were recorded from medical records. A tibial tuberosity radiolucency was found in 145/675 dogs (prevalence = 21.5%). Statistically significant associations were identified between tibial tuberosity radiolucency and stifle condition (P < 0.0001), breed size (P = 0.011), and younger age of presentation (P = 0.001), but not with gender (P = 0.513). Dogs with a tibial tuberosity radiolucency had higher odds of having a medial patellar luxation than dogs without (OR = 9.854, P < 0.0001, 95% CI 6.422-15.120). Dogs with a tibial tuberosity radiolucency had lower odds of having a cranial cruciate ligament rupture than dogs without (OR = 0.418, P < 0.0001, 95% CI 0.287-0.609). Four canine cadavers, two with normal stifles and two with tibial tuberosity radiolucencies, underwent radiographic, computed tomographic, and histologic examination of the stifles. Computed tomography revealed a hypoattenuating cortical defect in the lateral aspect of the proximal tibial tuberosity that corresponded histopathologically to a hyaline cartilage core. Findings indicated that the tibial tuberosity radiolucency may be due to a retained cartilage core and associated with medial patellar luxation in dogs. PMID:23662944

Paek, Matthew; Engiles, Julie B; Mai, Wilfried

2013-05-13

287

In Situ Forces in the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament Under Simulated Functional Loading Conditions  

PubMed Central

Background The in situ forces of the anteromedial (AM) and posterolateral bundles (PL) of the anterior cruciate ligament (ACL) under simulated functional loads such as simulated muscle loads have not been reported. These data are instrumental for improvement of the anatomical double-bundle ACL reconstruction. Hypothesis The load-sharing patterns of the 2 bundles are complementary under simulated muscle loads. Study Design Descriptive laboratory study. Methods Eight cadaveric knees in this study were sequentially studied using a robotic testing system. Each knee was tested under 3 external loading conditions including (1) a 134-N anterior tibial load; (2) combined rotational loads of 10 N·m of valgus and 5 N·m internal tibial torques; and (3) a 400-N quadriceps muscle load with the knee at 0°, 15°, 30°, 60°, and 90° of flexion. The in situ forces of the 2 bundles of ACL were determined using the principle of superposition. Results Under the anterior tibial load, the PL bundle carried peak loads at full extension and concurrently had significantly lower force than the AM bundle throughout the range of flexion (P <.05). Under the combined rotational loads, the PL bundle contributed to carrying the load between 0° and 30°, although less than the AM bundle. Under simulated muscle loads, both bundles carried loads between 0° and 30°. There was no significant difference between the 2 bundle forces at all flexion angles (P > .05). Conclusion Under externally applied loads, in general, the AM bundle carried a greater portion of the load at all flexion angles, whereas the PL bundle only shared the load at low flexion angles. The bundles functioned in a complementary rather than a reciprocal manner to each other. Clinical Relevance The data appear to support the concept that both bundles function in a complementary manner. Thus, how to re-create the 2 bundle functions in an ACL reconstruction should be further investigated.

Wu, Jia-Lin; Seon, Jong Keun; Gadikota, Hemanth R.; Hosseini, Ali; Sutton, Karen M.; Gill, Thomas J.; Li, Guoan

2013-01-01

288

Fibula-related complications during bilateral tibial lengthening  

PubMed Central

Background and purpose Complications related to the fibula during distraction osteogenesis could cause malalignment. Most published studies have analyzed only migration of the fibula during lengthening, with few studies examining the effects of fibular complications. Patients and methods We retrospectively reviewed 120 segments (in 60 patients) between 2002 and 2009. All patients underwent bilateral tibial lengthening of more than 5 cm. The mean follow-up time was 4.9 (2.5–6.9) years. Results The average lengthening percentage was 34% (21–65). The ratio of mean fibular length to tibial length was 1.05 (0.91–1.11) preoperatively and 0.83 (0.65–0.95) postoperatively. The mean proximal fibular migration (PFM) was 15 (4–31) mm and mean distal fibular migration (DFM) was 9.7 (0–24) mm. Premature consolidation occurred in 10 segments, nonunion occurred in 12, and angulation of fibula occurred in 8 segments after lengthening. Valgus deformities of the knee occurred in 10 segments. Interpretation PFM induced valgus deformity of the knee, and premature consolidation of the fibula was associated with the distal migration of the proximal fibula. These mechanical malalignments could sometimes be serious enough to warrant surgical correction. Thus, during lengthening repeated radiographic examinations of the fibula are necessary to avoid complications.

2012-01-01

289

Outcome of complex tibial plateau fractures treated with external fixator  

PubMed Central

Background: Tibial plateau fractures are usually associated with communition and soft tissue injury. Percutaneous treatment of these complex fractures is intended to reduce soft issue complications and postoperative stiffness of the knee joint. We assessed the complications, clinical outcome scores, and postoperative knee range of movements, after fluoroscopic assisted closed reduction and external fixator application. Materials and Methods: Seventy eight complex tibial plateau fractures in 78 patients were included in the study. All fractures were managed with closed reduction and external fixator application. In 28 cases with intraarticular split, we used percutaneous cancellous screw fixation for reduction and fixation of condylar parts. In nine open fractures, immediate debridement was done. In 16 cases, elevation of depressed segment and bone grafting was required, which was done from a very small incision. All patients were clinically and radiographically evaluated at a mean followup of 26.16 months (range 6–60 months). Results: Clinical results were evaluated according to the Rasmussen's criteria. Average healing time was 13.69 weeks (range 12– 28 weeks). Mean knee range of motion was 122.60° (range 110°–130°). Forty seven results were scored as excellent, 25 good, 2 fair, and 1 as poor. Conclusion: We believe that minimally invasive treatment by percutaneous techniques and external fixation is a fairly reasonable treatment alternative, if near anatomical reduction of joint surface can be confirmed on fluoroscopy.

Mankar, Sushil H; Golhar, Anil V; Shukla, Mayank; Badwaik, Prashant S; Faizan, Mohammad; Kalkotwar, Sameer

2012-01-01

290

Chondroclasts in fusarium-induced tibial dyschondroplasia. A histomorphometric study.  

PubMed

The role of chondroclasts in the pathogenesis of Fusarium roseum-induced tibial dyschondroplasia (TD) was examined in a histomorphometric study. TD developed rapidly in broiler chickens placed at 1 day of age on rations containing either 3% (Experiment 1) or 2% (Experiment 2) F roseum cultures. In Experiment 1 the frequency of TD in birds killed at 4 weeks of age was 90%. In Experiment 2, birds were killed at intervals from 4 days until 4 weeks of age. By 1 week of age, 70% of birds examined had characteristic accumulations of prehypertrophic cartilage at the proximal tibial physis, and the frequency of TD in 4-week-old birds was 80%. Sections of hypertrophic cartilage from F roseum-fed and control birds from both experiments were examined for determination of the volume density of chondroclasts along the vascular channel boundary. Chondroclast density was consistently lower in F roseum-fed than in control birds, but the difference was significant only at 4 weeks of age. The fact that gross lesions were evident before a significant decrease in chondroclast density occurred indicates that a decrease in the density of chondroclasts was not an essential factor in the accumulation of cartilage characteristic of TD. PMID:4025512

Lawler, E M; Fletcher, T F; Walser, M M

1985-08-01

291

Evaluation of short-term precision for tibial ultrasonometry.  

PubMed

Tibial quantitative ultrasonometry is a relatively novel technique in the field of bone sonometry, an emerging alternative to bone densitometry. The implementation of this technique in a pediatric population could prove valuable from a clinical as well as a research viewpoint. In clinical practice it is necessary to know the precision of this technique and the possible influence on measurements before implementation. This study presents the precision in a Caucasian pediatric population and the influence of measurement site, dexterity, brand of coupling gel, and temperature of coupling gel. To assess intra- and interobserver variance duplicate measurements, with repositioning, ultrasonometry was performed in 10 children over a short period of time. The observers were blinded for the results of the other observer and after each measurement the skin markings were removed. Intraobserver variance for operator one (MHL) and for observer two (SFGR) was CV 0.43%. The interobserver variance was CV 0.61%. Left midtibial and right midtibial speed of sound (SOS) measurements showed no significant differences. There were, however, significant differences in both boys and girls between right proximal versus right midtibial, right midtibial versus right distal, and right proximal versus right distal (for all P < 0.001). One-way analysis of variance (ANOVA) showed that neither the use of different coupling gels nor an increase in gel temperature had a significant influence on measurements. The results of our study show that tibial quantitative ultrasonography (QUS) is a highly reproducible technique in a Caucasian pediatric population. PMID:9868279

Lequin, M H; van Rijn, R R; Robben, S G; Hop, W C; Dijkhuis, S; Fijten, M M; Meijer, L A; van Kuijk, C

1999-01-01

292

Early radiographic features in patients with anterior cruciate ligament rupture  

PubMed Central

OBJECTIVE—To determine, in a preliminary cross sectional study of patients with anterior cruciate ligament (ACL) ruptured knees, which of the radiographic features—subchondral cortical plate thickness, trabecular sclerosis, and osteophytosis—appears before or in association with changes in joint space width (JSW) as a surrogate for articular cartilage thickness in patients with ruptured knees.?METHODS—19 patients (14 men), mean (95% CI) age 28.7 (23.6 to 33.8) years, had ACL rupture in one knee only, confirmed by arthroscopy. Anterior draw, Lachman's test, and pivot shift tests were performed and ×5 posteroanterior macroradiographs of both knees in a standing semiflexed view were taken at a mean (95% CI) time from injury of 34.3 (26.9 to 41.7) months. In each radiograph, computerised methods were used to measure minimum JSW and fractal signature analysis (FSA) to quantify the vertical and horizontal trabecular organisation, osteophyte area, and the subchondral cortical plate thickness, in the medial and lateral tibial compartments of all knees.?RESULTS—Physical examination confirmed the presence of joint laxity in the injured knees. No statistical difference in either medial or lateral JSW and subchondral cortical plate thickness was detected between ACL ruptured and uninjured knees. FSA showed a significant decrease in fractal dimension for the horizontal trabeculae (size 0.42 mm) in the medial compartment of the ACL ruptured knees compared with the uninjured knees (p<0.01, multivariate analysis of variance). There was an inverse correlation (R ?0.74) between the time since knee injury and the difference in FSA values for ACL ruptured and uninjured knees in medial compartment horizontal trabeculae (size 0.4 mm). No significant changes were detected in the lateral compartment. Osteophytes were detected in the medial compartment of nine ACL injured knees.?CONCLUSION—Compared with the uninjured knee, ACL rupture leads to thickening of subchondral horizontal trabeculae (decreased FSA) in the medial tibial compartment of all knees, reaching significance at about four years after injury. Osteophytes were present in the same compartment in 9/19 knees. No changes in JSW and subchondral cortical plate thickness were detected. Whether the bony changes detected in these ACL ruptured knees presage those of early osteoarthritis requires further study.??

Buckland-Wright, J; Lynch, J; Dave, B

2000-01-01

293

No-tunnel anterior cruciate ligament reconstruction: the transtibial all-inside technique.  

PubMed

The purpose of this technical note is to describe the transtibial all-inside anterior cruciate ligament (ACL) reconstruction technique. This technique combines the advantages of previously described but technically demanding all-inside ACL reconstruction techniques with the ease and familiarity of transtibial guide pin placement. The all-inside technique uses bone sockets as opposed to bone tunnels in both the femur and the tibia and represents a "no-tunnel" technique. When performed with allograft tissue, the method requires only arthroscopic portals and percutaneous guide pin passage. In such cases, this represents a "no-incision" ACL reconstruction. The technique requires the use of a Dual Retrocutter (Arthrex, Naples, FL). This cannulated drill is placed via the anteromedial arthroscopic portal and threads onto a transtibial, percutaneous, reverse-threaded guide pin. Because the drill is assembled arthroscopically (within the joint), a skin incision is not required. The Dual Retrocutter is capable of retrograde and antegrade drilling. Thus, a single Dual Retrocutter achieves transtibial drilling of both tibial and femoral bone sockets. The transtibial all-inside technique may be performed with the use of any ACL graft option. Graft diameter should equal socket diameter. To prevent the graft from "bottoming-out" during tensioning and fixation, graft length must be less than the sum of combined femoral plus tibial socket lengths plus ACL intra-articular distance. During the learning curve, surgeons may choose to wait until the sockets have been prepared, so that graft length need not be estimated. If the graft is prepared before arthroscopic surgery is performed, a 79-mm graft length could be recommended as ideal. To prepare for graft passage, both femoral and tibial graft passing suture loops must be brought out the anteromedial arthroscopic portal without soft tissue interposition between or within the loops. To prepare for graft fixation, a nitinol wire must be brought into the joint via the transtibial, percutaneous guide pin tract for the purpose of guiding the introduction of a cannulated Retroscrewdriver. All of these goals may be accomplished in a single pass. The graft is fixed with femoral and tibial Retroscrews. Backup fixation is optional and may be achieved by tying sutures over small, percutaneously placed cortical buttons. Advantages of this technique may result from "anatomic" graft fixation at the levels of the femoral and tibial joint lines and from retrograde screw fixation, which may eliminate interference screw divergence and increase graft tension when the retrograde screw is advanced. Additionally, because this technique minimizes skin incisions and eliminates open bone tunnels, patients may experience decreased pain, more rapid return to function, and improved cosmesis. PMID:16904591

Lubowitz, James H

2006-08-01

294

Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3DCT  

Microsoft Academic Search

Purpose  To reveal the relationship between anatomically placed anterior cruciate ligament (ACL) graft and the intercondylar roof using\\u000a three-dimensional computed tomography (3D-CT).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty-four patients undergoing anatomical double-bundle ACL reconstruction were included in this study. Anatomical double-bundle\\u000a ACL reconstruction was performed with two femoral tunnels (antero-medial; AM and postero-lateral; PL) and two tibial tunnels.\\u000a Hamstring autograft was used in all cases. Six

Takanori Iriuchishima; Takashi Horaguchi; Tatsuya Kubomura; Yusuke Morimoto; Freddie H. Fu

2011-01-01

295

The posterior to anterior controlled technique of percutaneous Achilles tenotomy in the correction of idiopathic clubfoot: a technical report.  

PubMed

Percutaneous tenotomy of the Achilles tendon is an integral part of the Ponseti technique of clubfoot correction. Although originally described by Ponseti as an office procedure that was performed under local anaesthesia, serious neurovascular complications that include iatrogenic injury to the lesser saphenous vein, the posterior tibial neurovascular bundle, the sural artery and pseudoaneurysm formation have been reported. We describe a new tenotomy technique, the posterior to anterior controlled technique, that may decrease the possibility of neurovascular damage, does not require exposure of the Achilles tendon and can be performed as an office procedure under local anaesthesia. PMID:23407431

Sharma, Siddhartha; Butt, Mohammad F; Singh, Manjeet; Sharma, Sudesh

2013-05-01

296

An unusual case of aneurysmal tibial nerve compression detected in ED.  

PubMed

We present an unusual case of tibial nerve compression caused by a true tibial posterior artery aneurysm. A 61-year-old man was admitted to the emergency department due to suspected muscle rupture. He had experienced a sudden, intense right calf pain and swelling that had begun during walking. He had a 6-month-long history of symptoms suggestive to the tibial nerve dysfunction and a month-long history of neurologic finding consistent with the right tibial nerve paresis. An examination of the legs revealed a painful mass in the posterior-medial compartment of the right calf. Emergency ultrasound scanning of the right lower leg vascularization showed an expansive saccular aneurysm of the proximal segment posterior tibial artery with mural thrombus and splitting of the aneurysmal wall. An angiography confirmed the diagnosis. Under spinal anesthesia, we performed aneurysmectomy and decompressed the tibial nerve. The histologic examination was compatible with a true aneurysm of the right posterior tibial artery. PMID:23702068

Toncev, Slavco; Sretenovic, Sasa; Mitrovic, Slobodanka; Toncev, Gordana

2013-05-21

297

Kinematic gait analysis of the hind limb after tibial plateau levelling osteotomy and cranial tibial wedge osteotomy in ten dogs.  

PubMed

This study identifies and compares the kinematic gait changes occurring in tibial plateau levelling osteotomy (TPLO) and cranial tibial wedge osteotomy (CTWO) limbs after transection of the cranial cruciate ligament (CrCL). Ten, healthy, adult beagle dogs were assigned to TPLO (five dogs) and CTWO (five dogs) groups. Hind limb kinematics were assessed, while dogs were trotted at speeds ranging from 2.0 to 2.3 m/s. The animals were evaluated preoperatively (prior to TPLO and CTWO surgery) and at both 8 and 12 weeks after surgery. Two-dimensional evaluation was synchronized to obtain the three-dimensional coordinates using the APAS motion analysis software. Gait patterns were assessed by measuring stifle, tibiotarsal joint angles and stifle joints angular velocity. Stifle and tibiotarsal joint functions were not affected by TPLO surgery, but stifle and tibiotarsal joint angles were changed, following CTWO surgery, compared with their preoperative values. The angular velocity patterns of CTWO were characterized by increased stifle joint extension velocity from the middle to end swing phase and decrease in the peak velocities (flexion) during swing phase. None of these changes was observed in the stance phase after the CTWO surgery. These kinematic results showed that dogs that underwent a CTWO procedure were more likely to have significantly hyperextended gait patterns of the swing phase postoperatively than the dogs that had a TPLO procedure for repair of a ruptured CrCL. PMID:18045343

Lee, J Y; Kim, G; Kim, J-H; Choi, S H

2007-12-01

298

Anterior Lumbar Interbody Fusion (ALIF)  

Microsoft Academic Search

\\u000a Anterior lumbar interbody fusion (ALIF) is a method of achieving intersegmental arthrodesis that is indicated for the treatment\\u000a of symptomatic degenerative disease [1, 2]. While ALIF has use for indications involving multiple levels and complex combinations\\u000a of anterior and posterior instrumentation, fusions for degenerative and deformity cases, spondylolisthesis [3, 4], and failed\\u000a posterior surgery with pseudoarthroses, a common indication remains

Henry E. Aryan; Sigurd H. Berven; Christopher P. Ames

299

[The perforator pedicled propeller flap for distal tibial exposure: two case reports].  

PubMed

Distal lower leg soft tissue defect is frequently a challenge to repair, particularly on the tibial crest. The coverage of this kind of lesion has some limitations because of regional minimal blood supply and paucity of local soft-tissue flaps. The perforator pedicled propeller (PPP) method tries to find a new place in lower leg reconstruction in bringing similar tissues at the recipient site and avoiding long and difficult free flap transfer or muscular sacrifice. The authors report on the use of PPP method for a tibial crest exposure after trauma and for a soft tissue defect with osteomyelitis on the tibial crest. PMID:21109340

Bous, A; Ronsmans, C; Nizet, J-L; Jacquemin, D; Nardella, D

2010-11-24

300

Navigated opening wedge high tibial osteotomy improves intraoperative correction angle compared with conventional method  

Microsoft Academic Search

Purpose  The correction angle after high tibial osteotomy (HTO) depends on an accurate preoperative planning and an accurate intraoperative\\u000a technique. We hypothesized that the use of a navigation system in opening wedge HTO would improve the intraoperative target\\u000a angles in the coronal and sagittal planes.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Postoperative femoro-tibial angle (FTA) and tibial posterior slope (TPS) in 28 knees with navigated opening wedge

Y. Akamatsu; N. Mitsugi; Y. Mochida; N. Taki; H. Kobayashi; R. Takeuchi; T. Saito

301

Radiographic and histologic study of porous coated tibial component fixation in cementless total knee arthroplasty.  

PubMed

Radiographic changes occurring beneath three types of non-cemented, porous coated, cobalt-chrome tibial components were retrospectively reviewed a minimum of 1 year after arthroplasty. Radiolucent zones, radiodense lines, and loose sintered particles were commonly observed. These changes are consistent with non-rigid, fibrous tissue fixation. Histologic evaluation of two specimens retrieved at revision surgery revealed predominantly fibrous tissue within the porous surface under the tibial plateau. The long-term implication of fibrous tissue fixation of porous coated tibial implants in unknown. PMID:3399443

Engh, G A; Bobyn, J D; Petersen, T L

1988-05-01

302

Recovery of the posterior tibial muscle after late reconstruction following tendon rupture.  

PubMed

The purpose of this study was to determine the recovery potential of the posterior tibial muscle after late reconstruction following tendon rupture in stage II of posterior tibial tendon dysfunction. Fourteen patients (18 women, 6 men; mean age 59.8 years) were investigated 47 months (range, 24-76 months) after surgical reconstruction of a completely ruptured posterior tibial tendon (end-to-end anastomosis, side-to-side augmentation with the flexor digitorum longus tendon) in combination with a distal calcaneal osteotomy with a tricortical iliac crest bone graft for lengthening of the lateral column. At follow-up, clinical and radiological investigations were performed, including strength measurement and qualitative and quantitative MRI investigation. The overall clinical results were graded excellent in 12 patients, good in one, fair in one, and poor in none. The average ankle-hindfoot score (American Orthopaedic Foot and Ankle Society) improved from preoperatively 49.1 (range, 32-60) to 93.1 (range, 76-100) at follow-up. The functional result correlated with patient's satisfaction and sports activities (p <.05). All patients showed a significant strength of the posterior tibial muscle on the affected side, but it was smaller than on non-affected side (p <.05). The mean posterior tibial muscle strength was 75.1 N on affected and 104.9 N on nonaffected side, corresponding to a ratio of 0.73 between the two legs. The mean area of the posterior tibial muscle was 1.89 cm(2) on affected side, and 3.48 cm(2) on nonaffected side, corresponding to a ratio of 0.55 between the two legs. While fatty degeneration for the posterior tibial muscle was found in all patients, it was found to decrease with increasing strength of the posterior tibial muscle (p <.05) and muscular size (p <.05). On postoperative MRI, the posterior tibial tendon could be found to be intact in all patients. The recovery potential of the posterior tibial muscle was shown to be significant even after delayed repair of its ruptured tendon. A ruptured and/or diseased posterior tibial tendon should not be transected as it excludes any recovery possibilities of the posterior tibial muscle. PMID:14992708

Valderrabano, Victor; Hintermann, Beat; Wischer, Thorsten; Fuhr, Peter; Dick, Walter

2004-02-01

303

Complications of tibial plateau levelling osteotomy in dogs.  

PubMed

The tibial plateau levelling osteotomy (TPLO) is one of the most common surgical procedures used to treat cranial cruciate ligament disease in dogs. Complications occurring during or after TPLO can range in severity from swelling and bruising to fracture and osteomyelitis. Ten to 34% of TPLO surgical procedures are reported to experience a complication and approximately two to four percent require revision surgery to address a complication. Although the risk factors for many complications have not been fully assessed, the best available evidence suggests that complications of TPLO can be reduced with increased surgeon experience, careful surgical planning, and accurate execution of the surgical procedure. Identification of known or suspected risk factors and intra-operative technical errors allow subsequent action to be taken that is aimed at decreasing postoperative morbidity. There is a need for prospective studies with consistent data reporting in order to fully reveal the incidence risk factors for complications associated with TPLO. PMID:22534675

Bergh, M S; Peirone, B

2012-04-25

304

[Treatment of tibial shaft fractures by intramedullary locking nailing].  

PubMed

Authors analyzed consecutive series of 56 tibial shaft fractures (43 men and 13 women) treated by intramedullary locking nails in years 1993-2004. Age of patients ranged from 17 to 83 years (mean 38 years). The final result was analyzed in 51 patients (91%). The bone union was observed in 50 patients. Fractures united within 6 months in 45 patients (88%), between 8 and 15 months in 5 patients. Operative treatment of non-union was necessary in one patient. The fractures united in anatomical axis in 45 cases, small (less than 10 degrees) valgus deviation was noticed in four patients, whereas five patients with fractures localized in distal part of the tibia had 11-30 degrees valgus deviation. The limb length inequality more than 1 cm was noticed in one case. There was neither infection nor compartment syndrome. One patient died because of fatal pulmonary embolism. PMID:16875183

Ko?odziej, Robert; Blacha, Jan; Blicharski, Tomasz; Gagala, Jacek

2005-01-01

305

A case of bilateral tibial hemimelia type VIIa  

PubMed Central

Congenital absence of tibia is a rare anomaly, and may be total or partial, unilateral or bilateral. Total absence is more frequent than partial, unilateral absence occurs more often than bilateral, with right limb more commonly affected than the left. In partial defect, almost always the distal end of the bone is affected, and of the bilateral cases, there may be total absence on both sides, or total on one side and partial on the other. Males are slightly more commonly affected than the females. Though, the family history is usually negative for congenital abnormalities and other diseases, there is a considerable chance of occurrence of congenital defect of the tibia or of other abnormalities, in near or remote relatives. We report a case of newborn having bilateral tibial hemimelia type VIIa.

Chinnakkannan, Selvakumar; Das, Rashmi Ranjan; Rughmini, K.; Ahmed, Sufath

2013-01-01

306

Dysphagia following anterior cervical spinal surgery: a systematic review.  

PubMed

Dysphagia is a common complication of anterior surgery of the cervical spine. The incidence of post-operative dysphagia may be as high as 71% within the first two weeks after surgery, but gradually decreases during the following months. However, 12% to 14% of patients may have some persistent dysphagia one year after the procedure. It has been shown that female gender, advanced age, multilevel surgery, longer operating time and severe pre-operative neck pain may be risk factors. Although the aetiology remains unclear and is probably multifactorial, proposed causes include oesophageal retraction, prominence of the cervical plate and prevertebral swelling. Recently, pre-operative tracheal traction exercises and the use of retropharyngeal steroids have been proposed as methods of reducing post-operative dysphagia. We performed a systematic review to assess the incidence, aetiology, risk factors, methods of assessment and management of dysphagia following anterior cervical spinal surgery. PMID:23814234

Cho, S K; Lu, Y; Lee, D-H

2013-07-01

307

Anterior cruciate ligament rupture: differences between males and females.  

PubMed

The rate of anterior cruciate ligament (ACL) rupture is three times higher in female athletes than in male athletes. Intrinsic factors such as increased quadriceps angle and increased posterior tibial slope may predispose girls and women to ACL injury. Compared with males, females have smaller notch widths and smaller ACL cross-sectional area; however, no conclusive correlation between ACL size and notch dimension exists, especially in relation to risk of ACL injury. Female athletes who land with the knees in inadequate flexion and in greater-than-normal valgus and external rotation are at increased risk of ACL injury. No conclusive link has been made between ACL injury and the menstrual cycle. Neuromuscular intervention protocols have been shown to reduce the rate of injury in girls and women. Females are more likely than males to have a narrow A-shaped intercondylar notch, and special surgical considerations are required in such cases. Following ACL reconstruction, female athletes are more likely than male athletes to rupture the contralateral ACL; however, males and females are equally likely to rupture the reconstructed knee. Although self-reported outcomes in the first 2 years following reconstruction are worse for females than for males, longer-term studies demonstrate no difference between males and females. PMID:23281470

Sutton, Karen M; Bullock, James Montgomery

2013-01-01

308

The effect of tibial curvature and fibular loading on the tibia index.  

PubMed

The tibia index (TI) is commonly used to predict leg injury based on measurements taken by an anthropomorphic test device (ATD). The TI consists of an interaction formula that combines axial loading and bending plus a supplemental compressive force criterion. Current ATD lower limbs lack geometric biofidelity with regard to tibial curvature and fibular load-sharing. Due to differences in tibial curvature, the midshaft moments induced by axial loading are different in humans and ATDs. Midshaft tibial loading in the human is also reduced by load-sharing through the fibula, which is not replicated in current ATDs. In this study, tibial curvature and fibular load-sharing are quantified through CT imaging and biomechanical testing, and equations are presented to correct ATD measurements to reflect the loading that would be experienced by a human tibia. PMID:15203953

Funk, James R; Rudd, Rodney W; Kerrigan, Jason R; Crandall, Jeff R

2004-06-01

309

[Spontaneous avulsion of the tibial tuberosity following Osgood-Schlatter disease].  

PubMed

Two cases of spontaneous fracture and dislocation of the tibial tuberosity in boys (15 and 19 years of age), who had both suffered from Osgood-Schlatter disease are described. The treatment and prognosis are discussed. PMID:7792962

Bang, J; Broeng, L

1995-05-22

310

Anterior Orbit and Adnexal Amyloidosis  

PubMed Central

Purpose: To describe six cases of anterior orbital and adnexal amyloidosis and to report on proteomic analysis to characterize the nature of amyloid in archived biopsies in two cases. Materials and Methods: The clinical features, radiological findings, pathology, and outcome of six patients with anterior orbit and adnexal amyloidosis were retrieved from the medical records. The biochemical nature of the amyloid was determined using liquid chromatography/mass spectroscopy archived paraffin-embedded tissue in two cases. Results: Of the six cases, three had unilateral localized anterior orbit and lacrimal gland involvement. Four of the six patients were female with an average duration of 12.8 years from the time of onset to presentation eyelid infiltration by amyloid caused ptosis in five cases. CT scan in patients with lacrimal gland involvement (n = 3) demonstrated calcified deformable anterior orbital masses and on pathological exmaintionamyloid and calcific deposits replaced the lacrimal gland acini. Ptosis repair was performed in three patients with good outcomes. One patient required repeated debulking of the mass and one patient had recurrenct disease. Proteomic analysis revealed polyclonal IgG-associated amyloid deposition in one patient and AL kappa amyloid in the second patient. Conclusion: Amyloidosis of the anterior orbit and lacrimal gland can present with a wide spectrum of findings with good outcomes after surgical excision. The nature of amyloid material can be precisely determined in archival pathology blocks using diagnostic proteomic analysis.

Al Hussain, Hailah; Edward, Deepak P.

2013-01-01

311

Do Capacitively Coupled Electric Fields Accelerate Tibial Stress Fracture Healing?A Randomized Controlled Trial  

Microsoft Academic Search

Background: Tibial stress fractures increasingly affect athletes and military recruits, with few known effective management options. Electrical stimulation enhances regular fracture healing, but the effect on stress fractures has not been definitively tested.Hypothesis: Capacitively coupled electric field stimulation will accelerate tibial stress fracture healing.Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Twenty men and 24 women with acute posteromedial

Belinda R. Beck; Gordon O. Matheson; Gabrielle Bergman; Tracey Norling; Michael Fredericson; Andrew R. Hoffman; Robert Marcus

2008-01-01

312

Surgical Treatment of Refractory Tibial Stress Fractures in Elite DancersA Case Series  

Microsoft Academic Search

Background: Treatment of tibial stress fractures in elite dancers is centered on rest and activity modification. Surgical intervention in refractory cases has important implications affecting the dancers’ careers.Hypothesis: Refractory tibial stress fractures in dancers can be treated successfully with drilling and bone grafting or intramedullary nailing.Study Design: Case series; Level of evidence, 4.Methods: Between 1992 and 2006, 1757 dancers were

Ryan G. Miyamoto; Herman S. Dhotar; Donald J. Rose; Kenneth Egol

2009-01-01

313

Tibial plateau stress fracture after unicondylar knee arthroplasty using a navigation system: two case reports  

Microsoft Academic Search

Satisfactory alignments of components in total knee arthroplasty have been reported since the introduction of navigation systems.\\u000a And thus, such techniques have been introduced for minimally invasive unicondylar knee arthroplasty (UKA). Several intraoperative\\u000a fractures of the tibial plateau have been reported in association with minimally invasive UKA and some stress fractures of\\u000a tibial plateau associated with design of instrument have

Jong Keun Seon; Eun Kyoo Song; Taek Rim Yoon; Hyoung Yeon Seo; Sang Gwon Cho

2007-01-01

314

Model-based ankle joint angle tracing by cuff electrode recordings of peroneal and tibial nerves  

Microsoft Academic Search

The main goal of the present study was to estimate the ankle joint angle from the peroneal and tibial electroneurography (ENG)\\u000a recordings. Two single-channel cuff electrodes for recording ENG were placed on the proximal part of rabbit peroneal and tibial\\u000a nerves respectively and static positioning and ramp-and-hold stretches were performed to characterize the static and dynamic\\u000a ENG responses. An ENG

Chou-Ching K. Lin; Ming-Shaung Ju; Hang-Shing Cheng

2007-01-01

315

Infections after high tibial open wedge osteotomy: a case control study  

Microsoft Academic Search

Background and purpose  High tibial open wedge valgisation osteotomy (HTO) is a widely used procedure for the treatment of unicompartimental osteoarthritis\\u000a of the knee. Instead of the classical paramedian longitudinal skin incision, some advocate an oblique incision, in order to\\u000a get a better exposure of the postero-medial aspect of the tibial head, while reducing strain on the soft tissues. Risk factors

Nikolaus Reischl; Peter Wahl; Matthias Jacobi; Steve Clerc; Emanuel Gautier; Roland P. Jakob

2009-01-01

316

Static versus dynamic prosthetic weight bearing in elderly trans-tibial amputees  

Microsoft Academic Search

The purpose of this study was to compare prosthetic weight-bearing tolerance in the standing position to the dynamic vertical ground reaction forces (VGRF) experienced during walking in elderly dysvascular trans-tibial amputees. Ten unilateral trans-tibial amputees attending an amputee clinic (mean age =67±6.5 years) were selected as subjects. Selection criteria were the level of amputation, age, medical fitness to participate and

M. E. JONES; J. R. STEEL; G. M. BASHFORD; I. R. DAVIDSON

1997-01-01

317

Tibial component positioning in total knee arthroplasty: bone coverage and extensor apparatus alignment  

Microsoft Academic Search

Correct positioning of the tibial component in total knee arthroplasty (TKA) must take into account both an optimal bone\\u000a coverage (defined by a maximal cortical bearing with posteromedial and anterolateral support) and satisfactory patellofemoral\\u000a tracking. Consequently, a compromise position must be found by the surgeon during the operation to simultaneously meet these\\u000a two requirements. Moreover, tibial tray positioning depends upon

P. Lemaire; D. P. Pioletti; F.-M. Meyer; R. Meuli; J. Dörfl; P.-F. Leyvraz

1997-01-01

318

Aging is Not a Risk Factor for Femoral and Tibial Fractures in Motor Vehicle Crashes  

PubMed Central

Objective To determine the effect of aging on the occurence of femoral and tibial fractures during vehicular crashes. Methods The Crash Injury Research and Engineering Network (CIREN), which includes occupants of a vehicle < 8 years old with at least one AIS ?3 or two AIS ?2 injuries in different body regions, comprised the study population. The occurrence of femoral and tibial fractures during vehicular crashes was analyzed in relation to age and other confounders [gender, BMI, stature, change in velocity (?v), restraint use, occupant position (driver vs. passenger) and principal direction of force (PDOF)] using ?2, Mantel-Haenszel ?2 and student t test. Multiple logistic regression (MLR) models were built for the prediction of femoral and tibial fractures with age as the independent variable and possible confounders as co-variates. An ? = 0.05 was used for all statistics. Results The incidence of femoral and tibial fractures in the study population (N=1,418) was 23% and 27%, respectively. Univariate analyses revealed a negative association between increasing age and femoral fractures and no association between age and tibial fractures. MLR models revealed no clear effect of increasing age on the occurrence of either femoral or tibial fractures. Obesity, frontal PDOF, and high Delta;v affected the occurrence of femoral fractures. Tibial fractures were influenced by occupant position (driver), frontal PDOF, high ?v and shorter stature. Conclusion Despite the known changes in bone composition and strength with aging, elderly vehicular occupants do not experience higher odds of incurring femoral and tibial fractures during crashes.

Ryb, Gabriel; Dischinger, Patricia; Kleinberger, Michael; Burch, Cynthia; Ho, Shiu

2008-01-01

319

Rehabilitation of avulsion fracture of the tibial tuberosity following Osgood-Schlatter disease  

Microsoft Academic Search

A sixteen-year-old boy suffered from sharp pain in the knee during a jump while playing basketball. He had a positive history of Osgood Schlatter disease. Radiographic evaluation demonstrated an avulsion fracture of the tibial tuberosity Type III according to the classification of Watson-Jones. Rehabilitation after avulsion fracture of the tibial tuberosity is an important consideration for this relatively uncommon adolescent

G. Baltaci; H. Özer; V. B. Tunay

2004-01-01

320

Magnitude of cement-device interfacial stresses with and without tibial stemming: impact of BMI.  

PubMed

Patients expect their total knee arthroplasty to relieve pain and to be long lasting. With patients becoming more active, weighing more, and living longer, this expectation becomes increasingly more difficult to fulfill. Patients who are obese and active put greater loads on their implants and may have a greater risk of failure. Although much attention has been paid to decreasing polyethylene wear, a major cause of implant failure, very little research focus has been directed to elucidate other measures to reduce failure, such as the efficacy of prophylactic stemming of the tibial tray. This study explored whether additional mechanical support for tibial base plates would help reduce bone cement stresses in heavy patients, who, like patients with a high activity level, put added stress on their implants. A tibial base plate with a 12-mm-diameter x 50-mm-long stem was compared with the same tibial base plate with a 15-mm-diameter x 20-mm-long end cap using finite element analysis. The results indicate that the tibial base plate with a prophylactic stem significantly reduced compressive and shear stresses on the cement-device interface and therefore may help to reduce the possibility of tibial loosening in these at-risk patients. Further, such studies will aid the surgeon in educating patients and in selecting the appropriate implant strategy. PMID:21618932

Gopalakrishnan, Ananthkrishnan; Hedley, Anthony Keith; Kester, Mark A

2011-03-01

321

How does tibial cartilage volume relate to symptoms in subjects with knee osteoarthritis?  

PubMed Central

Background: No consistent relationship between the severity of symptoms of knee osteoarthritis (OA) and radiographic change has been demonstrated. Objectives: To determine the relationship between symptoms of knee OA and tibial cartilage volume, whether pain predicts loss of cartilage in knee OA, and whether change in cartilage volume over time relates to change in symptoms over the same period. Method: 132 subjects with symptomatic, early (mild to moderate) knee OA were studied. At baseline and 2 years later, participants had MRI scans of their knee and completed questionnaires quantifying symptoms of knee OA (knee-specific WOMAC: pain, stiffness, function) and general physical and mental health (SF-36). Tibial cartilage volume was determined from the MRI images. Results: Complete data were available for 117 (89%) subjects. A weak association was found between tibial cartilage volume and symptoms at baseline. The severity of the symptoms of knee OA at baseline did not predict subsequent tibial cartilage loss. However, weak associations were seen between worsening of symptoms of OA and increased cartilage loss: pain (rs = 0.28, p = 0.002), stiffness (rs = 0.17, p = 0.07), and deterioration in function (rs = 0.21, p = 0.02). Conclusion: Tibial cartilage volume is weakly associated with symptoms in knee OA. There is a weak association between loss of tibial cartilage and worsening of symptoms. This suggests that although cartilage is not a major determinant of symptoms in knee OA, it does relate to symptoms.

Wluka, A; Wolfe, R; Stuckey, S; Cicuttini, F

2004-01-01

322

Measurement of blood flow to the tibial diaphysis using 11-microns radioactive microspheres. A comparative study in the adult rabbit  

SciTech Connect

The commonly used size of microsphere for bone blood flow estimation is 15 microns, because it has appeared to be the smallest size that is not subject to significant nonentrapment in bone. Soft-tissue studies suggest that it is microspheres of 9-10 microns or less that pass through peripheral tissues and give low calculated flows, whereas many vessels passing into and within cortical bone are less than 15 microns in diameter. We have therefore performed a comparison between microspheres approximately 15 and 11 microns in average size. Blood flows to the cortex and marrow of the tibial diaphysis, and to the skeletal muscle of the anterior compartment, were obtained in six adult New Zealand White rabbits by the reference sample technique, injecting microspheres of 16.5 +/- 0.1 microns and 11.3 +/- 0.1 microns simultaneously. The calculated cortical flows averaged 2.07 and 2.51 ml/min/100 g, respectively, and the marrow flows 26.63 and 24.92 ml/min/100 g. Mean skeletal muscle flows were 15.57 and 14.54 ml/min/100 g, respectively. There were no significant differences between the calculated flows for the two sizes of microsphere. Thus, the smaller microspheres do not appear by this method to be subject to significant nonentrapment, and they are therefore suitable for blood flow measurement in these tissues.

Triffitt, P.D.; Gregg, P.J. (Univ. of Leicester (England))

1990-09-01

323

Time-varying activation of different cytoarchitectonic areas of the human SI cortex after tibial nerve stimulation.  

PubMed

We followed cortical activation in eight healthy adults after electric stimulation of the left tibial nerve at the ankle. The recordings were made noninvasively with a whole-scalp neuromagnetometer. The first cortical activation peaked in different subjects at 37-45 ms in the foot area of the right (contralateral) primary somato-sensory (SI) cortex, with mean source current orientation perpendicular to the longitudinal fissure. The current orientation changed within the next 5 ms counterclockwise in all subjects, with a mean rotation of 64 degrees. A two-dipole time-varying model, with two dipoles differing by 28-119 degrees in orientation but less than 1 cm in location in the right SI cortex, explained the signal pattern satisfactorily during the first 100 ms. We suggest that the observed field patterns reflect sequential activation of different cytoarchitectonic areas in the foot SI cortex and imply considerable differences in the structural organization between the foot and the hand SI cortices. The initial activation is considered to take place in area 3b facing the interhemispheric fissure, and the later source, due to the systematic rotations of the field patterns, is assumed to reflect activation of area 5 in the anterior wall of the marginal ramus of the cingulate sulcus. PMID:9345503

Hari, R; Nagamine, T; Nishitani, N; Mikuni, N; Sato, T; Tarkiainen, A; Shibasaki, H

1996-10-01

324

Giant anterior mediastinal parathyroid adenoma.  

PubMed

A 57-year-old woman with type 2 diabetes was admitted to our hospital presenting with generalized bone pains, hypercalcemia, and elevated parathyroid hormone level. Enhanced CT scan demonstrated a large soft tissue mass in the right anterior mediastinum. Tc-MIBI scintigraphy revealed the focal accumulation of radiotracer uptake in the anterior mediastinum. Tc-MIBI SPECT/CT imaging also corroborated the same finding. The patient underwent surgery to have a giant ectopic parathyroid adenoma (7 × 4.5 × 1.5 cm) removed. The patient has been observed for 2 years, with normal parathyroid hormone and calcium levels. PMID:22889780

Li, Lianxi; Chen, Libo; Yang, Yi; Han, Junfeng; Wu, Songhua; Bao, Yuqian; Jia, Weiping

2012-09-01

325

Comparison study of therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming.  

PubMed

Tibia fractures are the most common type of long bone fractures in US. This study aimed at comparing the therapeutic results of closed tibial shaft fracture with intramedullary nails inserted with and without reaming. In this randomized clinical trial study, 60 patients with a fracture of the tibia were examined. The patients were randomly divided into two groups. Thirty patients treated through inserting intramedullary nail with reaming technique (group A). The other 30 patients treated through inserting intramedullary nail without reaming technique (group B). After operation physical examination and control radiography were taken up to 6 month and results were compared. Sixty patients suffering from closed tibial diaphysis fractures were studied. Mean age of the group A and B were 40.24 +/- 12.32 and 38.42 +/- 14.28, respectively. Group A consisted of 24 (80%) males and 6 (20%) females while group B consisted of 24% females and 76% males. Considering fracture based on OTA criteria (p = 0.4) and severity of soft tissue damage based on Tscherne classification (p = 0.6), there was no statistically meaningful difference between groups A and B. The study demonstrated that degree of horizontal displacement, mean time of surgery, post-operation infection, organ shortness at the end of the follow-up period, organ deviation in patients of the group A was significantly more than that of the group B. Time required for callus formation (mean time of union), mean time of full weight bearing time and mean time of return to normal activities in group B was significantly more than that of the group A. PMID:22514897

Sadighi, Ali; Elmi, Asghar; Jafari, Mohamad Ali; Sadeghifard, Vahid; Goldust, Mohamad

2011-10-15

326

[Diabetes insipidus and postpartum anterior hypophyseal insufficiency].  

PubMed

There have only been thirty cases of total post-partum hypopituitarism published in the literature and these have nearly all been secondary to Sheehan's syndrome. The authors report a case of partial anterior hypopituitarism associated with diabetes insipidus which arose after an uneventful Caesarean operation and the origin of which seems to lie in auto-immune hypophysitis. The authors first describe the morphological and endocrine changes that the hypophysis undergoes during pregnancy and then point out that auto-immune hypophysitis seems to have been only recently recognised. This can be used to explain some cases of post-partum hypophyseal insufficiency occurring almost silently without any history of third haemorrhage. Research has been made systematically for anti-hypophyseal antibodies and for specific antibodies of the organ, but has not always been positive. So the diagnosis of auto-immune hypophysitis is often made only after eliminating other reasons for it. A brief review of the physiopathological mechanisms of diabetes insipidus makes it possible to suggest that vasopressinase coming from the placenta together with prostaglandins could play a role. PMID:8228021

Tordjeman, N; Monnier, J C; Vantyghem-Haudiquet, M C; Bouthors-Ducloy, A S; Vinatier, D

1993-01-01

327

A symptomatic cyclops lesion 4 years after anterior cruciate ligament reconstruction.  

PubMed

The cyclops lesion is a fibrous nodule with central granulation tissue located anterolateral to the tibial tunnel after intra-articular reconstruction of the anterior cruciate ligament (ACL) that has been shown to be a cause of failure to regain full extension in the early postoperative period. We present the case of a 23-year-old woman who had undergone arthroscopic ACL reconstruction with a patellar tendon autograft 4 years prior to presentation. Following her reconstruction, she regained full range of motion and returned to collegiate cheerleading. At presentation, she complained of a gradual loss of full extension and joint-line pain with terminal extension. On examination, her graft was stable and she lacked 3 degrees of extension. Magnetic resonance imaging documented a 1-cm mass of low signal intensity immediately anterior to the ACL graft within the intercondylar notch. At arthroscopy, a large amount of thick, immobile scar tissue was found immediately anterior to the ACL, consistent with a cyclops lesion. The lesion was debrided and the patient did well postoperatively. Patients who present with delayed-onset loss of extension after ACL reconstruction should undergo careful evaluation including radiographs and magnetic resonance imaging. If a cyclops lesion is diagnosed, arthroscopic resection should be undertaken. PMID:11172260

Nuccion, S L; Hame, S L

2001-02-01

328

Subcutaneous anterior hairline forehead rhytidectomy  

Microsoft Academic Search

An anterior hairline incision with subcutaneous (superficial to the frontalis muscle) dissection is recommended for certain categories of rhytidectomy patients. Patient selection is a very important preoperative procedure. The technique and results are described and illustrated. Advantages and disadvantages are discussed.

Bahman Guyuron; Brian Davies

1988-01-01

329

The anterior vertical SMAS lift  

Microsoft Academic Search

With minimal skin and SMAS undermining, as well as a rotation point that is closest to the nasolabial folds and jowls, the “anterior vertical SMAS lift” reduces the risk of hematoma while optimizing direct pull on those surface features that require improvement. The vertical rotation enhances the malar region and decreases preauricular skin excision. Further, the author has found this

Robert W. Bernard

2003-01-01

330

Failure locus of the anterior cruciate ligament: 3D finite element analysis.  

PubMed

Anterior cruciate ligament (ACL) disruption is a common injury that is detrimental to an athlete's quality of life. Determining the mechanisms that cause ACL injury is important in order to develop proper interventions. A failure locus defined as various combinations of loadings and movements, internal/external rotation of femur and valgus and varus moments at a 25(o) knee flexion angle leading to ACL failure was obtained. The results indicated that varus and valgus movements were more dominant to the ACL injury than femoral rotation. Also, Von Mises stress in the lateral tibial cartilage during the valgus ACL injury mechanism was 83% greater than that of the medial cartilage during the varus mechanism of ACL injury. The results of this study could be used to develop training programmes focused on the avoidance of the described combination of movements which may lead to ACL injury. PMID:21590555

Homyk, Andrew; Orsi, Alexander; Wibby, Story; Yang, Nicholas; Nayeb-Hashemi, Hamid; Canavan, Paul K

2011-05-23

331

Long term outcome of anterior cervical discectomy and fusion using coral grafts  

Microsoft Academic Search

Background  To determine the long term efficacy of coral grafts in anterior cervical discectomy and fusion.\\u000a \\u000a \\u000a \\u000a Methods  In this prospective longitudinal study, All patients presenting with myelopathy and\\/or radiculopathy due to discal hernia\\u000a or cervical spondylosis underwent anterior cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior\\u000a cervical locking plates. Clinical and radiological post-operative evaluations were performed at 2 days, 3, 6, and

Najib Ramzi; Geraldo Ribeiro-Vaz; Edward Fomekong; Frédéric E. Lecouvet; Christian Raftopoulos

2008-01-01

332

Anatomical versus Non-Anatomical Single Bundle Anterior Cruciate Ligament Reconstruction: A Cadaveric Study of Comparison of Knee Stability  

PubMed Central

Background The purpose of this study was to compare the initial stability of anatomical and non-anatomical single bundle anterior cruciate ligament (ACL) reconstruction and to determine which would better restore intact knee kinematics. Our hypothesis was that the initial stability of anatomical single bundle ACL reconstruction would be superior to that of non-anatomical single bundle ACL reconstruction. Methods Anterior tibial translation (ATT) and internal rotation of the tibia were measured with a computer navigation system in seven pairs of fresh-frozen cadaveric knees under two testing conditions (manual maximum anterior force, and a manual maximum anterior force combined with an internal rotational force). Tests were performed at 0, 30, 60, and 90 degrees of flexion with the ACL intact, the ACL transected, and after reconstruction of one side of a pair with either anatomical or non-anatomical single bundle ACL reconstruction. Results Under manual maximal anterior force, both reconstruction techniques showed no significant difference of ATT when compared to ACL intact knee state at 30° of knee flexion (p > 0.05). Under the combined anterior and internal rotatory force, non-anatomical single-bundle ACL reconstruction showed significant difference of ATT compared to those in ACL intact group (p < 0.05). In contrast, central anatomical single bundle ACL reconstruction showed no significant difference of ATT compared to those in ACL intact group (p > 0.05). Internal rotation of the tibia showed no significant difference in the ACL intact, the ACL transected, non-anatomical reconstructed and anatomical reconstructed knees. Conclusions Anatomical single bundle ACL reconstruction restored the initial stability closer to the native ACL under combined anterior and internal rotational forces when compared to non-anatomical ACL single bundle reconstruction.

Lim, Hong-Chul; Yoon, Yong-Cheol; Wang, Joon-Ho

2012-01-01

333

Ankle arthrodesis combined with tibial lengthening using the Ilizarov apparatus.  

PubMed

We report our experience using the Ilizarov method to perform combined ankle arthrodesis and tibial lengthening in six patients (mean age 47 years; range 25-66 years). The average distraction length was 4.1 cm (range 1.1-6.8 cm), and the mean period of follow-up was 36 months (range 26-44 months). Three patients had active infection of the ankle. Four patients had undergone previous surgery, two of which were primary ankle arthrodeses. We performed compression-distraction in three patients and bone transport in three. In the compression-distraction group, the mean length gained was 1.9 cm, the mean external fixation index (EFI) was 144 days/cm, and the mean external fixation time was 246 days. In the bone transport group, the mean length gained was 6.2 cm, the mean EFI was 35.4 days/cm, and the mean external fixation time was 233 days. All cases achieved a good clinical result with a solid ankle arthrodesis and no infection, deformity, or need for additional support. The Ilizarov method may be practically applied for ankle arthrodesis, especially in complicated cases. The EFI and external fixation time tended to increase for patients with a length gain of 3 cm or less. PMID:12560881

Sakurakichi, Keisuke; Tsuchiya, Hiroyuki; Uehara, Kenji; Kabata, Tamon; Yamashiro, Teruhisa; Tomita, Katsuro

2003-01-01

334

High energy tibial plateau fractures treated with hybrid external fixation  

PubMed Central

Management of high energy intra-articular fractures of the proximal tibia, associated with marked soft-tissue trauma, can be challenging, requiring the combination of accurate reduction and minimal invasive techniques. The purpose of this study was to evaluate whether minimal intervention and hybrid external fixation of such fractures using the Orthofix system provide an acceptable treatment outcome with less complications. Between 2002 and 2006, 33 patients with a median ISS of 14.3 were admitted to our hospital, a level I trauma centre, with a bicondylar tibial plateau fracture. Five of them sustained an open fracture. All patients were treated with a hybrid external fixator. In 19 of them, minimal open reduction and stabilization, by means of cannulated screws, was performed. Mean follow-up was 27 months (range 24 to 36 months). Radiographic evidence of union was observed at 3.4 months (range 3 to 7 months). Time for union was different in patients with closed and grade I open fractures compared to patients with grade II and III open fractures. One non-union (septic) was observed (3.0%), requiring revision surgery. Pin track infection was observed in 3 patients (9.1%). Compared to previously reported series of conventional open reduction and internal fixation, hybrid external fixation with or without open reduction and minimal internal fixation with the Orthofix system, was associated with satisfactory clinical and radiographic results and limited complications.

2011-01-01

335

Nanoindentation Results from Direct Molded vs. Machined UHMWPE Tibial Bearings  

SciTech Connect

Nanoindentation has been used to compare the micromechanical properties of direct molded vs. machined bearing surfaces on UHMWPE tibial components. Differences in micromechanical properties (hardness and elastic storage modulus) were observed between these two types of bearing surfaces, and are believed to result from (1) differences in surface roughness, and (2) differences in morphology of the UHMWPE. Clinical studies of in-vivo UHMWPE wear rates in acetabular cups have reported differences between direct molded and machined bearings.{sup 1,2} Other studies of retrieved components have reported differences as well.{sup 3} Variations in surface characteristics (rather than bulk properties) may cause these differences in wear behavior. This study's objective was to compare micro-mechanical interactions at the bearing surfaces of direct molded components with those of machined components. A nanoindenter was used to perform instrumented microindentations on these surfaces. Da ta was analyzed to study both the load vs. displacement behavior during the indentation cycle, and also to measure the elastic storage modulus and hardness as a function of depth.

Higgins, J.E.; Joy, D.C.; Pharr, G.M.; Schmidt, M.A.; Swadener, J.G.

1999-11-13

336

Mini-open anterior spine surgery for anterior lumbar diseases  

Microsoft Academic Search

Minimally invasive surgeries including endoscopic surgery and mini-open surgery are current trend of spine surgery, and its\\u000a main advantages are shorter recovery time and cosmetic benefits, etc. However, mini-open surgery is easier and less technique\\u000a demanding than endoscopic surgery. Besides, anterior spinal fusion is better than posterior spinal fusion while considering\\u000a the physiological loading, back muscle function, etc. Therefore, we

Ruey-Mo Lin; Kuo-Yuan Huang; Kuo-An Lai

2008-01-01

337

Extensor retinaculum syndrome after distal tibial fractures: anatomical basis.  

PubMed

Fractures of the distal extremity of the tibia include physeal injuries among teenagers and more complex fractures among adults. Displacement causes the compression of the muscles located between the distal tibia and the superior extensor retinaculum (SER). Among the muscles of anterior compartment of the leg, the extensor hallucis longus (EHL) is particularly vulnerable due to the amount of muscle fibers extending under the SER. Consequently, a partial anterior compartment syndrome could result, affecting only the distal portion located under the SER. In clinical practice, Mubarak measured the intramuscular pressure isolated under the SER and suggested the physio-pathological hypothesis of a compression of distal muscle fibers. The aim of this study is to compare the ratios of anterior compartment muscle fibers extending under the SER. Twenty legs were dissected in order to study how much of these muscles extend under the SER, their passages possibly dividing into two of the SER, as well as their vascularization and their innervation. On the last seven legs, the engagement of the muscles were measured in the spontaneous position and with a dorsal flexion of 0 degrees . The posterior muscle fibers of this compartment always descend lower than the anterior fibers. EHL muscle fibers and those of the inconsistent fibularis tertius always extend under the retinaculum, unlike those of the tibialis anterior and of the extensor digitorum longus. The EHL muscle extends under the SER more than the other muscles. Its posterior fibers are longer when this muscle goes through a dividing into two of the retinaculum. Its vascularization seems lesser, which could explain why this muscle tends to suffer more. The deep fibular nerve innervates the anterior compartment of the leg, yet no nerve branches can be found under the upper edge of the retinaculum. In all cases, the muscle fibers do not extend as much under the SER in a 0 degrees of dorsal flexion. This anatomical study allows us to explain why the EHL is more likely to suffer from this partial compartment syndrome and confirms that when the latter occurs it is necessary, in all cases, to do emergency surgery opening the distal crural fascia and necessarily including the SER. PMID:17502984

Haumont, T; Gauchard, G C; Zabee, L; Arnoux, J-M; Journeau, P; Lascombes, P

2007-05-15

338

Evaluation of the vascular status of autogenous hamstring tendon grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography.  

PubMed

The purpose of this study is to evaluate the vascular status of autogenous semitendinosus grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography. Twelve patients (mean age, 24.3 years) who underwent anterior cruciate ligament reconstruction with the 4-strand semitendinosus tendon were studied. All patients underwent contrast-enhanced magnetic resonance angiography and second-look arthroscopy in their reconstructed knees on an average of 15.8 months (range 9-22 months) after surgery. Blood vessels to the graft were visualised and contrast medium enhancement for visualising the femoral tunnel, graft, and tibial tunnel was evaluated. Magnetic resonance angiography showed that a branch of the middle genicular artery extended to the upper side of the graft through the posterior capsule and that branches of the inferior genicular artery ended at the lower side of the graft in all patients. These were consistent with the actual findings of the second-look arthroscopy. We found contrast medium enhancement in the femoral and tibial tunnels in all patients. The effect of enhancement at 9 months after ACL reconstruction was higher than that at 22 months. The graft showed enhancement patterns in the posterior portion of the femoral side and the anterior portion of the tibial side. This study demonstrated that the branches of the middle and inferior genicular arteries provide blood supply to the graft, which may influence the maturation of the graft. The revascularisation of the bone tunnels could play an important role in the healing of the ligament-bone tunnel junction. PMID:18193195

Arai, Yuji; Hara, Kunio; Takahashi, Takeshi; Urade, Hidenori; Minami, Ginjiro; Takamiya, Hisatake; Kubo, Toshikazu

2008-01-09

339

Spontaneous resolution of double anterior chamber with perforation of Descemet's membrane in deep anterior lamellar keratoplasty  

PubMed Central

Deep anterior lamellar keratoplasty (DALK) using Dr. Anwar's big bubble technique was performed for a patient with granular dystrophy. Intraoperatively, a perforation of the Descemet's membrane (DM) was noted inferonasally. Though the surgery was completed, the donor graft appeared to have an intact endothelium, which was inadvertently left behind by the surgeon. Intraoperatively, there was a perforation of inferonasal DM and surgery was completed by inadvertently placing a donor with an intact endothelium. Postoperatively the patient presented with a complete DM detachment and a resultant double anterior chamber (DAC). In spite of two attempts at an air tamponade on the first and fifth post operative days, the DAC still persisted. Surprisingly, during the 6th week follow up visit, there was a complete resolution of the DAC as well as total recovery of vision. This interesting case clearly exemplifies that, in spite of failed attempts at air tamponade, a DM detachment and a DAC due to DM perforation following a DALK procedure can resolve spontaneously with good visual outcome.

Venkatraman, Arvind

2012-01-01

340

Spontaneous resolution of double anterior chamber with perforation of Descemet's membrane in deep anterior lamellar keratoplasty.  

PubMed

Deep anterior lamellar keratoplasty (DALK) using Dr. Anwar's big bubble technique was performed for a patient with granular dystrophy. Intraoperatively, a perforation of the Descemet's membrane (DM) was noted inferonasally. Though the surgery was completed, the donor graft appeared to have an intact endothelium, which was inadvertently left behind by the surgeon. Intraoperatively, there was a perforation of inferonasal DM and surgery was completed by inadvertently placing a donor with an intact endothelium. Postoperatively the patient presented with a complete DM detachment and a resultant double anterior chamber (DAC). In spite of two attempts at an air tamponade on the first and fifth post operative days, the DAC still persisted. Surprisingly, during the 6(th) week follow up visit, there was a complete resolution of the DAC as well as total recovery of vision. This interesting case clearly exemplifies that, in spite of failed attempts at air tamponade, a DM detachment and a DAC due to DM perforation following a DALK procedure can resolve spontaneously with good visual outcome. PMID:22993468

Venkatraman, Arvind

2012-05-01

341

Extensor retinaculum syndrome after distal tibial fractures: anatomical basis  

Microsoft Academic Search

Fractures of the distal extremity of the tibia include physeal injuries among teenagers and more complex fractures among adults.\\u000a Displacement causes the compression of the muscles located between the distal tibia and the superior extensor retinaculum\\u000a (SER). Among the muscles of anterior compartment of the leg, the extensor hallucis longus (EHL) is particularly vulnerable\\u000a due to the amount of muscle

T. Haumont; G. C. Gauchard; L. Zabee; J.-M. Arnoux; P. Journeau; P. Lascombes

2007-01-01

342

Update on anterior ankle impingement.  

PubMed

Anterior ankle impingement results from an impingement of the ankle joint by a soft tissue or osteophyte formation at the anterior aspect of the distal tibia and talar neck. It often occurs secondary to direct trauma (impaction force) or repetitive ankle dorsiflexion (repetitive impaction and traction force). Chronic ankle pain, swelling, and limitation of ankle dorsiflexion are common complaints. Imaging is valuable for diagnosis of the bony impingement but not for the soft tissue impingement, which is based on clinical findings. MR imaging and MR arthrography are helpful in doubtful diagnoses and the identification of associated injuries. Recommended methods for initial management include rest, physical therapy, and shoe modification. If nonoperative treatment fails, arthroscopic bony or soft tissue debridement both offer significant symptomatic relief with long-term positive outcomes in cases that have no significant arthritic change, associated ligament laxity, and chondral lesion. PMID:22403038

Vaseenon, Tanawat; Amendola, Annunziato

2012-06-01

343

The influence of tibial tray design on the wear of fixed-bearing total knee replacements.  

PubMed

Debris-induced osteolysis due to surface wear is a potential long-term problem in total knee replacements (TKRs). Wear between the tibial tray and ultra-high molecular weight polyethylene insert is thought to contribute to the wear. This study investigated the influence of tibial tray design on the wear of fixed-bearing TKRs. Specifically, this study investigated the influence of the material's surface finish and design characteristics of the locking mechanism of the tibial tray on the wear in fixed-bearing knees for both cruciate-retaining (CR) and posterior-stabilized designs. A new fixed-bearing tibial tray design using Co-Cr and with an improved locking mechanism significantly reduced polyethylene wear from 22.8 +/- 6.0 mm3 per 10(6) cycles to 15.9 +/- 2.9 mm3 per 10(6) cycles compared with a previous titanium alloy tray with a CR design. The wear rates were similar to those of a fixed-bearing insert clamped into a tibial tray, suggesting that the decrease in wear was due to a reduction in backside wear. There was no significant difference between the wear rates of a cruciate-retaining design and a posterior-stabilized design under the two kinematic conditions tested. PMID:19143421

Galvin, A; Jennings, L M; McEwen, H M; Fisher, J

2008-11-01

344

Sequential avulsions of the tibial tubercle in an adolescent basketball player.  

PubMed

Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life. PMID:20093955

Huang, Ying Chieh; Chao, Ying-Hao; Lien, Fang-Chieh

2010-05-01

345

Improved Biometry of the Anterior Eye Segment  

Microsoft Academic Search

In this paper, a method is presented to evaluate the true values of several optical parameters of the anterior eye segment. These are: the thicknesses of the cornea and lens, the depth of the anterior chamber and the anterior and posterior curvatures of the cornea and lens. First, a photo is taken of each patient’s eye with a Topcon SL-45

T. Kampfer; A. Wegener; V. Dragomirescu; O. Hockwin

1989-01-01

346

Secondary anterior crocodile shagreen of Vogt  

Microsoft Academic Search

The clincopathological features and pathogenesis of secondary mosaic degeneration of the cornea (anterior crocodile shagreen of Vogt) are described. The structural basis for the normal anterior corneal mosaic pattern seems to lie in the particular arrangement of many prominent collagen lamellae of the anterior stroma that thake an oblique course to gain insertion into Bowman's layer. Since, at normal intraocular

R C Tripathi; A J Bron

1975-01-01

347

Anterior and posterior ankle impingement.  

PubMed

Anterior ankle impingement is characterized by anterior ankle pain on activity. Recurrent (hyper) dorsiflexion is often the cause. Typically, there is pain on palpation at the anteromedial or anterolateral joint line. Some swelling or limitation in dorsiflexion are present. Plain radiographs can disclose the cause of the impingement. In the case of spurs or osteophytes, the diagnosis is anterior bony impingement. In the absence of spurs or osteophytes, the diagnosis is anterior soft tissue impingement. In patients with anteromedial impingement, plain radiographs ae often falsely negative. An oblique view (anteromedial impingement view = AMI view) is recommended in these patients. Arthroscopic management with removal of the offending tissue provides good to excellent long-term (5-8 years) results in 83% of patients with grade 0 and grade I lesions. Long-term results are good/excellent in 50% of patients with grade II lesions (osteophytes secondary to arthritis with joint space narrowing). In posterior ankle impingement, patients experience hindfoot pain when the ankle is forcedly plantarflexed. Trauma or overuse can be the cause. The trauma mechanism is hyperplantarflexion or a combined inversion plantarflexion injury. Overuse injuries typically occur in ballet dancers and downhill runners, who report pain on palpation at the posterolateral aspect of the talus. On plain radiographs, an os trigonum or hypertrophic posterior or talar process can be detected. Surgical management involves removal of the os trigonum, scar tissue, or hypertrophic posterior talar process. In the case of combined posterior bony impingement and flexor hallucis longus tendinopathy, a release of the flexor hallucis longus is performed simultaneously. Endoscopic management is associated with a low morbidity, a short recovery time, and provides good/excellent results at 2-5 years follow-up in 80% of patients. PMID:16971256

Niek van Dijk, C

2006-09-01

348

Full knee extension magnetic resonance imaging for the evaluation of intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction  

Microsoft Academic Search

Purpose  The purpose of this study was to reveal the relationship between anatomically placed anterior cruciate ligament (ACL) graft\\u000a and the intercondylar roof using magnetic resonance imaging (MRI).\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Twenty patients undergoing anatomical double-bundle ACL reconstruction were included in this study. Anatomical double-bundle\\u000a ACL reconstruction was performed with two femoral tunnels (antero-medial; AM and postero-lateral; PL) and two tibial tunnels.\\u000a Hamstring autograft

Takanori Iriuchishima; Kenji Shirakura; Takashi Horaguchi; Yusuke Morimoto; Freddie H. Fu

349

Avulsion fractures of the tibial tuberosity in adolescent athletes treated by internal fixation and tension band wiring  

Microsoft Academic Search

Avulsion of the tibial tuberosity is a rarely reported fracture. It is mainly considered as an athletic injury accounting for less than 3% of all epiphyseal lesions. In this study, we hypothesized that the use of tension band wiring as a supplement of the internal fixation for the avulsion fractures of the tibial tuberosity would lead the adolescent athletes to

Panayiotis A. Nikiforidis; George C. Babis; Ioannis K. Triantafillopoulos; George S. Themistocleous; Konstantinos Nikolopoulos

2004-01-01

350

Post varicella angiopathy.  

PubMed

Varicella zoster vasculopathy is a rare complication of chicken pox. Varicella cerebellitis, a post or para-infectious condition, is a common sequelae of chicken pox. Varicella angiopathy presents as acute hemiparesis, aphasia, hemianaesthesia or other focal neurologic or retinal deficits associated with mononuclear pleocytosis and VZV specific antibodies in CSF. Varicella angiopathy affecting the posterior circulation is very rare. We report a 15 yr old boy with progressive neurologic deficits over a month following a chicken pox 3 months prior to the onset of symptoms. On investigation he had infarcts both in the anterior and posterior circulation territories in CT and MRI with mononuclear pleocytosis in CSF elevated IgG and IgM in CSF. He was treated with intravenous acyclovir and corticosteroids. PMID:21391380

Selvakumar, C J; Justin, C; Gnaneswaran, T R; Chandrasekaran, M

2010-09-01

351

Combined Posterior and Anterior Ankle Arthroscopy  

PubMed Central

Treatment of combined anterior and posterior ankle pathology usually consists of either combined anterior and posterior arthrotomies or anterior ankle arthroscopy with an additional posterolateral portal. The first technique bears the risk of complications associated with the extensive exposure, the latter technique provides limited access to the posterior ankle joint. A case is described of combined anterior and posterior arthroscopy, with the patient lying prone and then turned supine, addressing both anterior and posterior ankle pathologies in one tempo. This minimally invasive combined approach allows quick recovery and early return to work and sports activities.

Scholten, Peter E.; van Dijk, C. Niek

2012-01-01

352

The evaluation of knee bone mineral density following open-wedge high tibial osteotomy.  

PubMed

Examinations of bone density changes in selected knee bone ends were evaluated prospectively in a randomized group of 28 patients, aged from 41 to 65 (mean: 55.3 years), who had varus deformations of their mechanic limb axes, mean 8 degrees. The examinations were conducted during the preoperative period, 10 days, 3, 6, and 12 weeks, as well as 6 and 12 months after the procedure. A statistically significant increase in bone density was observed in the medial tibial condyle area, while a statistically insignificant decrease of bone density was noted in the medial femoral condyles. Bone density increased in the lateral tibial condyle area, whereas there were no density changes in the area of the lateral femoral condyles. The research results demonstrate that the relief achieved in ailments after high tibial osteotomies does not directly correspond to the bone density of the affected areas. PMID:22085840

Kosior, Piotr; Czuraszkiewicz, Lukasz; Tarczynska, Marta; Mazurkiewicz, Tomasz; Gaweda, Krzysztof

2011-11-14

353

Ultrastructure of Fusarium-induced tibial dyschondroplasia in chickens: a sequential study.  

PubMed

Female broiler chicks were randomly placed into two groups; one was treated twice daily with TDP-1 (a mycotoxin produced by Fusarium roseum), the other was controls. Chicks were sacrificed after 2, 4, 6, 8, 10, and 14 days of treatment and were evaluated for tibial dyschondroplasia. TDP-1-treated chicks examined after 2, 4, or 6 days of treatment had either no gross lesions (2 days) or mild gross lesions (4 and 6 days); growth plates from these groups did not have ultrastructural changes. TDP-1-treated chicks examined after 8, 10, or 12 days of treatment had moderate to severe gross lesions of tibial dyschondroplasia. These groups also had intracellular lipid accumulation and necrosis of chondrocytes within the retained cartilage. It was concluded that the cellular changes in tibial dyschondroplasia develop only after the cartilage accumulates; the changes are sequelae, possibly due to nutrient depletion from an increased distance between chondrocytes and perforating epiphyseal vessels, their nutrient source. PMID:2856859

Haynes, J S; Walser, M M

1986-07-01

354

A Qualitative Study of Recovery from Type III-B and III-C Tibial Fractures  

PubMed Central

The literature has shown that long-term outcomes for both below-knee amputation and reconstruction following type III-B and III-C tibial fracture are poor. Yet, patients often report satisfaction with their treatment and/or outcomes. The aim of this study is to explore the relationship between patient outcomes and satisfaction after open tibial fractures via qualitative methodology. Twenty patients who were treated for open tibial fractures at one institution were selected using purposeful sampling and interviewed in-person in a semi-structured manner. Data were analyzed using grounded theory methodology. Despite reporting marked physical and psychosocial deficits, participants relayed high satisfaction. We hypothesize that the use adaptive coping techniques successfully reduces stress, which leads to an increase in coping self-efficacy that results in the further use of adaptive coping strategies, culminating in personal growth. This stress reduction and personal growth leads to satisfaction despite poor functional and emotional outcomes.

Shauver, Melissa S.; Aravind, Maya S.; Chung, Kevin C.

2011-01-01

355

Tosic external fixator in the management of proximal tibial fractures in adults.  

PubMed

This retrospective clinical study assessed proximal tibial fractures managed with the Tosic external fixator. Nineteen patients with 21 proximal tibial fractures treated with the Tosic external fixator between July 1997 and October 1998 comprised the study population. Eleven fractures were graded as 41A2, 3 fractures as 41 A3, 4 fractures as 41C1, and 3 fractures as 41 C2. Fourteen fractures were closed, and 7 fractures were open. Average time to healing was 1 7 weeks. No revision of fixation was needed. There were five cases of pin tract infection. Average range of knee motion was 2 degrees-135 degrees. These results indicate the Tosic external fixator is an efficient and simple way to treat proximal tibial metaphyseal fractures. PMID:11430739

Tosic, A; Ebraheim, N A; Abou Chakra, I; Emara, K

2001-06-01

356

Clinical Results of Technique for Double Bundle Anterior Cruciate Ligament Reconstruction Using Hybrid Femoral Fixation and Retroscrew  

PubMed Central

Background Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome. Methods Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration. Results Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up. Conclusions Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.

Kim, Doo-Sup; Yi, Chang-Ho; Chung, Hoi-Jung

2011-01-01

357

A method of determining the angular malalignments of the knee and ankle joints resulting from a tibial malunion.  

PubMed

Malalignments of the knee and ankle joints resulting from tibial angular malunion can be determined using mathematical analysis. The angular deformity of the tibia is equal to the sum of the angular malalignments formed by the knee and ankle joints in relation to the horizontal plane. These malalignments are not equal. A larger percentage of the deformity is reflected inferiorly as the deformity approaches the ankle joint. A table was formulated to provide the corresponding degrees of joint malalignment (knee and ankle) for tibial angular deformities at different positions along the tibia. The analysis provides a useful tool to quantify the knee and ankle joint malalignments secondary to tibial angular malunion. Although designation of prognosis at different degrees of angular deformity is beyond the scope of this study, it does provide improved correlation between tibial angular deformities and the clinical outcome, e.g., degenerative arthroses of the adjacent joints, in future studies on tibial fractures. PMID:3652579

Puno, R M; Vaughan, J J; von Fraunhofer, J A; Stetten, M L; Johnson, J R

1987-10-01

358

Chronic shin splints. Classification and management of medial tibial stress syndrome.  

PubMed

A clinical classification and treatment programme has been developed for chronic medial tibial stress syndrome. Medial tibial stress syndrome has been reported to be either tibial stress fracture or microfracture, tibial periostitis, or distal deep posterior chronic compartment syndrome. Three chronic types exist and may coexist: Type I (tibial microfracture, bone stress reaction or cortical fracture); type II (periostalgia from chronic avulsion of the periosteum at the periosteal-fascial junction); and type III (chronic compartment syndrome syndrome). Type I disease is treated nonoperatively. Operations for resistant types II and III medial tibial stress syndrome were performed in 41 patients. Bilaterality was common (type II, 50% type III, 88%). Seven had coexistent type II/III; one had type I/II. Preoperative symptoms averaged 24 months in type II, 6 months in type III, and 33 months in types II/III. Mean age was 22 years (15 to 51). Resting compartment pressures were normal in type II (mean 12 mm Hg) and elevated in type III and type II/III (mean 23 mm Hg). Type II and type II/III patients received fasciotomy plus periosteal cauterisation. Type III patients had fasciotomy only. All procedures were performed on an outpatient basis using local anaesthesia. Follow up was complete and averaged 6 months (2 to 14 months). Improved performance was as follows: type II, 93%, type III, 100%; type II/III, 86%. Complete cures were as follows: type II, 78%; type III, 75%; and type II/III, 57%. This experience suggests that with precise diagnosis and treatment involving minimal risk and cost the athlete has a reasonable chance of return to full activity. PMID:3787005

Detmer, D E

359

Anterior-posterior asymmetry in iris mechanics measured by indentation.  

PubMed

Indentation and histological analysis of the porcine iris were done to assess the relative stiffness of the anterior (stroma) and posterior (dilator and sphincter) layers. The dimensions of the constituent structures were documented histologically by staining with a monoclonal anti-human ?-smooth muscle actin antibody to determine the location of the stroma, sphincter, and dilator. Intact porcine irides (4-8 h post-mortem) were bisected into two equal C-shaped halves to indent both surfaces. Indentation experiments were performed using a 1 mm cylindrical indenter tip. The load-displacement curve for each experiment was used to estimate effective instantaneous and equilibrium moduli for the anterior and posterior surfaces of the tissue. A total of 18 irides (9 pairs) with 3-5 indentations per iris surface was performed. The average thickness of the samples was 550 ?m; the indentation depth was limited to 60-100 ?m depending on the thickness of the sample at each point. Posterior surface indentation gave larger forces than anterior, with the resulting instantaneous modulus of 6.0 ± 0.6 kPa versus 4.0 ± 0.5 kPa (mean ± 95% CI, n = 45, p < 0.001) and equilibrium modulus of 4.4 ± 0.9 versus 2.3 ± 0.3 (p = 0.007). The stress-relaxation analysis revealed that the anterior surface had a shorter relaxation time (121.31 ± 6.84 s) than the posterior surface (210.61 ± 9.41 s, p = 0.03), perhaps due to the permeability of the stroma. Recognizing that our effective modulus calculations in this study did not account for heterogeneity, viscoelasticity, or poroelasticity, we conclude that the posterior components of the iris - dilator, pigment epithelium, and sphincter - are on average stiffer than the stroma and anterior border layer. PMID:21787771

Whitcomb, Julie E; Amini, Rouzbeh; Simha, Narendra K; Barocas, Victor H

2011-07-23

360

In Vitro Quantification of Wear in Tibial Inserts Using Microcomputed Tomography  

Microsoft Academic Search

Background  Wear of polyethylene tibial inserts can decrease the longevity of total knee arthroplasty. Wear is currently assessed using\\u000a laboratory methods that may not permit backside wear measurements or do not quantify surface deviation.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We developed and validated a technique to quantify polyethylene wear in tibial inserts using microcomputed tomography (micro-CT),\\u000a a nondestructive high-resolution imaging technique that provides detailed images of

Matthew G. Teeter; Douglas D. R. Naudie; David D. McErlain; Jan-M. Brandt; Xunhua Yuan; Steven J. MacDonald; David W. Holdsworth

2011-01-01

361

Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study  

Microsoft Academic Search

Purpose  To identify and describe reliable landmarks for tibial tunnel placement in anatomical ACL reconstruction.\\u000a \\u000a \\u000a \\u000a Methods  Eight non-paired cadaveric knees were used. After dissection, the tibial plateaus, menisci and ACL insertions were grossly\\u000a observed to identify anatomical landmarks and relate them to the ACL insertion site. The specimens were scanned with a laser\\u000a scanner, and 3-Dimensional images were obtained. Measurements of the

Mario Ferretti; Daniel Doca; Sheila M. Ingham; Moises Cohen; Freddie H. Fu

362

Complications associated with 696 tibial plateau leveling osteotomies (2001-2003).  

PubMed

A total of 696 tibial plateau leveling osteotomy (TPLO) procedures were performed over a 30-month period following TPLO training. The overall complication rate was 18.8%. Complications were classified as perioperative (1%), short-term (9.3%), and long-term (8.5%). Examples of complications encountered during the study were hemorrhage, swelling at the incision site, premature staple removal by the dog, tibial tuberosity fracture, patella tendon swelling, and implant complications. Based on the rate of complications observed, clinical outcomes of TPLO procedures within 30 months of TPLO training were considered good. PMID:16397194

Stauffer, Kent D; Tuttle, Trent A; Elkins, A D; Wehrenberg, Aaron P; Character, Ben J

363

A comparison of the effect of shoes on human tibial axial strains recorded during dynamic loading.  

PubMed

Percutaneous axial extensometers were mounted on the medial cortex of the midtibial diaphysis in seven male volunteers and the effect of three different shoes on in vivo peak-to-peak axial compression-tension strains measured during dynamic loading. Zohar shoes had lower axial strains and strain rates during treadmill walking than Nike Air Max running shoes or Israeli infantry boots. During running on a running track, there was no statistically significant difference between the axial strains or strain rates between the shoes tested. Shoe gear can modify tibial strains and strain rates that contribute to the development of tibial stress fractures. PMID:9498580

Milgrom, C; Burr, D; Fyhrie, D; Hoshaw, S; Finestone, A; Nyska, M; Davidson, R; Mendelson, S; Giladi, M; Liebergall, M; Lehnert, B; Voloshin, A; Simkin, A

1998-02-01

364

Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee  

Microsoft Academic Search

Objective  To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat varus knee\\u000a in young and active patients.\\u000a \\u000a \\u000a \\u000a Methods  Between June 2001 to July 2008, 18 patients with monocompartmental degeneration of the knee combined with a varus malalignment\\u000a of the leg had the modified biplanar opening high tibial osteotomy and the osteotomy was fixed with the

Hai-ning Zhang; Jie Zhang; Cheng-yu Lv; Ping Leng; Ying-zhen Wang; Xiang-da Wang; Chang-yao Wang

2009-01-01

365

Effect of Varying Hamstring Tension on Anterior Cruciate Ligament Strain During in Vitro Impulsive Knee Flexion and Compression Loading  

PubMed Central

Background: The hamstring muscles are well positioned to limit both anterior tibial translation and anterior cruciate ligament strain during the knee flexion phase of a jump landing. We hypothesized that systematically increasing or decreasing hamstring tension during the knee flexion phase of a simulated jump landing would significantly affect peak relative strain in the anterior cruciate ligament. Methods: Ten cadaveric knees from four male and six female donors (mean age [and standard deviation] at the time of death, 60.3 ± 23.6 years) were mounted in a custom fixture to initially position the specimen in 25° of knee flexion and simulate axial impulsive loading averaging 1700 N to cause an increase in knee flexion. Quadriceps, hamstring, and gastrocnemius muscle forces were simulated with use of pretensioned linear springs, with the tension in the hamstrings arranged to be increased, held constant, decreased, at “baseline,” or absent during knee flexion. Impulsive loading applied along the tibia and femur was monitored with use of triaxial load transducers, while uniaxial load cells monitored quadriceps and medial and lateral hamstring forces. Relative strain in the anterior cruciate ligament was measured with use of a differential variable reluctance transducer, and tibiofemoral kinematics were measured optoelectronically. For each specimen, anterior cruciate ligament strains were recorded over eighty impact trials: ten preconditioning trials, ten “baseline” trials involving decreasing hamstring tension performed before and after three sets of ten trials conducted with increasing hamstring tension, constant hamstring tension, or no hamstring tension. Peak relative strains in the anterior cruciate ligament were normalized for comparison across specimens. Results: Increasing hamstring force during the knee flexion landing phase decreased the peak relative strain in the anterior cruciate ligament by >70% compared with the baseline condition (p = 0.005). Neither a constant hamstring muscle force nor the absence of a hamstring force significantly changed the peak strain in the anterior cruciate ligament relative to the baseline condition. Conclusions: Increasing hamstring muscle force during the knee flexion phase of a simulated jump landing significantly reduces the peak relative strain in the anterior cruciate ligament in vitro. Clinical Relevance: It may be possible to proactively limit peak anterior cruciate ligament strain during the knee flexion phase of jump landings by accentuating hip flexion, thereby increasing the tension in active hamstring muscles by lengthening them.

Withrow, Thomas J.; Huston, Laura J.; Wojtys, Edward M.; Ashton-Miller, James A.

2008-01-01

366

Anterior tooth wear and retention type until 5 years after orthodontic treatment  

Microsoft Academic Search

OBJECTIVES: To study occlusal wear of anterior teeth in orthodontic patients retained with different retainers until 5 years post-treatment, and to investigate whether type of retention influences occlusal wear. MATERIAL AND METHODS: Orthodontic patients (n=222), aged 15 years maximally at the start of treatment, were followed until 5 years post-treatment. In the maxilla, a retainer bonded on all six teeth

Mette Kuijpers; Stavros Kiliaridis; Annemarie Renkema; Ewald Bronkhorst; Anne Kuijpers-Jagtman

2009-01-01

367

[Injuries and dysfunction of the posterior tibial tendon].  

PubMed

The function of the posterior tibial (PT) tendon is to stabilize the hindfoot against valgus and eversion forces. It functions as the primary invertor of the foot and assists the Achilles tendon in plantar flexion. The PT tendon is a stance phase muscle, firing from heel strike to shortly after heel lift-off. It decelerates subtalar joint pronation after heel contact. It functions as a powerful subtalar joint supinator and as a support of the medial longitudinal arch. The action of the tendon travels to the transverse tarsal joints, locking them and allowing the gastrocnemius to support heel rise. Acute injuries of the PT tendon are rare and mostly affect the active middle-aged patient or they are the result of complex injuries to the ankle joint complex. Dysfunction of the PT tendon following degeneration and rupture, in contrast, has shown an increasing incidence in recent years. To which extent changed lifestyle, advancing age, comorbidities, and obesity play a role has not yet been clarified in detail. Dysfunction of the PT tendon results in progressive destabilization of the hind- and midfoot. Clinically, the ongoing deformation of the foot can be classified into four stages: in stage 1, the deformity is distinct and fully correctable; in stage II, the deformity is obvious, but still correctable; in stage III, the deformity has become stiff; and in stage IV, the ankle joint is also involved in the deformity. Treatment modalities depend on stage: while conservative measures may work in stage I, surgical treatment is mandatory for the later stages. Reconstructive surgery is advised in stage II, whereas in stage III and IV correcting and stabilizing arthrodeses are advised. A promising treatment option for stage IV may be adding an ankle prosthesis to a triple arthrodesis, as long as the remaining competence of the deltoid ligament is sufficient. An appropriate treatment is mandatory to avoid further destabilization and deformation of the foot. Failures of treatment result mostly from underestimation of the problem or insufficient treatment of existing instability and deformity. PMID:21088955

Hintermann, B; Knupp, M

2010-12-01

368

Differential diagnosis of anterior chamber cysts with ultrasound biomicroscopy: ciliary body medulloepithelioma  

PubMed Central

Purpose To describe a case with motile cyst in the anterior chamber in the right eye of a 7-year-old boy. Methods The right eye's visual acuity was 20/50. Intraocular pressure was 59 mmHg. Slit-lamp examination showed prominent rubeosis iridis and a grey-white mass floating freely in the anterior chamber. Ultrasound biomicroscopy revealed a cystic mass in the anterior chamber. A diagnostic cyclectomy with removal of the anterior chamber cyst was performed. Histopathology of the anterior chamber lesion showed an intact cyst composed of medullary epithelial cells. Medulloepithelioma with malignant criteria was diagnosed and the eye was enucleated. Results Pathology demonstrated an medulloepithelioma with a few mitotic figures and nuclear pleomorphisms within the ciliary body. The patient was followed for 8 months without any metastasis in the orbit or elsewhere. Conclusion Intraocular medulloepithelioma is a rare embryonic benign or malignant neoplasm typically diagnosed in the first decade of life as a ciliary body mass. A dislodged, free-floating anterior chamber cyst associated with neovascular glaucoma is typical of medulloepithelioma in children. This unique presentation should be differentiated from congenital iris epithelial, post-traumatic, epithelial, parasitic and neoplastic cysts. Ultrasound biomicroscopy is useful for analysing the structure of the anterior segment mass. Ciliary body medulloepithelioma is characterized by echogenic mass heterogeneity and an irregular surface containing multiple cystic cavities. Lack of glial differentiation may predict a better clinical outcome in primary neuroectodermal brain tumours.

Zhou, Min; Xu, Gezhi; Bojanowski, Christine M.; Song, Yuelian; Chen, Rongjia; Sun, Xinhuai; Wang, Weiji; Chan, Chi-Chao

2008-01-01

369

Study of the post-natal effects of chemopreventive agents on ethylnitrosourea-induced transplacental carcinogenesis in rats. II. Influence of low-molecular-weight polypeptide factors from the thymus, pineal gland, bone marrow, anterior hypothalamus, brain cortex and brain white substance  

Microsoft Academic Search

The influence of the polypeptide factors extracted from thymus, pineal gland, bone marrow, anterior hypothal- amus, brain cortex or brain white substance on N-ethyl-ZV- nitrosourea (ENU)-induced transplacental carcinogenesis was studied in rats. ENU was given to pregnant rats as a single i.v. exposure at a dose of 75 mg\\/kg body weight on the 21st day of gestation. The polypeptide factors

Valerij A. Alexandrov; Vladimir G. Bespalov; Vjacheslav G. Morozov; Vladimir Kh. Khavinson; Vladimir N. Anisimov

1996-01-01

370

Impact of Partial and complete rupture of anterior cruciate ligament on medial meniscus: A cadavaric study  

PubMed Central

Background: The clinical relationship between medial meniscus tear and anterior cruciate ligament (ACL) rupture has been well documented. However, the mechanism of this clinical phenomenon is not exactly explained. Our aim is to investigate the biomechanical impact of partial and complete ACL rupture on different parts of medial meniscus. Materials and Methods: Twelve fresh human cadaveric knee specimens were divided into four groups: ACL intact (ACL-I), anteromedial bundle transection (AMB-T), posterolateral bundle transection (PLB-T), and ACL complete transection (ACL-T) group. Strain on the anterior horn, body part, and posterior horn of medial meniscus were measured under 200 N axial compressive tibial load at 0°, 30°, 60°, and 90° of knee flexion, respectively. Results: Compared with the control group (ACL-I), the ACL-T group had a higher strain on whole medial meniscus at 0°, 60°, and 90° of flexion. But at 30°, it had a higher strain on posterior horn of meniscus only. As to PLB-T group, strain on whole meniscus increased at full extension, while strain increased on posterior horn at 30° and on body of meniscus at 60°. However, AMB-T only brought about higher strain at 60° of flexion on body and posterior horn of meniscus. Conclusions: Similar to complete rupture, partial rupture of ACL can also trigger strain concentration on medial meniscus, especially posterior horn, which may be a more critical reason for meniscus injury associated with chronic ACL deficiency.

Jiang, Wei; Gao, Shu-guang; Li, Kang-hua; Luo, Ling; Li, Yu-sheng; Luo, Wei; Lei, Guang-hua

2012-01-01

371

New meniscus repair technique for peripheral tears near the posterior tibial attachment of the posterior horn of the medial meniscus.  

PubMed

We introduce a suture technique to repair a peripheral tear near the posterior tibial attachment of the posterior horn. A suture hook was inserted through the posteromedial portal, and the peripheral capsular rim was penetrated from superior to inferior by the sharp hook. Both relay limbs were brought out through the posteromedial portal. The outer limb of the superior peripheral capsular rim was identified with a hemostat. An 18-gauge spinal needle loaded with a No. 0 polydioxanone suture (PDS) was introduced into the joint from the anteromedial portal; it was passed through the joint space until it penetrated the inner torn meniscus. The PDS suture loaded within the needle was pushed into the joint and picked up through the posteromedial portal. The needle was pulled out of the torn meniscus and readvanced over it while the suture was kept loaded. The other limb of the suture from the tip of the spinal needle was retrieved through the posteromedial portal. The initial PDS suture limb was hooked to the shuttle-relay system; it then was passed through the inner torn meniscus and the peripheral capsular rim. The suture limb exiting from the peripheral capsular rim was used as a post and was joined to the other suture limb to form a sliding knot. PMID:16904598

Park, In-Seop; Kim, Sung-Jae

2006-08-01

372

Corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament injury  

Microsoft Academic Search

In the present report, we investigated changes in corticomotor excitability associated with unilateral knee dysfunction secondary to anterior cruciate ligament (ACL) injury. Ten participants, each with a previous history of unilateral ACL injury (median time post-injury 22 months) and eight healthy controls underwent transcranial magnetic stimulation (TMS) to assess excitability of the lower limb motor representation. Resting motor thresholds (RMTs) and

Martin E. Héroux; François Tremblay

2006-01-01

373

Arthrometric Curve-Shape Variables to Assess Anterior Cruciate Ligament Deficiency  

PubMed Central

Background Instrumented measurement of asymmetry in anterior-posterior knee laxity is commonly used to assess anterior cruciate ligament integrity. Significant advances in arthrometric technology and data visualization have occurred since first generation arthrometers. However, little has changed with regard to diagnostic criteria employed. To our knowledge, no investigations have assessed the shape of laxity curves to diagnose anterior cruciate ligament (ACL) deficiency. We hypothesized that linear stiffness and compliance after positive curve inflection would be more sensitive and specific to anterior cruciate ligament injury than current measures and would require data from the involved limb only. Methods Laxity curves were obtained from 130 knees on 65 subjects (Anterior Cruciate Injured n=15, Controls n=50) using a CompuKT Knee Ligament Arthrometer. Traditional diagnostic variables and novel descriptive curve-shape variables [(1) inflection point, (2) pre- and post-inflection linear stiffness and (3) a modified compliance index based on the post-inflection linear stiffness] were assessed for sensitivity to anterior cruciate ligament deficiency. Statistical interactions were evaluated using 2-by-2 ANOVA. Findings Significant interactions (p<0.001) were identified for laxity symmetry, stiffness, compliance index and modified compliance index. Modified compliance index predicted anterior cruciate ligament deficiency with the highest sensitivity (93%) and specificity (100%). For a test performed on a single limb, modified compliance index demonstrated 98% sensitivity and 80% specificity. Interpretation The modified compliance index is a highly sensitive and specific measure to diagnose anterior cruciate ligament deficiency, and may serve as a simple and accurate diagnostic tool for individuals without a healthy contralateral limb.

Wordeman, Samuel C.; Paterno, Mark V.; Quatman, Carmen E.; Bates, Nathaniel A.; Hewett, Timothy E.

2012-01-01

374

Development and Validation of an Instrument to Predict Functional Recovery in Tibial Fracture Patients: The Somatic Pre-Occupation and Coping (SPOC) Questionnaire  

PubMed Central

Objective To explore the role of patients’ beliefs in their likelihood of recovery from severe physical trauma. Methods We developed and validated an instrument designed to capture the impact of patients’ beliefs on functional recovery from injury; the Somatic Pre-occupation and Coping (SPOC) questionnaire. At 6-weeks post-surgical fixation, we administered the SPOC questionnaire to 359 consecutive patients with operatively managed tibial shaft fractures. We constructed multivariable regression models to explore the association between SPOC scores and functional outcome at 1-year, as measured by return to work and short form-36 (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Results In our adjusted multivariable regression models that included pre-injury SF-36 scores, SPOC scores at 6-weeks post-surgery accounted for 18% of the variation in SF-36 PCS scores and 18% of SF-36 MCS scores at 1-year. In both models, 6-week SPOC scores were a far more powerful predictor of functional recovery than age, gender, fracture type, smoking status, or the presence of multi-trauma. Our adjusted analysis found that for each 14 point increment in SPOC score at 6-weeks (14 chosen on the basis of half a standard deviation of the mean SPOC score) the odds of returning to work at 1-year decreased by 40% (odds ratio = 0.60; 95% CI = 0.50 to 0.73). Conclusion The SPOC questionnaire is a valid measurement of illness beliefs in tibial fracture patients and is highly predictive of their long-term functional recovery. Future research should explore if these results extend to other trauma populations and if modification of unhelpful illness beliefs is feasible and would result in improved functional outcomes.

Busse, Jason W.; Bhandari, Mohit; Guyatt, Gordon H.; Heels-Ansdell, Diane; Kulkarni, Abhaya V.; Mandel, Scott; Sanders, David; Schemitsch, Emil; Swiontkowski, Marc; Tornetta, Paul; Wai, Eugene; Walter, Stephen D.

2011-01-01

375

An implantable telemetry device to measure intra-articular tibial forces  

Microsoft Academic Search

Tibial forces are important because they determine polyethylene wear, stress distribution in the implant, and stress transfer to underlying bone. Theoretic estimates of tibiofemoral forces have varied between three and six times the body weight depending on the mathematical models used and the type of activity analyzed. An implantable telemetry system was therefore developed to directly measure tibiofemoral compressive forces.

Darryl D. D’Lima; Christopher P. Townsend; Steven W. Arms; Beverly A. Morris; Clifford W. Colwell

2005-01-01

376

Correlation of bone scintigraphy and histological findings in medial tibial syndrome  

PubMed Central

Objective—To correlate bone scintigraphy and histopathological findings in patients with medial tibial syndrome. Methods—Twenty patients (32 limbs) with a clinical diagnosis of medial tibial syndrome had surgery. Bone scintigraphy before the operation was compared with the histological appearance of bone and periosteal specimens obtained at surgery. Results—Delayed bone scintigraphy showed normal appearance in 11 limbs, characteristic diffuse tubular pattern uptake in 16 limbs, and focal uptake in five. Periosteal histology disclosed fibrous thickening as the most common finding associated with increased vascularity, occasionally with chronic inflammatory cell infiltration, haemosiderin, and acid mucopolysaccharide deposition. Loss of osteocytes was the main finding of bone histology associated with some enlargement of lacunae and lamellar structure disruption. A grading system was used to score normal and abnormal histological appearance. For analysis the findings were regrouped to provide tables using Fisher's exact test. There was no correlation between bone scintigraphy and the histology of bone and periosteum, but two interesting observations were noted. Those cases with periosteal thickening had mostly normal bone scan appearance (p = 0.0028). Those cases with low levels of osteocyte loss had mostly abnormal bone scintigraphy. Conclusion—Abnormal histological appearance of bone and periosteum is a feature of medial tibial syndrome. These histological findings show poor correlation with bone scintigraphy. The exact pathogenesis of this syndrome remains unclear. Key Words: medial tibial syndrome; bone; periosteum; scintigraphy; histology

Bhatt, R; Lauder, I; Finlay, D; Allen, M; Belton, I

2000-01-01

377

The posterior tibial island flap for coverage in complex injuries of the lower extremity.  

PubMed

The lower third of the leg poses a surgical challenge in patients with complex injuries requiring reconstruction of soft tissue defects. The posterior tibial island fasciocutaneous flap is recognized as a suitable option for coverage of these defects, and provides a versatile solution for a complex problem. A retrospective audit was conducted at our institution from 1996 to 2008 including all patients who underwent this procedure. Patient's demographics, clinical features, outcome, and complications were noted. The study population was 24 patients (23 males, one female) with age ranging from 11 to 60 years. Mechanism of injury was road traffic accident in 20 patients and firearm injury in 4. The defect was located in the lower half of the leg in all cases. Tibial fracture was present in 15 patients, treated by external fixation in 13 and internal fixation in two patients. Fasciocutaneous flap from the medial aspect of leg was raised based on a perforator of the posterior tibial artery and rotated distally. Average length of the flaps was 12.3 cm. Patients were followed for an average of 11 months (minimum 3 months). Clinical outcome was graded as good in 19 patients, fair in four patients, and poor in one patient. Posterior tibial island flap appears to be a safe and reliable option for coverage of complex wounds in lower third of the leg. PMID:22718325

Hafeez, Kamran; Siddiqui, Ather; Haroon-ur-Rashid; Ch, Sara Iqbal; Cheema, Tahseen A

2012-06-20

378

Control of knee stability after ACL injury or repair: interaction between hamstrings contraction and tibial translation  

Microsoft Academic Search

Objective. The aim of this study was to investigate the interaction between hamstrings contraction and tibial translation during isometric quadriceps contraction (IQC) and their effects on cruciate ligament forces.Methods. A mathematical model of the knee in the sagittal plane was used with simple geometric representation for the model muscles, ligaments and bones. A mechanical analysis was used to calculate muscle,

A Imran; JJ O'Connor

1998-01-01

379

SIMULTANEOUS BILATERAL TIBIAL STRESS FRACTURES IN A 15YEAROLD MILKMAN—A CASE REPORT  

Microsoft Academic Search

SUMMARY Although stress fractures are well recognized, their frequency, sequelae and complex aetiology are often under-rated. In this case report, we describe an unusual case of simultaneous bilateral stress fractures of the proximal tibial shaft in a young man, exposed to a sudden increase in unaccustomed joint loading due to his part-time occupation. The pathogenesis is discussed.

C. A. SPEED; J. N. FORDHAM; J. L. CUNNINGHAM

1996-01-01

380

Free moment as a predictor of tibial stress fracture in distance runners  

Microsoft Academic Search

Stress fractures are a common and serious overuse injury in runners, particularly female runners. They may be related to loading characteristics of the lower extremity during running stance. Some tibial stress fractures (TSFs) are spiral in nature and, therefore, may be related to torque. Free moment (FM) is a measure of torque about a vertical axis at the interface with

Clare E. Milner; Irene S. Davis; Joseph Hamill

2006-01-01

381

Tibial Shaft Stress Fractures Resulting from Placement of Navigation Tracker Pins  

Microsoft Academic Search

The use of navigation during joint arthroplasty is believed to allow better placement of components. Gross fracture or stress fracture through navigation tracker pin placement is a complication reported in the literature. This case series presents details of stress fracture of tibial shaft through navigation pin track in 3 patients of 220 cases who underwent total knee arthroplasty at our

David Hoke; S. Mehdi Jafari; Fabio Orozco; Alvin Ong

2011-01-01

382

Kinetic asymmetry in female runners with and without retrospective tibial stress fractures  

Microsoft Academic Search

Gait asymmetry may be linked to the tendency for runners to sustain chronic overuse injuries. This paper compares gait asymmetry in female runners who have never sustained a running-related injury to those who have sustained unilateral tibial stress fractures. The symmetry index was used to characterize asymmetry in the kinetics of both subject groups. There were three aims to this

Rebecca Avrin Zifchock; Irene Davis; Joseph Hamill

2006-01-01

383

Ten year experience with use of Ilizarov bone transport for tibial defects.  

PubMed

Tibial defects greater than 4 cm and secondary to high-energy trauma or debridement for infected nonunion pose a significant challenge to the treating orthopaedic surgeon. Twelve patients who had been treated with Ilizarov bone transport for tibial defects over the past ten years were retrospectively reviewed. All patients were male with an average age of thirty-two. Ten of the twelve limbs were categorized as Grade IIIB fractures initially. The average tibial defect at initiation of bone transport was 9.45 cm (range 4 to 20 cm). The mean external fixator time (EFT) was 16.7 months with a mean external fixator index (EFI) of 2.0 months per centimeter. There were a total of 36 complications. Twenty were minor, fourteen were major without sequelae and two were major with sequelae. Overall bone results were good or excellent in nine patients. Overall functional results were good or excellent in eight patients. Ten patients achieved union after Ilizarov bone transport. Use of Ilizarov bone transport can be an effective tool for treating large tibial defects. However, the treatment time is lengthy with a considerable risk of complications. PMID:15156806

Bobroff, Gene D; Gold, Stuart; Zinar, Daniel

2003-01-01

384

Tibial Inlay Technique Using Hamstring Graft for Posterior Cruciate Ligament Reconstruction and Remnant Revision  

PubMed Central

The posterior tibial inlay technique is currently accepted as a standard operation for the posterior cruciate ligament–deficient knee. The classical technique requires a graft construct consisting of a bony part to be fitted into the posterior tibial socket. When an autogenous source is chosen, morbidity at the donor site generated by obtaining the graft with a bony part (e.g., bone–patellar tendon–bone or quadriceps tendon–bone) can be more serious than when obtaining the soft-tissue graft (e.g., hamstring). This study describes an alternative use of soft-tissue graft anchored in a bone socket at the posterior tibial margin by a transfixing cancellous screw. The graft is secured on top by a “bone washer” harvested from this bone socket to provide biological bone-tendon-bone healing. The posterior cruciate ligament remnant with integral fibers at the femur can have its tibial part revised, tensioned, and reattached concomitantly. This additional procedure is deemed to enhance joint stability and promote graft healing.

Laupattarakasem, Wiroon; Boonard, Manusak; Laupattarakasem, Pat; Kosuwon, Weerachai

2012-01-01

385

Surgical treatment of depression fractures of the lateral tibial plateau using porous titanium granules  

PubMed Central

The clinical and radiological results were excellent in this pilot study of four cases of depression fracture of the lateral tibial plateau, where, in addition to internal fixation with screws or a buttress plate, porous titanium granules were used to support the elevated articular surface.

Mjoberg, Bengt

2009-01-01

386

The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes  

Microsoft Academic Search

OBJECTIVE: To determine the relationship between lower extremity alignment and MTSS amongst non-professional athletes DESIGN: In a prospective Study, sixty six subjects were evaluated. Bilateral navicular drop test, Q angle, Achilles angle, tibial angle, intermalleolar and intercondylar distance were measured. In addition, runner's height, body mass, history of previous running injury, running experience was recorded. Runners were followed for 17

Golam Reza D Raissi; Afsaneh D Safar Cherati; Kourosh D Mansoori; Mohammad D Razi

2009-01-01

387

The Influence of Dynamic Trans-tibial Prosthetic Alignment on Standing Plantar Foot Pressure  

Microsoft Academic Search

In order to study quantitative effect of dynamic prosthetic alignment on standing biomechanical property for trans-tibial amputees, plantar foot pressure of one subject during natural standing were recorded by using the Pedar in-shoe pressure measurement system with different alignment angles in the sagittal and frontal planes. The results showed that angular alignment had significant effects on the foot pressure distribution

Jia Xiaohong; Li Xiaobing; Dou Peng; Zhang Ming

2005-01-01

388

21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.  

Code of Federal Regulations, 2013 CFR

...constraints) translation in one or more planes. It has no linkage across-the-joint. This prosthesis is made of alloys, such as cobalt-chromium-molybdenum, and is intended to resurface one tibial condyle. The generic type of device is limited to those...

2013-04-01

389

A geometric morphometric analysis of the medial tibial condyle of african hominids.  

PubMed

Although the hominid knee has been heavily scrutinized, shape variation of the medial tibial condyle has yet to be described. Humans, chimpanzees, and gorillas differ in the shape of their medial femoral condyles and in their capacity for external and internal rotation of the tibia relative to the femur. I hypothesize that these differences should be reflected in the shape of the medial tibial condyle of these hominids. Here I use geometric morphometric techniques to uncover shape differences between the medial tibial condyles of humans, chimpanzees, and gorillas. Humans are distinguished from the other two species by having a much more oval-shaped medial tibial condyle, while those of chimpanzees and gorillas are more triangular in outline. Gorillas (especially males) are distinguished by having more concavely-curved condyles (mediolateral direction), which is interpreted as an effect of heavy loading through the medial compartment of the knee in conjunction with differences in the degree of arboreality. Anat Rec, 296:1518-1525, 2013. © 2013 Wiley Periodicals, Inc. PMID:23956043

Sylvester, Adam D

2013-08-19

390

Internal fixation of closed tibial fractures for the management of sports injuries  

Microsoft Academic Search

From 1985 to 1988, 90 closed tibial fractures were prospectively studied to assess the morbidity of such injuries to sports people and how this can be influenced by treatment regimens. All fractures were sustained during rugby or football matches. After random selection, 45 fractures were openly reduced and internally fixed (group A), and 45 fractures were manipulated under general anaesthesia

A Abdel-Salam; K S Eyres; J Cleary

1991-01-01

391

Mesodermal and neural crest derived ovine tibial and mandibular osteoblasts display distinct molecular differences.  

PubMed

Mandibular osteoblasts originate from the neural crest and deposit bone intramembranously, mesoderm derived tibial osteoblasts by endochondral mechanisms. Bone synthesized by both cell types is identical in structure, yet functional differences between the two cell types may exist. Thus, both matched juvenile and adult mandibular and tibial osteoblasts were studied regarding their proliferative capacity, their osteogenic potential and the expression of osteogenic and origin related marker genes. Juvenile tibial cells proliferated at the highest rate while juvenile mandibular cells exhibited higher ALP activity depositing more mineralized matrix. Expression of Hoxa4 in tibial cells verified their mesodermal origin, whereas very low levels in mandibular cells confirmed their ectodermal descent. Distinct differences in the expression pattern of bone development related genes (collagen type I, osteonectin, osteocalcin, Runx2, MSX1/2, TGF-?1, BAMBI, TWIST1, ?-catenin) were found between the different cell types. The distinct dissimilarities in proliferation, alkaline phosphatase activity, the expression of characteristic genes, and mineralization may aid to explain the differences in bone healing time observed in mandibular bone when compared to long bones of the extremities. PMID:23632238

Reichert, J C; Gohlke, J; Friis, T E; Quent, V M C; Hutmacher, D W

2013-04-28

392

Cost implications of the physiotherapy management of complex tibial fractures treated with circular frames.  

PubMed

Seventy-three consecutive patients with complex tibial fractures treated with an Ilizarov frame or Taylor Spatial Frame received physiotherapy between April 2008 and April 2010. Data were collected prospectively, and physiotherapy input was recorded (in minutes) for the patients identified. This included treatment received as an inpatient as well as an outpatient. The data were categorized for proximal, middle and distal third tibial fractures for analysis. The average cost of physiotherapy for an inpatient with an Ilizarov frame is £121.82 per case, whereas that for an outpatient receiving treatment for trauma was calculated as £404.60. The combined average cost of physiotherapy to support treatment of a complex tibial fracture with a fine wire fixator is £546.27. Treatment involving circular frames is complex and expensive, and the high physiotherapy cost is not reflected in Healthcare Resource Group codes. This cost calculation will help service units, and NHS Trusts develop realistic costing plans to support treatment. Cost implications of the physiotherapy management of complex tibial fractures using the Ilizarov technique. PMID:23943063

Barron, E; Rambani, R; Bailey, H; Sharma, H K

2013-08-13

393

Effect of High Dietary Vitamin A on Tibial Dyschondroplasia , skin pigmentation and Growth Performance in Broilers  

Microsoft Academic Search

An experiment was conducted to study high dietary vitamin A on tibial dyschondroplasia, growth performance and skin pigmentation in broilers. One hundred and twenty Avian commercial broilers were randomly allotted to three treatments: group C (control group), in which broilers were fed basic diet containing vitamin A 5512 IU\\/kg diet; group A, in which broilers were fed basic diet with

Li Jiakui; Pan Siyi

394

COMPARATIVE EFFICACY OF DIFFERENT DITHIOCARBAMATES TO INDUCE TIBIAL DYSCHONDROPLASIA IN POULTRY.  

Technology Transfer Automated Retrieval System (TEKTRAN)

Tibial dyschondroplasia (TD) is a metabolic cartilage disease in poultry the natural etiology of which is not known. In the absence of biomarkers to monitor the initiation and progression of the naturally occurring disease, experimentally induced TD can provide a suitable venue to study the mechani...

395

Percutaneous Posterior Tibial Nerve Stimulation in Patients with Chronic Pelvic Pain: A Preliminary Study  

Microsoft Academic Search

Background: We evaluated the clinical effect of intermittent percutaneous posterior tibial nerve stimulation (PTNS) in patients with chronic pelvic pain (CPP). Methods: A total of 15 patients (10 women and 5 men, mean age 60.0 years, range 41–78) with CPP were enrolled in an open prospective clinical trial. The patients had 12 weekly outpatient treatment sessions, each lasting 30 min.

Soo Woong Kim; Jae-Seung Paick; Ja Hyeon Ku

2007-01-01

396

Limb salvage treatment for Gollop-Wolfgang complex (femoral bifurcation, complete tibial hemimelia, and hand ectrodactyly).  

PubMed

We reported the findings from three patients with Gollop-Wolfgang complex and demonstrated the results of five limb salvage treatments for this condition. All three femoral bifurcations were accompanied by ipsilateral complete tibial hemimelia. Two patients showed contralateral complete or partial tibial hemimelia, and one patient had hand ectrodactyly. The five limb salvage treatments included resection of the anteromedial bifurcated femur in three limbs, foot centralization in five limbs, tibiofibular fusion in one limb with partial tibial hemimelia, fibular transfer (Brown's procedure) in three limbs with complete tibial hemimelia, and callus distraction lengthening in one limb. The duration from the first operation to the final follow-up ranged from 3.5 to 5.4 years. None of the three knees treated by fibular transfer achieved a successful functional result, but all of the knees were ultimately able to withstand weight bearing. Early knee disarticulation and resection of the protruded bifurcated femur, followed by fitting of a modern prosthesis is likely to be the best treatment for patients with Gollop-Wolfgang syndrome. We note that limb salvage treatment is an alternative in patients who opt to retain their feet and refuse amputation. PMID:23660549

Wada, Akifusa; Nakamura, Tomoyuki; Fujii, Toshio; Urano, Noriko; Yanagida, Haruhisa; Takamura, Kazuyuki; Taketa, Mayuki; Oketani, Yutaka; Kubota, Hideaki

2013-09-01

397

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis  

Microsoft Academic Search

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39–76) years. For the clinical

Mehmet Asik; Cengiz Sen; Bulent Kilic; S. Bora Goksan; Feyyaz Ciftci; Omer F. Taser

2006-01-01

398

Transverse sacral fractures with anterior displacement  

Microsoft Academic Search

Transverse fractures of the sacrum with anterior displacement are the rarest type of transverse sacral fractures. They usually\\u000a occur at the S1–S2 region in suicide jumpers. A clinical study was performed to evaluate the diagnosis, treatment and outcome\\u000a of transverse sacral fractures with anterior displacement. We present six patients with a transverse fracture of the sacrum\\u000a with anterior displacement. All

George S. Sapkas; Andreas F. Mavrogenis; Panayiotis J. Papagelopoulos

2008-01-01

399

Anterior fontanelle size in the neonate.  

PubMed Central

A simple method is described for measuring the area of the anterior fontanelle at birth. Normal values in preterm and term infants suggest enlargement of the fontanelle with gestational age. Small-for-dates infants have significantly larger anterior fontanelles than either preterm or term infants. Knowledge of the normal variation in anterior fontanelle size may be of help in the early diagnosis of congenital hypothyroidism or provide a clue to other disorders of skeletal development.

Davies, D P; Ansari, B M; Cooke, T J

1975-01-01

400

Arthroscopic Hybrid Fixation of a Tibial Eminence Fracture in Children  

PubMed Central

The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients.

Kim, Jong In; Kwon, Jae Ho; Seo, Dong Hyun; Soni, Shaishav M.; Munoz, Michael; Nha, Kyung Wook

2013-01-01

401

Arthroscopic hybrid fixation of a tibial eminence fracture in children.  

PubMed

The treatment of an anterior cruciate ligament (ACL) avulsion fracture is controversial, especially in skeletally immature patients, because of concerns about physeal damage. To reduce the risk of physeal injury, an arthroscopic technique was performed. A bioabsorbable suture anchor was inserted through anteromedial portals and fixed to a bioabsorbable suture anchor at the center of the fracture bed; it was then passed through the threads at the ACL avulsion fragment and tied with the ACL substance. After this, the avulsion fragment was repaired by an all-inside technique between the distal portion of the ACL and the transverse ligament and periosteum by a suture hook. The arthroscopic hybrid technique using a suture anchor with an all-inside repair is more rigid and safe. In addition, this physeal-sparing fixation is possible in immature patients. PMID:23875135

Kim, Jong In; Kwon, Jae Ho; Seo, Dong Hyun; Soni, Shaishav M; Muñoz, Michael; Nha, Kyung Wook

2013-04-06

402

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis.  

PubMed

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39-76) years. For the clinical evaluation of the patients Hospital of Special Surgery (HSS) score, American Knee Society and Oxford knee scores, and for the radiological assessment mechanical axis deviation (MAD), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), femorotibial angle and Insall-Salvati index were basically taken into consideration. Our patients were followed up for an average of 34 (range 18-60) months. In the last assessments of our cases, mean improvements detected in HSS scores, Oxford knee scores, knee and functional scores of Knee Society were 26.72, 19.18, 49.9, and 30 points, respectively. The radiological examinations revealed that their mechanical axes on the average passed 5.09 mm laterally achieving an average of 6.5 degrees genu valgum, and a mean Insall-Salvati index of 1.09. As complications, superficial wound infection in two patients (3%), implant infections in one patient (1.5%), deep vein thrombosis in two patients (3%), peroperative lateral tibial plateau fracture in one patient (1.5%), and postoperative lateral tibial plateau fracture due to a falling down were encountered. According to the results obtained, postoperative pain resolves promptly and a significant degree of improvement of knee functions of the patients are achieved. Therefore, we believe that high tibial osteotomy with a Puddu plate is a valuable alternative to total knee arthroplasty in cases with varus gonarthrosis. Although early results are satisfactory, long-term follow-up studies are required especially in the middle aged and elderly patient populations. PMID:16607564

Asik, Mehmet; Sen, Cengiz; Kilic, Bulent; Goksan, S Bora; Ciftci, Feyyaz; Taser, Omer F

2006-04-11

403

Intensity, repetitiveness, and directionality of habitual adolescent mobility patterns influence the tibial diaphysis morphology of athletes.  

PubMed

Mobility patterns affect the loads placed on the lower limbs during locomotion and may influence variation in lower limb diaphyseal robusticity and shape. This relationship commonly forms the basis for inferring mobility patterns from hominin fossil and skeletal remains. This study assesses the correspondence between athletic histories, varying by loading intensity, repetition and directionality, measured using a recall questionnaire, and peripheral quantitative computed tomography-derived measurements of tibial diaphysis rigidity and shape. Participants included male university varsity cross-country runners (n = 15), field hockey players (n = 15), and controls (n = 20) [mean age: 22.1 (SD +/- 2.6) years]. Measurements of tibial rigidity (including J, %CA, Imax, Imin, and average cortical thickness) of both runners and field hockey players were greater than controls (P < or = 0.05). Differences in tibial shape (Imax/Imin, P < or = 0.05) between runners and hockey players reflect pronounced maximum plane (Imax) rigidity in runners, and more symmetrical hypertrophy (Imax, Imin) among hockey players. This corresponds with the generally unidirectional locomotor patterns of runners, and the multidirectional patterns of hockey players. These results support the relationship between mobility and tibial diaphysis morphology as it is generally interpreted in the anthropological literature, with greater levels of mobility associated with increased diaphyseal robusticity and shape variation. Although exercise intensity may be the primary influence on these properties, the repetitiveness of the activity also deserves consideration. In conclusion, bone morphological patterns can reflect habitual behaviors, with adaptation to locomotor activities likely contributing to variation in tibial rigidity and shape properties in archaeological and fossil samples. PMID:19358289

Shaw, Colin N; Stock, Jay T

2009-09-01

404

Surface pretreatment for prolonged survival of cemented tibial prosthesis components: full- vs. surface-cementation technique  

PubMed Central

Background One of few persisting problems of cemented total knee arthroplasty (TKA) is aseptic loosening of tibial component due to degradation of the interface between bone cement and metallic tibial shaft component, particularly for surface cemented tibial components. Surface cementation technique has important clinical meaning in case of revision and for avoidance of stress shielding. Degradation of the interface between bone cement and bone may be a secondary effect due to excessive crack formation in bone cement starting at the opposite metallic surface. Methods This study was done to prove crack formation in the bone cement near the metallic surface when this is not coated. We propose a newly developed coating process by PVD layering with SiOx to avoid that crack formation in the bone cement. A biomechanical model for vibration fatigue test was done to simulate the physiological and biomechanical conditions of the human knee joint and to prove excessive crack formation. Results It was found that coated tibial components showed a highly significant reduction of cement cracking near the interface metal/bone cement (p < 0.01) and a significant reduction of gap formation in the interface metal-to-bone cement (p < 0.05). Conclusion Coating dramatically reduces hydrolytic- and stress-related crack formation at the prosthesis interface metal/bone cement. This leads to a more homogenous load transfer into the cement mantle which should reduce the frequency of loosening in the interfaces metal/bone cement/bone. With surface coating of the tibial component it should become possible that surface cemented TKAs reveal similar loosening rates as TKAs both surface and stem cemented. This would be an important clinical advantage since it is believed that surface cementing reduces metaphyseal bone loss in case of revision and stress shielding for better bone health.

Marx, Rudolf; Qunaibi, Mutaz; Wirtz, Dieter Christian; Niethard, Fritz Uwe; Mumme, Thorsten

2005-01-01

405

Fatigue load of current tibial intramedullary nail designs: a simulated study.  

PubMed

Comminuted tibial shaft fractures are traditionally treated with statically locked intramedullary nailing and protected weight bearing until fracture callous is evident. The purpose of this study was to demonstrate that a simulation of immediate full weight bearing following intramedullary nailing of these fractures does not result in implant failure.A comminuted fracture model was created using 2 pieces of polyvinyl chloride (PVC) pipe. Ten-millimeter-diameter tibial nails (Synthes, Paoli, Pennsylvania; Styker, Mahwah, New Jersey; Zimmer, Warsaw, Indiana; Smith & Nephew, Memphis, Tennessee) were inserted within the PVC pipe and secured proximally and distally with 2 or 3 locking bolts. The constructs were cycled in axial compression for 500,000 cycles or until implant failure. The tests were conducted using a modified staircase method (200 N per step), and the fatigue strength was identified for each of the tibial nail designs. When 2 interlocking bolts were placed proximally and distally, the fatigue strength was between 900 and 1100 N for the Stryker nail, 1100 and 1300 N for the Zimmer nail, 1200 and 1400 N for the Synthes nail, and 1400 and 1600 N for the Smith & Nephew nail. Adding a third interlocking bolt proximally and distally to the Smith & Nephew nail increased the fatigue strength by 13% to between 1700 and 1900 N. In all cases, implant failures occurred through the proximal or distal interlocking bolts.Biomechanical tests suggest that current tibial nail designs may permit immediate full weight bearing of comminuted tibial shaft fractures with minimal risk of implant failure. This may facilitate mobilization in the early postoperative period, especially in the multiply injured patient. PMID:21667907

Wagner, Mark; Liu, Qi; Ellis, Thomas J

2011-06-14

406

Post Clamp.  

National Technical Information Service (NTIS)

A pair of spaced collars are mounted at right angles on a clamp body by retaining rings which enable the collars to rotate with respect to the clamp body. Mounting posts extend through aligned holes in the collars and clamp body. Each collar can be clampe...

J. K. Ramsey E. M. Meyn

1989-01-01

407

Biomechanical comparison of anterior cervical plating and combined anterior\\/lateral mass plating  

Microsoft Academic Search

Background context: Previous studies showed anterior plates of older design to be inadequate for stabilizing the cervical spine in all loading directions. No studies have investigated enhancement in stability obtained by combining anterior and posterior plates.Purpose: To determine which modes of loading are stabilized by anterior plating after a cervical burst fracture and to determine whether adding posterior plating further

Mark S Adams; Neil R Crawford; Robert H Chamberlain; Bse; Volker K. H Sonntag; Curtis A Dickman

2001-01-01

408

The Inman Aligner for anterior tooth alignment.  

PubMed

The Inman Aligner is a highly effective and unique evolution of the traditional spring retainer that uses super-elastic Nickel-Titanium open coil springs to move upper and lower anterior teeth with light but consistent forces, enabling correction of anterior crowding, rotations and some types of spacing. Clinical Relevance: This article describes the appliance, its uses and limitations. PMID:19055094

Qureshi, Atif

2008-10-01

409

Aesthetic Parameters of Lower Anterior Teeth.  

National Technical Information Service (NTIS)

The training in aesthetic parameters has been, for the most part, confined to the upper arch, yet there are studies which show that as age increases, more is seen of the lower anterior teeth. To design a lower anterior fixed prosthesis for good aesthetics...

L. Lorton P. Whitbeck

1979-01-01

410

Anterior vaginal wall repair using local anaesthesia  

Microsoft Academic Search

Background: The purpose of the present study was to describe the possibility of surgical repair of anterior vaginal prolapse including amputation of the cervix using local anaesthesia. The description was made according to postoperative complication, recurrence rate, influence on urinary incontinence, and satisfaction of the patient. Material and methods: Eighty-three women were consecutively operated in the anterior wall of the

Susanne Maigaard Axelsen; Karl Møller Bek

2004-01-01

411

Anterior pericardial tracheoplasty for congenital tracheal stenosis.  

PubMed

Congenital tracheal stenosis may be a life-threatening anomaly not relieved by airway intubation. Over the past 7 years, anterior pericardial tracheoplasty has been used at our institution for treatment of congenital long-segment tracheal stenosis in infants with impeding airway obstruction. Case histories of eight patients undergoing nine anterior pericardial tracheoplasties have been reviewed to assess this technique. Of these patients, six have required preoperative tracheal intubation before repair to maintain ventilation. The surgical technique of anterior pericardial tracheoplasty includes a median sternotomy approach with partial normothermic cardiopulmonary bypass. An anterior tracheotomy through all hypoplastic rings allows enlargement with autologous pericardium to 1.5 times the predicted normal diameter. After insertion, the pericardium and hypoplastic tracheal cartilages are suspended to surrounding mediastinal structures, which prevents airway collapse. Seven of eight infants have survived without tracheoplasty dehiscence or wound infections. Five were ultimately extubated and are currently free of symptoms from 6 months to 5 years after anterior pericardial tracheoplasty. The other two survivors had residual stenosis as a result of complications of prior tracheostomy. One of these patients has undergone a successful second anterior pericardial tracheoplasty and is currently extubated and well. The other is palliated at 6 months with a tracheostomy awaiting a second anterior pericardial tracheoplasty. Our review of anterior pericardial tracheoplasty has demonstrated the safety, utility, and at least medium-term benefit of this procedure in infants of any age and weight. PMID:1943189

Heimansohn, D A; Kesler, K A; Turrentine, M W; Mahomed, Y; Means, L; Matt, B; Weisberger, E; Brown, J W

1991-11-01

412

Correlates of knee anterior laxity in sportswomen.  

PubMed

The purpose of this study was to evaluate whether any of the following factors are related to knee anterior laxity in healthy sportswomen: anthropometric characteristics, lower limb alignment characteristics, hormone-related factors and sport history. Six hundred and sixteen sportswomen were tested in the pre-season. The data have been analysed using linear regression for possible association of knee anterior laxity with other variables. Univariate linear regression indicated a positive association of knee anterior laxity with knee extension and navicular drop and a negative association with body height. Multivariate linear regression analysis showed statistically significant associations between knee anterior laxity and the combination of passive knee extension and the chosen sport (R(2)=0.089; p<0.05). The combination of passive knee extension and sport type was found to be related to the amount of knee anterior laxity, although the association was weak with this combination of factors able to explain only about 9% of the variability in laxity. Knowing which factors influence the amount of knee anterior laxity will help us to better interpret the results of knee anterior laxity testing and help us to understand the possible role of knee anterior laxity as a risk factor for knee injury. PMID:19423353

Vauhnik, Renata; Morrissey, Matthew C; Rutherford, Olga M; Turk, Zmago; Pilih, Iztok A; Perme, Maja Pohar

2009-05-07

413

Anterior sacrodural attachments–Trolard's ligaments revisited  

Microsoft Academic Search

SUMMARY. In contrast to the attention paid to the structures surrounding spinal nerve roots in the intervertebral foramina, the anterior dural attachments are largely ignored, although they have been described since the last decades of the 19th century. These anterior attachments were systematically studied in a series of 30 cadaver dissections and were found to be present in almost 94%

E. Barbaix; M. D. Girardin; J. P. Hoppner; P. Van Roy; J. P. Clarijs

1996-01-01

414

Surgical anatomy of the anterior clinoid process  

Microsoft Academic Search

We studied the surgical anatomy of the anterior clinoid process (ACP) and its adjacent structures in cadaver heads. We paid special attention to the anatomical relationships between the ACP and adjacent structures to determine the surgical landmarks for safe anterior clinoidectomy. Thirty-five cadaver heads were dissected and the ACP regions were examined in 55 skull sides. We observed that in

Phuong Huynh-Le; Yoshihiro Natori; Tomio Sasaki

2004-01-01

415

MRI of tibialis anterior tendon rupture  

Microsoft Academic Search

Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58–67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of

Robert A. Gallo; Brett H. Kolman; Richard H. Daffner; Robert L. Sciulli; Catherine C. Roberts; Patrick J. DeMeo

2004-01-01

416

A simple technique to prevent limb ischemia during veno-arterial ECMO using the femoral artery: the posterior tibial approach.  

PubMed

Lower extremity ischemia is common when the femoral artery is used for veno-arterial extracorporeal membrane oxygenation (VA ECMO). We describe a new technique to reperfuse the extremity. The ipsilateral posterior tibial artery is exposed via a small incision behind the medial malleolus. The vessel is cannulated in a retrograde fashion and connected to the arterial limb of the ECMO circuit. Thirty-six patients received a posterior tibial reperfusion cannula: average flow was 155.8 ml/min and increased over the initial 24 hours. Fifty-eight percent received the posterior tibial cannula within 6 hours of ECMO initiation and none sustained permanent lower extremity injury. Of the remaining 42%, three required amputation or developed permanent neurologic injury. Overall survival was 41%. Cannulation of the posterior tibial artery is a simple technique to reperfuse the lower extremity during VA ECMO. The cannula should be inserted within 6 hours of ECMO initiation to avoid irreversible ischemic damage. PMID:22143092

Spurlock, D J; Toomasian, J M; Romano, M A; Cooley, E; Bartlett, R H; Haft, J W

2011-12-05

417

Avulsion fragmentation of the tibial tuberosity apophysis and associated patellar tendon enthesopathy in a skeletally immature dog.  

PubMed

A 9.5-month-old, female entire, 31.3 kg crossbred dog was presented with a 12 week history of moderate weight-bearing right pelvic limb lameness. Radiographic, computed tomographic, and ultrasonographic imaging revealed progressive avulsion fragmentation of the right tibial tuberosity apophysis and a patellar tendon insertional enthesopathy without physeal involvement. Conservative management was successful in achieving a good clinical outcome. A progressive avulsion of the contralateral proximal tibial physes that occurred concurrently resulted in development of an excessive tibial plateau slope angle. The additional development of a moderate left distal femoral varus deformity was surgically corrected. This is the first report of a progressive, traction injury to the tibial tuberosity apophysis in a dog that appears clinically and radiographically very similar to Osgood-Schlatter disease in humans. PMID:23677126

Brown, G W; Kalff, S; Parry, A; Whitehead, M; McKee, W M

2013-03-22

418

[Sphincter preservation in rectal cancer: possibilities and limits of anterior resection].  

PubMed

The feasibility of sphincter preservation was studied in surgery of tumours in the upper, middle and lower third of the rectum. All patients operated on for rectal cancer between January 1977 and May 1980 were included in the investigation. Preoperative localization of the tumours was performed with the rigid sigmoidoscope. Every patient was scheduled for post-operative follow up. Altogether 211 patients were operated on for rectal cancer. 111 were treated by anterior resection, 90 by abdominoperineal excision, and 10 by other sphincter-saving methods. All of the 59 tumours located in the upper third of the rectum (12 to 16 cm from the anus) were treated by anterior resection. 62 tumours were located in the middle third (8 to 12 cm). In these cases anterior resection was carried out in 60% of the men and in 82% of the women, whereas the other patients underwent abdominoperineal excision. 80 tumours were located in the lower third (4 to 8 cm). Anterior resection was possible in only 4.4% of the men and in 14% of the women. Irrespective of their localization on sigmoidoscopy, 37% of the tumours which were within reach of the finger on rectal palpation could be removed by anterior resection. Local recurrence after anterior resection occurred in 18.3%, the median follow-up time being 50 months. The cumulative probable survival for all stages was more than 5 years for 60% of the patients. PMID:6673368

Schiessel, R; Wunderlich, M; Kovats, E; Rauhs, R

1983-11-11

419

Lower extremity vascular stenting for a post-traumatic pseudoaneurysm in a young trauma patient  

PubMed Central

Endovascular treatment of post-traumatic pseudoaneurysms has become a viable, less invasive option when compared to open repair. Due to the relative youth of this technology, studies have yet to be concluded on the long-term patency of stent grafts in this population. For this reason, concern exists with endovascular stent placement in the young trauma patient. In this study, we present a case and review the literature on a post-traumatic pseudoaneurysm of the posterior tibial artery in a 19-year-old man treated with an endovascular stent.

Marks, Joshua A; Hager, Eric; Henry, David; Martin, Niels D

2011-01-01

420