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Sample records for anterior tibial post

  1. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction.

    PubMed

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook; Ha, Jeong Ku

    2016-03-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  2. Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kim, Sang Bum; Lim, Jin Woo; Seo, Jeong Gook

    2016-01-01

    Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case. PMID:26929808

  3. Anterior tibial artery pseudoaneurysm after ankle arthroscopy.

    PubMed

    Salgado, C J; Mukherjee, D; Quist, M A; Cero, S

    1998-12-01

    Arthroscopy of the ankle has dramatically expanded its role in diagnostic and therapeutic value afforded to the patient; however, it is not without complications. Although the majority of the complications described are neurological in origin, vascular injuries can occur. A case of a patient with normal coagulation parameters who underwent a purely diagnostic ankle arthroscopy and later developed a pseudoaneurysm of her distal anterior tibial artery is described. The pseudoaneurysm was resected without complications and early postoperative recovery has been uneventful. PMID:10395264

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

    PubMed

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

    2006-01-01

    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

  5. Anterior tibial compartment syndrome following femoral artery perfusion

    PubMed Central

    Palmer, B. V.; Mercer, J. L.

    1973-01-01

    Palmer, B. V., and Mercer, J. L. (1973).Thorax, 28, 492-494. Anterior tibial compartment syndrome following femoral artery perfusion. Four patients are described who developed the anterior tibial compartment syndrome following open heart surgery. It occurred in the limb used for femoral artery perfusion in each patient. In two it was known that the collateral circulation to the limb was also considerably impaired. It is suggested that prolonged limb ischaemia is the major initiating factor. The treatment of these patients is discussed and although one patient was successfully treated conservatively, surgical treatment is advisable. PMID:4741453

  6. Ideal tibial tunnel length for endoscopic anterior cruciate ligament reconstruction.

    PubMed

    Olszewski, A D; Miller, M D; Ritchie, J R

    1998-01-01

    A successful single-incision endoscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft requires attention to many technical details. The emphasis of placing the femoral bone plug flush with the opening of the femoral tunnel results in distal shift of the graft. Longer tibial tunnels are required to prevent excessive graft extrusion. The purpose of this study is to compare four direct and indirect measurement methods of tibial tunnel preparation to determine which method can be used to create consistently reproducible tibial tunnels that prevent excessive extrusion or recession of the graft within the tunnel. Tunnels placed at the empiric angles of 40 degrees, 50 degrees, and 60 degrees to the tibial plateau resulted in the incidence of acceptable tibial tunnel lengths of 44%, 83%, and 39%, respectively. Tunnels placed at an angle determined by the formula "N + 7" where 7 degrees is added to the patellar tendon length (N) resulted in acceptable tunnels 89% of the time. Direct measurement methods using the formulas "graft - 50 mm" and "N + 2 mm" resulted in acceptable tibial tunnels of 44% and 100%, respectively. We recommend using the "N + 7" in conjunction with the "N + 2 mm" formula to obtain the advantages of both indirect and direct measurement methods. PMID:9486327

  7. Entrapment of the deep peroneal nerve and anterior tibial vessels by a spiral tibial fracture causing partial non-union: a case report.

    PubMed

    Tan, Evan Tai Long; Tan, Tien Jin; Poon, Kein Boon

    2016-04-01

    We report a case of entrapment of the deep peroneal nerve as well as the anterior tibial artery and vein by a spiral distal tibial shaft fracture, causing partial non-union. The authors describe the utility of MRI in making the diagnosis of this post-traumatic complication, which may potentially result in a permanent neurovascular deficit and adverse functional outcome if left undetected. The importance of recognizing the distinct possibility of entrapment and injury to the deep peroneal nerve as well as the anterior tibial vessels, when managing a fracture involving the distal third of the tibial shaft is emphasized. Absence of clinical symptoms or signs of neurovascular entrapment should not deter one from performing the relevant investigations to exclude this complication, in particular when surgical fixation is being contemplated, or in the presence of a non-healing fracture. PMID:26408316

  8. Direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact.

    PubMed

    Yeow, C H; Lee, P V S; Goh, J C H

    2010-01-19

    Anterior tibial loading is a major factor involved in the anterior cruciate ligament (ACL) injury mechanism during ski impact landing. We sought to investigate the direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact of intact knee joints without quadriceps activation. Twelve porcine knee specimens were procured. Four specimens were used as non-impact control while the remaining eight were mounted onto a material-testing system at 70 degrees flexion and subjected to simulated landing impact, which was successively repeated with incremental actuator displacement. Four specimens from the impacted group underwent pre-impact MRI for tibial plateau angle measurements while the other four were subjected to histology and microCT for cartilage morphology and volume assessment. The tibial plateau angles ranged from 29.4 to 38.8 degrees . There was a moderate linear relationship (Y=0.16X; R(2)=0.64; p<0.001) between peak axial impact compressive load (Y) and peak anterior tibial load (X). The anterior and posterior regions in the impacted group sustained surface cartilage fraying, superficial clefts and tidemark disruption, compared to the control group. MicroCT scans displayed visible cartilage deformation for both anterior and posterior regions in the impacted group. Due to the tibial plateau angle, increased axial impact compressive load can directly elevate anterior tibial load and hence contribute to ACL failure during simulated landing impact. Axial impact compressive load resulted in shear cartilage damage along anterior-posterior tibial plateau regions, due to its contribution to anterior tibial loading. This mechanism plays an important role in elevating ACL stress and cartilage deformation during impact landing. PMID:19863961

  9. Applying Cross-Pin System in Both Femoral and Tibial Fixation in Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons

    PubMed Central

    Qi, Wei; Liu, Yujie; Xue, Jing; Li, Haifeng; Wang, Junliang; Qu, Feng

    2015-01-01

    Use of the RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixation of grafts in anterior cruciate ligament reconstruction (ACLR). However, tibial fixation is still limited to the use of interference screws and post fixation, and few surgeons apply the femoral RigidFix system in tibial fixation. Meanwhile, tunnel enlargement is still a problem that affects the outcome of ACLR with hamstring grafts. We have used the femoral RigidFix system in femoral and tibial fixation. The rod top of the guide frame should be placed under the level of the subchondral bone at the proximal end of the tibial tunnel to ensure that the pins will not be inserted into the joint. The pins are inserted through the center of the lateral tibia. Using our technique, the fixation points of the femur and tibia are close to the anterior cruciate ligament insertions, and full contact of the graft with the tunnel wall can be accomplished. On the basis of our preliminary observations and investigation, we are optimistic about the prospect of performing ACLR using the RigidFix system in femoral and tibial fixation. PMID:26697293

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

    PubMed Central

    Wong, Jessica J.; Muir, Brad

    2013-01-01

    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. PMID:23754857

  11. Anterior Tibial Translation in Collegiate Athletes with Normal Anterior Cruciate Ligament Integrity

    PubMed Central

    Rosene, John M.; Fogarty, Tracey D.

    1999-01-01

    Objective: To examine differences in anterior tibial translation (ATT) among sports, sex, and leg dominance in collegiate athletes with normal anterior cruciate ligament integrity. Design and Setting: Subjects from various athletic teams were measured for ATT in right and left knees. Subjects: Sixty subjects were measured for ATT with a KT-1000 knee arthrometer. Measurements: Statistical analyses were computed for each sex and included a 2 × 3 × 4 mixed-factorial analysis of variance (ANOVA) for anterior cruciate ligament displacement, right and left sides, and force and sport. A 2 × 2 × 3 mixed-factorial ANOVA was computed to compare means for sex and force. A 2 × 3 mixed-factorial ANOVA was computed to compare sex differences across 3 forces. Results: For males and females, no significant interactions were found among leg, force, and sport for mean ATT, for leg and sport or leg and force, or for translation values between dominant and nondominant legs. Males had a significant interaction for force and sport, and a significant difference was found for side of body, since the right side had less translation than the left side. Females had greater ATT than males at all forces. Conclusions: Sex differences exist for ATT, and differences in ATT exist among sports for both sexes. Differences between the right and left sides of the body should be expected when making comparisons of ligamentous laxity. ImagesFigure 2.Figure 3.Figure 5. PMID:16558565

  12. Arthroscopic anterior cruciate ligament reconstruction with the tibial-remnant preserving technique using a hamstring graft.

    PubMed

    Lee, Byung-Ill; Min, Kyung-Dae; Choi, Hyung-Suk; Kim, Jun-Bum; Kim, Seong-Tae

    2006-03-01

    We propose that the tibial remnant of the anterior cruciate ligament (ACL) is able to enhance the revascularization and cellular proliferation of the graft, to preserve proprioceptive function, and to be able to acquire anatomic placement of the graft without roof impingement. Therefore, it seems reasonable to assume that preserving the tibial remnant as much as possible as a source of reinnervation, if technically possible without causing impingement, would be of potential benefit to the patient. Our surgical technique was developed to maximize the preservation of the tibial remnant. The distally attached semitendinosus and gracilis tendons are harvested using the tendon stripper. After satisfactory placement of 2 guide pins convergently, a closed-end socket in the lateral femoral condyle is created using an adequately sized curved curette. For anatomic placement of the graft, the tibial tunnel should be positioned within the boundaries of the normal ACL tibial remnant. The reamer must be advanced very carefully to minimize injury to the residual remnant at the intra-articular margin of the tibial tunnel. Penetration should stop at the base of the stump. The folded grafts are then pulled intra-articularly through the tibial tunnel, the tibial remnant, and the femoral socket by pulling sutures under arthroscopic visualization. The ACL tibial remnant is compacted by the tendon passage. The graft is secured proximally by tying sutures in the lateral femoral condyle and distally at the tibia with double staples by a belt-buckle method. The advantages of our technique include maximal preservation of the tibial remnant, no roof impingement caused by intrasynovial anatomic placement of the graft, the simplicity of the procedure, the minimal need for hardware or special instruments, the economic benefit, and the potential prevention of tibial tunnel enlargement by preventing synovial fluid leakage. PMID:16517320

  13. Tibialis Anterior Tendon Transfer for Posterior Tibial Tendon Insufficiency.

    PubMed

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas

    2016-01-01

    The Cobb procedure is useful for addressing stage 2 posterior tibial tendon dysfunction and is often accompanied by a medial displacement calcaneal osteotomy and/or lateral column lengthening. The Cobb procedure can also be combined with selected medial column arthrodesis and realignment osteotomies along with equinus correction when indicated. PMID:26590721

  14. The Changed Route of Anterior Tibial Artery due to Healed Fracture

    PubMed Central

    Gökkuş, Kemal; Sagtas, Ergin; Comert, Nuri; Unal, Mehmet Bekir; Baloglu, Murat

    2016-01-01

    We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia).

  15. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions☆

    PubMed Central

    Filho, Edmar Stieven; Mendes, Mariane Henseler Damaceno; Claudino, Stephanie; Baracho, Filipe; Borges, Paulo César; da Cunha, Luiz Antonio Munhoz

    2015-01-01

    Objective To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL). Methods Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1) standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2) inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3) control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength. Results There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05). Conclusion There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw. PMID:26229913

  16. Identification of a high-risk anterior tibial stress fracture.

    PubMed

    Thelen, Mark D

    2010-12-01

    The patient was a deployed 34-year-old female soldier with a chief complaint of bilateral anterior shin pain for the past 8 weeks. Due to concern for a stress fracture, radiographic views of the bilateral tibia and fibula were completed, which revealed cortical thickening through the anterior midtibial regions bilaterally, consistent with stress reactive changes. Furthermore, a transverse lucency through the anterior cortex of the anterior right midtibial region was noted, which was consistent with a stress fracture. The patient was immediately placed in a short leg cast and was given strict non-weight-bearing instructions for gait. She was subsequently evacuated to her home duty station for consultation with an orthopaedic surgeon to determine if surgical intervention was warranted. This report illustrates the importance of identifying stress fractures considered to be high risk. PMID:21169720

  17. Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Cho, Chul Hyun; Lee, Kyung Jae; Jeon, Jong Hyuk

    2015-01-01

    Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures. PMID:26060613

  18. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw

    PubMed Central

    Joshi, Yogesh V.; Phaltankar, Padmanabh M.; Charalambous, Charalambos P.

    2015-01-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  19. Tibial Tunnel Cyst Formation after Anterior Cruciate Ligament Reconstruction Using a Non-Bioabsorbable Interference Screw.

    PubMed

    Joshi, Yogesh V; Bhaskar, Deepu; Phaltankar, Padmanabh M; Charalambous, Charalambos P

    2015-12-01

    Tibial cyst formation following the use of bioabsorbable interference screws in anterior cruciate ligament (ACL) reconstruction is well-described; however, cyst formation after the use of metallic interference screws is not well-documented. We describe a case of osteolytic lesion of the proximal tibia presenting to us 20 years after ACL reconstruction using an autologous bone-tendon-bone graft. The original graft fixation technique was interference fixation with a metal screw in the tibial and femoral tunnels. A two-stage revision reconstruction of the ACL was undertaken with curettage and bone grafting of the tibial lesion in the first stage and reconstruction using a four-strand hamstring tendon in the second stage. The patient recovered satisfactorily with complete healing of the cyst and returned to pre-injury level of activities. We have reviewed case reports and case series that describe the aetiology of intra-osseous cyst formation following ACL reconstruction. PMID:26673117

  20. Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction

    PubMed Central

    Sinha, Skand; Naik, AK; Arya, CS; Arya, RK; Jain, Vijay K; Upadhyay, Gaurav

    2015-01-01

    Background: Femoral tunnel location is of critical importance for successful outcome of ACL reconstruction. The aim was to study the femoral tunnel created by placing free hand guide wire through tibial tunnel, using the toggle of the guide wire in the tibial tunnel to improve femoral tunnel location. Materials and Methods: 30 cases of a single bundle quadrupled hamstring graft anterior cruciate ligament reconstruction by trans-tibial free hand femoral tunnel creation is studied in this prospective study. The side to side play of the guide wire in the tibial tunnel was used to improve the tunnel location on femoral wall. The coronal angle of the femoral tunnel was measured on the anteroposterior radiograph. The femoral tunnel location on the lateral radiograph of the knee was recorded according to Amis method. Lysholm scoring was done preoperative and at each follow up. Assessment of laxity was done by Rolimeter (Aircast) and pivot shift test. Results: The mean coronal angle of the femoral tunnel in postoperative radiograph was 47. In lateral radiograph, the femoral tunnel was found to be >60% posterior on Blumensaat line in 67% cases (n = 20) and in the 33% cases (n = 10) it was anterior. The mean Lysholm score improved from 74.6 preoperative to 93.17 postoperative with no objective evidence of laxity. Conclusion: The free hand trans-tibial creation of the femoral tunnel leads to satisfactory coronal obliquity, but it is difficult to recreate anatomic femoral tunnel by this method as the tunnel is consistently anterior in the sagittal plane. PMID:26015638

  1. Effect of Femoral Tunnel Placement for Reconstruction of the Anterior Cruciate Ligament on Tibial Rotation

    PubMed Central

    Ristanis, Stavros; Stergiou, Nicholas; Siarava, Eleftheria; Ntoulia, Aikaterini; Mitsionis, Grigorios; Georgoulis, Anastasios D.

    2009-01-01

    Background: Rotational knee movement after reconstruction of the anterior cruciate ligament has been difficult to quantify. The purpose of this study was to identify in vivo whether a more horizontal placement of the femoral tunnel (in the ten o'clock position rather than in the eleven o'clock position) can restore rotational kinematics, during highly demanding dynamic activities, in a knee in which a bone-patellar tendon-bone graft had been used to reconstruct the anterior cruciate ligament. Methods: We evaluated ten patients in whom a bone-patellar tendon-bone graft had been used to reconstruct the anterior cruciate ligament with the femoral tunnel in the eleven o'clock position, ten patients who had had the same procedure with the femoral tunnel in the ten o'clock position, and ten healthy controls. Kinematic data were collected while the subjects (1) descended from a stairway, made foot contact, and then pivoted 90 on the landing lower limb and (2) jumped from a platform, landed with both feet on the ground, and pivoted 90 on the right or left lower limb. The dependent variable that we examined was tibial rotation during pivoting. Results: The results demonstrated that reconstruction of the anterior cruciate ligament with the femoral tunnel in either the ten or the eleven o'clock position successfully restored anterior tibial translation. However, both techniques resulted in tibial rotation values, during the dynamic activities evaluated, that were significantly larger than those in the intact contralateral lower limbs and those in the healthy controls. Tibial rotation did not differ significantly between the two reconstruction groups or between the healthy controls and the intact contralateral lower limbs. However, we noticed that positioning the tunnel at ten o'clock resulted in slightly decreased rotation values that may have clinical relevance but not statistical significance. Conclusions: Regardless of which of the two tested positions was utilized to fix the graft to the femur, reconstruction of the anterior cruciate ligament did not restore normal tibial rotation during dynamic activities. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence. PMID:19723992

  2. Accuracy of Proximal Tibial Bone Cut Using Anterior Border of Tibia as Bony Landmark in Total Knee Arthroplasty.

    PubMed

    Nishikawa, Kazutaka; Mizu-Uchi, Hideki; Okazaki, Ken; Matsuda, Shuichi; Tashiro, Yasutaka; Iwamoto, Yukihide

    2015-12-01

    The purpose of our study was to evaluate the accuracy of the tibial bone cut in total knee arthroplasty using the anterior tibial border as a guide compared to using bony and soft tissue landmarks of the ankle joint. The extramedullary alignment guide was set parallel to a line connecting the proximal and distal one-thirds of the anterior border of the tibia while the rotational direction of the distal end of the guide was adjusted to the anteroposterior axis of the proximal tibia. Significant differences were detected in the ideal coronal tibial component angles with improvements from 87.2% to 95.9%. The anterior tibial border was a reliable landmark in total knee arthroplasty in clinical practice, as shown by our previous computer simulation. PMID:26233701

  3. Results of bypasses to the anterior tibial artery through the interosseous membrane.

    PubMed

    Illuminati, G; Calio, F G; Bertagni, A; Martinelli, V

    1998-08-01

    The purpose of the present study was to retrospectively evaluate the results of anatomically tunneled grafts to the anterior tibial artery for distal revascularization in terms of patency and limb salvage rates as well as local morbidity, which can lengthen the postoperative hospital stay. Twenty-three patients received 24 bypasses to the anterior tibial artery, with grafts tunneled through the interosseous membrane. The mean age was 67 years; 10 patients were diabetic, 12 were smokers, 9 presented with significant coronary artery disease, and 2 with chronic renal insufficiency. The donor vessel was the common femoral artery in 17 cases, the superficial femoral artery in 4, and the infra-articular popliteal artery in 3. The graft material consisted in the reversed saphenous vein in 4 cases, the non-reversed devalvulated ex situ saphenous vein in 11, composite polytetrafluoroethylene (PTFE) + inversed saphenous vein in 6, and PTFE alone in 3 cases. No postoperative mortality was observed, nor was there postoperative graft occlusion or need for major amputation. The average postoperative length of stay in the hospital was 9.7 days. Two local surgical wound complications were observed, which did not necessitate a postoperative hospital stay exceeding 15 days. Cumulative primary patency and limb salvage rates at 3 years were 50% and 70%, respectively. Anatomic tunneling of grafts to the anterior tibial artery yields patency and limb salvage rates comparable to those reported in the literature for distal bypasses and, considered overall, an acceptably low local morbidity and short hospital stay. Definitive superiority over externally tunneled grafts, however, is not definitely demonstrated by this study and should be prospectively tested. PMID:9776453

  4. Relationship between tibial acceleration and proximal anterior tibia shear force across increasing jump distance.

    PubMed

    Sell, Timothy C; Akins, Jonathan S; Opp, Alexis R; Lephart, Scott M

    2014-02-01

    Proximal anterior tibia shear force is a direct loading mechanism of the anterior cruciate ligament (ACL) and is a contributor to ACL strain during injury. Measurement of this force during competition may provide insight into risk factors for ACL injury. Accelerometers may be capable of measuring tibial acceleration during competition. The purpose of this study was to examine the relationship between acceleration measured by a tibia-mounted accelerometer and proximal anterior tibia shear force as measured through inverse dynamics and peak posterior ground reaction forces during two leg stop-jump tasks. Nineteen healthy male subjects performed stop-jump tasks across increasing jump distances. Correlation coefficients were calculated to determine if a relationship exists between accelerometer data and proximal anterior tibia shear force and peak posterior ground reaction force. An analysis of variance was performed to compare these variables across jump distance. Significant correlations were observed between accelerometer data and peak posterior ground reaction force, but none between accelerometer data and proximal anterior tibia shear force. All variables except peak proximal anterior tibia shear force increased significantly as jump distance increased. Overall, results of this study provide initial, positive support for the use of accelerometers as a useful tool for future injury prevention research. PMID:23878269

  5. Construction of finite element model and stress analysis of anterior cruciate ligament tibial insertion

    PubMed Central

    Dai, Can; Yang, Liu; Guo, Lin; Wang, Fuyou; Gou, Jingyue; Deng, Zhilong

    2015-01-01

    Objective: The aim of the present study was to develop a more realistic finite element (FE) model of the human anterior cruciate ligament (ACL) tibial insertion and to analyze the stress distribution in the ACL internal fibers under load. Methods: The ACL tibial insertions were processed histologically. With Photoshop software, digital images taken from the histological slides were collaged, contour lines were drawn, and different gray values were filled based on the structure. The data were exported to Amira software and saved as .hmascii file. This document was imported into HyperMesh software. The solid mesh model generated using HyperMesh software was imported into Abaqus software. The material properties were introduced, boundary conditions were set, and load was added to carry out the FE analysis. Results: The stress distribution of the ACL internal fibers was uneven. The lowest stress could be observed in the ACL lateral fibers under tensile and shear load. Conclusion: The establishment of ACL tibial insertion FE model and mechanical analysis could reveal the stress distribution in the ACL internal fibers under load. There was greater load carrying capacity in the ACL lateral fibers which could sustain greater tensile and shear forces. PMID:26150858

  6. The tibialis anterior muscle flap for full-thickness tibial burns.

    PubMed

    Sood, Rajiv; Ranieri, Jaime; Murthy, Vimal; Weber, Karen

    2003-01-01

    Full-thickness burn wounds to the tibia present a challenging coverage problem. If skin grafting fails, few local options exist, and free tissue transfer may be required for coverage. We report on the use of the tibialis anterior muscle flap to cover longitudinal tibial defects in five extremities in four patients. These patients sustained 80, 55, 40, and 11% total body surface area burns. Postoperatively, all five extremity wounds healed with full coverage of the tibia. Minimal deficits in ankle inversion and eversion resulted, but all patients are fully capable of walking and able to bear weight. We feel that the tibialis anterior muscle flap is a safe, reliable, technically simple alternative for coverage of the burned tibia. PMID:14610424

  7. Muscle involvement in leprosy. Study of the anterior tibial muscle in 40 patients.

    PubMed

    Werneck, L C; Teive, H A; Scola, R H

    1999-09-01

    The involvement of skeletal striated muscle in leprosy is considered secondary due to peripheral neuropathy, but some studies point it to a primary muscle lesion. In order to investigate the muscle involvement in leprosy, we studied 40 patients (lepromatous 23, tuberculoid 13, borderline 2 and indeterminate 2). The motor nerve conduction of the peroneal nerves had a reduction of the velocity, decreased compound muscle action potential and sometimes absence of potentials. The electromyographic study of the anterior tibial muscle showed signs of recent and chronic denervation in 77.5% of the cases and no myopathic potentials. The anterior tibial muscle biopsy revealed denervation in 45% of the cases, interstitial inflammatory myopathy in 30% and mixed (myopathic and neuropathic) pattern in 12.5%. Acid fast bacillus was detected in 25% of the cases, always in the interstitial tissue. Inflammatory reaction was present in the interstitial space and in patients with the lepromatous type. The histological findings clearly defined the presence of the so-called "Leprous Interstitial Myositis" on the top of denervation signs. PMID:10751905

  8. The Lateral Meniscus as a Guide to Anatomical Tibial Tunnel Placement During Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Kassam, A.M.; Tillotson, L.; Schranz, P.J.; Mandalia, V.I.

    2015-01-01

    Purpose: The aim of the study is to show, on an MRI scan, that the posterior border of the anterior horn of the lateral meniscus (AHLM) could guide tibial tunnel position in the sagittal plane and provide anatomical graft position. Method: One hundred MRI scans were analysed with normal cruciate ligaments and no evidence of meniscal injury. We measured the distance between the posterior border of the AHLM and the midpoint of the ACL by superimposing sagittal images. Results: The mean distance between the posterior border of the AHLM and the ACL midpoint was -0.1mm (i.e. 0.1mm posterior to the ACL midpoint). The range was 5mm to -4.6mm. The median value was 0.0mm. 95% confidence interval was from -0.5 to 0.3mm. A normal, parametric distribution was observed and Intra- and inter-observer variability showed significant correlation (p<0.05) using Pearsons Correlation test (intra-observer) and Interclass correlation (inter-observer). Conclusion: Using the posterior border of the AHLM is a reproducible and anatomical marker for the midpoint of the ACL footprint in the majority of cases. It can be used intra-operatively as a guide for tibial tunnel insertion and graft placement allowing anatomical reconstruction. There will inevitably be some anatomical variation. Pre-operative MRI assessment of the relationship between AHLM and ACL footprint is advised to improve surgical planning. Level of Evidence: Level 4.

  9. Tibial bone plug resorption with extra-articular cyst: a rare complication of anterior cruciate ligament reconstruction.

    PubMed

    Brettler, D; Soudry, M

    1995-08-01

    Anterior cruciate ligament (ACL) reconstruction failure resulted in tibial bone plug resorption and the formation of a large extra-articular cyst. To our knowledge, this is the first report of this kind of ACL failure. The relationship to known factors is discussed. PMID:7575883

  10. [Individual cast posts for single anterior implants].

    PubMed

    Bonanini, M; Macaluso, G M; Pizzi, S; Vescovi, P; Gennari, P U

    1990-11-01

    The Authors utilized in order to replace anterior missing teeth osseointegrated implants provided with individual angled posts. These types of abutment are used to allow a good parallel situation between implants with different angulation and also between implants and proximal teeth. The head of this abutment is thread to receive the screw that allows the crown to be fastened. PMID:2097187

  11. Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

    PubMed Central

    Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

    2015-01-01

    Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0, 15, 30, 45 and 60 knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 1.7 mm and 9.0 2.2 mm for non-braced, and 10.1 3.4 mm and 7.4 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise. PMID:26557277

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

    PubMed

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

    2000-07-01

    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

  13. Effect of physiotherapy on the strength of tibial internal rotator muscles in males after anterior cruciate ligament reconstruction (ACLR)

    PubMed Central

    Czamara, Andrzej; Szuba, ?ukasz; Krzemi?ska, Aleksandra; Tomaszewski, Wies?aw; Wilk-Fra?czuk, Magdalena

    2011-01-01

    Summary Background The goal of this study was to evaluate the effect of physiotherapy on the strength of muscles responsible for tibial internal rotation (IR) in male patients after anterior cruciate ligament reconstruction (ACLR) using autografts of the semitendinosus and gracilis muscles (STGR). Material/Methods Fifty-nine males were examined. The first group consisted of 19 patients subjected to 4-stage physiotherapy following ACLR. The second group consisted of 20 males without knee injuries. The third group consisted of 20 males who had not undergone systematic physiotherapy within the last 12 months following lower limb injuries. Moments of maximal strength (MMS), isometric torque (IT), and peak torque (PT) were measured under static and isokinetic conditions using the Humac Norm System. In the first group, IT measurements were performed during the 13th and 21st week of physiotherapy, while PT measurements were performed during the 16th and 21st weeks of physiotherapy following ACLR. In the control groups (II and III) the measurements were performed once. Results In the first group, the IT (13 weeks) and PT (16 weeks) values of internal tibial rotator muscles, obtained from the operated extremities were significantly lower than the values obtained from the uninvolved knees and the control group results. During the 21st week of physiotherapy, the results obtained for IT and PT in patients after ACLR were similar to the values obtained from the uninvolved knees and the results of the second group subjects. Conclusions The 21-week physiotherapy in ACLR patients favorably affected the PT values of tibial rotator muscles of the operated knees. In the third group, the IT values did not indicate a complete improvement after 12 months without systematic physiotherapy. PMID:21873950

  14. A Surgical Trick for Adjusting an Inaccurate Guide Pin to the Center of the Tibial Footprint in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Apivatgaroon, Adinun; Chernchujit, Bancha

    2014-01-01

    Anatomic positioning of the graft in anatomic anterior cruciate ligament reconstruction is the key to improved knee stability, restoration of normal knee kinematics, and the prevention of long-term joint degeneration. We have developed a technique for adjusting inaccurate drill guide placement to the center of the tibial footprint in anatomic single-bundle anterior cruciate ligament reconstruction. This technique can solve the inaccurate drill guide placement problems that may be encountered during this surgical procedure. PMID:24904776

  15. Editorial Commentary: Combined High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction Yield Good Results With Unknown Effect of the Cartilage Restoration Procedure.

    PubMed

    Rossi, Michael J

    2016-02-01

    Realignment of the knee with high tibial osteotomy combined with anterior cruciate ligament reconstruction for a varus-deformed, anterior cruciate ligament-deficient knee yields improved International Knee Documentation Committee functional outcomes at 1 and 5 years, with cartilage restoration shown by second-look arthroscopy at 1 to 2 years. The effect of the cartilage restoration technique is still unknown, and recent literature poses a challenge to its need when realignment surgery is performed. PMID:26814391

  16. An Anterior Cruciate Ligament Reconstruction Technique With 4-Strand Semitendinosus Grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices.

    PubMed

    Colombet, Philippe; Graveleau, Nicolas

    2015-10-01

    We describe an anatomic single-bundle anterior cruciate ligament reconstruction using a 4-strand semitendinosus graft fixed with 2 Pullup adjustable suspensory fixation systems (SBM, Lourdes, France). Outside-in full tibial tunnel drilling represents a secure option for length management of the graft. The preferred graft choice is a 4-strand semitendinosus autologous graft. A special technique is used to stitch the graft with a figure-of-8 stitch to load the 4 strands. The Pullup adjustable loop is equipped with 2 buttons of different sizes: a small button for the standard Pullup system on the femoral side and a large button for the Pullup XL system on the tibial side. With this method, graft tension is equally distributed among the 4 strands and the graft cannot bottom out in the tibial tunnel in case of inadequate graft length. PMID:26697313

  17. An Anterior Cruciate Ligament Reconstruction Technique With 4-Strand Semitendinosus Grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices

    PubMed Central

    Colombet, Philippe; Graveleau, Nicolas

    2015-01-01

    We describe an anatomic single-bundle anterior cruciate ligament reconstruction using a 4-strand semitendinosus graft fixed with 2 Pullup adjustable suspensory fixation systems (SBM, Lourdes, France). Outside-in full tibial tunnel drilling represents a secure option for length management of the graft. The preferred graft choice is a 4-strand semitendinosus autologous graft. A special technique is used to stitch the graft with a figure-of-8 stitch to load the 4 strands. The Pullup adjustable loop is equipped with 2 buttons of different sizes: a small button for the standard Pullup system on the femoral side and a large button for the Pullup XL system on the tibial side. With this method, graft tension is equally distributed among the 4 strands and the graft cannot bottom out in the tibial tunnel in case of inadequate graft length. PMID:26697313

  18. Estimation of ligament loading and anterior tibial translation in healthy and ACL-deficient knees during gait and the influence of increasing tibial slope using EMG-driven approach.

    PubMed

    Shao, Qi; MacLeod, Toran D; Manal, Kurt; Buchanan, Thomas S

    2011-01-01

    The purpose of this study was to develop a biomechanical model to estimate anterior tibial translation (ATT), anterior shear forces, and ligament loading in the healthy and anterior cruciate ligament (ACL)-deficient knee joint during gait. This model used electromyography (EMG), joint position, and force plate data as inputs to calculate ligament loading during stance phase. First, an EMG-driven model was used to calculate forces for the major muscles crossing the knee joint. The calculated muscle forces were used as inputs to a knee model that incorporated a knee-ligament model in order to solve for ATT and ligament forces. The model took advantage of using EMGs as inputs, and could account for the abnormal muscle activation patterns of ACL-deficient gait. We validated our model by comparing the calculated results with previous in vitro, in vivo, and numerical studies of healthy and ACL-deficient knees, and this gave us confidence on the accuracy of our model calculations. Our model predicted that ATT increased throughout stance phase for the ACL-deficient knee compared with the healthy knee. The medial collateral ligament functioned as the main passive restraint to anterior shear force in the ACL-deficient knee. Although strong co-contraction of knee flexors was found to help restrain ATT in the ACL-deficient knee, it did not counteract the effect of ACL rupture. Posterior inclination angle of the tibial plateau was found to be a crucial parameter in determining knee mechanics, and increasing the tibial slope inclination in our model would increase the resulting ATT and ligament forces in both healthy and ACL-deficient knees. PMID:20683675

  19. Editorial Commentary: Tibial Tubercle-Trochlear Groove Distance as an Independent Risk Factor for Noncontact Anterior Cruciate Ligament Injury Is Possible but Remains Uncertain.

    PubMed

    Rossi, Michael J

    2016-01-01

    The MRI tibial tubercle-trochlear groove distance is statistically significantly higher in adolescent and young adults with noncontact anterior cruciate ligament (ACL) tears compared with those without tears. The authors use lateral thinking to assess this marker for extensor mechanism alignment as a potential risk factor for ACL tear. Yet the approximate 2 mm increase seen in those with ACL tears portends unproven clinical significance. PMID:26743411

  20. Effect of Fatigue on Hamstring Reflex Responses and Posterior-Anterior Tibial Translation in Men and Women

    PubMed Central

    Behrens, Martin; Mau-Moeller, Anett; Wassermann, Franziska; Bruhn, Sven

    2013-01-01

    Anterior cruciate ligament (ACL) rupture ranks among the most common injuries in sports. The incidence of ACL injuries is considerably higher in females than in males and the underlying mechanisms are still under debate. Furthermore, it has been suggested that muscle fatigue can be a risk factor for ACL injuries. We investigated gender differences in hamstring reflex responses and posterior-anterior tibial translation (TT) before and after fatiguing exercise. We assessed the isolated movement of the tibia relative to the femur in the sagittal plane as a consequence of mechanically induced TT in standing subjects. The muscle activity of the hamstrings was evaluated. Furthermore, isometric maximum voluntary torque (iMVT) and rate of torque development (RTD) of the hamstrings (H) and quadriceps (Q) were measured and the MVT H/Q as well as the RTD H/Q ratios were calculated. After fatigue, reflex onset latencies were enhanced in women. A reduction of reflex responses associated with an increased TT was observed in females. Men showed no differences in these parameters. Correlation analysis revealed no significant associations between parameters for TT and MVT H/Q as well as RTD H/Q. The results of the present study revealed that the fatigue protocol used in this study altered the latency and magnitude of reflex responses of the hamstrings as well as TT in women. These changes were not found in men. Based on our results, it is conceivable that the fatigue-induced decrease in neuromuscular function with a corresponding increase in TT probably contributes to the higher incidence of ACL injuries in women. PMID:23573178

  1. Relationship between Mucoid Degeneration of the Anterior Cruciate Ligament and Posterior Tibial Slope in Patients with Total Knee Arthroplasty

    PubMed Central

    Youm, Yoon-Seok; Cho, Hye-Yong; Jung, Seung-Hyun

    2016-01-01

    Purpose The purpose was to analyze the relationship between posterior tibial slope (PTS) and mucoid degeneration of the anterior cruciate ligament (ACL) in patients with total knee arthroplasty. Materials and Methods Four hundred and twenty-four patients (24 males and 400 females; 636 knees) who received total knee arthroplasty for osteoarthritis were included. Their mean age was 68.9 years (range, 48 to 88 years). The patients were classified into three groups according to the status of ACL; normal ACL group (group I), mucoid degeneration of ACL group (group II) and ruptured or absent ACL group (group III). Plain lateral radiographs were used to measure the PTS and the values were compared among groups. Results There were no significant differences with regard to gender, age and left-to-right side ratio among groups (p>0.05). The mean PTS was 9.9° (range, 0.6° to 20.1°) in group I (161 knees), 10.8° (range, 0.2° to 21.8°) in group II (342 knees) and 12.3° (range, 2° to 22.2°) in group III (133 knees), which showed significant differences (p<0.001). Conclusions The patients with mucoid degeneration of the ACL and those with ruptured or absent ACL had greater PTS than those with normal ACL. These findings suggest that an increased PTS may be one of the causative factors for mucoid degeneration of the ACL.

  2. Effect of Posterior Tibial Slope on Flexion and Anterior-Posterior Tibial Translation in Posterior Cruciate-Retaining Total Knee Arthroplasty.

    PubMed

    Chambers, Andrew W; Wood, Addison R; Kosmopoulos, Victor; Sanchez, Hugo B; Wagner, Russell A

    2016-01-01

    Reduced posterior tibial slope (PTS) and posterior tibiofemoral translation (PTFT) in posterior cruciate-retaining (PCR) total knee arthroplasty (TKA) may result in suboptimal flexion. We evaluated the relationship between PTS, PTFT, and total knee flexion after PCR TKA in a cadaveric model. We performed a balanced PCR TKA using 9 transfemoral cadaver specimens and changed postoperative PTS in 1 increments. We measured maximal flexion and relative PTFT at maximal flexion. We determined significant changes in flexion and PTFT as a function of PTS. Findings showed an average increase in flexion of 2.3 and average PTFT increase of 1mm per degree of PTS increase when increasing PTS from 1 to 4 (P<.05). Small initial increases in PTS appear to significantly increase knee flexion and PTFT. PMID:26476469

  3. Effects of Anterior-Posterior Constraint on Injury Patterns in the Human Knee During Tibial-Femoral Joint Loading from Axial Forces through the Tibia.

    PubMed

    Jayaraman, V M; Sevensma, E T; Kitagawa, M; Haut, R C

    2001-11-01

    According to the National Accident Sampling System (NASS), 10% of all automobile accident injuries involve the knee. These injuries involve bone fracture and/or "soft tissue" injury. Previous investigators have determined the tibial-femoral (TF) joint failure load for an experimentally constrained human knee at 90 degrees flexion. In these experiments bone fractures have been documented. During TF joint compression, however, anterior motion of the tibia has been noted by others. It was therefore the objectives of this study to document effects of flexion angle and anterior-posterior joint constraint on the nature and severity of knee injury during TF compression loading via axial loads in the tibia. The effect of flexion angle was examined using 10 unconstrained human knees from 5 cadavers aged 73.2+/-9.4 years. The tibial-femoral joint was loaded in compression as a result of axial loading along the tibia using a servo-hydraulic testing machine until gross failure with the knee flexed 60 degrees or 120 degrees . Pressure sensitive film measured the distribution of internal TF joint loads. Both 60 degrees and 120 degrees flexed preparations failed by rupture of the anterior cruciate ligament (ACL) at 4.6+/-1.2 kN, and the internal joint loads were significantly higher (2.6+/-1.5 kN) on the medial versus the lateral (0.4+/-0.5 kN) aspect of the tibial plateau. The effect of anterior-posterior (AP) constraint of the femur along the longitudinal axis of the femur was investigated in a second series of tests using the same TF joint loading protocol on 6 pairs of human joints (74.3+/-10.5 years) flexed at 90 degrees . The primary mode of failure for the AP constrained joints was fracture of bone via the femoral condyle at a maximum load of 9.2+/-2.6 kN. The mode of failure for unconstrained joints was primarily due to rupture of the ACL at a maximum load of 5.8+/-2.9 kN. Again, the pressure film indicated an unequal internal TF load distribution for the unconstrained knee (medial plateau 4.1+/-1.9 kN versus lateral plateau 0.8+/-0.8 kN). However, there was a more equal distribution of internal loads between the medial (4.4+/-1.8 kN) and lateral (2.8+/-1.9 kN) aspects of the tibial plateau in the constrained joints. This study showed that the mechanism of tibial-femoral knee joint injury and internal TF joint load distribution depends on the degree of AP constraint offered by the test apparatus. Flexion angle did not significantly affect failure load or the mechanism of failure for the unconstrained knee. The findings from this study may be useful in understanding the complex failure mechanisms for an unconstrained knee under axial compression loads in the tibia during automobile crashes. PMID:17458758

  4. Influence of screw length and diameter on tibial strain energy density distribution after anterior cruciate ligament reconstruction

    NASA Astrophysics Data System (ADS)

    Yao, Jie; Kuang, Guan-Ming; Wong, Duo Wai-Chi; Niu, Wen-Xin; Zhang, Ming; Fan, Yu-Bo

    2014-04-01

    Postoperative tunnel enlargement has been frequently reported after anterior cruciate ligament (ACL) reconstruction. Interference screw, as a surgical implant in ACL reconstruction, may influence natural loading transmission and contribute to tunnel enlargement. The aims of this study are (1) to quantify the alteration of strain energy den sity (SED) distribution after the anatomic single-bundle ACL reconstruction; and (2) to characterize the influence of screw length and diameter on the degree of the SED alteration. A validated finite element model of human knee joint was used. The screw length ranging from 20 to 30mm with screw diameter ranging from 7 to 9 mm were investigated. In the post-operative knee, the SED increased steeply at the extra-articular tunnel aperture under compressive and complex loadings, whereas the SED decreased beneath the screw shaft and nearby the intra-articular tunnel aperture. Increasing the screw length could lower the SED deprivation in the proximal part of the bone tunnel; whereas increasing either screw length or diameter could aggravate the SED deprivation in the distal part of the bone tunnel. Decreasing the elastic modulus of the screw could lower the bone SED deprivation around the screw. In consideration of both graft stability and SED alteration, a biodegradable interference screw with a long length is recommended, which could provide a beneficial mechanical environment at the distal part of the tunnel, and meanwhile decrease the bone-graft motion and synovial fluid propagation at the proximal part of the tunnel. These findings together with the clinical and histological factors could help to improve surgical outcome, and serve as a preliminary knowledge for the following study of biodegradable interference screw. [Figure not available: see fulltext.

  5. Modified intracanal post for severely mutilated primary anterior teeth

    PubMed Central

    Rallan, Mandeep; Rallan, Neelakshi Singh; Navit, Pragati; Malhotra, Garima

    2013-01-01

    Early childhood caries leads to early damage, discolouration and gross destruction of the maxillary anterior teeth. This leads to difficulty in speech, decreased masticatory efficiency, development of abnormal tongue thrust and subsequent malocclusion, psychological problems and problem with self-esteem, if aesthetics are compromised. Thus, restoration of severely mutilated primary anterior teeth is often considered as a special challenge, especially in an emotionally immature child. This case documents the restoration of severely mutilated incisors in a patient with early childhood caries. PMID:23605834

  6. Short-term effects of thermotherapy for spasticity on tibial nerve F-waves in post-stroke patients

    NASA Astrophysics Data System (ADS)

    Matsumoto, Shuji; Kawahira, Kazumi; Etoh, Seiji; Ikeda, Satoshi; Tanaka, Nobuyuki

    2006-03-01

    Thermotherapy is generally considered appropriate for post-stroke patients with spasticity, yet its acute antispastic effects have not been comprehensively investigated. F-wave parameters have been used to demonstrate changes in motor neuron excitability in spasticity and pharmacological antispastic therapy. The present study aimed to confirm the efficacy of thermotherapy for spasticity by evaluating alterations in F-wave parameters in ten male post-stroke patients with spastic hemiparesis (mean age: 49.015.0 years) and ten healthy male controls (mean age: 48.74.4 years). The subjects were immersed in water at 41C for 10 min. Recordings were made over the abductor hallucis muscle, and antidromic stimulation was performed on the tibial nerve at the ankle. Twenty F-waves were recorded before, immediately after, and 30 min following thermotherapy for each subject. F-wave amplitude and F-wave/M-response ratio were determined. Changes in body temperature and surface-skin temperature were monitored simultaneously. The mean and maximum values of both F-wave parameters were higher on the affected side before thermotherapy. In the post-stroke patients, the mean and maximum values of both parameters were significantly reduced after thermotherapy ( P<0.01). Hence, the antispastic effects of thermotherapy were indicated by decreased F-wave parameters. Body temperature was significantly increased both immediately after and 30 min after thermotherapy in all subjects. This appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after thermotherapy in both groups and returned to baseline 30 min later. These findings demonstrate that thermotherapy is an effective nonpharmacological antispastic treatment that might facilitate stroke rehabilitation.

  7. Use of a tooth-colored post for anterior restorations.

    PubMed

    Perdigão, Jorge; Villar, Anamaria

    2002-01-01

    The restoration of endodontically treated teeth is still a challenge to the general dentist. Extensive caries or traumatic fracture may result in insufficient coronal tooth structure remaining to support a core. The introduction of fiber post systems in the 1990s has provided dentists with new options for the restoration of the pulpless tooth. This clinical article demonstrates the use of a fiber post and a composite buildup material. PMID:12572105

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

    PubMed Central

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

    2010-01-01

    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. PMID:20385387

  9. Screening for variations in anterior digastric musculature prior to correction of post-traumatic anterior open bite by injection of botulinum toxin type A: a technical note.

    PubMed

    Zdilla, Matthew J

    2015-06-01

    It has recently been reported that long-standing post-traumatic open bite can be successfully corrected with botulinum toxin type A (BTX-A) injection into the anterior belly of the digastric muscle (ABDM). The report documented an individual with bilaterally symmetrical and otherwise unremarkable anterior digastric musculature. However, the existence of variant anterior digastric musculature is common and may complicate the management of anterior open bite with BTX-A injection. Screening for variant ABDM can be accomplished via ultrasound, computed tomography, and magnetic resonance imaging. Screening for variant ABDM should be performed prior to BTX-A injection in order to account for musculature that may exert undesired forces, such as inferolateral deviation, on the anterior mandible in patients with anterior open bite. PMID:26131435

  10. Screening for variations in anterior digastric musculature prior to correction of post-traumatic anterior open bite by injection of botulinum toxin type A: a technical note

    PubMed Central

    2015-01-01

    It has recently been reported that long-standing post-traumatic open bite can be successfully corrected with botulinum toxin type A (BTX-A) injection into the anterior belly of the digastric muscle (ABDM). The report documented an individual with bilaterally symmetrical and otherwise unremarkable anterior digastric musculature. However, the existence of variant anterior digastric musculature is common and may complicate the management of anterior open bite with BTX-A injection. Screening for variant ABDM can be accomplished via ultrasound, computed tomography, and magnetic resonance imaging. Screening for variant ABDM should be performed prior to BTX-A injection in order to account for musculature that may exert undesired forces, such as inferolateral deviation, on the anterior mandible in patients with anterior open bite. PMID:26131435

  11. Polyethylene fiber tape used as a post and core in decayed primary anterior teeth: a treatment option.

    PubMed

    Viera, C L; Ribeiro, C C

    2001-01-01

    The early loss of the anterior primary teeth can cause problems in phonation, development of the maxilla and is related to deleterious habits. This case presents the clinical sequence of rehabilitation of upper anterior primary teeth, where endodontic treatments were done. This was followed by the construction of root post using polyethylene ribbon fibers and the fabrication of crowns composed of resin. PMID:11688805

  12. Massage Therapy Protocol for PostAnterior Cruciate Ligament Reconstruction Patellofemoral Pain Syndrome: A Case Report

    PubMed Central

    Zalta, Jennifer

    2008-01-01

    Background: The intent of the present study was to determine the effectiveness of massage therapy in the rehabilitation of postanterior cruciate ligament reconstruction patellofemoral pain syndrome. The primary complications following surgical repair of the anterior cruciate ligamentclassified as patellofemoral pain syndromeare hamstring flexion contracture and quadriceps weakness, leading to patellofemoral dysfunction and retropatellar pain. Methods: Treatment included lymphatic drainage, myofascial release, neuromuscular techniques including trigger point release, muscle energy techniques and cross-fiber friction. Orthopedic physical assessment tests were used to chart changes in patellofemoral function and changes in range of motion in the knee during the course of the massage interventions. Subjective reporting on pain level and function were also documented. Results: A decrease in pain level, hamstring flexion contracture and lateral tracking of the patella were documented. Conclusion: Massage therapy was determined to be an effective complementary therapy in the treatment of patellofemoral pain syndrome. PMID:21589717

  13. Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

    PubMed Central

    Shiehmorteza, Masoud; Trudell, Debra J.; Hefflin, Tori; Resnick, Donald

    2009-01-01

    Objective Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines. Materials and Methods A total of 35 tibial bone specimens were evaluated for the degree of osteoarthritis and presence of eburnation. Each plateau was also divided into four quadrants and the presence and size of bone outgrowths were recorded in each quadrant. The medial/lateral tibial intercondylar spine index for each specimen was calculated as follows: (medial/lateral intercondylar tibial spine height)/(anteroposterior width of the superior tibial surface). The relationships between medial and lateral tibial height indexes with the degree of osteoarthritis were then tested. Results Osteophytes were observed more frequently in the anterior quadrants of both tibial plateaus than in the posterior quadrants (29 vs 16 for the medial tibial plateau [p?=?0.01] and 28 vs 20 for the lateral tibial plateau [p?=?0.04]). Eburnation was seen more frequently in the posterior regions of both tibial plateaus than in the anterior regions (17 vs 5, p?tibial index was significantly lower than that in specimens with some degree of osteoarthritis (p?=?0.02). The medial intercondylar tibial index of the specimens with no signs of osteoarthritis was not significantly different from that of the specimens with some degree of osteoarthritis (p?=?0.45). There was a positive correlation between the lateral spine height index and the overall grading of osteoarthritis, (r?=?0.6, p?tibial plateau, the association between the lateral intercondylar tibial spine index and the grade of osteophytes was 0.5 (p?tibial intercondylar spine is associated with osteophyte formation and osteoarthritis. Eburnation occurs mainly in the posterior parts of the tibial plateaus while osteophytes arise mainly in the anterior parts. These findings suggest that stresses occurring in the flexed knee may contribute to many of the morphological abnormalities of osteoarthritis. PMID:19941134

  14. Rupture traumatique du tendon tibial postérieur survenue lors d'une fracture fermée de la cheville: à propos d'un cas

    PubMed Central

    Karabila, Mohamed Amine; Azouz, Mohamed; Mhamdi, Younes; Hmouri, Ismail; Kharmaz, Mohamed; Bardouni, Ahmed; Lahlou, Abdou; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Nous rapportons le cas d'une rupture post-traumatique du tendon tibial postérieur survenue lors d'une fracture bimalléolaire de la cheville. Le diagnostic a été posé lors de l'intervention chirurgicale. La réparation du tendon, non dégénératif, a été réalisée en même temps que l'ostéosynthèse. Bien que rare, cette possibilité de lésion tendineuse lors des fractures de la cheville ne doit pas êtreoubliée. Des douleurs résiduelles, un déficit de l'inversion active du pied, une modification de l'arche médiane du pied et à terme une évolution vers un pied plat valgus doivent faire évoquer rétrospectivement le diagnostic.

  15. Post-operative imaging of anterior cruciate ligament reconstruction techniques across the spectrum of skeletal maturity.

    PubMed

    Zbojniewicz, Andrew M; Meyers, Arthur B; Wall, Eric J

    2016-04-01

    Due to an increased frequency of anterior cruciate ligament (ACL) injuries in young patients and improved outcomes in athletic performance following ACL reconstruction, surgery is increasingly being performed across the spectrum of skeletal maturity. We present a review of the range of reconstruction techniques performed in skeletally immature patients (physeal sparing techniques, which may involve epiphyseal tunnels or the utilization of an iliotibial band autograft), those performed in patients nearing skeletal maturity (transphyseal techniques), and the more conventional ACL reconstruction techniques performed in skeletally mature adolescents. It is important that radiologists be aware of the range of techniques being performed throughout the spectrum of skeletal maturity in order to accurately characterize the expected post-operative appearance as well as to identify complications, including those unique to this younger population. PMID:26646675

  16. Evaluation of the changes in the muscle sympathetic nerve activity and anterior tibial muscle blood flow caused by the Valsalva maneuver in patients with lumbago and healthy subjects.

    PubMed

    Nambu, Akihiko; Aoki, Takafumi; Shirai, Yasumasa; Ito, Hiromoto

    2005-04-01

    Clinical symptoms affecting the lower extremities are common among lumber spinal disorder patients. Pain, numbness and sensory disturbance are major signs of these symptoms, and have been suggested to be related to sympathetic nerve disturbance. This study was designed to examine whether these patients experience a difference in sympathetic nerve flow in terms of muscle sympathetic nerve activity (MSA) compared to healthy subjects. Five patients with lumbar intervertebral disc herniation of the spine (LIDH) and four patients with lumbar spinal canal stenosis (LSCS) were examined along with six healthy volunteers. Basic MSAs for IDH and SCS patients that were introduced from a common peroneal nerve were found to be statistically higher than those of the control subjects. MSA behavior and muscle blood flow introduced from the tibialis anterior muscle over 30 seconds while performing the Valsalva maneuver, a well-known technique used to artificially facilitate MSA, were examined for all subjects, and showed relatively slower changes for LIDH and LSCS patients compared to the normal subjects. Muscle blood flow was inversely proportional to MSA for the normal subjects, and this relationship was observed for IDH patients as well as SCS patients. However, MSA and the muscle blood flow of patients gradually changed while performing the Valsalva maneuver relative to the control subjects. This suggests that the systemic physiological response to the maneuver is maintained, but that, some local modification mechanisms exist. PMID:15940017

  17. Post-Learning Infusion of Anisomycin into the Anterior Cingulate Cortex Impairs Instrumental Acquisition through an Effect on Reinforcer Valuation

    ERIC Educational Resources Information Center

    Jonkman, Sietse; Everitt, Barry J.

    2009-01-01

    The integrity of the rodent anterior cingulate cortex (ACC) is essential for various aspects of instrumental behavior, but it is not clear if the ACC is important for the acquisition of a simple instrumental response. Here, it was demonstrated that post-session infusions of anisomycin into the rat ACC completely prevented the acquisition of

  18. Post-Learning Infusion of Anisomycin into the Anterior Cingulate Cortex Impairs Instrumental Acquisition through an Effect on Reinforcer Valuation

    ERIC Educational Resources Information Center

    Jonkman, Sietse; Everitt, Barry J.

    2009-01-01

    The integrity of the rodent anterior cingulate cortex (ACC) is essential for various aspects of instrumental behavior, but it is not clear if the ACC is important for the acquisition of a simple instrumental response. Here, it was demonstrated that post-session infusions of anisomycin into the rat ACC completely prevented the acquisition of…

  19. Outcome of Posterior Tibial Plateau Fixation.

    PubMed

    Jiwanlal, Aneel; Jeray, Kyle James

    2016-01-01

    Isolated posterior tibial plateau fractures are rare injuries that encompass a wide variety of fracture patterns. Based on the variation in fracture pattern, the surgical approach varies, with both anterior and posterior approaches described for surgical fixation. Postoperative protocol also varies among studies. The aim of this article is to summarize the outcomes related to posterior column tibial plateau fractures. The papers reviewed, primarily small retrospective case series, showed functional knee range of motion is preserved, a low incidence of wound complications, and patient outcome scores comparable to other reported lower extremity injury outcome scores. PMID:26509660

  20. Fracture resistance of three different posts in restoration of severely damaged primary anterior teeth: An in vitro study

    PubMed Central

    Seraj, Bahman; Ghadimi, Sara; Estaki, Zohreh; Fatemi, Mostafa

    2015-01-01

    Background: Restoration of anterior primary teeth with severe caries lesion is a big challenge. The aim of this study was to compare the fracture resistance of three types of post, including composite resin, customized quartz fiber and prefabricated glass fiber in restoration of severely damaged primary anterior teeth. Materials and Methods: Sixty extracted human primary maxillary incisors were randomly divided into three groups: Group 1: Customized quartz fiber post, Group 2: Composite post and Group 3: Prefabricated glass fiber post. Due to the effect of bonded area on the fracture resistance, the bonded surface of each sample was measured 1 mm above cementoenamel junction. An increasing force was subjected with a crosshead speed of 0.5 mm/min by a universal testing machine until fracture occurred, and the failure mode was assessed afterwards. Data were analyzed using One-way analysis of variance and Kruskal–Wallis tests. The level of significance was considered at P < 0.05. Results: The mean fracture resistance values of three groups were 343.28 N, 278.70 N and 284.76 N, respectively. Although customized quartz fiber post showed the greatest fracture resistance, statistical analysis revealed no significant difference between groups (P = 0.21). The mean fracture strength values of three groups were 12.82 N/mm–2, 11.93 N/mm–2 and 11.31 N/mm–2, respectively; however, the differences were not statistically significant (P = 0.72). Favorable failure mode was more frequent in all groups (P = 0.12). Conclusion: Within the limitations of this study, it can be concluded that all three types of studied posts can be successfully used to restore badly destructed primary anterior teeth. PMID:26286271

  1. [Fracture of the tibial head].

    PubMed

    Raschke, M; Zantop, T; Petersen, W

    2007-12-01

    Fractures of the tibial head are marked by huge variety. They can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Luxation fractures are commonly associated with lesions of the menisci and intra- and extra-articular ligaments. Several factors may be responsible for the development of post-traumatic OA: anatomically nonreduced joint surface, malalignment, and unaddressed associated injuries. Therefore a sophisticated therapeutic regime is necessary. In case of severely damaged soft tissue or unstable patients, the fracture should first be reduced and fixed with an external fixateur and the osteosynthesis should be performed in a second setting. Arthroscopically assisted reduction and osteosynthesis are indicated for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted fractures can be addressed via several different incisions. Due to locking plates, the bilateral use of large plates can be avoided. In specific cases such as compound fractures and for patients with low compliance, hybrid fixateurs may be an alternative. PMID:18026913

  2. [Fracture of the tibial head].

    PubMed

    Petersen, W; Zantop, T; Raschke, M

    2006-03-01

    Fractures of the tibial head are severe injuries, characterized by enormous variety. Fractures can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Due to the mechanism of injury luxation fractures are frequently associated with lesions of the menisci and intra- and extra-articular ligaments. Multiple factors can be etiologic for post-traumatic gonarthrosis: nonanatomic reduction of the joint surface, malalignment, and unaddressed associated injuries. Therefore in addition to diagnostic steps such as X-ray, CT scan, and MRI a sophisticated therapeutic regime is necessary. In cases with severely damaged soft tissue or unstable patients, the fracture should initially be reduced and fixed with an external fixator and the definite fixation should be performed in a second setting. Arthroscopically assisted treatment is reserved for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted and bilateral fractures can be addressed via different incisions. New locking plates with angular stability allow avoidance of bilateral plating in most situations. In specific cases such as compound fractures and for patients with low compliance, a hybrid fixator may be a well-chosen alternative. PMID:16523282

  3. Lessons learnt from managing an avulsion fracture of the tibial tubercle extending into the tibial physis

    PubMed Central

    Subbu, Rajiv; Nandra, Rajpal; Jordan, Robert; Krikler, Steve

    2013-01-01

    Acute avulsions of the tibial tubercle apophysis are uncommon, with reported incidence of 0.42.7% of all physeal injuries. In our case the extent of the injury was not realised at first presentation and initial internal fixation was attempted. At first outpatient follow-up, repeat radiographs indicated the fracture was not reduced and further CT imaging requested. The three-dimensional CT reconstructed images provide considerably more information on the fracture pattern and retrospectively these may have been helpful during the initial procedure. Therefore we would recommend obtaining a preoperative CT scan if extension of the fracture into the tibial physis is suspected. During the second procedure arthroscopy was tried to aid fracture reduction, but visualisation of the anterior articular surface under the anterior horns of the menisci was difficult through the anterior portals with a standard 30 arthroscope and we further recommend having a 70 scope available to ensure optimal visualisation. PMID:24057332

  4. Fourth-generation intraradicular posts for the aesthetic restoration of anterior teeth.

    PubMed

    Martelli, R

    2000-08-01

    Endodontically treated teeth have been traditionally restored with cost-metal posts prior to receiving aesthetic care. Due to the difficulties associated with early posts, resources have been invested to develop biocompatible endodontic posts capable of satisfying functional and aesthetic criteria. These initiatives have resulted in the introduction of carbon-based and glass-fiber posts with translucencies and moduli of elasticity closely approximating that of the dentin for use in adhesive dental procedures. This article demonstrates the rationale and application of translucent glass-fiber posts for the restoration of pulpless teeth. PMID:11404909

  5. The accuracy of extramedullary guides for tibial component placement in total knee arthroplasty

    PubMed Central

    Yau, W. P.; Ng, T. P.; Tang, W. M.

    2007-01-01

    Anteroposterior radiographs that included the whole tibia were taken before and after 75 total knee arthroplasties in 48 patients. The same tibial extra-medullary alignment guide system was used in every knee. The average tibial component alignment was 0.4 (SD 2.5, range −4.9 to 6.4) degrees of valgus post-operatively. 59 tibial components (78.7%) had a tibial cut within 3 degrees from being perpendicular to the mechanical axis, ten were too valgus (13.3%) and six were too varus (8%). The chance of the tibial components becoming too varus was higher if there was lateral tibial bowing, compared with no tibial bowing (p = 0.048). A smaller lateral width of the leg increased the chance of the tibial components becoming too valgus (p = 0.047). PMID:17364176

  6. Modified Technique of Tibial Tuberosity Transfer

    PubMed Central

    Pemmaraju, Gopalakrishna; Raad, Abbas; Kotecha, Amit; Chugh, Sanjiv; Mughal, Ejaz

    2015-01-01

    Tibial tuberosity transfer is a well-established procedure in the treatment of patellar instability and in selected cases of anterior knee pain. Several techniques have been advocated in the literature. Some of the common complications associated with this procedure have been pain and discomfort due to prominent screw heads, necessitating their removal; nonunion and delayed union of the osteotomy; and failure of fixation. Tibial fractures have also been reported in some case reports. We present our technique of tibial tuberosity transfer using two 4-mm cannulated screws for stabilization of the tuberosity fragment. We have used this technique either for isolated tibial tuberosity transfer or as part of a combined procedure along with medial patellofemoral ligament reconstruction in treating patellar instability. Using this technique, we have encountered no patients with wound problems, nonunion, delayed union, or loss of fixation and only 1 patient with a metal work problem needing a second procedure for its removal. We attribute our good outcomes to the preservation of the soft-tissue attachments to the tuberosity fragment; minimal soft-tissue dissection, which allows rapid bony consolidation of the osteotomy, which in turn allows accelerated rehabilitation; and the use of 4-mm cannulated screws for fixation of the osteotomy, minimizing the potential for metal work problems. PMID:26759775

  7. [Diffuse post-traumatic calcification of the anterior longitudinal ligamentum of cervical and dorsal spine].

    PubMed

    Manzini, C U; Spina, V; Mascia, M T; Magistro, R; Carpenito, G; Ferri, C

    2004-01-01

    Among the different conditions causing inflammation and calcification/ossification of the soft tissues of the spinal cord, single or recurrent traumatic events are included. Within the international literature, the involvement of the posterior longitudinal ligament, following spinal cord injuries is frequently reported, especially in the elders. The Authors describe here an uncommon calcification/ossification of the anterior longitudinal ligament occurred after a double traumatic event in a young man, followed clinically and radiologically for a long-term period. On the basis of clinical, laboratory and radiological findings, the differential diagnosis with other possible aetiologies, especially DISH (Diffuse idiopathic skeletal hyperostosis) and ankylosing spondylitis, is discussed. PMID:15309220

  8. Biological Dentin Post for Intra Radicular Rehabilitation of A Fractured Anterior Tooth

    PubMed Central

    Swarupa, C.H; Sajjan, Girija S; Bhupahupathiraju, Vijaya Lakshmi; Anwarullahwarullah, Anupreeta; Y.V, Sashikanth

    2014-01-01

    Ideal coronal reconstruction of endodontically treated tooth is still a challenge for restorative dentistry. Despite having varied types of commercially available posts, none of them meet all the ideal biological and mechanical properties. In this context a Biological Post serves as a homologous recipe for intraradicular rehabilitation of a fractured endodontically treated tooth by virtue of its biomimetic property.This case report addresses the esthetic and functional restoration of a fractured, endodontically treated maxillary lateral incisor in a young patient, through the preparation and adhesive cementation of a Biological Post made from a freshly extracted, intact human canine. The use of biological post can be considered as a novel alternative technique for the rehabilitation of an extensively damaged tooth. PMID:24701545

  9. Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication.

    PubMed

    Armangil, Mehmet; Basat, H Çağdaş; Bilgin, S Sinan

    2015-01-01

    Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications. PMID:25803264

  10. Lessons Learnt from an Atypical Mycobacterium Infection Post-Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Yee Han, Dave Lee

    2015-01-01

    Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well. PMID:25729530

  11. The Effect of Malrotation of Tibial Component of Total Knee Arthroplasty on Tibial Insert during High Flexion Using a Finite Element Analysis

    PubMed Central

    Todo, Mitsugu

    2014-01-01

    One of the most common errors of total knee arthroplasty procedure is a malrotation of tibial component. The stress on tibial insert is closely related to polyethylene failure. The objective of this study is to analyze the effect of malrotation of tibial component for the stress on tibial insert during high flexion using a finite element analysis. We used Stryker NRG PS for analysis. Three different initial conditions of tibial component including normal, 15 internal malrotation, and 15 external malrotation were analyzed. The tibial insert made from ultra-high-molecular-weight polyethylene was assumed to be elastic-plastic while femoral and tibial metal components were assumed to be rigid. Four nonlinear springs attached to tibial component represented soft tissues around the knee. Vertical load was applied to femoral component which rotated from 0 to 135 while horizontal load along the anterior posterior axis was applied to tibial component during flexion. Maximum equivalent stresses on the surface were analyzed. Internal malrotation caused the highest stress which arose up to 160% of normal position. External malrotation also caused higher stress. Implanting prosthesis in correct position is important for reducing the risk of abnormal wear and failure. PMID:24895658

  12. Correlations of dimensional and discrete dental traits in the post-canine and anterior dental segments.

    PubMed

    Kieser, J A; Becker, P J

    1989-03-01

    The present study explores the associations of metric and discrete variation in human canines and first molars. Emphasis is placed on the relation between tooth size and the various grades of expression of the canine distal accessory ridge (CDAR) and Carabelli's trait, in order to test the hypothesis that metric and non-metric variation in the posterior teeth are less well integrated than in the anterior teeth. Metric and discrete dental data were gathered from 120 Lengua Indians (52 male, 68 female), 100 Negroes (52 male, 48 female) and 100 caucasoids (50 male, 50 female). Our results indicate that first maxillary molar size and the Carabelli trait vary independently of one another. Similarly, variation in canine size and in the CDAR appears to be independently determined. Hence it is concluded that tooth size and morphology in the maxillary canines and molars are poorly integrated, irrespective of intra-arcadal position. Furthermore, sex dimorphism and interpopulation differences in the expressivity of Carabelli's trait and the CDAR appear to be unrelated to odontometric differences. PMID:2609355

  13. Case Series of Post-Thrombolysis Patients Undergoing Hemicraniectomy for Malignant Anterior Circulation Ischaemic Stroke

    PubMed Central

    Williams, A.; Sittampalam, M.; Barua, N.; Mohd Nor, A.

    2011-01-01

    While ischaemic stroke remains a leading cause of death and disability, there have been recent advancements in treatment modalities including thrombolysis and decompressive hemicraniectomy. A retrospective review of patients treated in our NHS teaching hospital, in Plymouth (UK), over a 2 year period identified 17 thrombolysed patients, of whom two had undergone subsequent decompressive hemicraniectomy. These were non-dominant hemisphere strokes in young patients, aged 51 and 57. Initial NIHSS scores were 16 and 17, and they received thrombolysis at 2?hrs 42?min and 5?hrs 10?min post onset of symptoms respectively. CT imaging demonstrated cerebral swelling with significant midline shift in both cases, and decompressive hemicraniectomy was undertaken at 29?hrs 8?min and 27?hrs 30?min post-thrombolysis. We found no significant intra-operative complications attributable to prior use of thrombolytics. Both patients have had acceptable psychological and physical outcomes, with Barthel Index scores of 40 and 25, and MMSE scores of 29/30 and 27/30. We conclude that the use of thrombolytic therapy does not contra-indicate subsequent decompressive hemicraniectomy in well selected patients with non-dominant hemisphere strokes. More research in this field is required to elucidate factors which would facilitate recognition of stroke patients who will benefit most from aggressive medical and neurosurgical intervention. PMID:21541210

  14. Treatment of tibial eminence fractures with arthroscopic suture fixation technique: a retrospective study

    PubMed Central

    Yuan, Yanhao; Huang, Xiaohan; Zhang, Yanjie; Wang, Zhanchao

    2015-01-01

    Aims: The present study aims to investigate the clinical outcomes of arthroscopic suture fixation in treating tibial eminence fracture with a retrospective study design of two years’ follow-up. Methods: A total of 33 patients with imaging evidence of tibial eminence avulsion fractures who underwent arthroscopic surgery between 2008 and 2012 were included in this study. The inclusion criteria for the study were a displaced tibial eminence avulsion fracture and anterior knee instability of grade II or higher inskeletally mature patients. These patients were treated with arthroscopic suture fixation and followed with a mean period of 24 months. Anteroposterior and lateral radiographs were obtained 3 months postoperatively to assess fracture healing. At 24 months after surgery, all patients were evaluated by an independent orthopaedic professor with clinical examination like anteroposterior laxity (Lachman-Noulis and anterior drawer tests) and Rolimeter knee tester (Aircast, Vista, CA). Knee range of motion was evaluated actively and passively with a goniometer. Knee function was evaluated by the Lysholm and International Knee Documentation Committee (IKDC) scores. Knee radiographs in standing anteroposterior, standing lateral, and Merchant views were examined for alignment, joint space narrowing, and degenerative knee changes. Results: No major complication like infection, deep venous thrombosis, or neurovascular deficit happened peri-operatively. At the final follow-up, there were no symptoms of instability and no clinical signs of ACL deficiency. Radiographs showed that all fractures healed 3 months post-operative, but at the last follow-up, there was one person with degenerative changes like joint space narrowing in radiographs. Anterior translation of the tibia was 0.47 mm on average (0 to 2.5 mm) compared with the uninjured side. Range-of-motion measurement showed a mean extension deficit of 1.5° (0° to 5°) and a mean flexion deficit of 2.7° (0° to 10°) compared with the unaffected side. The mean Lysholm score was 96 (85 to 100), and the mean IKDC score was 94 (80 to 100). Overall, the IKDC grade was A (normal) in 24 patients (58%), B (nearly normal) in 8 patients (33%), and C (abnormal) in 1 patient (8%). Conclusion: The present study demonstrated tibial eminence fractures in adults can be effectively treated with arthroscopic suture fixation. PMID:26550328

  15. Non-invasive measurement of tibialis anterior muscle temperature during rest, cycling exercise and post-exercise recovery.

    PubMed

    Flouris, Andreas D; Dinas, Petros C; Tsitoglou, Kiriakos; Patramani, Ioanna; Koutedakis, Yiannis; Kenny, Glen P

    2015-07-01

    We introduce a non-invasive and accurate method to assess tibialis anterior muscle temperature (Tm) during rest, cycling exercise, and post-exercise recovery using the insulation disk (INDISK) technique. Twenty-six healthy males (23.6????6.2?years; 24.1????3.1 body mass index) were randomly allocated into the 'model' (n = 16) and the 'validation' (n = 10) groups. Participants underwent 20?min supine rest, 20?min cycling exercise at 60% of age-predicted maximum heart rate, and 20?min supine post-exercise recovery. In the model group, Tm (34.55????1.02?C) was greater than INDISK temperature (Tid; 32.44????1.23?C; p??0.05) and a strong correlation (r = 0.804; p??0.05), a strong correlation (r = 0.644; p?post-exercise recovery, providing a valid and cost-efficient alternative when direct Tm measurement is not feasible. PMID:26012697

  16. Genetics Home Reference: Tibial muscular dystrophy

    MedlinePLUS

    ... Recent literature OMIM Genetic disorder catalog Conditions > Tibial muscular dystrophy On this page: Description Genetic changes Inheritance Diagnosis ... Glossary definitions Reviewed February 2012 What is tibial muscular dystrophy? Tibial muscular dystrophy is a condition that affects ...

  17. Genetics Home Reference: Tibial muscular dystrophy

    MedlinePLUS

    ... Where can I find information about diagnosis or management of tibial muscular dystrophy? These resources address the diagnosis or management of tibial muscular dystrophy and may include treatment ...

  18. Posterior tibial tendoscopy.

    PubMed

    Monteagudo, Manuel; Maceira, Ernesto

    2015-03-01

    The posterior tibial tendon (PTT) helps the triceps surae to work more efficiently during ambulation. Disorders of the PTT include tenosynovitis, acute rupture, degenerative tears, dislocation, instability, enthesopathies, and chronic tendinopathy with dysfunction and flat foot deformity. Open surgery of the PTT has been the conventional approach to deal with these disorders. However, tendoscopy has become a useful technique to diagnose and treat PTT disorders. This article focuses on PTT tendoscopy and tries to provide an understanding of the pathomechanics of the tendon, indications for surgery, surgical technique, advantages, complications, and limitations of this procedure. PMID:25726479

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

    PubMed Central

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

    2011-01-01

    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. PMID:22134408

  20. Relationship between Tibial Baseplate Design and Rotational Alignment Landmarks in Primary Total Knee Arthroplasty

    PubMed Central

    Indelli, Pier Francesco; Graceffa, Angelo; Baldini, Andrea; Payne, Brielle; Pipino, Gennaro; Marcucci, Massimiliano

    2015-01-01

    This study evaluated the influence of modern tibial baseplate designs when using the anterior tibial cortex as a primary rotational landmark for the tibial baseplate in TKA. Eighty patients undergoing TKA were randomized in two groups. Group 1 included 25 females and 15 males receiving a posterior-stabilized (PS) symmetric tibial baseplate while Group 2 included 24 females and 16 males receiving a PS anatomical tibial component. Identical surgical technique, including the use of the surgical transepicondylar femoral axis (sTEA) and the anterior tibial cortex (Curve-on-Curve) as rotational alignment landmarks, was used. All patients underwent CT evaluation performed with the knee in full extension. Three observers independently measured the rotational alignment of the tibial component in relation to the sTEA. The rotational alignment of the symmetric baseplate showed an average external rotation of 1.3 (minimum 5, maximum ?1): 91% of the knees showed 0 3 with respect to the surgical sTEA, being internally rotated in 20%. The rotational alignment of the anatomical baseplate showed an average external rotation of 4.1 (minimum 0.4, maximum 8.9): only 47.5% of the knees showed 0 3, being externally rotated in 100%. The difference between the two groups was statistically significant. This study confirms the reliability of the Curve-on-Curve technique as an adequate rotational alignment anatomical landmark in TKA: the use of an asymmetric tibial baseplate might lead to external rotation of the tibial component when this technique is intraoperatively chosen. PMID:26491564

  1. Tibial loading after UKA: evaluation of tibial slope, resection depth, medial shift and component rotation.

    PubMed

    Small, Scott R; Berend, Michael E; Rogge, Renee D; Archer, Derek B; Kingman, Amanda L; Ritter, Merrill A

    2013-10-01

    With increased precision in alignment offered by new generations of instrumentation and customized guides, this study was designed to establish a biomechanically-based target alignment for the balance of tibial loading in order to diminish the likelihood of pain and subsidence related to mechanical overload post-UKA. Sixty composite tibias were implanted with Oxford UKA tibial components with varied sagittal slope, resection depth, rotation and medial shift using patient matched instrumentation. Digital image correlation and strain gage analysis was conducted in static loading to evaluate strain distribution as a result of component alignment. In this model, minimal distal resection and most lateral positioning, neutral component rotation, and 3° of slope (from mechanical axis) exhibited the most balanced strain response to loading following UKA. PMID:23518429

  2. Conservative management of a post-traumatic pseudoaneurysm of the artery of cervical enlargement-anterior spinal artery junction.

    PubMed

    Boeris, Davide; Mortimer, Alex; Sakthithasan, Mathuri; Evins, Alexander Ian; Sandeman, David; Renowden, Shelly

    2016-04-01

    A 22-year-old man suffered severe sudden onset head and neck pain after being pushed from behind during an assault. Physical examination was normal. Cervical MRI demonstrated an intradural hematoma, anterior to the cord, between C2-4. Subsequent contrast enhanced MR angiography and digital subtraction vertebral angiography confirmed that the cause of the hemorrhage was a fusiform (presumed dissecting) pseudoaneurysm of the artery of the cervical enlargement at its junction with the anterior spinal artery. The aneurysm was managed conservatively. Follow-up angiography demonstrated that the aneurysm had spontaneously thrombosed within 10 days and remained occluded at 2 months. The patient remained occluded at 6 months following the initial injury. Anterior spinal aneurysms represent a management dilemma and options are discussed. PMID:25817516

  3. Effect of tapering internal coronal walls on fracture resistance of anterior teeth treated with cast post and core: In vitro study

    PubMed Central

    Eid, Rita; Homsy, Fodda; Elhusseini, Hasan

    2014-01-01

    When fabricating indirect post and core, internal coronal walls are tapered to remove undercuts and allow a better adaptation. To evaluate the fracture strength of anterior tooth reconstructed with post and core and crowned, with two different taper of internal coronal walls, 6 and 30 to the long axis, two groups of 30 clear plastic analogues simulating endodontically treated maxillary central incisors were prepared. The analogues crowned were subjected to a compressive load with a 1-kN cell at a crosshead speed of 0.05?mm/min at 130 to the long axis until fracture occurred. Data were analyzed by Lillifors and MannWhitney tests. Mean failure loads for the groups were as follows: group I 1038.69?N (standard deviation 243.52?N) and group II 1231.86?N (standard deviation 368.76?N). Statistical tests showed significant difference between groups (p?=?0.0010?anterior maxillary teeth post and core reconstructed. PMID:25342986

  4. Finite element analysis to study the effects of using CAD/CAM glass-fiber post system in a severely damaged anterior tooth.

    PubMed

    Chen, Aijie; Feng, Xiaoli; Zhang, Yanli; Liu, Ruoyu; Shao, Longquan

    2015-01-01

    To investigate the stress distribution of a severely damaged maxillary anterior tooth restored with a computer-aided design/computer-aided manufacturing (CAD/CAM) glass-fiber post system. Twelve models were fabricated with different alveolar bone levels and cervical dentin wall thicknesses and studied using a two-dimensional finite element method. A force of 100 N was applied to the lingual surface of the crown at 45 degrees, and the maximum von Mises stress was calculated. A higher stress level was observed in the dentin than in the post and crown. With the reduction of dentin thickness, the maximum von Mises stress in the dentin increased slightly to a peak at a thickness of 1.5 mm, followed by a slight decrease at a thickness of 1.0 mm. However, the relative ratio (RR) values did not show a large difference (RR > 80%). Meanwhile, a large difference in RR values was observed with a change in bone level (RR < 80%). When using a CAD/CAM glass-fiber post system, the maximal von Mises stress was significantly affected by the bone level, rather than by the dentin thickness. Moreover, this system may be applied to the treatment of a maxillary anterior tooth with a bone level of only 2/3. PMID:26406043

  5. Biomechanical Characterization of a Model of Noninvasive, Traumatic Anterior Cruciate Ligament Injury in the Rat.

    PubMed

    Maerz, Tristan; Kurdziel, Michael D; Davidson, Abigail A; Baker, Kevin C; Anderson, Kyle; Matthew, Howard W T

    2015-10-01

    The onset of post-traumatic osteoarthritis (PTOA) remains prevalent following traumatic joint injury such as anterior cruciate ligament (ACL) rupture, and animal models are important for studying the pathomechanisms of PTOA. Noninvasive ACL injury using the tibial compression model in the rat has not been characterized, and it may represent a more clinically relevant model than the common surgical ACL transection model. This study employed four loading profiles to induce ACL injury, in which motion capture analysis was performed, followed by quantitative joint laxity testing. High-speed, high-displacement loading repeatedly induces complete ACL injury, which causes significant increases in anterior-posterior and varus laxity. No loading protocol induced valgus laxity. Tibial internal rotation and anterior subluxation occurs up to the point of ACL failure, after which the tibia rotates externally as it subluxes over the femoral condyles. High displacement was more determinative of ACL injury compared to high speed. Low-speed protocols induced ACL avulsion from the femoral footprint whereas high-speed protocols caused either midsubstance rupture, avulsion, or a combination injury of avulsion and midsubstance rupture. This repeatable, noninvasive ACL injury protocol can be utilized in studies assessing PTOA or ACL reconstruction in the rat. PMID:25777293

  6. Arthroscopic Absorbable Suture Fixation for Tibial Spine Fractures

    PubMed Central

    Verdano, Michele Arcangelo; Pellegrini, Andrea; Lunini, Enricomaria; Tonino, Pietro; Ceccarelli, Francesco

    2013-01-01

    The purpose of this technical note and accompanying video is to describe a modified arthroscopic suture fixation technique to treat tibial spine avulsion fractures. Twenty-one patients underwent arthroscopic treatment for tibial spine avulsion with our technique; they were clinically and biomechanically evaluated at 2 years' follow-up and showed optimal clinical and radiographic outcomes. Repair with this arthroscopic technique provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the anterior cruciate ligament: suture methods based on the avulsed bone fragment are technically impossible, but sutures through the base of the ligament itself provide secure fixation, reducing the risks of comminution of the fracture fragment and eliminating the time for hardware removal. This arthroscopic technique restores the length and the integrity of the anterior cruciate ligament and provides a simplified, reproducible method of treating patients, including young patients, with low hardware costs in comparison to sutures using anchors or other hardware. PMID:24749022

  7. TIBIAL SHAFT FRACTURES

    PubMed Central

    Kojima, Kodi Edson; Ferreira, Ramon Venzon

    2015-01-01

    The long-bone fractures occur most frequently in the tibial shaft. Adequate treatment of such fractures avoids consolidation failure, skewed consolidation and reoperation. To classify these fractures, the AO/OTA classification method is still used, but it is worthwhile getting to know the Ellis classification method, which also includes assessment of soft-tissue injuries. There is often an association with compartmental syndrome, and early diagnosis can be achieved through evaluating clinical parameters and constant clinical monitoring. Once the diagnosis has been made, fasciotomy should be performed. It is always difficult to assess consolidation, but the RUST method may help in this. Radiography is assessed in two projections, and points are scored for the presence of the fracture line and a visible bone callus. Today, the dogma of six hours for cleaning the exposed fracture is under discussion. It is considered that an early start to intravenous antibiotic therapy and the lesion severity are very important. The question of early or late closure of the lesion in an exposed fracture has gone through several phases: sometimes early closure has been indicated and sometimes late closure. Currently, whenever possible, early closure of the lesion is recommended, since this diminishes the risk of infection. Milling of the canal when the intramedullary nail is introduced is still a controversial subject. Despite strong personal positions in favor of milling, studies have shown that there may be some advantage in relation to closed fractures, but not in exposed fractures.

  8. Visual Memory in Post-Anterior Right Temporal Lobectomy Patients and Adult Normative Data for the Brown Location Test (BLT)

    PubMed Central

    Brown, Franklin C.; Tuttle, Erin; Westerveld, Michael; Ferraro, F. Richard; Chmielowiec, Teresa; Vandemore, Michelle; Gibson-Beverly, Gina; Bemus, Lisa; Roth, Robert M.; Blumenfeld, Hal; Spencer, Dennis D.; Spencer, Susan S

    2010-01-01

    Several large and meta-analytic studies have failed to support a consistent relationship between visual or nonverbal memory deficits and right mesial temporal lobe changes. However, the Brown Location Test (BLT) is a recently developed dot location learning and memory test that uses a nonsymmetrical array and provides control over many of the confounding variables (e.g., verbal influence and drawing requirements) inherent in other measures of visual memory. In the present investigation, we evaluated the clinical utility of the BLT in patients who had undergone left or right anterior mesial temporal lobectomies. We also provide adult normative data of 298 healthy adults in order to provide standardized scores. Results revealed significantly worse performance on the BLT in the right as compared to left lobectomy group and the healthy adult normative sample. The present findings support a role for the right anterior-mesial temporal lobe in dot location learning and memory. PMID:20056493

  9. Permanent ligation of the left anterior descending coronary artery in mice: a model of post-myocardial infarction remodelling and heart failure.

    PubMed

    Muthuramu, Ilayaraja; Lox, Marleen; Jacobs, Frank; De Geest, Bart

    2014-01-01

    Heart failure is a syndrome in which the heart fails to pump blood at a rate commensurate with cellular oxygen requirements at rest or during stress. It is characterized by fluid retention, shortness of breath, and fatigue, in particular on exertion. Heart failure is a growing public health problem, the leading cause of hospitalization, and a major cause of mortality. Ischemic heart disease is the main cause of heart failure. Ventricular remodelling refers to changes in structure, size, and shape of the left ventricle. This architectural remodelling of the left ventricle is induced by injury (e.g., myocardial infarction), by pressure overload (e.g., systemic arterial hypertension or aortic stenosis), or by volume overload. Since ventricular remodelling affects wall stress, it has a profound impact on cardiac function and on the development of heart failure. A model of permanent ligation of the left anterior descending coronary artery in mice is used to investigate ventricular remodelling and cardiac function post-myocardial infarction. This model is fundamentally different in terms of objectives and pathophysiological relevance compared to the model of transient ligation of the left anterior descending coronary artery. In this latter model of ischemia/reperfusion injury, the initial extent of the infarct may be modulated by factors that affect myocardial salvage following reperfusion. In contrast, the infarct area at 24 hr after permanent ligation of the left anterior descending coronary artery is fixed. Cardiac function in this model will be affected by 1) the process of infarct expansion, infarct healing, and scar formation; and 2) the concomitant development of left ventricular dilatation, cardiac hypertrophy, and ventricular remodelling. Besides the model of permanent ligation of the left anterior descending coronary artery, the technique of invasive hemodynamic measurements in mice is presented in detail. PMID:25489995

  10. Inside-Out Antegrade Tibial Tunnel Drilling Through the Posterolateral Portal Using a Flexible Reamer in Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Alentorn-Geli, Eduard; Stuart, Joseph J.; Choi, J.H. James; Toth, Alison P.; Moorman, Claude T.; Taylor, Dean C.

    2015-01-01

    Posterior cruciate ligament (PCL) reconstruction using the transtibial drilling or arthroscopic tibial-inlay technique has a risk of injury to the popliteal neurovascular bundle because a pin is drilled anterior to posterior. Intraoperative fluoroscopy is used to decrease the risk of neurovascular injury. In addition, graft passage in the transtibial technique may be problematic because of a sharp turn when placing the graft into the tibial tunnel, which may damage graft fibers. In the surgical technique described in this report, the posteromedial portal is used for visualization and the posterolateral portal is used for debridement of the PCL tibial footprint and the synovial fold closest to the PCL. A curved guide is placed from the posterolateral portal to the tibial footprint, and a flexible pin is drilled across the tibia. The tibial tunnel is then created using a flexible reamer under direct visualization up to the desired length, and a graft can be positioned in the tibial tunnel through the posterolateral portal. This technique has the potential advantages of decreasing the risk of injury to the popliteal neurovascular bundle (use of anteriorly directed, inside-out drilling), avoiding a sharp turn during graft passage, and allowing accurate and anatomic tibial tunnel placement without intraoperative fluoroscopy. PMID:26900551

  11. Effects of Neuromuscular Fatigue on Quadriceps Strength and Activation and Knee Biomechanics in Individuals Post-Anterior Cruciate Ligament Reconstruction and Healthy Adults.

    PubMed

    Thomas, Abbey C; Lepley, Lindsey K; Wojtys, Edward M; McLean, Scott G; Palmieri-Smith, Riann M

    2015-12-01

    Study Design Laboratory-based experiment using a pretest/posttest design. Objectives To determine the effects of neuromuscular fatigue on quadriceps strength and activation and sagittal and frontal plane knee biomechanics during dynamic landing following anterior cruciate ligament reconstruction (ACLR). Background Impaired quadriceps central activation occurs post-ACLR, likely altering lower extremity biomechanics. Neuromuscular fatigue similarly reduces volitional muscle activation and impairs neuromuscular control. Upon return to full activity post-ACLR, individuals likely concurrently experience quadriceps central activation deficits and neuromuscular fatigue, though the effects of fatigue on muscle strength and activation and biomechanics post-ACLR are unknown. Methods Seventeen individuals 7 to 10 months post-ACLR and 16 controls participated. Quadriceps strength and central activation ratio were recorded prefatigue and postfatigue, which was induced via sets of double-leg squats. Knee biomechanics were recorded during a dynamic landing activity prefatigue and postfatigue. Results Both groups demonstrated smaller knee flexion (initial contact, P = .017; peak, P = .004) and abduction (initial contact, P = .005; peak, P = .009) angles postfatigue. The ACLR group had smaller peak knee flexion angles (P<.001) prefatigue and postfatigue than controls. Knee flexion moment was smaller in those post-ACLR than controls prefatigue (P<.001), but not postfatigue (P = .103). Controls had smaller knee flexion moments postfatigue (P = .001). Knee abduction moment was smaller in both groups postfatigue (P = .003). All participants demonstrated significantly lower strength (P<.001) and activation (P = .003) postfatigue. Conclusion Impaired strength, central activation, and biomechanics were present postfatigue in both groups, suggesting that neuromuscular fatigue may increase noncontact ACL injury risk. However, these changes were not exaggerated in those post-ACLR, likely because they already demonstrated a stiff-legged landing strategy prefatigue. J Orthop Sports Phys Ther 2015;45(12):1042-1050. Epub 15 Oct 2015. doi:10.2519/jospt.2015.5785. PMID:26471851

  12. Posterior Tibial Tendon Dysfunction (PTTD)

    MedlinePLUS

    ... ACFAS | Información en Español Advanced Search Home » Foot & Ankle Conditions » Posterior Tibial Tendon Dysfunction (PTTD) Text Size ... the arch, and an inward rolling of the ankle. As the condition progresses, the symptoms will change. ...

  13. Anterior cruciate ligament injury about 20 years post-treatment: A kinematic analysis of one-leg hop.

    PubMed

    Tengman, E; Grip, H; Stensdotter, Ak; Häger, C K

    2015-12-01

    Reduced dynamic knee stability, often evaluated with one-leg hops (OLHs), is reported after anterior cruciate ligament (ACL) injury. This may lead to long-standing altered movement patterns, which are less investigated. 3D kinematics during OLH were explored in 70 persons 23 ± 2 years after ACL injury; 33 were treated with physiotherapy in combination with ACL reconstruction (ACL(R)) and 37 with physiotherapy alone (ACL(PT)). Comparisons were made to 33 matched controls. We analyzed (a) maximal knee joint angles and range of motion (flexion, abduction, rotation); (b) medio-lateral position of the center of mass (COM) in relation to knee and ankle joint centers, during take-off and landing phases. Unlike controls, ACL-injured displayed leg asymmetries: less knee flexion and less internal rotation at take-off and landing and more lateral COM related to knee and ankle joint of the injured leg at landing. Compared to controls, ACL(R) had larger external rotation of the injured leg at landing. ACL(PT) showed less knee flexion and larger external rotation at take-off and landing, and larger knee abduction at Landing. COM was more medial in relation to the knee at take-off and less laterally placed relative to the ankle at landing. ACL injury results in long-term kinematic alterations during OLH, which are less evident for ACL(R). PMID:25728035

  14. [External patello-tibial transfixation. I: Indications and technique].

    PubMed

    Gotzen, L; Ishaque, B; Morgenthal, F; Petermann, J

    1997-01-01

    Patello-tibial transfixation using the MPT-fixator is a new kind of external fixation. The device works biomechanically transferring the quadriceps tension forces from the patella to the lower leg and converting them into extension of the knee. The fixator can be applied in two different configurations. When performing configuration A, a Steinmann pin with a central thread is transversely placed through the patella and proximal tibia. Both pins are joined to connecting rods. Configuration B differs from type A in that a Schanz screw is inserted from anterior to posterior through the proximal tibia. The frame construction is achieved by fastening the tibial-sided Steinmann pin with a special clamp at the Schanz screw. Patello-tibial transfixation is indicated in the repair of fresh extensor mechanism disruption and reconstruction of neglected rupture of the patellar tendon. The technique provides a secure protection of the repair and reconstruction against mechanical overloading during the healing period. It enables immediate functional after-treatment and mobilization with early full weight bearing. PMID:9132951

  15. Detached Anterior Horn of the Medial Meniscus Mimicking a Parameniscal Cyst

    PubMed Central

    Fukuta, Shoji; Tsutsui, Takahiko; Matsuura, Tetsuya; Suzue, Naoto; Hamada, Daisuke; Goto, Tomohiro; Sairyo, Koichi

    2015-01-01

    We report a case of a detached anterior horn of the medial meniscus with anterior knee pain. Preoperative magnetic resonance images of the knee were initially interpreted as a parameniscal cyst. Arthroscopic examination revealed subluxation of the anterior horn of the medial meniscus due to detachment from its anterior tibial insertion. Arthroscopic fixation with a suture anchor was successful and the cystic lesion was no longer visible on postoperative images. PMID:26550510

  16. Anatomic femorotibial changes associated with tibial plateau leveling osteotomy

    PubMed Central

    Schultz, Jennifer A.; Allen, David A.; Bergman, Philip J.

    2015-01-01

    This prospective study evaluated anatomic femorotibial changes utilizing the relationship between the intercondylar notch and the intercondylar eminence following tibial plateau leveling osteotomy (TPLO). We hypothesized that TPLO results in anatomic alteration of the femorotibial joint. Pre- and post-operative computed tomography (CT) scans of cranial cruciate deficient stifle joints treated with TPLO were performed on 25 client-owned dogs. Computed tomography scans were performed at 3 different stifle angles: extension, 135 walking angle, and 90 of flexion. Tibial plateau leveling osteotomy did not result in a significant medial or lateral shift of the intercondylar eminence relative to the intercondylar notch. There was a significant cranial shift of the intercondylar eminence with the stifle in extension following TPLO. In addition, TPLO resulted in a significantly narrowed femorotibial joint space. The biomechanical effects of TPLO and medial meniscal release need to be further defined. PMID:26345618

  17. Effect of Wedge Insertion Angle on Posterior Tibial Slope in Medial Opening Wedge High Tibial Osteotomy

    PubMed Central

    Ogawa, Hiroyasu; Matsumoto, Kazu; Ogawa, Takahiro; Takeuchi, Kentaro; Akiyama, Haruhiko

    2016-01-01

    Background: Medial opening wedge high tibial osteotomy (HTO) is a well-established surgery for medial compartment knee osteoarthritis (OA) wherein the lower extremity is realigned to shift the load distribution from the medial compartment of the knee to the lateral compartment. However, this surgery is known to affect the posterior tibial slope angle (PTSA), which could lead to abnormal knee kinematics and instability, and eventually to knee OA. Although PTSA control is as important as coronal realignment, few appropriate measurements for this parameter have been reported. The placement of a wedge spacer might have an effect on PTSA. Purpose: To elucidate the relationship between the PTSA and the direction of insertion of a wedge spacer. Study Design: Case series; Level of evidence, 4. Methods: This study assessed 43 knees from 34 patients who underwent medial opening wedge HTO for knee OA. Pre- and postoperative lateral radiographs of the knee as well as postoperative computed tomography scans were performed to evaluate the relationship among PTSA, wedge insertion angle (WIA), and opening gap ratio (distance of the anterior opening gap/distance of the posterior opening gap at the osteotomy site). Results: The PTSA significantly increased from 9.0° ± 2.8° preoperatively to 13.2° ± 4.1° postoperatively (P < .001), resulting in a mean ΔPTSA of 4.7° ± 4.5°. The mean opening gap ratio was 0.86 ± 0.11, and the mean WIA was 25.9° ± 8.4°. The WIA and opening gap ratio were both highly correlated with ΔPTSA (r = 0.71 and 0.72, respectively), implying that a smaller WIA or smaller gap ratio leads to less increase in posterior slope. Conclusion: The direction of wedge insertion is highly correlated with PTSA increase, which suggests that the PTSA can be controlled for by adjusting the direction of wedge insertion during surgery. Clinical Relevance: Study results suggest that it is possible to adjust the PTSA by controlling the WIA during surgery. Proper attention to WIA can avoid an iatrogenic increase in posterior tibial slope. PMID:26977420

  18. Phosphorylated CaMKII post-synaptic binding to NR2B subunits in the anterior cingulate cortex mediates visceral pain in visceral hypersensitive rats.

    PubMed

    Li, Ying; Zhang, Xu; Liu, Haiyan; Cao, Zhijun; Chen, Shengliang; Cao, Bing; Liu, Jin

    2012-05-01

    The NR2B subunit of NMDA receptor in the anterior cingulate cortex (ACC) is up-regulated in viscerally hypersensitive (VH) rats induced by colonic anaphylaxis. It plays a critical role in modulation of ACC sensitization and visceral pain responses. Given the key role of calcium/calmodulin-dependent protein kinase II (CaMKII) in synaptic plasticity and behavior learning and memory, we hypothesize that phosphorylation of CaMKII binding to NR2B mediates visceral pain in VH states. We performed in vivo electroporation of CaMKII siRNA produced inhibition of colorectal distension-induced visceromotor response in the VH rats. The NR2B, CaMKII and P-CaMKII-Thr²⁸⁶ protein levels were increased in 180%, 220% and 304% fold in the post-synaptic density (PSD) fraction in VH rats separately. Western blotting following co-immunoprecipitation showed that P-CaMKII-Thr²⁸⁶ bound to NR2B in the PSD, which was increased to 267% of control in VH rats. Administration of CaMKII antagonist Antennapedia-CaMKIINtide suppressed visceromotor response in VH rats in parallel with decrease of NR2B levels and reduction of the NR2B-P-CaMKII-Thr²⁸⁶ protein complex in PSD. In conclusion, CaMKII is a critical signaling molecule in the ACC glutamatergic synaptic transmission and phosphorylation of CaMKII at Thr286, which binds to NR2B subunit at post-synaptic site, modulates visceral pain in viscerally hypersensitive state. PMID:22380661

  19. Tibial Tuberosity Avulsion Fracture and Open Proximal Tibial Fracture in an Adult

    PubMed Central

    Liu, Yu-Ping; Hao, Qing-Hai; Lin, Feng; Wang, Ming-Ming; Hao, Yue-Dong

    2015-01-01

    Abstract A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. A literature search was done to determine the expected clinical outcome of this fracture pattern. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures. PMID:26426669

  20. Genu Recurvatum after Tibial Tuberosity Fracture

    PubMed Central

    Nathan, Senthil T.; Parikh, Shital N.

    2013-01-01

    Fractures of the tibial tuberosity are infrequent injuries that occur during adolescence. Displaced tibial tuberosity fractures are typically treated with open reduction and internal fixation. Since these fractures occur at or near skeletal maturity, growth disturbances are not seen. This paper presents a case, the first report to our knowledge, of genu recurvatum deformity after open reduction and internal fixation of a tibial tuberosity fracture. A successful treatment plan of tibial tuberosity osteotomy with proximal tibial opening wedge osteotomy was used for the correction of genu recurvatum deformity and to maintain appropriate patellar height. At eighteen-month followup, the deformity remains corrected with satisfactory functional results. This case highlights the importance of recognition of potential complications of fracture management in adolescence. PMID:23710399

  1. Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques

    PubMed Central

    Gadikota, Hemanth R; Hosseini, Ali; Asnis, Peter

    2015-01-01

    Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0, 15, 30, 60, and 90 of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load. PMID:26060604

  2. Shape optimization of tibial prosthesis components

    NASA Technical Reports Server (NTRS)

    Saravanos, D. A.; Mraz, P. J.; Davy, D. T.

    1993-01-01

    NASA technology and optimal design methodologies originally developed for the optimization of composite structures (engine blades) are adapted and applied to the optimization of orthopaedic knee implants. A method is developed enabling the shape tailoring of the tibial components of a total knee replacement implant for optimal interaction within the environment of the tibia. The shape of the implant components are optimized such that the stresses in the bone are favorably controlled to minimize bone degradation, to improve the mechanical integrity of the implant/interface/bone system, and to prevent failures of the implant components. A pilot tailoring system is developed and the feasibility of the concept is demonstrated and evaluated. The methodology and evolution of the existing aerospace technology from which this pilot optimization code was developed is also presented and discussed. Both symmetric and unsymmetric in-plane loading conditions are investigated. The results of the optimization process indicate a trend toward wider and tapered posts as well as thicker backing trays. Unique component geometries were obtained for the different load cases.

  3. Assessment of tibial rotation and meniscal movement using kinematic magnetic resonance imaging

    PubMed Central

    2014-01-01

    Objective This work aimed to assess tibial rotations, meniscal movements, and morphological changes during knee flexion and extension using kinematic magnetic resonance imaging (MRI). Methods Thirty volunteers with healthy knees were examined using kinematic MRI. The knees were imaged in the transverse plane with flexion and extension angles from 0 to 40 and 40 to 0, respectively. The tibial interior and exterior rotation angles were measured, and the meniscal movement range, height change, and side movements were detected. Results The tibia rotated internally (11.55??3.20) during knee flexion and rotated externally (11.40??3.0) during knee extension. No significant differences were observed between the internal and external tibial rotation angles (P?>?0.05), between males and females (P?>?0.05), or between the left and right knee joints (P?>?0.05). The tibial rotation angle with a flexion angle of 0 to 24 differed significantly from that with a flexion angle of 24 to 40 (P?anterior horn than in the posterior horn and greater in the lateral meniscus than in the medial meniscus (P?anterior and posterior horns decreased, with the decrease more apparent in the lateral meniscus (P?tibial rotations, which may be related to the ligament and joint capsule structure and femoral condyle geometry. PMID:25142267

  4. Results of Arthroscopic Bankart Lesion Repair in Patients with Post-Traumatic Anterior Instability of the Shoulder and a Non-Engaging Hill-Sachs Lesion with a Suture Anchor after a Minimum of 6-Year Follow-Up

    PubMed Central

    Szyluk, Karol; Jasi?ski, Andrzej; Widuchowski, Wojciech; Mielnik, Micha?; Koczy, Bogdan

    2015-01-01

    Background Shoulder instability is an important clinical problem. Arthroscopic surgery is an established treatment modality in shoulder instability, but it continues to be associated with a high rate of recurrences and complications. The purpose of the study was to analyze late outcomes of arthroscopic repair of Bankart lesions in patients with post-traumatic anterior shoulder instability and non-engaging Hill-Sachs lesion, with special focus on the incidence and causes of recurrences and complications. Material/Methods We investigated 92 patients (92 shoulders) who underwent surgery on account of post-traumatic anterior shoulder instability. The duration of follow-up ranged from 6 to 12.5 years (mean: 8.2 years). All patients were operated on in the lateral decubitus position using FASTak 2.8-mm suture anchors (FASTak, Arthrex, Naples, Florida). Treatment outcomes were evaluated using the Rowe and University of California at Los Angeles rating system (UCLA). Results According to Rowe scores, there were 71 (81.5%) excellent, 12 (12.6%) good, 5 (5.3%) satisfactory, and 2 (2.1%) poor results. Rowe scores improved in a statistically significant manner (p=0.00) post-surgery, to a mean of 90 (range: 25100). Treatment outcomes measured as UCLA scores improved in a statistically significant manner (p=0.00), reaching post-operative levels of 1235 (mean: 33.5). There were 9 recurrences, 1 case of axillary nerve praxia, and 1 case of anchor loosening. Conclusions With rigorous criteria for qualifying patients for surgery, arthroscopic treatment of post-traumatic anterior shoulder instability produces good outcomes and low recurrence and complication rates irrespective of the number of previous dislocations, age, or sex. PMID:26256225

  5. Fractures of the proximal tibial epiphysis.

    PubMed

    Burkhart, S S; Peterson, H A

    1979-10-01

    Fractures of the proximal tibial epiphysis are rare. A series of twenty-eight fractures classified according to the Salter-Harris method showed that nine were Type II and eight, Type IV. Lawn-mower injuries, a previously unreported mode of injury for this fracture, caused five of the eight Type-IV fractures and were associated with the worst prognosis by far. Two Type-V fractures in the proximal tibial epiphysis, previously unreported, are described. PMID:489664

  6. Allograft anterior tibialis tendon with bioabsorbable interference screw fixation in anterior cruciate ligament reconstruction.

    PubMed

    Caborn, David N M; Selby, Jeffrey B

    2002-01-01

    For a variety of reasons, bone-patellar tendon-bone and Achilles tendon allografts have been used more commonly in anterior cruciate ligament reconstruction. Soft-tissue allografts used mainly are the semitendinosus, gracilis, and occasionally the quadriceps tendons. The anterior tibialis tendon is a thick, strong tendon that can be prepared with one doubling of the graft, has a large cross-sectional area, and has been shown to be stronger than semitendinosus, gracilis, patellar tendon, and native anterior cruciate ligament. Use of allograft shortens surgical time, eliminates graft harvest-site morbidity, and allows for a large supply of grafts for repeat or multiple ligament procedures. This graft can be fixed to the femoral and tibial bone tunnels with bioabsorbable interference screws for a hardware-free, completely endoscopic procedure. Two- to 4-year results of allograft procedures are comparable to autograft procedures, and there have been no early failures with this described technique using anterior tibialis tendon. PMID:11774151

  7. Allograft anterior tibialis tendon with bioabsorbable interference screw fixation in anterior cruciate ligament reconstruction.

    TOXLINE Toxicology Bibliographic Information

    Caborn DN; Selby JB

    2002-01-01

    For a variety of reasons, bone-patellar tendon-bone and Achilles tendon allografts have been used more commonly in anterior cruciate ligament reconstruction. Soft-tissue allografts used mainly are the semitendinosus, gracilis, and occasionally the quadriceps tendons. The anterior tibialis tendon is a thick, strong tendon that can be prepared with one doubling of the graft, has a large cross-sectional area, and has been shown to be stronger than semitendinosus, gracilis, patellar tendon, and native anterior cruciate ligament. Use of allograft shortens surgical time, eliminates graft harvest-site morbidity, and allows for a large supply of grafts for repeat or multiple ligament procedures. This graft can be fixed to the femoral and tibial bone tunnels with bioabsorbable interference screws for a hardware-free, completely endoscopic procedure. Two- to 4-year results of allograft procedures are comparable to autograft procedures, and there have been no early failures with this described technique using anterior tibialis tendon.

  8. Quantitative Comparison of the Microscopic Anatomy of the Human ACL Femoral and Tibial Entheses

    PubMed Central

    Beaulieu, Mlanie L.; Carey, Grace E.; Schlecht, Stephen H.; Wojtys, Edward M.; Ashton-Miller, James A.

    2015-01-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p < 0.001), a 43% greater calcified fibrocartilage tissue area (p < 0.001), and a 226% greater uncalcified fibrocartilage depth (p < 0.001), with the latter differences being particularly pronounced in the central region. We conclude that the ACL femoral enthesis has more fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure. PMID:26134706

  9. Quantitative comparison of the microscopic anatomy of the human ACL femoral and tibial entheses.

    PubMed

    Beaulieu, Mlanie L; Carey, Grace E; Schlecht, Stephen H; Wojtys, Edward M; Ashton-Miller, James A

    2015-12-01

    The femoral enthesis of the human anterior cruciate ligament (ACL) is known to be more susceptible to injury than the tibial enthesis. To determine whether anatomic differences might help explain this difference, we quantified the microscopic appearance of both entheses in 15 unembalmed knee specimens using light microscopy, toluidine blue stain and image analysis. The amount of calcified fibrocartilage and uncalcified fibrocartilage, and the ligament entheseal attachment angle were then compared between the femoral and tibial entheses via linear mixed-effects models. The results showed marked differences in anatomy between the two entheses. The femoral enthesis exhibited a 3.9-fold more acute ligament attachment angle than the tibial enthesis (p<0.001), a 43% greater calcified fibrocartilage tissue area (p<0.001), and a 226% greater uncalcified fibrocartilage depth (p<0.001), with the latter differences being particularly pronounced in the central region. We conclude that the ACL femoral enthesis has more fibrocartilage and a more acute ligament attachment angle than the tibial enthesis, which provides insight into why it is more vulnerable to failure. PMID:26134706

  10. Use of Both the Short Musculoskeletal Function Assessment Questionnaire and the Short Form-36 among Tibial Fracture Patients was Redundant

    PubMed Central

    2009-01-01

    Objective To compare the Short Musculoskeletal Function Assessment Dysfunction Index and the Short Form-36 Physical Component Summary scores among patients undergoing operative management of tibial fractures. Study Design and Setting Between July 2000 and September 2005, we enrolled 1319 skeletally mature patients with open or closed fractures of the tibial shaft that were managed with intramedullary nailing. Patients were asked to complete the Short Musculoskeletal Function Assessment and Short Form-36 at discharge and 3, 6, and 12 months post surgical fixation. Results Short Musculoskeletal Function Assessment Dysfunction Index and Short Form-36 Physical Component Summary scores were highly correlated at 3, 6, and 12 months post surgical fixation. The difference in mean standardized change scores for the Short Musculoskeletal Function Assessment Dysfunction Index and the Short Form-36 Physical Component Summary, from 3 to 12 months post-surgical fixation, was not statistically significant. Both the Short Musculoskeletal Function Assessment Dysfunction Index and Short Form-36 Physical Component Summary scores were able to discriminate between healed and non-healed tibial fractures at 3, 6, and 12 months post surgery. Conclusion In patients with tibial shaft fractures, the Short Musculoskeletal Function Assessment Dysfunction Index offered no important advantages over the Short Form-36 Physical Component Summary score. These results, along with the usefulness of the Short Form-36 for comparing populations, recommends the Short Form-36 for assessing physical function in studies of patients with tibial fractures. PMID:19364637

  11. Porous tantalum tibial component prevents periprosthetic loss of bone mineral density after total knee arthroplasty for five years-a matched cohort study.

    PubMed

    Minoda, Yukihide; Kobayashi, Akio; Ikebuchi, Mitsuhiko; Iwaki, Hiroyoshi; Inori, Fumiaki; Nakamura, Hiroaki

    2013-12-01

    In 21 knees receiving porous tantalum tibial component and 21 knees receiving a cemented cobalt-chromium tibial component, dual x-ray absorptiometry scans were performed for five years post-operatively. The postoperative decrease in the bone mineral density in the lateral aspect of the tibia was significantly less in knees with porous tantalum tibial components (11.6%) than in knees with cemented cobalt-chromium tibial components (29.6%) at five years (p < 0.05). No prosthetic migration or periprosthetic fracture was detected in either group. The present study is one of the studies with the longest follow-up period on bone mineral density after total knee arthroplasty. Porous tantalum tibial component has a favorable effect on the bone mineral density of the proximal tibia after total knee arthroplasty up to five years. PMID:23642446

  12. Biomechanical Evaluation of the Quadriceps Tendon Autograft for Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Sasaki, Norihiro; Farraro, Kathryn F.; Kim, Kwang E.; Woo, Savio L-Y.

    2014-01-01

    Background Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft. Purpose To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft. Study Design Controlled laboratory study. Methods Ten human cadaveric knees (age, 5464 years) were tested in 3 conditions: (1) intact, (2) ACL deficient, and (3) after ACL reconstruction using a QT or QSTG autograft. With use of a robotic/universal force-moment sensor testing system, knee kinematics and in situ forces in the ACL and autografts were obtained at 5 knee flexion angles under externally applied loads: (1) 134-N anterior tibial load, (2) 134-N anterior tibial load with 200-N axial compression, and (3) 10-Nm valgus and 5-Nm internal tibial torque. Results Under the anterior tibial load, both autografts restored anterior tibial translation to within 2.5 mm of the intact knee and in situ forces to within 20 N of the intact ACL at 15, 30, and 60. Adding compression did not change these findings. With the combined rotatory load, the anterior tibial translation and graft in situ forces were again not significantly different from the intact ACL. There were no significant differences between the grafts under any experimental condition. Conclusion Reconstruction of the ACL with a QT autograft restored knee function to similar levels as that reconstructed with a QSTG autograft under loads simulating clinical examinations. Clinical Relevance The positive biomechanical results of this cadaveric study lend support to the use of a QT autograft for ACL reconstruction, as it could restore knee function immediately after surgery under applied loads that mimic clinical examinations. PMID:24401682

  13. One-stage anatomic double bundle anterior and posterior cruciate ligament reconstruction

    PubMed Central

    Acar, Baver; Ba?ar?r, Kerem; Armangil, Mehmet; Binnet, Mehmet Serdar

    2014-01-01

    Introduction: Main evidence of the heavy knee dislocations is the rupture of both Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL). There are limited sources for the treatment of both ligaments at a single stage. Materials-method: One-staged anatomic double-bundle ACL and PCL reconstruction technique has been applied to 2 cases aged 20 and 36 with traumatic knee dislocation. Lateral collateral ligament and posteriolateral corner reconstruction added to one case, and medial collateral ligament and posteriomedial corner reconstruction for the other case. Because of additional femur fractures of the both cases, ligament reconstructions have been applied after the main treatment. Anterior tibialis tendon (ATT) allograft has been used for graft for both cases because of other stabilization deficiencies of knees. It has been confirmed that femoral and tibial tunnels constructed with anatomic double-bundle technique are fitting to anatomic locations by the post-operation CT results. Post fixation screw has been used for tibia, and endobutton at femur. Results: Tracking records of patients at 8th month shows that; Lysholm score of the case aged 20 was 89, and 85 for the case aged 36. While KT-1000 values was 3.7 mm, and 4.1 mm for 15 N power; and 9.1 mm-9.6 mm with the maximum power. Conclusion: Surgical technical details of one-staged double-bundle reconstruction for ACL and PCL injuries which is gaining popularity recently has been stated. PMID:25419422

  14. EFFECT OF AXIAL TIBIAL TORQUE DIRECTION ON ACL RELATIVE STRAIN AND STRAIN RATE IN AN IN VITRO SIMULATED PIVOT LANDING

    PubMed Central

    Oh, Youkeun K.; Kreinbrink, Jennifer L.; Wojtys, Edward M.; Ashton-Miller, James A.

    2011-01-01

    Anterior cruciate ligament (ACL) injuries most frequently occur under the large loads associated with a unipedal jump landing involving a cutting or pivoting maneuver. We tested the hypotheses that internal tibial torque would increase the anteromedial (AM) bundle ACL relative strain and strain rate more than would the corresponding external tibial torque under the large impulsive loads associated with such landing maneuvers. Twelve cadaveric female knees [mean (SD) age: 65.0 (10.5) years] were tested. Pretensioned quadriceps, hamstring and gastrocnemius muscle-tendon unit forces maintained an initial knee flexion angle of 15°. A compound impulsive test load (compression, flexion moment and internal or external tibial torque) was applied to the distal tibia while recording the 3-D knee loads and tibofemoral kinematics. AM-ACL relative strain was measured using a 3mm DVRT. In this repeated measures experiment, the Wilcoxon Signed-Rank test was used to test the null hypotheses with p<0.05 considered significant. The mean (± SD) peak AM-ACL relative strains were 5.4±3.7 % and 3.1±2.8 % under internal and external tibial torque, respectively. The corresponding mean (± SD) peak AM-ACL strain rates reached 254.4±160.1 %/sec and 179.4±109.9 %/sec, respectively. The hypotheses were supported in that the normalized mean peak AM-ACL relative strain and strain rate were 70% and 42% greater under internal than external tibial torque, respectively (p=0.023, p=0.041). We conclude that internal tibial torque is a potent stressor of the ACL because it induces a considerably (70%) larger peak strain in the AM-ACL than does a corresponding external tibial torque. PMID:22025178

  15. Hardware removal after tibial fracture has healed

    PubMed Central

    Sidky, Adam; Buckley, Richard E.

    2008-01-01

    Background Tibial fractures are the most common long bone fracture. The standard of care for the treatment of diaphyseal tibial fractures is an intramedullary nail (IMN). Implant removal is one of the most common procedures in bone and joint surgery, and criteria for implant removal are typically left to the treating surgeon. Currently, no clear criteria exist to guide a surgeon's decision to remove implanted tibial IMNs after healing. Methods We undertook a retrospective chart review of a single surgeon's practice from January 1996 to February 2005. We identified patients aged 1670 years with a tibial fracture treated with an IMN. Patients were followed until fracture union and/or request for IMN removal. The following parameters were recorded: reason for implant removal, age, sex, mechanism of fracture, location of fracture, diameter of IMN, Workers' Compensation Board (WCB) status, activity level, litigation status, insurance involvement, height, weight and body mass index (BMI). Results Factors influencing the likelihood of removal were sex and litigation. Factors not influencing the likelihood of removal were age, weight, height, BMI, diameter of IMN, patients' level of activity, insurance claim involvement and WCB involvement. Overall, 72.2% of patients had an improvement in their symptoms after IMN removal. Conclusion Sex and litigation are positive predictive factors for patient requests to have tibial IMNs removed after healing. PMID:18815648

  16. Bilateral tibial stress fracture in a young man due to hypercalciuric osteoporosis: a case report.

    PubMed

    Ofluoglu, Demet; Ofluoglu, Onder; Akyuz, Gulseren

    2006-03-01

    Osteoporosis is commonly thought of as a disease of postmenopausal women, and older men have a lower risk of fracture than women. A stress fracture is an overuse injury and an important cause of disability in the athletic population. Presented here is a 30-year-old healthy man with pain on the anterior surface of the bilateral tibia. He did not communicate any trauma or overuse activity. The neurologic and locomotor system examinations were normal. Radiological examinations revealed tibial stress fractures in both left and right tibia and he had low bone mineral density. Routine hematological tests, bone resorption and formation markers were normal, except for hypercalciuria. After analyzing the results of these tests, the patient was diagnosed with bilateral tibial stress fractures due to hypercalciuric secondary osteoporosis. Osteoporosis should be considered in the differential diagnosis of atraumatic insufficiency fractures, especially in young healthy adults. PMID:16096792

  17. What Strains the Anterior Cruciate Ligament During a Pivot Landing?

    PubMed Central

    Oh, Youkeun K.; Lipps, David B.; Ashton-Miller, James A.; Wojtys, Edward M.

    2015-01-01

    Background The relative contributions of an axial tibial torque and frontal plane moment to anterior cruciate ligament (ACL) strain during pivot landings are unknown. Hypothesis The peak normalized relative strain in the anteromedial (AM) bundle of the ACL is affected by the direction of the axial tibial torque but not by the direction of the frontal plane moment applied concurrently during a simulated jump landing. Study Design Controlled and descriptive laboratory studies. Methods Fifteen adult male knees with pretensioned knee muscle-tendon unit forces were loaded under a simulated pivot landing test. Compression, flexion moment, internal or external tibial torque, and knee varus or valgus moment were simultaneously applied to the distal tibia while recording the 3D knee loads and tibiofemoral kinematics. The AM-ACL relative strain was measured using a 3-mm differential variable reluctance transducer. The results were analyzed using nonparametric Wilcoxon signed–rank tests. A 3D dynamic biomechanical knee model was developed using ADAMS and validated to help interpret the experimental results. Results The mean (SD) peak AM-ACL relative strain was 192% greater (P <.001) under the internal tibial torque combined with a knee varus or valgus moment (7.0% [3.9%] and 7.0% [4.1%], respectively) than under external tibial torque with the same moments (2.4% [2.5%] and 2.4% [3.2%], respectively). The knee valgus moment augmented the AM-ACL strain due to the slope of the tibial plateau inducing mechanical coupling (ie, internal tibial rotation and knee valgus moment); this augmentation occurred before medial knee joint space opening. Conclusion An internal tibial torque combined with a knee valgus moment is the worst-case ACL loading condition. However, it is the internal tibial torque that primarily causes large ACL strain. Clinical Relevance Limiting the maximum coefficient of friction between the shoe and playing surface should limit the peak internal tibial torque that can be applied to the knee during jump landings, thereby reducing peak ACL strain and the risk for noncontact injury. PMID:22223717

  18. COMPLICATIONS OF THE SCREW/WASHER TIBIAL FIXATION TECHNIQUE FOR KNEE LIGAMENT RECONSTRUCTION

    PubMed Central

    Almeida, Alexandre; Roveda, Gilberto; Valin, Márcio Rangel; Almeida, Nayvaldo Couto de; Sartor, Vanderlei; Alves, Soraya Melina

    2015-01-01

    To evaluate the presence of pain at the site of the surgical incision and the need to remove the tibial fixation screw in anterior cruciate ligament (ACL) reconstruction, in relation to sex and body mass index (BMI). Methods: A group of 265 patients who underwent ACL reconstruction with ipsilateral flexor tendon grafts from the thigh in which the tibial fixation technique consisted of using a cortical screw and metal washer, between July 2000 and November 2007, were evaluated. Results: 176 patients were evaluated for an average of 33.3 ± 19.5 months; median of 29.5 months; IIQ: 17-45 months; minimum of 8 and maximum of 87 months. There was no statistical difference regarding complaints of pain at the site of the screw (p = 0.272) and the need to remove the tibial screw (p = 0.633) between sexes. There was no statistical difference regarding complaints of pain at the site of the screw (p = 0.08) and the need to remove the tibial screw (p = 0.379) according to BMI. Conclusion: The pain complaint rate at the screw site from the screw and metal washer method used for tibial fixation in ACL reconstruction was of the order of 25%, and the screw had to be removed in 10.8% of the cases. There was no predominance of pain complaints at the surgical wound between the sexes. There was a greater tendency to complain about pain among patients with BMI < 25. There was no predominance of screw and washer removal between the sexes or between individuals with different BMIs.

  19. Avian tibial dyschondroplasia. I. Ultrastructure.

    PubMed Central

    Hargest, T. E.; Leach, R. M.; Gay, C. V.

    1985-01-01

    Tibial dyschondroplasia is an abnormality of the growth cartilage that occurs in chickens and other rapidly growing animals. The disease is characterized by a mass of avascular opaque cartilage, which is continuous with the growth plate of the proximal tibia and extends into the metaphysis. In this study electron micrographs revealed that chondrocytes in the hypertrophic zone of the growth plate were normal in appearance with the exception that the cells did not undergo complete hypertrophy. In the proximal region of the lesion, cells began to undergo necrotic changes suggestive of an energy depletion. These changes included dilatation and vesiculation of the endoplasmic reticulum, enlargement of the paranuclear space, mitochondrial swelling with dilatation of the intracristal spaces and the appearance of electron-dense, flocculent material in the mitochondrial matrix, chromatin margination, and dilatation of the Golgi saccules. Chondrocytes also occurred with rarefied cytoplasm and atrophic Golgi saccules. A few cartilage cells in the proximal region of smaller lesions contained crescentic caps of condensed chromatin in the nuclei, which is indicative of apoptosis. These cells also exhibited dilated endoplasmic reticulum and lamellar bodies; and sometimes, in the proximal region of the lesion, they appeared to be condensed and convoluted. This process continued in the mid and distal regions. The condensed necrotic cells appeared as amorphous osmiophilic masses with karyorrhexic and pyknotic nuclei. Matrix vesicles were observed at all levels of the lesion, but calcified only at the distal edge of the lesion, where mineralization of both matrix and cells occurred. The resulting shell of mineral may act as a diffusion barrier. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 PMID:3993737

  20. Arthroscopic distal tibial allograft augmentation for posterior shoulder instability with glenoid bone loss.

    PubMed

    Gupta, Anil K; Chalmers, Peter N; Klosterman, Emma; Harris, Joshua D; Provencher, Matthew T; Romeo, Anthony A

    2013-01-01

    Glenoid bone loss is commonly associated with recurrent shoulder instability. Failure to recognize and appropriately address it can lead to poor outcomes. Numerous studies have found anterior-inferior glenoid bone loss in the setting of recurrent anterior instability. Though much less common, posterior shoulder instability can be seen in the setting of acute trauma, epilepsy, electrocution, and alcoholism. Heightened awareness has led to recognition in collision athletes as well. Posterior glenoid bone loss must be addressed in a similar fashion to anterior glenoid bone loss to prevent recurrent instability. Open bone augmentation procedures have been described with successful results. In this technical note, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation. In addition, a current review regarding the diagnosis and management of recurrent posterior shoulder instability is provided. PMID:24400190

  1. Arthroscopic Distal Tibial Allograft Augmentation for Posterior Shoulder Instability With Glenoid Bone Loss

    PubMed Central

    Gupta, Anil K.; Chalmers, Peter N.; Klosterman, Emma; Harris, Joshua D.; Provencher, Matthew T.; Romeo, Anthony A.

    2013-01-01

    Glenoid bone loss is commonly associated with recurrent shoulder instability. Failure to recognize and appropriately address it can lead to poor outcomes. Numerous studies have found anterior-inferior glenoid bone loss in the setting of recurrent anterior instability. Though much less common, posterior shoulder instability can be seen in the setting of acute trauma, epilepsy, electrocution, and alcoholism. Heightened awareness has led to recognition in collision athletes as well. Posterior glenoid bone loss must be addressed in a similar fashion to anterior glenoid bone loss to prevent recurrent instability. Open bone augmentation procedures have been described with successful results. In this technical note, we describe an arthroscopic technique using fresh distal tibial allograft for posterior glenoid augmentation. In addition, a current review regarding the diagnosis and management of recurrent posterior shoulder instability is provided. PMID:24400190

  2. Compartment syndrome after tibial plateau fracture?

    PubMed Central

    Pitta, Guilherme Benjamin Brando; dos Santos, Thays Fernanda Avelino; dos Santos, Fernanda Thaysa Avelino; da Costa Filho, Edelson Moreira

    2014-01-01

    Fractures of the tibial plateau are relatively rare, representing around 1.2% of all fractures. The tibia, due to its subcutaneous location and poor muscle coverage, is exposed and suffers large numbers of traumas, not only fractures, but also crush injuries and severe bruising, among others, which at any given moment, could lead compartment syndrome in the patient. The case is reported of a 58-year-old patient who, following a tibial plateau fracture, presented compartment syndrome of the leg and was submitted to decompressive fasciotomy of the four right compartments. After osteosynthesis with internal fixation of the tibial plateau using an L-plate, the patient again developed compartment syndrome. PMID:26229779

  3. Compartment syndrome after tibial plateau fracture.

    PubMed

    Pitta, Guilherme Benjamin Brando; Dos Santos, Thays Fernanda Avelino; Dos Santos, Fernanda Thaysa Avelino; da Costa Filho, Edelson Moreira

    2014-01-01

    Fractures of the tibial plateau are relatively rare, representing around 1.2% of all fractures. The tibia, due to its subcutaneous location and poor muscle coverage, is exposed and suffers large numbers of traumas, not only fractures, but also crush injuries and severe bruising, among others, which at any given moment, could lead compartment syndrome in the patient. The case is reported of a 58-year-old patient who, following a tibial plateau fracture, presented compartment syndrome of the leg and was submitted to decompressive fasciotomy of the four right compartments. After osteosynthesis with internal fixation of the tibial plateau using an L-plate, the patient again developed compartment syndrome. PMID:26229779

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

    ERIC Educational Resources Information Center

    Couture, Christopher J.; Karlson, Kristine A.

    2002-01-01

    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

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

    ERIC Educational Resources Information Center

    Couture, Christopher J.; Karlson, Kristine A.

    2002-01-01

    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…

  6. Fracture of tibial tuberosity in an adult

    PubMed Central

    Albuquerque, Rodrigo Pires e; Campos, Andr Siqueira; de Arajo, Gabriel Costa Serro; Gameiro, Vincius Schott

    2013-01-01

    The fracture of tibial tuberosity is a rare lesion and still more unusual in adults. We describe a case in an adult who suffered a left knee injury due to a fall from height. No risk factors were identified. The lesion was treated with surgical reduction and internal fixation. The rehabilitation method was successful, resulting in excellent function and rage of motion of the knee. The aim of this study was to present an unusual case of direct trauma of the tibial tuberosity in an adult and the therapy performed. PMID:24293543

  7. Insufficiency fractures of the tibial plateau

    SciTech Connect

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

    1983-06-01

    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.

  8. Effect of step width manipulation on tibial stress during running.

    PubMed

    Meardon, Stacey A; Derrick, Timothy R

    2014-08-22

    Narrow step width has been linked to variables associated with tibial stress fracture. The purpose of this study was to evaluate the effect of step width on bone stresses using a standardized model of the tibia. 15 runners ran at their preferred 5k running velocity in three running conditions, preferred step width (PSW) and PSW5% of leg length. 10 successful trials of force and 3-D motion data were collected. A combination of inverse dynamics, musculoskeletal modeling and beam theory was used to estimate stresses applied to the tibia using subject-specific anthropometrics and motion data. The tibia was modeled as a hollow ellipse. Multivariate analysis revealed that tibial stresses at the distal 1/3 of the tibia differed with step width manipulation (p=0.002). Compression on the posterior and medial aspect of the tibia was inversely related to step width such that as step width increased, compression on the surface of tibia decreased (linear trend p=0.036 and 0.003). Similarly, tension on the anterior surface of the tibia decreased as step width increased (linear trend p=0.029). Widening step width linearly reduced shear stress at all 4 sites (p<0.001 for all). The data from this study suggests that stresses experienced by the tibia during running were influenced by step width when using a standardized model of the tibia. Wider step widths were generally associated with reduced loading of the tibia and may benefit runners at risk of or experiencing stress injury at the tibia, especially if they present with a crossover running style. PMID:24935171

  9. Fracture of an ossified tibialis anterior tendon.

    PubMed

    Lee, Woo-Chun; Moon, Jeong-Seok; Kim, Ji-Yeong; Ko, Hyeong-Tak

    2009-02-01

    Fractures of ossified tibialis anterior tendon have been successfully managed by the excision of the ossified tendon and transfer of the extensor hallucis longus tendon. A 64-year-old man sustained an injury during mountain hiking 2 weeks prior to presentation, falling down on his heels with his ankle fully plantarflexed. Two tender and bony hard masses were palpable along the course of the tibialis anterior tendon, one at the anteromedial aspect of the ankle and another at the dorsum of the talonavicular joint. Radiographs of the ankle demonstrated an approximately 2x1-cm ovoid-shaped bony mass at the anterior aspect of the ankle joint and another bony mass of similar size and shape at the dorsal aspect of the talonavicular joint. He underwent operative exploration, and complete rupture of the tendon through a bony mass was observed. The gap between the torn ends of the tendon after excision of the mass was too long to be repaired directly. Extensor hallucis longus tendon was retrieved 1 cm proximal to the metatarsophalangeal joint and was passed through the insertion of the anterior tibial tendon and pulled proximally and sutured to itself with the ankle in neutral. At 1 year after surgery, plain radiographs and ultrasonography showed no recurrence of calcification or ossification in the tendon and good mobility of the tibialis anterior muscle was observed. PMID:19301787

  10. Tibial Nerve Transection - A Standardized Model for Denervation-induced Skeletal Muscle Atrophy in Mice

    PubMed Central

    Batt, Jane A. E.; Bain, James Ralph

    2013-01-01

    The tibial nerve transection model is a well-tolerated, validated, and reproducible model of denervation-induced skeletal muscle atrophy in rodents. Although originally developed and used extensively in the rat due to its larger size, the tibial nerve in mice is big enough that it can be easily manipulated with either crush or transection, leaving the peroneal and sural nerve branches of the sciatic nerve intact and thereby preserving their target muscles. Thus, this model offers the advantages of inducing less morbidity and impediment of ambulation than the sciatic nerve transection model and also allows investigators to study the physiologic, cellular and molecular biologic mechanisms regulating the process of muscle atrophy in genetically engineered mice. The tibial nerve supplies the gastrocnemius, soleus and plantaris muscles, so its transection permits the study of denervated skeletal muscle composed of fast twitch type II fibers and/or slow twitch type I fibers. Here we demonstrate the tibial nerve transection model in the C57Black6 mouse. We assess the atrophy of the gastrocnemius muscle, as a representative muscle, at 1, 2, and 4 weeks post-denervation by measuring muscle weights and fiber type specific cross-sectional area on paraffin-embedded histologic sections immunostained for fast twitch myosin. PMID:24300114

  11. Tibial nerve transection - a standardized model for denervation-induced skeletal muscle atrophy in mice.

    PubMed

    Batt, Jane A E; Bain, James Ralph

    2013-01-01

    The tibial nerve transection model is a well-tolerated, validated, and reproducible model of denervation-induced skeletal muscle atrophy in rodents. Although originally developed and used extensively in the rat due to its larger size, the tibial nerve in mice is big enough that it can be easily manipulated with either crush or transection, leaving the peroneal and sural nerve branches of the sciatic nerve intact and thereby preserving their target muscles. Thus, this model offers the advantages of inducing less morbidity and impediment of ambulation than the sciatic nerve transection model and also allows investigators to study the physiologic, cellular and molecular biologic mechanisms regulating the process of muscle atrophy in genetically engineered mice. The tibial nerve supplies the gastrocnemius, soleus and plantaris muscles, so its transection permits the study of denervated skeletal muscle composed of fast twitch type II fibers and/or slow twitch type I fibers. Here we demonstrate the tibial nerve transection model in the C57Black6 mouse. We assess the atrophy of the gastrocnemius muscle, as a representative muscle, at 1, 2, and 4 weeks post-denervation by measuring muscle weights and fiber type specific cross-sectional area on paraffin-embedded histologic sections immunostained for fast twitch myosin. PMID:24300114

  12. Surgical repair of an anterior tibialis muscle hernia with Mersilene mesh.

    PubMed

    Siliprandi, L; Martini, G; Chiarelli, A; Mazzoleni, F

    1993-01-01

    The most frequent muscle hernia of the lower extremities is the anterior tibialis muscle hernia. A number of surgical procedures are available for the treatment of symptomatic anterior tibialis muscle hernias. However, in case of a large fascial defect, their use may be unfeasible or inconvenient. Moreover, current surgical procedures are prone to the risk of an anterior tibial compartment syndrome. The use of a synthetic patch could provide an alternative, particularly for large defects. In this paper we report the repair of a large, symptomatic, long-standing anterior tibialis muscle hernia with polyester mesh (Mersilene) fixed to the edges of the defect (muscular fascia and tibial periosteum). This simple procedure provided excellent functional results and a good cosmetic appearance without complications and sequelae. PMID:8257460

  13. Simultaneous ACL-PCL reconstructions with high tibial osteotomy: salvage for an unstable arthritic knee.

    PubMed

    Beyzadeoglu, Tahsin; Demirel, Murat; Circi, Esra

    2016-01-01

    We present a case of a 28-year-old man with a severe osteoarthritic varus knee after a neglected multiligamentous injury sustained 10?years prior. Simultaneous anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions with high tibial osteotomy (HTO) were performed at a single stage. Five years after surgery, there were no signs of effusion and no instability, and the patient could easily kneel down without any discomfort. We think that salvage procedures and biological reconstructions would be the primary choice of surgical treatment in young patients to delay arthroplasty, and it is possible to perform simultaneous reconstructions of ACL and PCL with HTO in a single stage. PMID:26762346

  14. Posterior Tibial Labrum Injury in a Professional Soccer Player: A Case Report.

    PubMed

    Batista, Jorge Pablo; Del Vecchio, Jorge Javier; Maestu, Rodrigo

    2016-01-01

    Ankle ligament injuries are one of the most frequent lesions identified in professional soccer players. In most cases, the ligaments involved are the anterior talofibular ligament and the calcaneal fibular ligament. In the present report, we describe a professional soccer player who sustained an ankle sprain that did not respond to initial therapy. The findings from radiographic and magnetic resonance images were inconclusive. Ultimately, rupture of the posterior, transverse ligament with avulsion of the tibial labrum was identified as the cause of his ongoing ankle pain. Confirmation of the pathologic findings and successful treatment were performed arthroscopically. PMID:25459088

  15. Tibial Tuberosity Avulsion Fracture and Open Proximal Tibial Fracture in an Adult: A Case Report and Literature Review.

    PubMed

    Liu, Yu-Ping; Hao, Qing-Hai; Lin, Feng; Wang, Ming-Ming; Hao, Yue-Dong

    2015-09-01

    A displaced tibial tuberosity avulsion fracture associated with an open extra-articular proximal tibial diaphyseal fracture is an uncommon fracture pattern. This case report describes the successful management of such a fracture pattern in a 45-year old male using an open reduction and lag screw fixation of the tuberosity with a minimally invasive reduction and plate fixation of the proximal tibial diaphyseal fracture. A literature search was done to determine the expected clinical outcome of this fracture pattern. This is the first reported adult case of an avulsion fractures of the tibial tuberosity associated with an open proximal tibial diaphyseal fracture successfully treated by an anatomical reduction and fixation of the avulsion fracture of the tibial tuberosity combined with minimally invasive percutaneous plate osteosynthesis of the proximal tibial diaphyseal fractures. PMID:26426669

  16. Tibial Fixation Properties of a Continuous-Loop ACL Hamstring Graft Construct with Suspensory Fixation in Porcine Bone.

    PubMed

    Smith, Patrick A; DeBerardino, Thomas M

    2015-12-01

    The aim of this article is to compare tibial fixation strength of suspensory fixation for a quadrupled semitendinosus continuous loop all-inside anterior cruciate ligament (ACL) construct versus a doubled semitendinosus and gracilis graft fixated with an interference screw. Biomechanical testing was conducted using human hamstring allografts and porcine tibias. Constructs were cycled from 50 to 250 N for 500 cycles followed by a pull to failure. The average load to failure of tibial suspensory fixation of the all-inside continuous loop construct (1,012 N) was statistically different compared with the tibial interference screw group (612 N) (p < 0.001). The cyclic displacement of the continuous loop construct (2.5 mm) was not statistically different from the interference screw construct (1.9 mm). For both the groups, approximately half the overall cyclic displacement occurred with the first cycle. Tibial side suspensory fixation of a novel all-inside continuous loop hamstring graft provided suitable strength for tibial fixation for ACL reconstruction. The continuous loop construct had a significantly higher load to failure compared with the use of an interference screw, and cyclic loading was comparable. Use of hamstring soft tissue grafts is very common for ACL reconstruction. An all-inside ACL reconstruction is based on a continuous loop construct utilizing a single semitendinosus graft that is quadrupled employing suspensory fixation on both the femoral and tibial side. Suspensory fixation on the femoral side been previously reported, but this is the first report of strength of this method of suspensory fixation on the tibia. PMID:25347056

  17. Anterior Cruciate Ligament Reconstruction and Preservation: The SingleAnteromedial Bundle Biological Augmentation (SAMBBA) Technique

    PubMed Central

    Sonnery-Cottet, Bertrand; Freychet, Benjamin; Murphy, Colin G.; Pupim, Barbara H.B.; Thaunat, Mathieu

    2014-01-01

    Preservation of the anterior cruciate ligament (ACL) remnant during ACL reconstruction has the advantages of improved vascularity and synovial encircling of the graft tendon. We describe a technique called singleanteromedial bundle biological augmentation (SAMBBA) using complete preservation of the ACL remnant, as well as preservation of the semitendinosus tibial insertion, that uses standard portals and equipment. PMID:25685675

  18. Editorial Commentary: Anatomy of the Anterior Cruciate Ligament - Are We Up to Date?

    PubMed

    Provencher, Matthew T

    2016-01-01

    This systematic review demonstrates that knee anterior cruciate ligament (ACL) anatomic landmarks continue to be better defined, but debate as to the precise location of the ACL femoral and tibial footprints persists. The ACL anatomy of an individual patient may ultimately be impossible to determine using generalized research data, but current research probably gets us pretty close. PMID:26743423

  19. Single-Tunnel Double-Bundle Anterior Cruciate Ligament Reconstruction With Anatomical Placement of Hamstring Tendon Graft

    PubMed Central

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

    2013-01-01

    Background Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently. Hypothesis Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction. Study Design Controlled laboratory study. Methods Kinematic responses after single-bundle anterior cruciate ligament reconstruction and single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft were compared with the intact knee in 9 fresh-frozen human cadaveric knee specimens using a robotic testing system. Kinematics of each knee were determined under an anterior tibial load (134 N), a simulated quadriceps load (400 N), and combined torques (10 Nm valgus and 5 Nm internal tibial torques) at 0, 15, 30, 60, and 90 of flexion. Results Anterior tibial translations were more closely restored to the intact knee level after single-tunnel double-bundle reconstruction with anatomical placement of hamstring tendon graft than with a single-bundle reconstruction under the 3 external loading conditions. Under simulated quadriceps load, the mean internal tibial rotations after both reconstructions were lower than that of the anterior cruciate ligamentintact knee with no significant differences between these 3 knee conditions at 0 and 30 of flexion (P > .05).The increased medial tibial shifts of the anterior cruciate ligamentdeficient knees were restored to the intact level by both reconstruction techniques under the 3 external loading conditions. Conclusion Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can better restore the anterior knee stability compared with a conventional single-bundle reconstruction. Both reconstruction techniques are efficient in restoring the normal medial-lateral stability but overcorrect the internal tibial rotations. Clinical Relevance Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft could provide improved clinical outcomes over a conventional single-bundle reconstruction. PMID:20139332

  20. Non-invasive mouse models of post-traumatic osteoarthritis.

    PubMed

    Christiansen, B A; Guilak, F; Lockwood, K A; Olson, S A; Pitsillides, A A; Sandell, L J; Silva, M J; van der Meulen, M C H; Haudenschild, D R

    2015-10-01

    Animal models of osteoarthritis (OA) are essential tools for investigating the development of the disease on a more rapid timeline than human OA. Mice are particularly useful due to the plethora of genetically modified or inbred mouse strains available. The majority of available mouse models of OA use a joint injury or other acute insult to initiate joint degeneration, representing post-traumatic osteoarthritis (PTOA). However, no consensus exists on which injury methods are most translatable to human OA. Currently, surgical injury methods are most commonly used for studies of OA in mice; however, these methods may have confounding effects due to the surgical/invasive injury procedure itself, rather than the targeted joint injury. Non-invasive injury methods avoid this complication by mechanically inducing a joint injury externally, without breaking the skin or disrupting the joint. In this regard, non-invasive injury models may be crucial for investigating early adaptive processes initiated at the time of injury, and may be more representative of human OA in which injury is induced mechanically. A small number of non-invasive mouse models of PTOA have been described within the last few years, including intra-articular fracture of tibial subchondral bone, cyclic tibial compression loading of articular cartilage, and anterior cruciate ligament (ACL) rupture via tibial compression overload. This review describes the methods used to induce joint injury in each of these non-invasive models, and presents the findings of studies utilizing these models. Altogether, these non-invasive mouse models represent a unique and important spectrum of animal models for studying different aspects of PTOA. PMID:26003950

  1. DARTHROSCOPIC DOUBLE- BUNDLE RECONSTRUCTION OF ANTERIOR CRUCIATE LIGAMENT USING HAMSTRING TENDON GRAFTS - FIXATION WITH TWO INTERFERENCE SCREWS

    PubMed Central

    Carneiro, Mario; Navarro, Ricardo Dizioli; Nakama, Gilberto Yoshinobu; Barretto, João Mauricio; Bessa de Queiroz, Antonio Altenor; Malheiro Luzo, Marcus Vinicius

    2015-01-01

    Surgical procedures for double-bundle reconstruction of anterior cruciate ligament, which currently use semitendinous and gracilis tendon grafts, have been described in the last decade. Most of the techniques utilize twice the hardware used in single-bundle reconstructions. We report an original anterior cruciate ligament double-bundle reconstruction technique using semitendinous and gracilis tendon grafts, maintaining their tibial bone insertions with two tibial and two femoral tunnels. A simplified and precise outside-in femoral drilling technique is utilized, and the graft fixation is made utilizing only two interference screws.

  2. Extended Exposure in Difficult Total Knee Arthroplasty Using Tibial Tubercle Osteotomy

    PubMed Central

    RADULESCU, Radu; BADILA, Adrian; NUTIU, Octavian; JAPIE, Ionut; TERINTE, Silvia; RADULESCU, Dragos; MANOLESCU, Robert

    2013-01-01

    ABSTRACT Objectives: In some total knee arthroplasty cases, the usual medial parapatellar approach does not allow the appropriate patellar eversion and the desired exposure of the knee joint. Partial disinsertion of the patellar tendon doesn't substantially improve the surgical exposure and can lead to extensor apparatus weakening and complete secondary ruptures, while the V-Y quadricipital plasty leads to post-op immobilization of the knee, which delays the functional rehabilitation, with negative impact on the range of motion. The tibial tubercle osteotomy, however, allows an extension of the approach in total knee arthroplasty, without endangering the quadricipital extensor apparatus. Material and Methods: In this study we analysed the post-operative results of 11 cases of primary total knee arthroplasty in which a frontal plane osteotomy of the tibial tubercle was performed in addition to the standard medial parapatellar approach, as a result of the patients associated conditions, like rheumatoid arthritis with an extension deficit higher than 150, previous knee synovectomy by arthrotomy, progressive genu varum with more than 150 deviation, varus deviation of the lower limb with previous closing wedge proximal tibial osteotomy or patellar fractures with vicious consolidation. Outcomes: Overall, the results were more than satisfactory with a significant increase in the patients mean range of motion and Knee Society Score. There were some post-op issues in some of the patients, but they were adressed accordingly, having no long-term impact on the results. Conclusions:. We could thus conclude that, in special cases, the frontal plane tibial tubercle osteotomy is an effective technique which can provide a wide approach with appropriate protection of the knee extensor apparatus. PMID:24790673

  3. Total knee arthroplasty following tibial plateau fracture: a matched cohort study.

    PubMed

    Scott, C E H; Davidson, E; MacDonald, D J; White, T O; Keating, J F

    2015-04-01

    Radiological evidence of post-traumatic osteoarthritis (PTOA) after fracture of the tibial plateau is common but end-stage arthritis which requires total knee arthroplasty is much rarer. The aim of this study was to examine the indications for, and outcomes of, total knee arthroplasty after fracture of the tibial plateau and to compare this with an age and gender-matched cohort of TKAs carried out for primary osteoarthritis. Between 1997 and 2011, 31 consecutive patients (23 women, eight men) with a mean age of 65 years (40 to 89) underwent TKA at a mean of 24 months (2 to 124) after a fracture of the tibial plateau. Of these, 24 had undergone ORIF and seven had been treated non-operatively. Patients were assessed pre-operatively and at 6, 12 and > 60 months using the Short Form-12, Oxford Knee Score and a patient satisfaction score. Patients with instability or nonunion needed total knee arthroplasty earlier (14 and 13.3months post-injury) than those with intra-articular malunion (50 months, p < 0.001). Primary cruciate-retaining implants were used in 27 (87%) patients. Complication rates were higher in the PTOA cohort and included wound complications (13% vs 1% p = 0.014) and persistent stiffness (10% vs 0%, p = 0.014). Two (6%) PTOA patients required revision total knee arthroplasty at 57 and 114 months. The mean Oxford knee score was worse pre-operatively in the cohort with primary osteoarthritis (18 vs 30, p < 0.001) but there were no significant differences in post-operative Oxford knee score or patient satisfaction (primary osteoarthritis 86%, PTOA 78%, p = 0.437). Total knee arthroplasty undertaken after fracture of the tibial plateau has a higher rate of complications than that undertaken for primary osteoarthritis, but patient-reported outcomes and satisfaction are comparable. Cite this article: Bone Joint J 2015;97-B:532-8. PMID:25820894

  4. A posterior tibial tendon skipping rope.

    PubMed

    van Sterkenburg, M N; Haverkamp, D; van Dijk, C N; Kerkhoffs, G M M J

    2010-12-01

    This report presents an athletic patient with swelling and progressive pain on the posteromedial side of his right ankle on weight bearing. MRI demonstrated tenosynovitis and suspicion of a length rupture. On posterior tibial tendoscopy, there was no rupture, but medial from the tendon a tissue cord came into view, causing impingement on the tendon at the level of maximum pain. The cord was released and 2 weeks and 1 year after the procedure the patient reported no complaints. PMID:20556356

  5. Complications of closing wedge high tibial osteotomy

    PubMed Central

    Tunggal, James A. W.; Higgins, Gordon A.

    2009-01-01

    Closing wedge high tibial osteotomy is a common, effective and well-established procedure to treat unicompartment osteoarthrosis of the knee. It is, however, not without its complications. This article will discuss some of these complications and present an overview of the current literature. It will examine current thoughts on aetiology, techniques to try to avoid, and methods of treatment of these complications. PMID:19547973

  6. The risk of revision in total knee arthroplasty is not affected by previous high tibial osteotomy

    PubMed Central

    Badawy, Mona; Fenstad, Anne M; Indrekvam, Kari; Havelin, Leif I; Furnes, Ove

    2015-01-01

    Background and purpose Previous studies have found different outcomes after revision of knee arthroplasties performed after high tibial osteotomy (HTO). We evaluated the risk of revision of total knee arthroplasty with or without previous HTO in a large registry material. Patients and methods 31,077 primary TKAs were compared with 1,399 TKAs after HTO, using Kaplan-Meier 10-year survival percentages and adjusted Cox regression analysis. Results The adjusted survival analyses showed similar survival in the 2 groups. The Kaplan-Meier 10-year survival was 93.8% in the primary TKA group and 92.6% in the TKA-post-HTO group. Adjusted RR was 0.97 (95% CI: 0.771.21; p = 0.8). Interpretation In this registry-based study, previous high tibial osteotomy did not appear to compromise the results regarding risk of revision after total knee arthroplasty compared to primary knee arthroplasty. PMID:26058747

  7. The worsening of tibialis anterior muscle atrophy during recovery post-immobilization correlates with enhanced connective tissue area, proteolysis, and apoptosis.

    PubMed

    Slimani, Lamia; Micol, Didier; Amat, Julien; Delcros, Geoffrey; Meunier, Bruno; Taillandier, Daniel; Polge, Ccile; Bchet, Daniel; Dardevet, Dominique; Picard, Brigitte; Attaix, Didier; Listrat, Anne; Combaret, Lydie

    2012-12-01

    Sustained muscle wasting due to immobilization leads to weakening and severe metabolic consequences. The mechanisms responsible for muscle recovery after immobilization are poorly defined. Muscle atrophy induced by immobilization worsened in the lengthened tibialis anterior (TA) muscle but not in the shortened gastrocnemius muscle. Here, we investigated some mechanisms responsible for this differential response. Adult rats were subjected to unilateral hindlimb casting for 8 days (I8). Casts were removed at I8, and animals were allowed to recover for 10 days (R1 to R10). The worsening of TA atrophy following immobilization occurred immediately after cast removal at R1 and was sustained until R10. This atrophy correlated with a decrease in type IIb myosin heavy chain (MyHC) isoform and an increase in type IIx, IIa, and I isoforms, with muscle connective tissue thickening, and with increased collagen (Col) I mRNA levels. Increased Col XII, Col IV, and Col XVIII mRNA levels during TA immobilization normalized at R6. Sustained enhanced peptidase activities of the proteasome and apoptosome activity contributed to the catabolic response during the studied recovery period. Finally, increased nuclear apoptosis prevailed only in the connective tissue compartment of the TA. Altogether, the worsening of the TA atrophy pending immediate reloading reflects a major remodeling of its fiber type properties and alterations in the structure/composition of the extracellular compartment that may influence its elasticity/stiffness. The data suggest that sustained enhanced ubiquitin-proteasome-dependent proteolysis and apoptosis are important for these adaptations and provide some rationale for explaining the atrophy of reloaded muscles pending immobilization in a lengthened position. PMID:23032683

  8. Clipping of anterior communicating artery aneurysms in the early post-rupture stage via transorbital keyhole approach-Chinese neurosurgical experience.

    PubMed

    Wang, Hui; Luo, Lun; Ye, Zhuopeng; Li, Wensheng; Chen, Chuan; Ba, Yueyang; Ning, Xinjie; Guo, Ying

    2015-10-01

    The anterior communicating artery (AComA) complex is the site at which intracranial aneurysms occur most frequently. At present, effective treatments for AComA aneurysms are yet to be developed. Here, we present our experience in successfully managing AComA aneurysms via the transorbital keyhole approach. A total of 52 patients having a history of aneurysm rupture received surgery. All patients were assigned a Hunt-Hess grade prior to surgery. The cistern was opened to expose the AComA complex using a keyhole approach, and aneurysms were then surgically clipped with the assistance of neuroendoscopy or indocyanine green angiography. Surgery outcomes were confirmed using computed tomography angiography (CTA). Each of the 52 AComA aneurysms was successfully clipped with a single operation. Three of these patients experienced intraoperative aneurysm rupture. Five had postoperative hydrocephalus which was successfully treated with ventriculoperitoneal shunt. All patients survived the surgical procedure. Using the Glasgow Outcome Scale scores for evaluation, 39 patients (75.0%) had good recovery, 9 (17.3%) had moderate disability, 2 (3.8%) had severe disability, and 2 patients who had been in preoperative comas (3.8%) remained in a vegetative state. During the follow-up period, CTA showed no recurrence of rupture or bleeding in all cases. Results of logistic analysis indicated that the transorbital keyhole approach was feasible based on the patients' preoperative Hunt-Hess grades, which should be considered a priority in using this approach in the treatment of ruptured AComA aneurysms. PMID:25968329

  9. Exposed tibial bone after burns: Flap reconstruction versus dermal substitute.

    PubMed

    Verbelen, Jozef; Hoeksema, Henk; Pirayesh, Ali; Van Landuyt, Koenraad; Monstrey, Stan

    2016-03-01

    A 44 years old male patient had suffered extensive 3rd degree burns on both legs, undergoing thorough surgical debridement, resulting in both tibias being exposed. Approximately 5 months after the incident he was referred to the Department of Plastic and Reconstructive Surgery of the University Hospital Gent, Belgium, to undergo flap reconstruction. Free flap surgery was performed twice on both lower legs but failed on all four occasions. In between flap surgery, a dermal substitute (Integra(®)) was applied, attempting to cover the exposed tibias with a layer of soft tissue, but also without success. In order to promote the development of granulation tissue over the exposed bone, small holes were drilled in both tibias with removal of the outer layer of the anterior cortex causing the bone to bleed and subsequently negative pressure wound therapy (NPWT) was applied. The limited granulation tissue resulting from this procedure was then covered with a dermal substitute (Glyaderm(®)), consisting of acellular human dermis with an average thickness of 0.25mm. This dermal substitute was combined with a NPWT-dressing, and then served as an extracellular matrix (ECM), guiding the distribution of granulation tissue over the remaining areas of exposed tibial bone. Four days after initial application of Glyaderm(®) combined with NPWT both tibias were almost completely covered with a thin coating of soft tissue. In order to increase the thickness of this soft tissue cover two additional layers of Glyaderm(®) were applied at intervals of approximately 1 week. One week after the last Glyaderm(®) application both wounds were autografted. The combination of an acellular dermal substitute (Glyaderm(®)) with negative pressure wound therapy and skin grafting proved to be an efficient technique to cover a wider area of exposed tibial bone in a patient who was not a candidate for free flap surgery. An overview is also provided of newer and simpler techniques for coverage of exposed bone that could question the universal plastic surgery paradigm that flap surgery is the only way to cover these defects. PMID:26376411

  10. Comparison of the operation of arthroscopic tibial inlay and traditional tibial inlay for posterior cruciate ligament reconstruction

    PubMed Central

    Lu, Daifeng; Xiao, Mochao; Lian, Yongyun; Zhou, Yong; Liu, Xuefeng

    2014-01-01

    Objective: To perform dual-bundle reconstruction of posterior cruciate ligament using full arthroscopic tibial inlay technology with self-designed tibia tunnel drilling system and to compare the effect of arthroscopic tibial inlay versus traditional technique for posterior cruciate ligament reconstruction. Material and methods: 32 patients were randomly divided into experiment group (improved tibial inlay, n = 17) and control group (traditional tibial inlay, n = 15). Self-designed tibia tunnel drill system was used to produce intraoperative deep-limited bone tunnel. During follow-up, the location of the bone block and the healing situation were checked by knee X-ray and spiral CT scan. Blood loss, operation time and nerve vascular injuries were evaluated. Results: Mean intraoperative blood loss was 123.53 ± 74.05 ml in the improved tibial inlay group compared with 332 ± 114.26 ml in the traditional tibial inlay group (t = 6.12, P < 0.05). Mean operation time was 235.27 ± 58.88 min in the improved tibial inlay group compared with 346.37 ± 59.67 min in the traditional tibial inlay group (t = 5.19, P < 0.05). Posterior drawer test were negative in 15 cases, slight positive in 2 with improved tibial inlay technique compared with 14 negative cases and 2 positive cases of traditional tibial Inlay technique. The X-ray and spiral CT scan showed the location of the bone block were perfect and healed well with the patent who received improved tibial inlay technology after 12 weeks postoperatively. Conclusion: Accurate depth-limited bone tunnel can be produced by the tibia tunnel drill system with minor trauma, less bleeding and reducing of nerves or vessels and the recent clinical effects of PCL reconstruction were pretty good. PMID:25419349

  11. Tibial sesamoid fracture in a softball player.

    PubMed

    Jones, Jeanine L; Losito, James M

    2007-01-01

    A single case of a tibial sesamoid fracture in a softball player is reported here. A review of the literature confirms that this is an unusual and difficult problem to treat in the athletic population given the significant loads placed on the sesamoids during athletic activity. In the case presented, conservative care was not effective, and the athlete underwent surgical excision of the fractured sesamoid. With use of a postoperative orthosis and cleat modification, surgical management was successful and allowed the athlete to return to her athletic endeavors without restrictions in 8 weeks. PMID:17218630

  12. Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction With Remnant Preservation Using Outside-In Technique

    PubMed Central

    Lee, Byung-Ill; Kwon, Sai-Won; Choi, Hyung-Suk; Chun, Dong-Il; Kim, Yong-Beom; Kim, Byoung-Min

    2015-01-01

    This report describes a modified anatomic single-bundle anterior cruciate ligament (ACL) reconstruction technique using the FlipCutter guide pin (Arthrex, Naples, FL) as a retrograde drill and a cortical suspensory fixation device (TightRope; Arthrex) with an adjustable graft loop length. Preservation of the ACL remnant as a biological sleeve for the graft is an important issue from the viewpoints of acceleration of revascularization and ligamentization, preservation of the proprioceptive nerve fibers, enhancement of the biological environment for healing, and maintenance of the anchor point at the native tibial attachment, in addition to yielding a lower incidence of tibial bone tunnel enlargement. The goal of our technique is to obtain some advantages of the remnant-preserving technique through an anatomic single-bundle ACL reconstruction, which is performed to minimize damage to the ACL tibial remnant. PMID:26759771

  13. Modular tibial augmentations in total knee arthroplasty.

    PubMed

    Fehring, T K; Peindl, R D; Humble, R S; Harrow, M E; Frick, S L

    1996-06-01

    Proximal tibial bony deficiencies are not uncommon in primary and revision total knee arthroplasty. Modular tibial augmentations were introduced to address these deficiencies. Alterations in strain distribution as a result of medial wedge and block augmentations were evaluated for a modular total knee arthroplasty system in 6 fresh frozen anatomic specimen tibias. Full-field strain patterns were examined using photoelastic coating methods, and high strain regions were evaluated using strain gage rosette techniques. The total knee arthroplasty installations were tested in static physiologic axial and torsional load configurations. The relative effects of sequential wedge and block augmentations compared with the nonaugmented case were statistically analyzed. There were no overall statistical differences in the 3 treatments in terms of maximal (principal) strains. A secondary analysis that evaluated specific location and load pattern combinations established several minor statistical differences along with insights into the manner in which each construct loads the proximal tibia. Although metal wedge augmentation commonly is used, block augmentation seems to be an appropriate alternative from a strain distribution standpoint in cases in which the block geometry better approximates the bony defect. PMID:8641065

  14. Surgical Approaches to Posterolateral Tibial Plateau Fractures.

    PubMed

    Garner, Matthew R; Warner, Stephen J; Lorich, Dean G

    2016-01-01

    Tibial plateau fractures involving the posterolateral articular surface present a unique challenge to treating surgeons due to the complex anatomy of the region. The posterolateral corner complex and the proximity of the common peroneal nerve restrict both the exposure of the joint surface and the ability to distract across the joint using a varus force. Further, injury to the soft tissue envelope may prevent use of the optimal surgical incision. For these reasons, a thorough understanding of the anatomy and available approaches is essential when treating these fractures. Approach selection should be based on fracture pattern, the surrounding soft tissue envelope, and the patient's clinical conditions; concomitant injuries and overall health status must be accounted for. In this article, we highlight five surgical approaches that can be utilized to improve visualization and access to the posterolateral tibial plateau. These include three separate osteotomies performed through an anterolateral approach: lateral femoral epicondyle osteotomy, fibular head resection osteotomy, and a novel digastric fibular osteotomy. In addition, we will discuss a posterolateral approach and a direct posterior approach. PMID:26480345

  15. Tibial somatosensory evoked potential can prognosticate for ambulatory function in subacute hemiplegic stroke.

    PubMed

    Hwang, Pyoungsik; Sohn, Min Kyun; Kim, Cuk-Seong; Jee, Sungju

    2016-04-01

    Early prediction of expected recovery in stroke can help in planning appropriate medical and rehabilitation interventions. Recovery of ambulation is one of the essential endpoints in stroke rehabilitation. However, the correlation of somatosensory evoked potentials (SSEP) with clinical parameters and their predictive significance are not clearly defined. We aimed to examine the association between tibial nerve SSEP and ambulatory outcomes in subacute hemiplegic stroke patients. We reviewed medical records for hemiplegic patients with first-ever stroke who received inpatient rehabilitation from January 2009 to May 2013. We excluded patients with diabetes mellitus, quadriplegia, bilateral lesions, brainstem lesions, those aged over 80years, and those with severe musculoskeletal problems. Tibial nerve SSEP were performed when they were transferred to the rehabilitation department. SSEP findings were divided into three groups; normal, abnormal and absent response. Berg balance scale and functional ambulation category (FAC) at discharge were compared with initial tibial SSEP findings using one-way analysis of variance. Thirty-one hemiplegic patients were included. Berg balance scale and FAC were significantly different according to the SSEP (P<0.001). Post hoc analysis showed a significant difference between normal and absent response in Berg balance scale (P<0.001) and FAC (P<0.001), and between abnormal and absent response in Berg balance scale (P=0.012) and FAC (P=0.019). Functional outcomes of the normal response group were better than the abnormal response group, but there was no statistical significance. These findings suggest that initial tibial nerve SSEP may be a useful biomarker for prognosticating functional outcomes in hemiplegic patients. PMID:26778357

  16. An in vitro study of the Mller anterolateral femorotibial ligament tenodesis in the anterior cruciate ligament deficient knee.

    PubMed

    Draganich, L F; Reider, B; Miller, P R

    1989-01-01

    The biomechanical effectiveness of the Mller anterolateral femorotibial ligament (ALFTL) iliotibial band tenodesis on anterior stability and internal rotational stability of the ACL deficient knee was investigated in six cadaver knees. Anterior drawer and internal rotation of the tibia were measured at 15 degrees increments from 0 degrees to 90 degrees in response to 50 N of anteriorly applied tibial force and 3 Nm of internally applied internal torque, respectively, in the intact knee, the ACL excised knee, and following the ALFTL reconstruction. A strain gage was used to measure the resting graft tension and to measure strain in the graft during the load-displacement tests. The Mller ALFTL tenodesis failed to return normal anterior stability to the ACL deficient knee (P less than 0.05). The tenodesis did, however, reduce the anterior laxity of the ACL deficient knee from 30 degrees to 90 degrees of knee flexion (P less than 0.05). The tenodesis overconstrained internal tibial rotation of the ACL excised knee from 30 degrees to 90 degrees (P less than 0.05). Measurements of strain in the tenodesis supported the load-displacement findings that the tenodesis was most effective in constraining anterior drawer and internal tibial rotation from 30 degrees to 90 degrees of knee flexion. PMID:2658630

  17. Polyaxial Screws in Locked Plating of Tibial Pilon Fractures.

    PubMed

    Yenna, Zachary C; Bhadra, Arup K; Ojike, Nwakile I; Burden, Robert L; Voor, Michael J; Roberts, Craig S

    2015-08-01

    This study examined the axial and torsional stiffness of polyaxial locked plating techniques compared with fixed-angle locked plating techniques in a distal tibia pilon fracture model. The effect of using a polyaxial screw to cross the fracture site was examined to determine its ability to control relative fracture site motion. A laboratory experiment was performed to investigate the biomechanical stiffness of distal tibia fracture models repaired with 3.5-mm anterior polyaxial distal tibial plates and locking screws. Sawbones Fourth Generation Composite Tibia models (Pacific Research Laboratories, Inc, Vashon, Washington) were used to model an Orthopaedic Trauma Association 43-A1.3 distal tibia pilon fracture. The polyaxial plates were inserted with 2 central locking screws at a position perpendicular to the cortical surface of the tibia and tested for load as a function of axial displacement and torque as a function of angular displacement. The 2 screws were withdrawn and inserted at an angle 15 from perpendicular, allowing them to span the fracture and insert into the opposing fracture surface. Each tibia was tested again for axial and torsional stiffness. In medial and posterior loading, no statistically significant difference was found between tibiae plated with the polyaxial plate and the central screws placed in the neutral position compared with the central screws placed at a 15 position. In torsional loading, a statistically significant difference was noted, showing greater stiffness in tibiae plated with the polyaxial plate and the central screws placed at a 15 position compared with tibiae plated with the central screws placed at a 0 (or perpendicular) position. This study showed that variable angle constructs show similar stiffness properties between perpendicular and 15 angle insertions in axial loading. The 15 angle construct shows greater stiffness in torsional loading. PMID:26270750

  18. Malrotation following reamed intramedullary nailing of closed tibial fractures

    PubMed Central

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

    2012-01-01

    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 33.413.3 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. PMID:22719118

  19. Simple method for confirming tibial osteotomy during total knee arthroplasty

    PubMed Central

    2012-01-01

    Background Achieving precise implant alignment is crucial for producing good outcomes after total knee arthroplasty (TKA). We introduce a simple method for confirming the accuracy of tibial osteotomy during TKA. Findings Two metallic markers were placed on the skin 20 cm apart, one on the tibial tuberosity and other on the tibial crest, points that are easily identified and palpated intraoperatively. Anteroposterior radiographs of the legs were obtained. We defined the line along the markers as the tuberosity line. The osteotomy line is perpendicular to the anatomical axis of the tibia. We then calculated the angle between these two lines and designated it the osteotomy angle. We set the osteotomy angle of the protractor, and cut the bone parallel to the osteotomy line of the protractor. Postoperatively, we analyzed the varus angle of the tibial osteotomy in 35 TKAs using the protractor. The average of the varus angle of the tibial osteotomy was 89.4° ± 1.6° (95% confidence interval of −1.0976, 0.0119). There was no significant difference from the target angle of 90° (p = 0.055). The varus angles of 90° and 90° ± 2° for the tibial osteotomy were 42.9% and 82.9%, respectively. Conclusions We determined the accuracy of the tibial osteotomy in the coronal plane using the protractor to be satisfactory. PMID:23153271

  20. Nonunion of the tibial facture as a consequence of posterior tibial artery pseudoaneurysm

    PubMed Central

    Kalyan, Jiten P.; Kordzadeh, Ali; Hanif, Muhammad A.; Griffiths, Mathew; Lyall, Harry; Prionidis, Ioannis

    2015-01-01

    Pseudoaneurysm of the posterior tibial artery (PTA) is uncommon, and they mainly occur following high-velocity trauma, open fractures and can be iatrogenic in nature. To the best of our knowledge, this is the first reported and successfully treated case of PTA pseudoaneurysm identified as a consequence of tibia fracture nonunion in an otherwise healthy young individual 6 months following the original incident with a novel intraoperative technique. PMID:26521160

  1. Computational modelling of mobile bearing TKA anterior-posterior dislocation.

    PubMed

    Müller, J H; Zakaria, T; van der Merwe, W; D'Angelo, F

    2016-04-01

    Anterior-posterior stability in an unconstrained mobile-bearing total knee arthroplasty (TKA) and one with rotational constraints is compared in a computational model based on an ASTM test. Both TKA designs dislocate at loads greater than reported maximum in vivo forces. The posterior drawer forces (mean: 3027 N vs. 1817 N) needed to induce subluxation increase with a greater anterior jump distance (12 mm vs. 7 mm; refers to the vertical height of the anterior or posterior border of the tibial insert's articulating surface). The posterior jump distance for both tested TKA differed by 1.5 mm and had minimal effect on the magnitude of the anterior drawer forces at dislocation in mid-flexion (unconstrained vs. constrained: 445 N vs. 412 N). The unconstrained insert dislocated by means of spin-out whereas in the constrained TKA the femur dislocated from the bearing during posterior drawer and the bearing from the baseplate during anterior drawer. MCL function is an important consideration during ligament balancing since a ± 10% variation in MCL tension affects dislocation forces by ± 20%. The simulation platform provided the means to investigate TKA designs in terms of anterior-posterior stability as a function of knee flexion, collateral ligament function and mechanical morphology. PMID:26047039

  2. Fibular segment bone bridging in trans-tibial amputation.

    PubMed

    Pinto, M A G S; Harris, W W

    2004-12-01

    The purpose of this paper is to present an alternative method of achieving a synostosis between tibia and fibula in trans-tibial amputations by means of a fibular segment in place of tibial osteoperiosteal flaps as described by Ertl, in 1949. From May 1997 through to February 2003, 15 patients were submitted to the proposed procedure. As a result, all patients produced a solid synostosis between tibia and fibula and were rehabilitated with the use of prostheses. The capacity of these patients for distal weight-bearing on the stump was remarkable when compared to patients submitted to the conventional trans-tibial amputation technique. PMID:15658634

  3. Single intra-articular dexamethasone injection immediately post-surgery in a rabbit model mitigates early inflammatory responses and post-traumatic osteoarthritis-like alterations.

    PubMed

    Heard, Bryan J; Barton, Kristen I; Chung, May; Achari, Yamini; Shrive, Nigel G; Frank, Cyril B; Hart, David A

    2015-12-01

    Despite surgical reconstruction of the anterior cruciate ligament, a significant number of patients will still develop post-traumatic osteoarthritis (PTOA). Our objective was to determine if mitigating aspects of the acute phase of inflammation following a defined knee surgery with a single administration of a glucocorticoid could prevent the development of PTOA-like changes within an established rabbit model of surgically induced PTOA. An early and late post-surgical time-point was investigated in this study (48?h and 9 weeks post-surgery) in which the following groups were repeated (each n=6, for a total of 24 rabbits per time-point, and 48 rabbits used in the study): control (age/sex matched), sham (arthrotomy), drill injury (arthrotomy+two drill holes to a non-cartilaginous area of the femoral notch), and drill injury+single intra-articular (IA) injection of dexamethasone (DEX). At 48?h post-surgery, DEX treatment significantly lowered the mRNA levels for a subset of pro-inflammatory mediators, and significantly lowered the histological grade. Nine weeks post surgery, DEX treatment significantly lowered the histological scores (presented as effect size) for synovium (3.8), lateral femoral condyle (3.9), and lateral tibial cartilage (5.1) samples. Thus, DEX likely acts to prevent injury induced inflammation that could contribute to subsequent joint damage. PMID:26135713

  4. Flexible multibody simulation approach in the analysis of tibial strain during walking.

    PubMed

    Al Nazer, R; Rantalainen, T; Heinonen, A; Sievänen, H; Mikkola, A

    2008-01-01

    Strains within the bone tissue play a major role in bone (re)modeling. These small strains can be assessed using experimental strain gage measurements, which are challenging and invasive. Further, the strain measurements are, in practise, limited to certain regions of superficial bones only, such as the anterior surface of the tibia. In this study, tibial strains occurring during walking were estimated using a numerical approach based on flexible multibody dynamics. In the introduced approach, a lower body musculoskeletal model was developed by employing motion capture data obtained from walking at a constant velocity. The motion capture data were used in inverse dynamics simulation to teach the muscles in the model to replicate the motion in forward dynamics simulation. The maximum and minimum tibial principal strains predicted by the model were 490 and -588 microstrain, respectively, which are in line with literature values from in vivo measurements. In conclusion, the non-invasive flexible multibody simulation approach may be used as a surrogate for experimental bone strain measurements and thus be of use in detailed strain estimations of bones in different applications. PMID:18191865

  5. Ilizarov treatment of complex tibial pilon fractures

    PubMed Central

    Rao, Sharath K.

    2006-01-01

    We treated 21 consecutive patients between 1998 and 2002 with complex tibial pilon fractures, eight type B and 13 type C, using percutaneous reduction and fixation with the small diameter Ilizarov apparatus. The average patient age was 345.6 years (range 2852 years). Nine of the patients had open fractures (two type I, four type II, and three type IIIA). The patients were followed up regularly at 6-month intervals for 2 years. All fractures united. The fixator was removed at an average of 26.64.2 weeks (range 2034 weeks). The average American Orthopaedic Foot and Ankle Society ankle-hind foot score was excellent in 11 patients, good in five, fair in four, and poor in one. Thirteen patients were able to squat and climb stairs. PMID:16435148

  6. [Tibial abscess caused by histoplasma capsulatum].

    PubMed

    de Fernndez, M I; Negroni, R; Arechavala, A

    2001-01-01

    Disseminated histoplasmosis is the most serious form of the disease produced by the fungus Histoplasma capsulatum. Histoplasmosis was first described by Darling in 1906, and it is endemic in certain areas of Central and Southeastern regions of USA, and most Latin America countries, including the Pampa hmeda and Mesopotamia regions in Argentina, but in other continents it has a limited regional distribution. Lung involvement predominates in 90% of cases, but H. capsulatum may involve bone and soft tissues. Bone lesions without other signs of infection are very rare, and are often misdiagnosed as cancer. We report a case of disseminated histoplasmosis in a man with a myelodysplasia who presented a left tibial abscess, without any clinical evidence of pulmonary involvement. The patient was successfully treated with itraconazole. PMID:11374144

  7. Surgical options for posterior tibial plateau fracture

    PubMed Central

    Chen, Hongwei; Wu, Lijun

    2015-01-01

    Objective: To investigate surgical methods and clinical effectiveness of posteromedial and posterolateral approaches for the posterior tibial plateau fracture. Method: 21 cases who received surgery through posterior approaches for the treatment of posterior tibial plateau fractures (PTPFs) were included. Results: 21 cases were subject to follow-up for 12-24 months (an average of 16.2 months). No cases developed incision inflammation, neurovascular injury, internal fixation loosening and breakage. All fractures were healed. No cases developed knee varus and valgus deformity and fracture dislocation. After surgery, Rasmussen score for knee joint functions was 13-30 points (a mean of 24.2). The results were excellent in 12 cases, good in 7 cases and fair in 2 cases. The percentage of excellent and good results was 90.5%. Rasmussen radiology score was 10-18 points (a mean of 15.6 points). The results were excellent in 13 cases, good in 7 cases and fair in 1 cases. The percentage of excellent and good results was 95.2%. 1 case had significant limited range of knee flexion and extension, which was improved after phase II release under arthroscopy combined with function exercise. 2 cases developed traumatic arthritis, which was relieved after intra-articular injection with sodium hyaluronate and oral nonsteroidal anti-inflammatory drug. Conclusion: The posteromedial and posterolateral approaches for PTPF is good for reduction and fixation of PTPF. The approaches have benefits such as clear exposure, convenient placement of internal fixation, less trauma and good clinical outcome. PMID:26885086

  8. Unique proximal tibial morphology in strepsirrhine primates.

    PubMed

    White, Jessica L; Gebo, Daniel L

    2004-11-01

    Although the morphology of the tibial plateau in primates has received very little attention in the literature, it does exhibit features of phylogenetic and functional interest. This paper describes the morphology of the tibial plateau (particularly the intercondylar region) in extant and fossil primates, and in three mammalian outgroups: the pen-tailed tree shrew (Ptilocercus), tree shrew (Tupaia), and flying lemur or dermopteran (Cynocephalus). Extant and fossil strepsirrhine primates exhibit an eminence with a single spine, which contrasts with the intercondylar morphology of haplorhine primates. Most extant platyrrhines, all catarrhine primates (including humans), and some fossil haplorhines possess an eminence with two spines (medial and lateral) connected by a ridge of bone that intersects the intercondylar groove. Tarsius and callitrichines possess an eminence with a reduced medial spine that superficially resembles that of strepsirrhine primates. Dermopterans also exhibit a morphology similar to that of strepsirrhines. In Scandentia, the intercondylar morphology of Tupaia is similar to that of rodents, whereas Ptilocercus resembles tarsiers and callitrichines. We hypothesize that proximal tibiae with either a single spine or reduced medial spine morphology facilitate a greater degree of knee rotation about the eminence relative to the double-spine condition, and are likely associated with more frequent adoption of vertical body positions. In contrast, a double-spine eminence limits knee rotation and is probably associated with greater use of horizontal supports. Although the polarity is complicated by the unknown phylogenetic status of likely sister taxa, it seems most probable that the single-spine morphology is a derived feature of strepsirrhines. PMID:15538762

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

    PubMed

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

    2011-07-01

    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

  10. Pathology of the Calcified Zone of Articular Cartilage in Post-Traumatic Osteoarthritis in Rat Knees

    PubMed Central

    Schultz, Melissa; Molligan, Jeremy; Schon, Lew; Zhang, Zijun

    2015-01-01

    Objectives This study aimed to investigate the pathology occurring at the calcified zone of articular cartilage (CZC) in the joints afflicted with post-traumatic osteoarthritis (PTOA). Methods Rats underwent bilateral anterior cruciate ligament (ACL) transection and medial meniscectomy to induce PTOA. Sham surgery was performed on another five rats to serve as controls. The rats were euthanized after four weeks of surgery and tibial plateaus were dissected for histology. The pathology of PTOA, CZC area and the tidemark roughness at six pre-defined locations on the tibial plateaus were quantified by histomorphometry. Results PTOA developed in the knees, generally more severe at the medial plateau than the lateral plateau, of rats in the experimental group. The CZC area was unchanged in the PTOA joints, but the topographic variations of CZC areas that presented in the control knees were reduced in the PTOA joints. The tidemark roughness decreased in areas of the medial plateau of PTOA joints and that was inversely correlated with the Mankins score of PTOA pathology. Conclusion Reduced tidemark roughness and unchanged CZC area differentiate PTOA from primary osteoarthritis, which is generally believed to have the opposite pathology at CZC, and may contribute to the distinct disease progression of the two entities of arthropathy. PMID:25807537

  11. Biological post

    PubMed Central

    Kumar, B. Suresh; Kumar, Senthil; Mohan Kumar, N. S.; Karunakaran, J. V.

    2015-01-01

    Anterior tooth fracture as a result of traumatic injuries, is frequently encountered in endodontic practice. Proper reconstruction of extensively damaged teeth can be achieved through the fragment reattachment procedure known as “biological restoration.” This case report refers to the esthetics and functional recovery of extensively damaged maxillary central incisor through the preparation and adhesive cementation of “biological post” in a young patient. Biological post obtained through extracted teeth from another individual–represent a low-cost option and alternative technique for the morphofunctional recovery of extensively damaged anterior teeth. PMID:26538952

  12. Rotational alignment of the tibial component in total knee arthroplasty.

    PubMed

    Indelli, Pier Francesco; Graceffa, Angelo; Marcucci, Massimiliano; Baldini, Andrea

    2016-01-01

    Many surgical techniques, correlated to different anatomical landmarks, have been proposed to allow a satisfactory rotational alignment of the tibial component in primary total knee arthroplasty (TKA). Unfortunately, an accurate landmark has not yet been established although many computer models using CT reconstructions and standard radiologic studies have been performed. In this review article, the authors propose a new anatomical rotational reference for a correct positioning of the tibial component during primary TKA; the authors compared the results of their studies with the current literature on rotational alignment references and previously proposed surgical techniques. The authors also analyzed the correlation between classic and newer tibial baseplate designs and different tibial rotational landmarks. PMID:26855939

  13. Rotational alignment of the tibial component in total knee arthroplasty

    PubMed Central

    Graceffa, Angelo; Marcucci, Massimiliano; Baldini, Andrea

    2016-01-01

    Many surgical techniques, correlated to different anatomical landmarks, have been proposed to allow a satisfactory rotational alignment of the tibial component in primary total knee arthroplasty (TKA). Unfortunately, an accurate landmark has not yet been established although many computer models using CT reconstructions and standard radiologic studies have been performed. In this review article, the authors propose a new anatomical rotational reference for a correct positioning of the tibial component during primary TKA; the authors compared the results of their studies with the current literature on rotational alignment references and previously proposed surgical techniques. The authors also analyzed the correlation between classic and newer tibial baseplate designs and different tibial rotational landmarks. PMID:26855939

  14. Tibial tubercle osteotomy for patello-femoral joint disorders.

    PubMed

    Hall, Matthew J; Mandalia, Vipul I

    2016-03-01

    Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage. Level of evidence III. PMID:25326765

  15. Physeal growth arrest after tibial lengthening in achondroplasia

    PubMed Central

    2012-01-01

    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Results Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Interpretation Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrenceespecially when lengthening of more than 50% is attempted. PMID:22489887

  16. Method of quadriceps attachment following upper tibial resection.

    PubMed

    Coombs, Christopher J; O'Sullivan, Mark; Theile, Richard; Tan, Sze C

    2006-01-01

    Limb salvage procedures for osteosarcomas of the upper tibia present combined problems of knee-joint and tibial reconstruction. Many methods of overcoming this have been described. We describe a new technique of prosthetic knee-joint and upper-tibial reconstruction, combined with a vascularized fibular bone flap for reattachment of the quadriceps muscle and tendon unit, resulting in superior long-term function. PMID:16538637

  17. The virtual model of the prosthetic tibial components.

    PubMed

    Tarni??, Daniela; Popa, D; Tarni??, D N; Grecu, D; Negru, M

    2006-01-01

    The paper presents a method of study and the steps to obtain the virtual tibial component of the human knee joint prosthesis. For that purpose CAD parametric software was used which allows the construction of a high definition model. The obtained 3D model was studied using the finite element method and the stress and displacements distribution was obtained for different solicitations of the prosthetic and non-prosthetic tibial component of the virtual knee joint. PMID:17392979

  18. Cartilage Strain Distributions Are Different Under the Same Load in the Central and Peripheral Tibial Plateau Regions.

    PubMed

    Briant, Paul; Bevill, Scott; Andriacchi, Thomas

    2015-12-01

    There is increasing evidence that the regional spatial variations in the biological and mechanical properties of articular cartilage are an important consideration in the pathogenesis of knee osteoarthritis (OA) following kinematic changes at the knee due to joint destabilizing events (such as an anterior cruciate ligament (ACL) injury). Thus, given the sensitivity of chondrocytes to the mechanical environment, understanding the internal mechanical strains in knee articular cartilage under macroscopic loads is an important element in understanding knee OA. The purpose of this study was to test the hypothesis that cartilage from the central and peripheral regions of the tibial plateau has different internal strain distributions under the same applied load. The internal matrix strain distribution for each specimen was measured on osteochondral blocks from the tibial plateau of mature ovine stifle joints. Each specimen was loaded cyclically for 20?min, after which the specimen was cryofixed in its deformed position and freeze fractured. The internal matrix was viewed in a scanning electron microscope (SEM) and internal strains were measured by quantifying the deformation of the collagen fiber network. The peak surface tensile strain, maximum principal strain, and maximum shear strain were compared between the regions. The results demonstrated significantly different internal mechanical strain distributions between the central and peripheral regions of tibial plateau articular cartilage under both the same applied load and same applied nominal strain. These differences in the above strain measures were due to differences in the deformation patterns of the collagen network between the central and peripheral regions. Taken together with previous studies demonstrating differences in the biochemical response of chondrocytes from the central and peripheral regions of the tibial plateau to mechanical load, the differences in collagen network deformation observed in this study help to provide a fundamental basis for understanding the association between altered knee joint kinematics and premature knee OA. PMID:26501505

  19. The distinct prediction standards for radiological assessments associated with soft tissue injuries in the acute tibial plateau fracture.

    PubMed

    Wang, Jun; Wei, Jie; Wang, Manyi

    2015-07-01

    The goal of this study was to assess the incidence of soft tissue injury in the tibial plateau fracture by magnetic resonance image (MRI) and reveal the relationship between the articular widening/depression and the risk of meniscus and ligament disorder. A total of 54 patients with tibial plateau fracture were indicated for operative intervention. Soft tissue injuries were assessed by MRI. Meniscus, anterior/posterior cruciate ligaments and medial/lateral collateral ligaments injuries on MRI were evaluated. The articular widening/depression was measured in picture archiving and communication systems. Schatzker classification of fracture types was not significantly associated with soft tissue injuries. The rates of soft tissue injury in types IV and II (respectively, 85.7 and 74.1 %) were higher than those in other types. The meniscus injury was the most common soft tissue damage, and the incidence of meniscus injury was 55.6 %. When LPDCT and LPWCT were, respectively, about 7.6 mm and 10.1 mm and LPDX-ray and LPWX-ray, respectively, 5.6 and 7.4 mm, more attention should be paid on the collateral and cruciate ligament injuries in types I, II and III. Furthermore, when LPWCT and LPWX-ray were, respectively, about 10.3 and 8.6 mm, the collateral and cruciate ligaments were susceptible to injury in types IV and V. In conclusion, tibial plateau fracture can occur high morbidity of soft tissue injury, including meniscus and ligament disorder. X-ray and CT scan had different predicting standards for soft tissue injury, and the articular widening/depression in the tibial plateau was associated with meniscus and ligament injuries. PMID:25749752

  20. RADIOGRAPHIC ASSESSMENT OF THE OPENING WEDGE PROXIMAL TIBIAL OSTEOTOMY

    PubMed Central

    Silva, Carlos Francisco Bittencourt; Camara, Eduardo Kastrup Bittencourt; Vieira, Luiz Antonio; Adolphsson, Fernando; Rodarte, Rodrigo Ribeiro Pinho

    2015-01-01

    Objective: To radiographically evaluate individuals who underwent opening wedge proximal tibial osteotomy, with the aim of analyzing the proximal tibial slope in the frontal and sagittal planes, and the patellar height. Method: The study included 22 individuals who were operated at the National Traumatology and Orthopedics Institute (INTO) for correction of varus angular tibial deviation using the opening wedge osteotomy (OWO) technique with the Orthofix monolateral external fixator. Patients with OWO whose treatment was completed between January 2000 and December 2006 were analyzed. The measurement technique consisted of using anteroposterior radiographs with loading and lateral views with the operated knees flexed at 30°. Results: There were no statistically significant differences between the pre and postoperative tibial slope and patellar height values in the patients evaluated. Conclusion: Opening wedge proximal tibial osteotomy is a technique that avoids the problems presented by high proximal tibial osteotomy, since it is done without causing changes to the extensor mechanism, ligament imbalance or distortions in the proximal tibia.

  1. Understanding the etiology of the posteromedial tibial stress fracture.

    PubMed

    Milgrom, Charles; Burr, David B; Finestone, Aharon S; Voloshin, Arkady

    2015-09-01

    Previous human in vivo tibial strain measurements from surface strain gauges during vigorous activities were found to be below the threshold value of repetitive cyclical loading at 2500 microstrain in tension necessary to reduce the fatigue life of bone, based on ex vivo studies. Therefore it has been hypothesized that an intermediate bone remodeling response might play a role in the development of tibial stress fractures. In young adults tibial stress fractures are usually oblique, suggesting that they are the result of failure under shear strain. Strains were measured using surface mounted unstacked 45 rosette strain gauges on the posterior aspect of the flat medial cortex just below the tibial midshaft, in a 48year old male subject while performing vertical jumps, staircase jumps and running up and down stadium stairs. Shear strains approaching 5000 microstrain were recorded during stair jumping and vertical standing jumps. Shear strains above 1250 microstrain were recorded during runs up and down stadium steps. Based on predictions from ex vivo studies, stair and vertical jumping tibial shear strain in the test subject was high enough to potentially produce tibial stress fracture subsequent to repetitive cyclic loading without necessarily requiring an intermediate remodeling response to microdamage. PMID:25933941

  2. Greater fear of re-injury and increased tibial translation in patients who later sustain an ACL graft rupture or a contralateral ACL rupture: a pilot study.

    PubMed

    Tagesson, Sofi; Kvist, Joanna

    2016-01-01

    The aim was to compare fear of re-injury, patient reported function, static and dynamic tibial translation and muscle strength assessed before and 5 weeks after an anterior cruciate ligament (ACL) reconstruction between individuals who sustained a subsequent ACL graft rupture or a contralateral ACL injury within 5years after the reconstruction, and individuals with no subsequent injury. Nineteen patients were investigated before, and 5 weeks after an ACL reconstruction with a quadruple hamstring tendon graft. At 5years follow up, 3 patients had sustained an ACL graft rupture and 2 patients had sustained a contralateral ACL rupture. Fear of re-injury, confidence with the knee, patient reported function, activity level, static and dynamic tibial translation and muscle strength were assessed. The re-injured group reported greater fear of re-injury and had greater static tibial translation in both knees before the ACL reconstruction compared to those who did not sustain another ACL injury. There were no other differences between groups. In conclusion, fear of re-injury and static tibial translation before the index ACL reconstruction were greater in patients who later on suffered an ACL graft rupture or a contralateral ACL rupture. These factors may predict a subsequent ACL injury. PMID:25894209

  3. The safety and efficacy of a new adjustable plate used for proximal tibial opening wedge osteotomy in the treatment of unicompartmental knee osteoarthrosis.

    PubMed

    Hennig, Alex C; Incavo, Stephen J; Beynnon, Bruce D; Abate, Joseph A; Urse, John S; Kelly, Stephen

    2007-01-01

    Twenty opening wedge tibial osteotomies were performed using the Osteotrac plate, which consists of a two-piece plate with a one-way ratcheting mechanism with two degrees of freedom. A variety of concomitant procedures were performed including osteochondral transfer, tibial tubercle medialization, and anterior cruciate ligament reconstruction. The change in tibiofemoral alignment in the coronal plane and the shift in lower extremity mechanical axis were determined. The average lateral shift in the lower extremity mechanical axis was 24% of the tibial plateau width. The average change in the mechanical tibiofemoral angle was 7 degrees of valgus. Union rate at the osteotomy site was 95%. No deep infections, clinical deep venous thrombosis, or device failures occurred. The Osteotrac plate provides safe and effective fixation and intraoperative adjustability to achieve and maintain a lateral shift of the lower extremity mechanical axis and valgus correction of the tibiofemoral alignment in patients with varus knees undergoing proximal tibial opening wedge osteotomy and associated meniscal and chondral procedures. PMID:17288082

  4. Contact Stress and Kinematic Analysis of All-Epiphyseal and Over-the-Top Pediatric Reconstruction Techniques for the Anterior Cruciate Ligament

    PubMed Central

    McCarthy, Moira M.; Tucker, Scott; Nguyen, Joseph T.; Green, Daniel W.; Imhauser, Carl W.; Cordasco, Frank A.

    2014-01-01

    Background Anterior cruciate ligament (ACL) injuries are an increasingly recognized problem in the pediatric population. Unfortunately, outcomes with conservative treatment are extremely poor. Furthermore, adult reconstruction techniques may be inappropriate to treat skeletally immature patients due to the risk of physeal complications. Physeal-sparing reconstruction techniques exist but their ability to restore knee stability and contact mechanics is not well understood. Purpose (1) To assess the ability of the all-epiphyseal (AE) and over-the-top (OT) reconstructions to restore knee kinematics; (2) to assess whether these reconstructions decrease the high posterior contact stresses seen with ACL deficiency; (3) to determine whether the AE or OT produce abnormal tibiofemoral contact stresses. Hypothesis The AE reconstruction will restore contact mechanics and kinematics similarly to that of the ACL intact knee. Methods Ten fresh-frozen human cadaveric knees were tested using a robotic manipulator. Tibiofemoral motions were recorded with the ACL intact, after sectioning the ACL, and after both reconstructions in each of the 10 specimens. The AE utilized an all-inside technique with tunnels exclusively within the epiphysis and fixed with suspensory cortical fixation devices. The OT had a central and vertical tibial tunnel with an over-the-top femur position and was fixed with staples and posts on both ends. Anterior stability was assessed with 134N anterior force at 0, 15, 30, 60, and 90 of knee flexion. Rotational stability was assessed with combined 8 Nm and 4 Nm of abduction and internal rotation, respectively, at 5, 15, and 30 of knee flexion. Results Both reconstruction techniques offloaded the posterior aspect of the tibial plateau compared to the ACL deficient knee in response to both anterior loads and combined moments as demonstrated by reduced contact stresses in this region at all flexion angles. Compared to the ACL intact condition, both the AE and OT had increased posteromedial contact stresses in response to anterior load at some flexion angles and the OT had increased peripheral posterolateral contact stresses at 15 in response to combined moments. Neither reconstruction completely restored the mid-joint contact stresses. Both reconstruction techniques restored anterior stability at flexion angles less than or equal to 30. In contrast, neither reconstruction restored anterior stability at 60 and 90 flexion. Both reconstructions restored coupled anterior translation under combined moments. Additionally, the AE over-constrained internal rotation in response to the combined moments by 12% at 15 flexion. Conclusions Both reconstructions provide anterior and rotational stability, and decrease posterior joint contact stresses compared to the ACL deficient knee. However, neither reconstruction restored the contact mechanics and kinematics of the ACL intact knee. Clinical Relevance Since the AE reconstruction has clinical advantages over the OT, our results support the hypothesis that the new AE technique is a potential candidate for use in the skeletally immature athlete. PMID:23613444

  5. Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy. A human cadaver study evaluating medial joint opening by stress radiography.

    PubMed

    Pape, Dietrich; Duchow, Jochen; Rupp, Stefan; Seil, Romain; Kohn, Dieter

    2006-02-01

    To perform an open-wedge high-tibial osteotomy (HTO), the medial proximal tibia is frequently exposed by partial distal release of the overlying insertion of the medial collateral ligament (MCL). Biomechanically, any release of the MCL can increase knee laxity when valgus stress is applied. Clinically however, post-surgical valgus instability following HTO with partial MCL release is an uncommon complication. It is known that the open-wedge procedure can re-tention an intact MCL by the width of the base of the wedge. However, this re-tentioning effect is uncertain in small wedge sizes, preexisting medial compartment laxity and in the presence of a partially detached MCL. Considering the good clinical results after HTO, we hypothesized that a partial release of the superficial MCL for HTO does not play a crucial role in stabilizing valgus forces in the human knee. We therefore measured the effect of partial versus complete release of the superficial MCL to determine medial knee laxity represented by the amount of medial joint opening (MJO) under valgus stress in this human cadaver study. In ten knee pairs, the superficial and deep MCL were sectioned in sequence with a standardized abduction force of 15 kp with a Scheuba apparatus applied. In group 1 (5 knee pairs), the superficial MCL was completely sectioned whereas in group 2 (5 knee pairs), sectioning of the superficial MCL was restricted to the anterior border to mimic the surgical exposure for an HTO. To account for the interindividual variability of ligamentous laxity, only increments of MJO within knee pairs were statistically evaluated. Stress radiography did not reveal any significant differences in increments of MJO between knee pair specimens with complete versus partial release of the superficial MCL. We disproved our hypothesis and concluded that the anterior fibers of the superficial MCL do play a crucial role in maintaining valgus stability in this biomechanical setting. Therefore, the release of the superficial MCL for open-wedge HTO should be kept to a minimum to decrease the potential of late valgus instability. This is especially important in patients with small wedge sizes and medial compartment laxity since the anterior MCL fibers are the main contributor to medial joint stability and the re-tentioning effect of the remaining MCL fibers is presumably decreased. PMID:15895293

  6. Quantification of the role of tibial posterior slope in knee joint mechanics and ACL force in simulated gait.

    PubMed

    Marouane, H; Shirazi-Adl, A; Hashemi, J

    2015-07-16

    The anterior cruciate ligament (ACL) rupture is a common knee joint injury with higher prevalence in female athletes. In search of contributing mechanisms, clinical imaging studies of ACL-injured individuals versus controls have found greater medial-lateral posterior tibial slope (PTS) in injured population irrespective of the sex and in females compared to males, with stronger evidence on the lateral plateau slope. To quantify these effects, we use a lower extremity musculoskeletal model including a detailed finite element (FE) model of the knee joint to compute the role of changes in medial and/or lateral PTS by 5 and 10 on knee joint biomechanics, in general, and ACL force, in particular, throughout the stance phase of gait. The model is driven by reported kinematics/kinetics of gait in asymptomatic subjects. Our predictions showed, at all stance periods, a substantial increase in the anterior tibial translation (ATT) and ACL force as PTS increased with reverse trends as PTS decreased. At mid-stance, for example, ACL force increased from 181 N to 317 N and 460 N as PTS increased by 5 and 10, respectively, while dropped to 102 N and 0 N as PTS changed by -5 and -10, respectively. These effects are caused primarily by change in PTS at the tibial plateau that carries a larger portion of joint contact force. Steeper PTS is a major risk factor, especially under activities with large compression, in markedly increasing ACL force and its vulnerability to injury. Rehabilitation and ACL injury prevention programs could benefit from these findings. PMID:25920895

  7. Bilateral Anterior Shoulder Dislocation

    PubMed Central

    Siu, Yuk Chuen; Lui, Tun Hing

    2014-01-01

    Introduction: Unilateral anterior shoulder dislocation is one of the most common problems encountered in orthopedic practice. However, simultaneous bilateral anterior dislocation of the shoulders is quite rare. Case Presentation: We report a case of a 75-year-old woman presented with simultaneous bilateral anterior shoulder dislocation following a trauma, complicated with a traction injury to the posterior cord of the brachial plexus. Conclusions: Bilateral anterior shoulder dislocation is very rare. The excessive traction force during closed reduction may lead to nerve palsy. Clear documentation of neurovascular status and adequate imaging before and after a reduction should be performed. PMID:25685749

  8. Pharyngocutaneous fistula after anterior cervical spine surgery

    PubMed Central

    Sansur, Charles A.; Early, Stephen; Reibel, James

    2009-01-01

    Pharyngocutaneous fistulae are rare complications of anterior spine surgery occurring in less than 0.1% of all anterior surgery cases. We report a case of a 19year old female who sustained a C6 burst fracture with complete quadriplegia. She was treated urgently with a C6 corpectomy with anterior cage and plating followed by posterior cervical stabilization at another institution. Post operatively she developed a pharyngocutaneous fistula that failed to heal despite several attempts of closure and esophageal exclusion with a Jpeg tube. The patient was eventually successfully treated with a three-stage procedure consisting of firstly a posterior approach to reinforce the posterior stabilization of the cervical spine that was felt to be inadequate, secondly an anterior approach with removal of all the anterior instrumentation followed by iliac crest bone graft and thirdly a superior based sternocleidomastoid flap that was interposed between the esophagus and the anterior cervical spine. The patient's fistula healed successfully. However, yet asymptomatic, the anterior iliac crest bone graft resorbed almost completely at 16months follow up. In light of this complication, we discuss the surgical options for the treatment of pharyngocutaneous fistulae and the closure of this fistula using a superiorly based sternocleidomastoid muscle flap. PMID:19330360

  9. [The rupture of the tibial anterior tendon in a world class veteran fencer].

    PubMed

    Kelm, J; Anagnostakos, K; Deubel, G; Schliessing, P; Schmitt, E

    2004-09-01

    The rupture of the tendon of the M. tibialis ant. is a rare sport injury and has not been yet described in fencing. The lunge, the most common offensive movement in fencing, displays a high stress on the spanned tendons and ligaments over the ankle joint and led to the rupture of the pre-damaged tendon of our patient. Pain over the inner side of the foot should be assessed as knells of this tendon injury. The exact patient's history and the precise clinical investigation are adequate for diagnosing the rupture. Hereby, an absence of the tendon shape over the ankle joint and a distinct active deficit of the extension are presented in comparison to the other side where a gap in the tendon course is palpable. An x-ray is obligate, a sonography and a MRI are helpful for the operative planning. The surgical treatment is necessary for athletes. If possible, a primary tendon suture should be aimed, in case of a distal torn an osseous reinsertion should occur. An early functional, postoperative treatment with an orthesis should be rather preferred for athletes than an immobilization. PMID:15375720

  10. Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs)

    PubMed Central

    Pelosi, L; Jardine, A; Webb, J

    1999-01-01

    We report a case of neurological complications of anterior release for correction of kyphosis. After the operation, the patient had pyramidal weakness and decreased pain sensation below T5, whereas light touch, proprioception and vibration sensation were intact. Clinical and neurophysiological findings in this patient suggested a partial lesion of the spinal cord probably due to ischaemia in the territory of the anterior spinal artery. Intraoperative and postoperative tibial nerve SEPs remained normal, which stresses the need for recording from the motor pathways.?? PMID:10209183

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

    NASA Astrophysics Data System (ADS)

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

    2008-09-01

    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.

  12. Avian tibial dyschondroplasia. III. Electron probe analysis

    SciTech Connect

    Hargest, T.E.; Gay, C.V.; Leach, R.M.

    1985-05-01

    Tibial dyschondroplastic (TD) lesions and their associated growth plates, obtained from chickens, were prepared by freeze-drying and embedding in an anhydrous epoxy resin. Quantitative electron probe analysis was performed on dry, unstained sections. Levels of Na, Mg, P, S, Cl, K, and Ca were determined in cytoplasm (endoplasmic reticulum), mitochondria, and extracellular matrix of the proliferative, prehypertrophic, and early hypertrophic zones of the growth plate and in the proximal, mid, and distal regions of the lesion. A zone of calcification in the growth plate was absent. The concentration of elements in all regions of the TD growth plate was the same as found in an earlier study for normal growth plate. The cytoplasm of proximal lesion chondrocytes was similar to that of early hypertrophic chondrocytes. However, in the remainder of the lesion there was a progressive increase in cellular Na, S, Cl, and Ca and a progressive loss of P. The first sign of the disease appears in the matrix of the growth plate, where it seems that S and K are in abnormally low amounts. Although there are sufficient levels of Ca and P present, the matrix does not calcify. The cartilage remains avascular, and the cells appear to be dying. The event that triggers the chondrocytes of the growth plate to form an abnormal uncalcified matrix is not known.

  13. Effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction

    PubMed Central

    Shim, Jae-Kwang; Choi, Ho-Suk; Shin, Jun-Ho

    2015-01-01

    [Purpose] This study examined the effects of neuromuscular training on knee joint stability after anterior cruciate ligament reconstruction. [Subjects and Methods] The subjects were 16 adults who underwent arthroscopic anterior cruciate reconstruction and neuromuscular training. The Lysholm scale was used to assess functional disorders on the affected knee joint. A KT-2000 arthrometer was used to measure anterior displacement of the tibia against the femur. Surface electromyography was used to detect the muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus before and after neuromuscular training. [Results] There was significant relaxation in tibial anterior displacement of the affected and sound sides in the supine position before neuromuscular training. Furthermore, the difference in the tibial anterior displacement of the affected knee joints in the standing position was reduced after neuromuscular training. Moreover, the variation of the muscle activation evoked higher muscle activation of the vastus medialis oblique, vastus lateralis, biceps femoris, and semitendinosus. [Conclusion] Neuromuscular training may improve functional joint stability in patients with orthopedic musculoskeletal injuries in the postoperative period. PMID:26834316

  14. Double tibial osteotomy for bow leg patients: A case series

    PubMed Central

    Nazem, Khalilollah; Fouladi, Arash; Chinigarzadeh, Mozhdeh

    2013-01-01

    Background: High tibia osteotomy (HTO) is a common surgical operation for correction of genu varum deformity. In some patients, there are concurrent tibia vara and genu varum (bow leg). This study aimed to consider the possibility of better correction of bow leg deformity after double level tibial osteotomy (DLTO). Materials and Methods: A case series of 10 patients of genu varum in addition to tibia vara (bow leg) deformity who were referred to orthopedic ward of an academic hospital of Isfahan- Iran during 20092011 were included in the study. The mean age was 17.3 3.1 years and all of them underwent DLTO. The results of treatment have been assessed based on clinical and radiological parameters before and after surgery. Results: The mean pre- and post operative values for Tibia-Femoral Angle, Medial Proximal of Tibia Angle (MPTA), and Lateral Distal of Tibia Angle (LDTA) were 18.13 3.05 vs. 3.93 0.66, 79.13 3.4 vs. 89.7 1.8 and 96.40 1.8 vs. 88.73 3.0 respectively (P < 0.05). Improvement of all radiological parameters was meaningful. Seventy three percent of patients had normal mechanical axis of limb after surgery. The remaining cases had varus deformity in distal femur that was corrected by valgus supracondylar osteotomy in an additional operation. Limited range of motion (ROM) near knee and ankle was not observed. Conclusion: DLTO correct bow leg deformity in the point of alignment of limb and paralleling of knee and ankle joint more effectively. This method can be used in metabolic and congenital bow leg which deformities are present in throughout of the lower limb. We described this technique for the first time. PMID:24523802

  15. Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Han, Hyuk Soo; Seong, Sang Cheol; Lee, Sahnghoon

    2008-01-01

    The bone-patellar tendon-bone has been widely used and considered a good graft source. The quadriceps tendon was introduced as a substitute graft source for bone-patellar tendon-bone. We compared the clinical outcomes of anterior cruciate ligament reconstructions using central quadriceps tendon-patellar bone and bone-patellar tendon-bone autografts. We selected 72 patients who underwent unilateral anterior cruciate ligament reconstruction using bone-patellar tendon-bone between 1994 and 2001 and matched for age and gender with 72 patients who underwent anterior cruciate ligament reconstruction using quadriceps tendon-patellar bone. All patients were followed up for more than 2years. We assessed anterior laxity, knee function using the Lysholm and International Knee Documentation Committee scores, and quadriceps strength, the means of which were similar in the two groups. More patients (28 or 39%) in the bone-patellar tendon-bone group reported anterior knee pain than in the quadriceps tendon-patellar bone group (six patients or 8.3%). Anterior cruciate ligament reconstruction using the central quadriceps tendon-patellar bone graft showed clinical outcomes comparable to those of anterior cruciate ligament reconstruction using the patellar tendon graft, with anterior knee pain being less frequent in the former. Our data suggest the quadriceps tendon can be a good alternative graft choice. Level of Evidence: Level III Therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196393

  16. Hybrid Fixation of Tibial Eminence Fractures in Skeletally Immature Patients

    PubMed Central

    Gans, Itai; Babatunde, Oladapo M.; Ganley, Theodore J.

    2013-01-01

    Tibial eminence fractures most commonly occur in children and adolescents. When treating displaced fractures of the tibial eminence, some surgeons prefer screw fixation whereas others prefer suture fixation. The ultimate goal is to limit morbidity through early return to range of motion and activity. In this technical note, we describe 2 hybrid fixation techniques for fixing tibial eminence fractures, one for type III and the other for type IV fractures. The first technique (variation A) is used to treat type III fractures and combines use of both a bioabsorbable compression screw and suture for fixation. The second technique (variation B) is used to treat type IV fractures and combines use of both a bioabsorbable compression screw and shoulder anchor fixation. We have found that these methods provide efficient, secure, and reliable fixation using standard techniques common to arthroscopic surgery. In addition, the growth plates are spared in children and adolescents, and the need for reoperation to remove hardware is eliminated. PMID:24265991

  17. [Sarmiento functional bracing of tibial fractures (author's transl)].

    PubMed

    Burdet, A; Fritschy, D

    1980-01-01

    The functional bracing advocated by Sarmiento was used in the conservative treatment of 74 recent tibial fractures (6) adults, 13 children) and in 12 fractures with delayed union. The leg was immobilized in an Orthoplast below-the-knee functional brace with patellar tendon bearing. A flexible plastic insert fitted on the heel allowed the use of sock and shoe. Knee and ankle motion were possible and early weight-bearing was allowed. The results of this method of treatment in recent fractures was excellent since healing occured without delay and function restoration was rapid. In delayed union of tibial fractures this method gave promising results. It is the authors' opinion that Sarmiento's functional bracing is a highly satisfactory method of conservative treatment of tibial fractures. PMID:6447337

  18. Smaller Anterior Cruciate Ligament Diameter Is a Predictor of Subjects Prone to Ligament Injuries: An Ultrasound Study

    PubMed Central

    Mahajan, Parag Suresh; Negi, Vidya Chander; Jayaram, Abhilash Pullincherry; Hussein, Sheik Akbar

    2015-01-01

    Purpose. To test if diameter of normal anterior cruciate ligament (ACL) can be measured by ultrasound (US), to see if there is a relationship between smaller ACL diameter and ACL injury, and to assess agreement between radiologists in measuring ACL diameter in cases and matched controls. Materials and Methods. In this ethics committee-approved study, maximum diameter of ACL near tibial insertion site was measured by static and dynamic US study in 25 normal contralateral knees of subjects who suffered noncontact ACL injury and in 25 matched control subjects. Results. ACL was visualized as a thick linear hypoechoic band inserted approximately 11?mm caudal to the tibial plateau and the intercondylar eminence. Maximum diameter of contralateral ACL near tibial insertion site among injured subjects was significantly smaller than in noninjured subjects (0.62??0.07?cm versus 0.81??0.06?cm; P < 0.0001). In the regression analysis, the diameter of ACL near tibial insertion site was found significantly proportional to body weight and not significantly associated to height, gender, and age. Conclusion. Diameter of normal ACL near tibial insertion site can be measured by US and the maximum diameter is significantly smaller among subjects with noncontact ACL injury. US is a promising modality that can be used as an excellent screening test to detect subjects especially aspiring athletes prone to ACL injury. Very strong agreement was observed between radiologists in measuring ACL diameter. PMID:25685812

  19. Anterior ophthalmic imaging.

    PubMed

    Wolffsohn, James S; Peterson, Rachael C

    2006-07-01

    Improvements in imaging chips and computer processing power have brought major advances in imaging of the anterior eye. Digitally captured images can be visualised immediately and can be stored and retrieved easily. Anterior ocular imaging techniques using slitlamp biomicroscopy, corneal topography, confocal microscopy, optical coherence tomography (OCT), ultrasonic biomicroscopy, computerised tomography (CT) and magnetic resonance imaging (MRI) are reviewed. Conventional photographic imaging can be used to quantify corneal topography, corneal thickness and transparency, anterior chamber depth and lateral angle and crystalline lens position, curvature, thickness and transparency. Additionally, the effects of tumours, foreign bodies and trauma can be localised, the corneal layers can be examined and the tear film thickness assessed. PMID:16776728

  20. Multiple Looping Technique for Tibial Fixation inPosterior Cruciate Ligament Reconstruction oftheKnee

    PubMed Central

    Noh, Jung Ho; Yoon, Kyoung Ho; Song, Sang Jun; Roh, Young Hak; Lee, Jae Woo

    2015-01-01

    The outcomes of posterior cruciate ligament reconstruction may be negatively affected by insufficient tibial tunnel fixation due to relatively lower bone density of the proximal tibia. We introduce a new technique of tibial fixation for posterior cruciate ligament reconstruction using free tendon Achilles allograft that is less affected by the bone density of the tibial metaphysis. PMID:25973367

  1. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  2. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  3. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  4. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  5. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  6. Posterior Cruciate Ligament Reconstruction Using Single-Bundle Achilles Allograft with Open Tibial Inlay Fixation

    PubMed Central

    Zehir, Sinan; Elmalı, Nurzat; Çalbıyık, Murat; Taşdemir, Zeki; Sağlam, Fevzi

    2014-01-01

    Objectives: PCL reconstruction research has shown that the tibial inlay and transtibial tunnel procedures offer similar biomechanical results. The purpose of this study was to evaluate the early results of PCL reconstruction using a single-bundle Achilles allograft and tibial inlay fixation. Methods: We retrospectively studied 14 patients who had undergone PCL reconstruction using the direct tibial inlay fixation technique from 2009 to 2013, with a mean follow-up of 13.4 months. (6-28 months). The patients were 11males and 3 females with an average age of 29.2 years (17-41 years). Ipsilateral femoral shaft fractures were determined in 2 cases, ipsilateral trochanteric fracture in 1 case and popliteal artery injury in 1 case. Surgery was performed within 2-4 weeks. Spanning-joint external fixation was applied to 2 patients because of gross instability with failure to maintain reduction in a brace. Combined reconstructions involving the posterolateral corner (9/14), anterior cruciate ligament (ACL (11/14)), or medial collateral ligament (MCL (1/14)) were performed. All PCL reconstructions were performed with Achilles allograft. In 1 case with arterial injury, the repair was made by a cardiovascular surgeon. In 2 case, deep infection developed, which was controlled with debridement and antibiotic treatment. Superficial peroneal nerve injury in 1 case was treated with tenolysis in the 6th month, then partial healing was seen at 18 months. In all patients, the preoperative posterior drawer (PD) examination was positive. All patients were evaluated with preoperative and postoperative examination and x-rays. The International Knee Documentation Committee (IKDC) evaluation was applied to all patients at the final follow-up. Results: Postoperative PD examination demonstrated the following: 0 (normal) in 4 patients, 1+ in 7 patients, and 2+ in 3 patients, compared to the preoperative PD of 3+ or greater in all patients. Preoperative IKDC objective evaluation rated all knees as severely abnormal based on instability. The final follow-up objective IKDC evaluation distribution was as follows: A, 4 knees; B, 6 knees; C, 3 knees and D, 1 knee, compared to D in all 14 knees preoperatively. The average final follow-up IKDC subjective score was 74.1 (20-100). Conclusion: Despite transtibial PCL reconstruction being advocated by several authors, it has technical difficulties of the arthroscopic approach to the posterior compartment of the knee. In the open inlay technique, posterior arthrotomy allows accurate placement of the tibial PCL insertion, avoiding the killer curve and more closely duplicating the normal PCL anatomy. Based on our initial experience with this technique at early follow-up, we continue to use the tibial inlay technique as our preferred technique for isolated or combined reconstruction of the PCL.

  7. Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The SingleBone Plug Technique

    PubMed Central

    Grawe, Brian; Smerina, Amber; Allen, Answorth

    2014-01-01

    Anterior cruciate ligament reconstruction, using autogenous bonepatellar tendonbone (BTB) as a graft material, is commonly performed in the setting of anterior cruciate ligament insufficiency. Although bonepatellar tendonbone autograft has an extensive track record, showing excellent clinical results, donor-site morbidity and graft-tunnel mismatch can still be problematic for a subset of patients. In the setting of a tendon graft that is too long, adequate interference screw fixation cannot be obtained, typically resulting in a tibial-sided bone plug that achieves less than 15 to 20mm of bone in the distal tibial tunnel. We present an easy and effective technique for avoiding the graft-tunnel mismatch problems that commonly occur in patients who have an excessively long patellar tendons. This technique involves a simple preoperative planning algorithm that ultimately results in a single tibial-sided plug harvest. Bony interference fixation is then obtained on the femoral side and soft-tissue fixation on the tibial side. This technique allows for satisfactory graft fixation while avoiding the donor-site morbidity associated with patellar bone plug harvest. PMID:25126515

  8. Inhibitory effects of tibial nerve stimulation on bladder neurophysiology in rats.

    PubMed

    Choudhary, Mahipal; van Mastrigt, Ron; van Asselt, Els

    2016-01-01

    Tibial nerve stimulation (TNS) is a form of peripheral neuromodulation which has been found effective in treating overactive bladder symptoms, with lesser side effects than first line pharmacotherapy. Despite its widespread clinical use, the underlying mechanism of action is not fully understood. Our aim was to study its effect on the bladder neurophysiology and the trigger mechanism of voiding in the overactive detrusor, simulated by acetic acid (AA) instillation. In urethane anaesthetized male Wistar rats, the tibial nerve was stimulated for 30min at 5Hz, pulse width 200s and amplitude approximately three times the threshold to induce a slight toe movement. The pressure at which a voiding contraction was triggered (pthres) did not change significantly between the pre- and post-TNS measurements in AA induced detrusor overactivity. It was found that TNS significantly reversed the effects of AA irritation by increasing the bladder compliance and the bladder volume at pthres, as well as suppressed the threshold afferent nerve activity. The slope of the linear relationship between pressure and the afferent activity increased after AA instillation and decreased significantly after stimulation. In addition to its well-known central inhibitory mechanisms, this study has demonstrated that TNS improves bladder storage capacity by delaying the onset of voiding, via an inhibitory effect on the bladder afferent signaling at the peripheral level. PMID:26835217

  9. Classifying Prosthetic Use via Accelerometry in Persons with Trans-Tibial Amputations

    PubMed Central

    Redfield, Morgan T.; Cagle, John C.; Hafner, Brian J.; Sanders, Joan E.

    2014-01-01

    Knowledge of how persons with amputation use their prostheses and how this use changes over time may facilitate effective rehabilitation practices and enhance understanding of prosthesis functionality. Perpetual monitoring and classification of prosthesis use may also increase the health and quality of life for prosthetic users. Existing monitoring and classification systems are often limited in that they require the subject to manipulate the sensor (e.g., attach, remove, or reset a sensor), record data over relatively short time periods, and/or classify a limited number of activities and body postures of interest. In this study, a commercially-available three-axis accelerometer (ActiLife ActiGraph GT3X+) was used to characterize the activities and body postures of individuals with trans-tibial amputation. Accelerometers were mounted on prosthetic pylons of ten persons with trans-tibial amputation as they performed a preset routine of actions. Accelerometer data was post-processed using a Binary Decision Tree to identify when the prosthesis was being worn and to classify periods of use as movement (i.e., leg motion like walking or stair climbing), standing (i.e., standing upright with limited leg motion), or sitting (i.e., seated with limited leg motion). Classifications were compared to visual observation by study researchers. The classifier achieved a mean accuracy of 96.6% (SD=3.0%). PMID:24458961

  10. Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture.

    PubMed

    Behera, Prateek; Aggarwal, Sameer; Kumar, Vishal; Kumar Meena, Umesh; Saibaba, Balaji

    2015-09-01

    Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques. PMID:26388278

  11. Leg hammock for closed reduction of tibial shaft fractures.

    PubMed

    Watkins, Colyn; Todd, Dane; Jamieson, Sarah; Mansour, Ashton

    2015-02-01

    Tibial shaft fractures are common injuries in emergency departments (EDs). Although many of these fractures require surgery, nearly all are stabilized in the ED with a long leg splint or bivalved cast. Long leg splinting is often challenging for a single health care provider. Further, even with assistance or previously described techniques for fracture reduction and stabilization, fracture angulation may occur, potentially leading to pain for the patient, fracture displacement, or further soft tissue injury. The authors propose a method for splinting tibial fractures that avoids fracture angulation, is cost-effective and quick, and can be easily performed by a single health care provider. PMID:25665109

  12. [Unreamed tibial nail in tibial shaft fractures with severe soft tissue damage. Initial clinical experiences].

    PubMed

    Krettek, C; Haas, N; Schandelmaier, P; Frigg, R; Tscherne, H

    1991-11-01

    In a prospective study, since March 1989, 55 tibial shaft fractures have been treated with a new, unreamed solid tibial nail (UTN). This nail was initially designed as a temporary implant. The first 33 cases with second or third degree soft tissue damage were reviewed 6 months or more after the operation. Fractures were classified according to Mller: 6 type A (18.2%), 15 type B (45.5%), and 12 type C (36.7%). In 9 cases (27.3%), there was GII (n = 4) or GIII (n = 5) closed soft tissue damage according to Tscherne's classification. The 24 open fractures (72.7%) comprised 11 OII, 3 OIIIA and 10 OIIIB fractures (Gustilo classification). 24 patients (72.7%) were polytraumatized, the mean PTS (Hannover Polytrauma Score) was 18 points (range: 8-65 points). All fractures were stabilized without reaming. The implant diameter was 8mm (n = 14) or 9 mm (n = 19). Static locking was performed in 31 cases. Dermatofasciotomy was necessary because of compartment syndrome in 14 cases. In 1 grade IIIB open fracture soft tissue coverage was performed with a latissimus dorsi myocutaneous free flap 4 days after nailing. In 32 of the 33 cases the use of an additional cast or brace was not necessary during the follow-up treatment; 1 patient had a cast for 8 weeks for the treatment of accompanying injuries. Full weight-bearing was achieved in 5 cases within 3 weeks, in 16 cases within 12 weeks, and in 30 cases within 26 weeks. In 16 cases (48.5%) the interlocking screws were removed after 5-26 weeks (mean: 10 weeks).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1771426

  13. In vitro modeling of human tibial strains during exercise in micro-gravity

    NASA Technical Reports Server (NTRS)

    Peterman, M. M.; Hamel, A. J.; Cavanagh, P. R.; Piazza, S. J.; Sharkey, N. A.

    2001-01-01

    Prolonged exposure to micro-gravity causes substantial bone loss (Leblanc et al., Journal of Bone Mineral Research 11 (1996) S323) and treadmill exercise under gravity replacement loads (GRLs) has been advocated as a countermeasure. To date, the magnitudes of GRLs employed for locomotion in space have been substantially less than the loads imposed in the earthbound 1G environment, which may account for the poor performance of locomotion as an intervention. The success of future treadmill interventions will likely require GRLs of greater magnitude. It is widely held that mechanical tissue strain is an important intermediary signal in the transduction pathway linking the external loading environment to bone maintenance and functional adaptation; yet, to our knowledge, no data exist linking alterations in external skeletal loading to alterations in bone strain. In this preliminary study, we used unique cadaver simulations of micro-gravity locomotion to determine relationships between localized tibial bone strains and external loading as a means to better predict the efficacy of future exercise interventions proposed for bone maintenance on orbit. Bone strain magnitudes in the distal tibia were found to be linearly related to ground reaction force magnitude (R(2)>0.7). Strain distributions indicated that the primary mode of tibial loading was in bending, with little variation in the neutral axis over the stance phase of gait. The greatest strains, as well as the greatest strain sensitivity to altered external loading, occurred within the anterior crest and posterior aspect of the tibia, the sites furthest removed from the neutral axis of bending. We established a technique for estimating local strain magnitudes from external loads, and equations for predicting strain during simulated micro-gravity walking are presented.

  14. Avian tibial dyschondroplasia. III. Electron probe analysis.

    PubMed Central

    Hargest, T. E.; Gay, C. V.; Leach, R. M.

    1985-01-01

    Tibial dyschondroplastic (TD) lesions and their associated growth plates, obtained from chickens, were prepared by freeze-drying and embedding in an anhydrous epoxy resin. Quantitative electron probe analysis was performed on dry, unstained sections. Levels of Na, Mg, P, S, Cl, K, and Ca were determined in cytoplasm (endoplasmic reticulum), mitochondria, and extracellular matrix of the proliferative, prehypertrophic, and early hypertrophic zones of the growth plate and in the proximal, mid, and distal regions of the lesion. A zone of calcification in the growth plate was absent. The concentration of elements in all regions of the TD growth plate was the same as found in an earlier study for normal growth plate. The cytoplasm of proximal lesion chondrocytes was similar to that of early hypertrophic chondrocytes. However, in the remainder of the lesion there was a progressive increase in cellular Na, S, Cl, and Ca and a progressive loss of P. In matrix, there was less S and K than expected in all regions of growth plate and lesion, except in the proliferating zone. Also, in matrix of the distal lesion there was less Na and Cl. The levels of Na, S, Cl, and K in matrix may have been lowered by their adsorption into the condensed masses of dead cells. Mitochondria acquire only half as much Ca and P as normal and release it earlier than usual (ie, early prehypertrophic cells, rather than chondrocytes of the lower hypertrophic zone). There were no granules in mitochondria of the cells at all levels of the lesion, even though anhydrous methods were used. The first sign of the disease appears in the matrix of the growth plate, where it seems that S and K are in abnormally low amounts. Although there are sufficient levels of Ca and P present, the matrix does not calcify. The cartilage remains avascular, and the cells appear to be dying. The event that triggers the chondrocytes of the growth plate to form an abnormal uncalcified matrix is not known. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 PMID:3993739

  15. A comparison of intramedullary and extramedullary alignment systems for tibial component placement in total knee arthroplasty.

    PubMed

    Brys, D A; Lombardi, A V; Mallory, T H; Vaughn, B K

    1991-02-01

    Fifty-two primary total knee arthroplasties (TKAs) using an intramedullary tibial jigging system to obtain ideal tibial alignment (90 degrees +/- 2 degrees) were compared with 62 TKAs using an extramedullary tibial jigging system. The Insall-Burstein total knee system was used in all cases, and all femoral components were positioned with extramedullary jigs. Postoperative evaluation consisted of a standing, hip-to-ankle anteroposterior roentgenogram and measurement of the following angles: (1) femorotibial, (2) tibial component, (3) femoral component, and (4) mechanical axis. Ideal tibial component alignment using the intramedullary system was statistically superior to alignment achieved with the extramedullary system. All other angle comparisons showed no statistical significance. PMID:1993372

  16. Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

    PubMed Central

    2010-01-01

    Background The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing. We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation. Methods In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw. In eight knees a wedge shaped bone block with an 11 mm by 10 mm base without a screw was used. In a further eight knees a similar wedge with a 13 mm by 10 mm base was used. Each specimen used a standard 10 mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure. Results Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p = 0.16), or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation) (P = 0.35). Conclusions Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation. PMID:20813059

  17. 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 ...

  18. [Staged management of open tibial fractures with soft tissue defect].

    PubMed

    Burda, R; Cibur, P; Morochovi?, R; Tom?ov?k, L

    2014-07-01

    Open tibial fractures with extensive soft tissue injury and accompanying bone defect are still a challenge for surgeons. Soft tissue injury is often underestimated in clinical practice. In our case report, we present the options for clinical usage of heterologous bone grafting combined with autologous bone stem cells as a therapeutic alternative to calotaxis and free bone flaps. PMID:25263475

  19. Tibial dyschondroplasia associated proteomic changes in chicken growth plate cartilage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tibial dyschondroplasia (TD) is a poultry leg problem that affects the proximal growth plate of tibia preventing its transition to bone. To understand the disease-induced proteomic changes we compared the protein extracts of cartilage from normal and TD- affected growth plates. TD was induced by fe...

  20. 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...

  1. Intraoperative anterior cruciate ligament graft contamination.

    PubMed

    Pasque, Charles B; Geib, Timothy M

    2007-03-01

    Intraoperative anterior cruciate ligament graft contamination is a rare but potentially devastating occurrence for any surgeon to encounter. Most instances in our experience have happened when a surgeon first enters practice or is operating in a new environment with new staff. Based on the currently available literature and the senior author's personal experience with 3 cases, intraoperative cleansing of the graft followed by implantation is a reasonable option. The protocol used successfully in these 3 cases includes getting the graft off of the floor immediately, removing any suture material in the graft, cleansing the graft for 15 to 30 minutes each in chlorohexidine and triple antibiotic solution, followed by a normal saline rinse. All graft sutures should then be replaced. The graft should then be resized and the tibial and femoral tunnels adjusted if needed. After implantation of the graft, additional intraoperative and postoperative intravenous antibiotic and/or oral antibiotic administration is also recommended for the first 1 to 2 weeks. Close clinical follow-up is also very important the first 6 weeks postoperatively and should include candid communication with the patient and family. PMID:17349486

  2. Anterior cruciate ligament surgery in the rabbit

    PubMed Central

    2013-01-01

    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. PMID:23957941

  3. Tibial Stems in Revision Total Knee Arthroplasty: Is There an Anatomic Conflict?

    PubMed

    Gobba, Mohamed S; Chan, Newton; Patel, Rikin; Noble, Philip C; Incavo, Stephen J

    2015-09-01

    Tibial stems are frequently used in revision total knee arthroplasty (TKA). We investigated the effect of tibial stems on final component alignment and tray position. Thirty 3D reconstructed cadaveric tibial models were classified according to canal bow angle. After virtual implantation of 120 mm and 200 mm stemmed tibial components, deviation from native mechanical axis was measured. Tibial alignment valgus malposition of up to three degrees occurred and most pronounced with 120 mm stems. Canal alignment using 200 mm stems deviated tray position medially and posteriorly. Mild to moderate valgus bowing of the tibial canal is not uncommon (57% in our series) possibly leading to valgus malalignment. Anatomic conflict between the tibial mechanical axis and intramedullary canal can exist, with alignment and tray placement implications. PMID:26118566

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

    PubMed Central

    van Raaij, T. M.

    2006-01-01

    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 70.599.5), and the mean Knee Society score score was 94.6 (70100) for function and 87.7 (47100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42100), for stiffness 82.8 (25100) and for pain 87.3 (55100). Radiographs showed a significant increase in posterior tibial slope of 9.4deg and a significant decrease of patellar height according to the BlackburnePeel 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. PMID:16521014

  5. Outcomes of total knee arthroplasty following high tibial osteotomy

    PubMed Central

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

    2013-01-01

    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]. PMID:24133306

  6. Factors Associated with the Outcome of Open Tibial Fractures

    PubMed Central

    YUSOF, Nazri Mohd; KHALID, Kamarul Ariffin; ZULKIFLY, Ahmad Hafiz; ZAKARIA, Zamzuri; AMIN, Mohammad Azril Mohammad; AWANG, Muhammad Shukimi; AHMAD, Aminudin Che; AKTER, Sheikh Farid Uddin

    2013-01-01

    Background: Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009. Methods: From 1 January until 31 December 2009, the Department of Orthopaedics of HTAA managed 58 patients with open tibial fracture who had a minimum of a one year follow-up period. The median age was 24.5 years (range: 4 to 72 years). The open tibial fractures were graded using the Gustilo open fracture classification as follows: 4 grade I, 21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were subjected to a standard treatment protocol at HTAA, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage, and bone reconstruction when required. The mean time from injury to the initial debridement was 29.7 hours (range: 13 to 216 hours). Results: Seventeen (29%) cases were complicated by infection, and 10 patients (17%) developed non-union. The grade of the open fracture was significantly associated with infection, and age and the time interval between the injury and the initial wound debridement were significantly associated with non-union. Conclusion: The high rates of infection and non-union, particularly in severe open fractures, indicate that there is a need to improve the management of open tibial fractures treated at HTAA. The time to initial debridement is an important factor that can be readily amended to improve the outcome. Further studies with larger sample sizes are likely needed to replicate and confirm our findings. PMID:24643115

  7. All-inside anterior cruciate ligament graft link: graft preparation technique.

    PubMed

    Lubowitz, James H

    2012-12-01

    The anatomic single-bundle, all-inside anterior cruciate ligament graft-link technique requires meticulous graft preparation. The graft choice is no-incision allograft or gracilis-sparing, posterior semitendinosus autograft. The graft is linked, like a chain, to femoral and tibial TightRope cortical suspensory fixation devices with adjustable-length graft loops (Arthrex, Naples, FL) in the following manner: the graft is quadrupled, and the free ends are first whip-stitched and then sutured with a buried-knot technique, 4 times through each strand in a loop. The graft is placed on a tensioning station under approximately 20 lb of tension during arthroscopic preparation of the knee and then removed from the tensioner and inserted into all-inside femoral and tibial sockets through the anteromedial arthroscopic portal. PMID:23766990

  8. Anterior femoroacetabular impingement.

    PubMed

    Laude, Frdric; Boyer, Thierry; Nogier, Alexis

    2007-03-01

    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 is often limited. Imaging studies show a non-spherical femoral head or overhang of the anterior acetabular rim. Computed arthrotomography or magnetic resonance arthrography visualize focal damage to the anterosuperior labrum and sometimes to the acetabular cartilage. Discontinuing the activity associated with the harmful hip movement is the main treatment. However, arthroplasty and removal of damaged labral tissue may be required. Surgical outcomes correlate negatively with the severity of the cartilage lesions. PMID:17337228

  9. Rationale and Design of a Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Evaluate the Efficacy of B-type Natriuretic Peptide For the Preservation of Left Ventricular Function Post Anterior Myocardial Infarction

    PubMed Central

    Sangaralingham, S. Jeson; Burnett, John C.; McKie, Paul M.; Schirger, John A.; Chen, Horng H.

    2013-01-01

    Background B-type natriuretic peptide (BNP) is a hormone with pleiotropic cardio-protective properties. Previously in our non-placebo controlled, un-blinded pilot study (BELIEVE) in human ST-elevation anterior acute myocardial infarction (AMI), a 72 hour intravenous infusion (IV) of recombinant human BNP (nesiritide) at a dose of 0.006 ug/kg/min suppressed plasma aldosterone and reduced cardiac dilatation while improved left ventricular ejection fraction (LV EF) at 1 month compared to baseline. Methods and Design The BELIEVE II study is a phase II, randomized, double-blind, placebo-controlled, single center clinical trial to assess the efficacy of 72 hour IV infusion of nesiritide therapy (0.006 ug/kg/min), in humans with first time ST-elevation anterior AMI and successful reperfusion, in preventing adverse LV remodeling and preserving LV function. A total of 60 patients will be randomized to placebo or nesiritide therapy. The primary efficacy endpoint is LV end-systolic and end-diastolic dimensions determined by MUGA scan between placebo and nesiritide group at 30 days; secondary endpoints include 30 day LV EF, diastolic function, infarct size, LV mass and combined total mortality and heart failure hospitalization. Conclusion This will be the first randomized, double-blind, placebo-controlled clinical trial that will assess the clinical efficacy of nesiritide in human ST-elevation anterior AMI. PMID:23910581

  10. Arthroscopic anatomical double bundle anterior cruciate ligament reconstruction: A prospective longitudinal study

    PubMed Central

    Devgan, Ashish; Singh, Amanpreet; Gogna, Paritosh; Singla, Rohit; Magu, Narender Kumar; Mukhopadhyay, Reetadyuti

    2015-01-01

    Background: Single bundle anterior cruciate ligament (ACL) reconstruction has been the current standard of treatment for ACL deficiency. However, a significant subset of patients continue to report residual symptoms of instability with a poor pivot control. Cadaveric biomechanical studies have shown double bundle (DB) ACL reconstructions to restore the knee kinematics better. This study evaluates the outcome of DB ACL reconstruction. Materials and Methods: 30 consecutive patients who underwent anatomic DB ACL reconstruction were included in this prospective longitudinal study. There were all males with a mean age of 25 7.45 years. All patients were prospectively evaluated using GeNouRoB (GNRB) arthrometer, functional knee scores (International Knee Documentation Committee [IKDC] and Lysholm) and postoperative magnetic resonance imaging (MRI) for comparing the graft orientation and footprint of the reconstructed ACL with that of the normal knee. Results: The average followup was 36.2 months. At the time of final followup the mean Lysholm score was 93.13 3.31. As per the objective IKDC score, 26 patients (86.6%) were in Group A while 4 patients (13.3%) were in Group B. The mean differential anterior tibial translation by GNRB, arthrometer was 1.07 0.8 mm (range 0.1-2.3 mm). All cases had a negative pivot shift test. MRI scans of operated and the contralateral normal knee showed the mean sagittal ACL tibial angle coronal ACL tibial angle and tibial ACL footprint to be in accordance with the values of the contralateral, normal knee. Conclusion: The study demonstrates that DB ACL reconstruction restores the ACL anatomically in terms of size and angle of orientation. However, long term studies are needed to further substantiate its role in decreasing the incidence of early osteoarthritic changes compared to the conventional single bundle reconstructions. PMID:26015600

  11. Morphologic Characteristics Help Explain the Gender Difference in Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing

    PubMed Central

    Lipps, David B.; Oh, Youkeun K.; Ashton-Miller, James A.; Wojtys, Edward M.

    2015-01-01

    Background Gender differences exist in anterior cruciate ligament (ACL) cross-sectional area and lateral tibial slope. Biomechanical principles suggest that the direction of these gender differences should induce larger peak ACL strains in females under dynamic loading. Hypothesis Peak ACL relative strain during a simulated pivot landing is significantly greater in female ACLs than male ACLs. Study Design Controlled laboratory study. Methods Twenty cadaveric knees from height- and weight-matched male and female cadavers were subjected to impulsive 3-dimensional test loads of 2 times body weight in compression, flexion, and internal tibial torque starting at 15° of flexion. Load cells measured the 3-dimensional forces and moments applied to the knee, and forces in the pretensioned quadriceps, hamstring, and gastrocnemius muscle equivalents. A novel, gender-specific, nonlinear spring simulated short-range and longer range quadriceps muscle tensile stiffness. Peak relative strain in the anteromedial bundle of the ACL (AM-ACL) was measured using a differential variable reluctance transducer, while ACL cross-sectional area and lateral tibial slope were measured using magnetic resonance imaging. A repeated-measures Mann-Whitney signed-rank test was used to test the hypothesis. Results Female knees exhibited 95% greater peak AM-ACL relative strain than male knees (6.37% [22.53%] vs 3.26% [11.89%]; P = .004). Anterior cruciate ligament cross-sectional area and lateral tibial slope were significant predictors of peak AM-ACL relative strain (R2 = .59; P = .001). Conclusion Peak AM-ACL relative strain was significantly greater in female than male knees from donors of the same height and weight. This gender difference is attributed to a smaller female ACL cross-sectional area and a greater lateral tibial slope. Clinical Relevance Since female ACLs are systematically exposed to greater strain than their male counterparts, training and injury prevention programs should take this fact into consideration. PMID:21917612

  12. Bone tunnel enlargement on anterior cruciate ligament reconstruction

    PubMed Central

    Leonardi, Adriano Barros de Aguiar; Duarte, Aires; Severino, Nilson Roberto

    2014-01-01

    Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

  13. In-vitro correlation between tension and length change in an anterior cruciate ligament substitute.

    PubMed

    Good, L

    1995-06-01

    The length change and tension patterns from multiple insertion locations of an anterior cruciate ligament substitute were studied in 10 cadaver knees. Length change was measured with a spring-loaded isometer of low stiffness, and tension was measured with a piezoelectric load cell. In both instances a thin Kevlar test ligament was positioned in five different femoral and two different tibial ligament insertion locations, that were all located within the normal attachments of the anterior cruciate ligament. Differences were found regarding length changes and tension patterns from a simulated active extension between the central, posterior, and anterior femoral locations. All locations showed larger length change and tension values in extension than in flexion. The anterior femoral ligament insertion location showed length change and tension patterns with increasing values in flexion compared to the other femoral locations. The anterior tibial ligament insertion location showed smaller excursions of both length and tension, than did the central one, but the patterns of the curves were similar. A statistically significant correlation was found between length change and tension patterns throughout a 130-0 degrees range of motion. A statistically significant correlation was also found between the maximum length and tension values. No fixed relationship was found between the magnitude of the length and tension values, when different intervals of the range of motion were studied. RELEVANCE: The intraoperative employment of length change measurements of a test ligament in anterior cruciate ligament reconstruction gives information on where high tension can be expected in the range of motion of the knee, and how this can differ depending on the angle of graft fixation. The information gained can also be used to improve drill channel location. However, no predictions on the magnitude of tension can be made, mainly due to large biological variability. PMID:11415553

  14. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

    PubMed Central

    Vaishya, Raju; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anteriorcruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Althoughmost patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  15. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  16. [Imaging and preoperative planning of osteotomy of tibial head osteotomy].

    PubMed

    Pape, D; Seil, R; Adam, F; Rupp, S; Kohn, D; Lobenhoffer, P

    2004-02-01

    Valgus-producing osteotomy of the proximal tibia is a well-established treatment for medial femorotibial osteoarthritis in the varus knee. The ideal patient is active, under 55 years of age, has a stable varus deformity of less than 10 degrees, a good bone stock, and an osteoarthritis stage that is restricted to the medial compartment of the knee. Coventry reported a failure rate in proximal tibial osteotomy to be significantly higher when the postoperative alignment was less than 8 degrees of anatomical valgus. Hernigou noted better clinical long-term results in cases with a precise correction of malalignment. There are different preoperative planning methods varying between simple estimates of correction angles and specific radiographic planning tools. The reproducibility of operative outcome with regard to a predictable anatomic alignment and functional recovery must have high priority. This chapter deals with different preoperative planning methods to improve the reliability of surgical results after tibial osteotomy. PMID:14872303

  17. Fracture of the Tibial Baseplate in Bicompartmental Knee Arthroplasty.

    PubMed

    Stuyts, Bart; Vandenberghe, Melanie; Van der Bracht, Hans; Fortems, Yves; Van den Eeden, Elke; Cuypers, Luc

    2015-01-01

    Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis. PMID:26843998

  18. Posterior Tibial Tendon Dysfunction: An Overlooked Cause of Foot Deformity

    PubMed Central

    Bubra, Preet Singh; Keighley, Geffrey; Rateesh, Shruti; Carmody, David

    2015-01-01

    Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A too many toes sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction. PMID:25810985

  19. Fracture of the Tibial Baseplate in Bicompartmental Knee Arthroplasty

    PubMed Central

    Stuyts, Bart; Vandenberghe, Melanie; Van der Bracht, Hans; Fortems, Yves; Van den Eeden, Elke; Cuypers, Luc

    2015-01-01

    Introduction. Bicompartmental knee arthroplasty (BKA) addresses combined medial and patellofemoral compartment osteoarthritis, which is relatively common, and has been proposed as a bridge between unicompartmental and total knee arthroplasty (TKA). Case Presentation. We present the case report of a young active man treated with BKA after unsuccessful conservative therapy. Four years later, loosening with fracture of the tibial baseplate was identified and the patient was revised to TKA. Discussion. Although our case is only the second fractured tibial baseplate to be reported, we believe that the modular titanium design, with two fixation pegs, is too thin to withstand daily cyclic loading powers. Light daily routine use, rather than high-impact sports, is therefore advised. Failures may also be related to the implant being an early generation and known to be technically complex, with too few implant sizes. We currently use TKA for the treatment of medial and patellofemoral compartment osteoarthritis. PMID:26843998

  20. [Minimally invasive treatment of tibial plateau fracture under arthroscopy monitoring].

    PubMed

    Chen, Lixin; Ma, Shaoyun; Li, Xianpeng

    2014-05-01

    Twenty six patients with fracture of tibial plateau was under arthroscopy assisted reduction, the joint surface of bone graft, and USES the steel plate fixation treatment. Average surgery time was 65 min (70-120 min), average fracture healing time was 15 weeks (12-17 weeks), joint surface anatomical reattachment rate was 92.9%. Using break knee function criteria evaluation of curative effect: 18 cases great 6 cases wed, 2 cases ok, fine rate was 92.3%. No infection, deep venous thrombosis and small leg fascia chamber syndrome and other complications. Conclusion is that treatment of tibial plateau fractures under arthroscope has advantages of small trauma, check intuitively and reset accurately, functional recovery of patients are satisfied, the treatment has certain clinical application value. PMID:25241526

  1. Arthroscopic management of tibial plateau fractures: special techniques.

    PubMed

    Perez Carro, L

    1997-04-01

    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

  2. Evaluation of bone tunnel placement for suture augmentation of an injured anterior cruciate ligament: effects on joint stability in a goat model.

    PubMed

    Fisher, Matthew B; Jung, Ho-Joong; McMahon, Patrick J; Woo, Savio L-Y

    2010-10-01

    Use of novel tissue engineering approaches to heal an injured anterior cruciate ligament (ACL) requires suture repair and/or augmentation to provide joint stability. We evaluated the effects of the location of suture augmentation at the femur and tibia in terms of joint stability using a goat model. Eight goat stifle joints were tested with augmentation sutures placed in two femoral tunnel locations: (1) anterior to, or (2) through the ACL footprint, and two tibial tunnel locations: (1) medial to, or (2) medial and lateral to the footprint. Using a robotic/universal force-moment sensor testing system, the anterior tibial translation (ATT) and the corresponding in situ force carried by the sutures were obtained at 30, 60, and 90 of flexion in response to external loads. No significant differences were found between augmentation groups due to tunnel location in terms of ATT or the in situ forces carried by the sutures at all flexion angles tested. Similar results were found under 5 N m of varus-valgus torque. Under a 67 N anterior tibial load, the ATT was restored to within 3 mm of the intact joint following suture augmentation (p?>?0.05). Suture augmentation, when placed close to the ACL insertion, could be helpful in providing initial joint stability to aid ACL healing in the goat model. PMID:20309958

  3. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

    PubMed Central

    Simon, David; Saltzman, Bryan M.; Rollins, Meaghan; Bach, Bernard R.; MacDonald, Peter

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

  4. The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee.

    PubMed

    Simon, David; Mascarenhas, Randy; Saltzman, Bryan M; Rollins, Meaghan; Bach, Bernard R; MacDonald, Peter

    2015-01-01

    Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables. PMID:25954533

  5. Compaction versus extraction drilling for fixation of the hamstring tendon graft in anterior cruciate ligament reconstruction.

    PubMed

    Nurmi, Janne T; Jrvinen, Teppo L N; Kannus, Pekka; Sievnen, Harri; Toukosalo, Jani; Jrvinen, Markku

    2002-01-01

    Initial strength of quadrupled hamstring tendon grafts fixed with titanium interference screws was assessed in 30 pairs of porcine tibiae. Bone tunnels were drilled with either compaction drilling (stepped routers) or conventional extraction drilling (cannulated drill bits). Fifteen pairs of specimens were subjected to a single-cycle load-to-failure test, while the rest underwent a cyclic-loading test to further assess the quality of the fixation. No significant difference between the two drilling techniques was found with regard to yield load, displacement at yield load, stiffness, or mode of failure. Porcine trabecular bone mineral density was determined using peripheral quantitative computed tomography and compared with that of young women and men at a site corresponding to that of the tibial bone drill hole of an anterior cruciate ligament reconstruction. There was a significant difference between the two species (210 +/- 45 mg/cm(3) in porcine tibial bone versus 129 +/- 30 mg/cm(3) in women and 134 +/- 34 mg/cm(3) in men), suggesting that porcine knee specimens may have limitations in studies of graft fixation in anterior cruciate ligament reconstruction. We found no difference between extraction and compaction drilling in initial fixation strength of a hamstring tendon graft for anterior cruciate ligament reconstruction using a porcine model. PMID:11912083

  6. Retrograde tibial nail: anatomical implantation and surgical feasibility study.

    PubMed

    Kuhn, S; Appelmann, P; Pairon, P; Gruszka, D; Rommens, P M

    2015-01-01

    PURPOSE OF THE STUDY The treatment of distal tibial fractures requires a stable fixation while minimizing the secondary trauma to the soft tissues by the surgical approach and implant. The experimental Retrograde Tibial Nail is currently investigated as a minimally invasive alternative to plating and antegrade nailing. The purpose of this study was to evaluate the surgical feasibility in a cadaver model for all distal tibial fracture types generally considered treatable by nailing. MATERIAL AND METHODS Five different fracture types (AO/OTA 43-A1/A2/A3 and 43-C1/C2) were created on separate cadaveric limbs. In simple fractures (AO/OTA 43-A1/A2/A3) primary nailing was performed. In intraarticular fractures (AO/OTA 43-C1/2) reduction of the articular block and lag screw fixation was performed before nailing. Intraoperative complications, quality of reduction, fluoroscopy duration and operative time were evaluated. RESULTS Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps. Retrograde nailing is possible in fractures with simple intraarticular involvement after primary lag screw fixation. The duration of surgery averaged 51.8 minutes (range 40-62 min). No major complications occurred during nailing. CONCLUSIONS The minimally invasive retrograde nail combines a minimally invasive local osteosynthesis with the ability to adequately fix extraarticular and simple intraarticular distal tibial fractures. The results suggests that retrograde tibia nailing is a promising new concept for the treatment of distal tibia fractures. Key words: minimally invasive surgery, tibia, metaphyseal fractures, intramedullary nailing, retrograde nailing. PMID:26317291

  7. Multiple Tibial Insufficiency Fractures in the Same Tibia

    PubMed Central

    Defoort, Saartje; Mertens, Peter

    2011-01-01

    Stress fractures were first described by Briethaupt in 1855. Since then, there have been many discussions in the literature concerning stress fractures, which have been described in both weight-bearing and non-weight-bearing bones. Currently, the tibia is the most frequent location, but multiple stress fractures in the same tibia are rare. This paper presents an unusual case of a 60-year-old woman with multiple tibial stress fractures of spontaneous onset. PMID:23569673

  8. Magnetic resonance imaging of tibial classic adamantinoma at 2 tesla.

    PubMed

    Torriani, Martin; Dertkigil, Sergio Sanjuan; Etchebehere, Maurcio; Amstalden, Eliane Maria Ingrid

    2002-01-01

    Adamantinoma is a rare malignant neoplasm arising most often in the tibia and is locally aggressive. Conservative surgical treatment frequently is followed by recurrence and magnetic resonance (MR) imaging plays an important role in preoperative planning. Magnetic resonance features of this tumor have not been described in detail. We report three cases of classic tibial adamantinoma examined at 2 Tesla. High-resolution images with findings that may influence management are discussed. PMID:12439328

  9. The impact of tibial torsion measurements on gait analysis kinematics

    PubMed Central

    Lucareli, Paulo Roberto Garcia; Santos, Nadia Maria; Godoy, Wagner De; Bernal, Milena Moreira Barreto; Paes, ngela Tavares; Ramalho, Amancio

    2014-01-01

    Objective: To measure and compare tibial torsion values as assessed by goniometry and three-dimensional kinematics. In addition, the impact of each one of these measurements on kinematic and kinetic results for normal gait was determined. Methods: Twenty-three healthy and fully ambulatory patients were assessed, 11 women and 12 men, from 20 to 40 years old. Data were collected at a laboratory for the three-dimensional analysis of movement with 10 cameras and two force plates. Tibial torsion measurements were obtained using goniometry and three-dimensional kinematics based on the Plug-in Gait model. Afterwards, both procedures were compared, and the impact of each result was assessed on the kinematic and kinetic modeling of the knee and ankle. Results: Pearson's linear correlation coefficient (r=0,504) showed a moderate correlation between the three-dimensional kinematics and goniometry, and between the changes in the measurements. Regarding the processed kinematic and kinetic results for every torsion position, no significant differences were noticed among any of the studied variables (p>0.05). Conclusion: Although statistical correlation among tibial torsion angles by goniometry and three-dimensional kinematic were moderate, kinematic and kinetic analysis of the joints did not reveal any significant changes. Level of Evidence I, Diagnostic Studies - Investigating a Diagnostic Test. PMID:25328438

  10. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePLUS

    ... Your Best Self Smart Snacking Losing Weight Safely Anterior Cruciate Ligament (ACL) Injuries KidsHealth > Teens > Sports Center > Sports Injuries > Anterior Cruciate Ligament (ACL) Injuries Print A A A Text Size ...

  11. Anterior mandibular ameloblastoma

    PubMed Central

    Bhandarwar, Ajay H.; Bakhshi, Girish D.; Borisa, Ashok D.; Wagh, Amol; Kapoor, Rajat; Kori, Channabasappa G.

    2012-01-01

    Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis-menti) is rare. Very few cases of midline anterior ameloblastomas are reported in the literature. They often require wide local excision. Reconstruction of mandible in these cases is challenging. We present a case of mandibular ameloblastoma arising from symphysis-menti. Patient underwent wide surgical excision of the tumor followed by immediate reconstruction using free fibular vascular flap, stabilized with titanium reconstructive plates. A brief case report ands review of literature is presented. PMID:24765429

  12. Anterior urethral stricture review

    PubMed Central

    Stein, Marshall J.

    2013-01-01

    Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures. PMID:26816721

  13. Congenital giant male anterior urethral diverticulum with calculi

    PubMed Central

    Kamal, Mir Reza; Jindal, Tarun; Sinha, Rajan Kumar; Karmakar, Dilip

    2014-01-01

    Urethral diverticulum is a sac-like outpouching of urethral mucosa. It may be anterior or posterior according to anatomical locations. It is less common in men than in women. It can be congenital or acquired. Anterior urethral diverticula are usually congenital as compared to majority of posterior diverticula which are acquired. The most common aetiologies of male acquired diverticula are stricture, abscess, trauma or post-hypospadias repair. We report a case of congenital giant anterior urethral diverticulum with a calculus which has been managed successfully with surgical excision and repair in two layers. PMID:24567184

  14. Anterior segment fluorescein cineangiography.

    PubMed

    Kottow, M H; Jednock, N; Sewell, J H

    1978-03-01

    We have developed a technique for performing anterior segment fluorescein cineangiography. Illumination is obtained with a halogen lamp of a standard slide projector that is fitted with a blue excitation filer. Cinematography occurs with a movie camera fitted with an absorption-type barrier filter and mounted to a photo slit lamp through a cineadapter. The technique has been successfully employed with animals, and it is anticipated that the light levels used are tolerable and safe for application with humans. PMID:306767

  15. Assessment of cortical and trabecular bone changes in two models of post-traumatic osteoarthritis.

    PubMed

    Pauly, Hannah M; Larson, Blair E; Coatney, Garrett A; Button, Keith D; DeCamp, Charlie E; Fajardo, Ryan S; Haut, Roger C; Haut Donahue, Tammy L

    2015-12-01

    Subchondral bone is thought to play a significant role in the initiation and progression of the post-traumatic osteoarthritis. The goal of this study was to document changes in tibial and femoral subchondral bone that occur as a result of two lapine models of anterior cruciate ligament injury, a modified ACL transection model and a closed-joint traumatic compressive impact model. Twelve weeks post-injury bones were scanned via micro-computed tomography. The subchondral bone of injured limbs from both models showed decreases in bone volume and bone mineral density. Surgical transection animals showed significant bone changes primarily in the medial hemijoint of femurs and tibias, while significant changes were noted in both the medial and lateral hemijoints of both bones for traumatic impact animals. It is believed that subchondral bone changes in the medial hemijoint were likely caused by compromised soft tissue structures seen in both models. Subchondral bone changes in the lateral hemijoint of traumatic impact animals are thought to be due to transmission of the compressive impact force through the joint. The joint-wide bone changes shown in the traumatic impact model were similar to clinical findings from studies investigating the progression of osteoarthritis in humans. PMID:26147652

  16. The effect of tibial diaphyseal lengthening on the longitudinal growth of the tibia.

    PubMed

    Cai, Gang; Yang, Lang; Saleh, Michael; Coulton, Les

    2007-11-01

    Limb lengthening by tibial callotasis is usually performed in the metaphysis but may cause growth inhibition. Is diaphyseal lengthening more advantageous? Sixteen immature rabbits underwent 30% diaphyseal lengthening by tibial callotasis. The tibial length was measured on radiographs at the end of the distraction period and after an additional 5 weeks. The proximal and distal growth plates were assessed histomorphometrically. Osteotomy stimulated tibial elongation; however, combined with diaphyseal lengthening the stimulation was suppressed resulting in longitudinal growth that matched the control side. In longer lengthenings of limbs diaphyseal callotasis may be more advantageous than metaphyseal by not inhibiting longitudinal growth. PMID:17909337

  17. A rare case of anterior chamber dirofilariasis

    PubMed Central

    Das, Dipankar; Das, Kalyan; Islam, Saidul; Bhattacharjee, Kasturi; Bhattacharjee, Harsha; Das, Shrutanjoy Mohan; Deka, Apurba

    2015-01-01

    We report a rare case of anterior chamber live dirofilariasis presenting as anterior uveitis. A 60-year-old man presented with dimness of vision in the right eye for 1 month. Vision recorded was 6/18 P, N 18 in the right eye. Slit lamp examination of the right eye revealed anterior uveitis with a moving nemathelminthes. The worm was removed live from the anterior chamber under local anesthesia with assisted methyl cellulose delivery and post-operatively, the worm was examined directly under light microscope. Morphometric measurement showed length of the worm was 6.061 mm. A thin, pale, slender worm was diagnosed as immature female Dirofilaria repens and was documented completely. Patient had made an excellent recovery of vision and intraocular inflammation after the surgical removal of the worm. Intraocular infection of dirofilaria is a rare presentation and successful surgical removal of the worm resulted in complete recovery of uveitis and visual status in the affected eye. PMID:25709276

  18. The Ilizarov external fixator - a useful alternative for the treatment of proximal tibial fractures A prospective observational study of 30 consecutive patients

    PubMed Central

    2013-01-01

    Background In dislocated proximal tibial fractures, the most frequently used treatment is ORIF with screws and plates. Minimally-invasive techniques using external fixation are an alternative. The aim of this study was to analyse the clinical and radiological results using the Ilizarov technique in both uni- and bicondylar tibial fractures. Methods Thirty consecutive patients with isolated fractures of the proximal tibia were treated with the Ilizarov technique, 11 Schatzker I-IV with 23 rings and 19 Schatzker V-VI with 34 tibial rings and a femoral, hinged, two-ring extension. Unrestricted weight-bearing was allowed. Pre and post-operatively, conventional radiographs, computerized tomography scans, post-operative pain assessments and complications were evaluated. The knee function was evaluated with the EQ-5D, NHP and KOOS scores, as well as self-appraisal. Results All the fractures healed. Twenty-five patients achieved a range of motion better than 10-100. The type I-IV fractures had a shorter operating time and hospital stay, as well as better knee flexion, and the self-appraisal indicated that they tolerated the treatment better. Pin infections occurred in 4% of the pin sites, but only two patients required debridement. Two patients developed compartment syndrome and underwent fasciotomy. No patient complained of functional knee instability. Two patients underwent a total knee arthroplasty because of residual pain. The overall result was judged as satisfactory in twenty-seven patients. Conclusions The Ilizarov method produces a good clinical outcome and is a valuable treatment alternative in proximal tibial fractures of all types. PMID:23294843

  19. Anterior Cruciate Ligament RemnantPreserving Reconstruction Using a Lasso-Loop Knot Configuration

    PubMed Central

    Boutsiadis, Achilleas; Karampalis, Christos; Tzavelas, Anastasios; Vraggalas, Vasileios; Christodoulou, Pavlos; Bisbinas, Ilias

    2015-01-01

    Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnantsparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a lasso-loop technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device. PMID:26870656

  20. Anterior Cruciate Ligament Remnant-Preserving Reconstruction Using a "Lasso-Loop" Knot Configuration.

    PubMed

    Boutsiadis, Achilleas; Karampalis, Christos; Tzavelas, Anastasios; Vraggalas, Vasileios; Christodoulou, Pavlos; Bisbinas, Ilias

    2015-12-01

    Anterior cruciate ligament (ACL) rupture predisposes to altered kinematics and possible knee joint degeneration. Graft fiber maturation and ligamentization may eliminate this risk during ACL reconstruction procedures. ACL remnant-sparing techniques support the theory that the preserved tissue enhances revascularization, preserves the mechanoreceptors, and leads to anatomic remodeling. The purpose of this article is to present a simple and reproducible technique of tensioning the preserved ACL remnant over the femur. A nonabsorbable suture is passed through the ACL remnant with a "lasso-loop" technique using a curved rotator cuff hook. Femoral and tibial tunnel preparation is performed according to a standard surgical technique for the EndoButton device (Smith & Nephew Endoscopy, Andover, MA). The free ends of the ACL remnant suture are retrieved through the tibial tunnel and passed through each outside hole of the EndoButton device. The hamstring graft is passed through the tibial and femoral tunnels and fixed to the femoral cortex by flipping the EndoButton and to the tibia by an interference screw. Finally, non-sliding half-stitch locking knots are made to secure the ACL remnant suture on the EndoButton device, by use of a knot pusher. This technique offers simple and secure tensioning of the ACL remnant on the fixation device. PMID:26870656

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

    PubMed Central

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

    2013-01-01

    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. PMID:23997261

  2. Comparison of Tibial Insert Polyethylene Damage in Rotating Hinge and Highly Constrained Total Knee Arthroplasty: A Retrieval Analysis.

    PubMed

    Bali, Kamal; Naudie, Douglas D; Howard, James L; McCalden, Richard W; MacDonald, Steven J; Teeter, Matthew G

    2016-01-01

    This study compared the damage scores and damage patterns in 19 tibial inserts from rotating hinge (RH) implants with 19 inserts from highly constrained (HC) implants. Each insert was divided into 16 damage zones and each zone was subjectively graded from a scale of 0-3 for seven different damage modes. The overall damage scores were comparable for the two groups (RH: 64.115.4; HC: 66.129.0; P=0.59). The HC group, however, had greater post damage (compared to the post-hole of RH) while the RH group had greater backside damage. The pattern of damage was also different, with burnishing and cold flow being more common in HC group while pitting, scratching and embedded debris were more common in the RH group. PMID:26253478

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

    PubMed Central

    Franklyn, Melanie; Field, Bruce

    2013-01-01

    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 rabbits 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. PMID:24147262

  4. Influence of Bundle Diameter and Attachment Point on Kinematic Behavior in Double Bundle Anterior Cruciate Ligament Reconstruction Using Computational Model

    PubMed Central

    Kwon, Oh Soo; Purevsuren, Tserenchimed; Park, Won Man; Kwon, Tae-Kyu; Kim, Yoon Hyuk

    2014-01-01

    A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon's preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL) reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified. PMID:24516506

  5. Single-Bundle Anterior Cruciate Ligament Reconstruction with Semitendinosus Tendon Using the PINN-ACL CrossPin System: Minimum 4-Year Follow-up

    PubMed Central

    Baek, Seung-Gil; Lee, Byoung-Joo; Lee, Chang-Hwa

    2015-01-01

    Purpose This study evaluated mid-term results of anterior cruciate ligament (ACL) reconstruction using the PINN-ACL CrossPin system that allowed for short graft fixation. Materials and Methods Forty-three patients underwent single-bundle ACL reconstruction with a 4-strand semitendinosus tendon graft using the PINN-ACL CrossPin system. Femoral fixation was done using the PINN-ACL CrossPin system, and the tibial side was fixed with post-tie and a bioabsorbable interference screw. The mean follow-up period was 50 months. Evaluation was done using the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) score and grade. Anterior displacement was assessed. Results There was improvement in the Lachman test and pivot-shift test at final follow-up, form grade II (n=40) or III (n=3) to grade I (n=3) or 0 (n=40) and from grade I (n=20) or II (n=10) to grade I (n=8) or 0 (n=22), respectively. The mean IKDC score was 88.7, and grade A and B were 93.0% at final follow-up. Side-to-side difference was improved from 6.7 mm to 2.1 mm at final follow-up. Complications occurred in 3 patients, a re-ruptured due to trauma at 2 years after surgery and a deep infection and a superficial infection. Conclusions The mid-term follow-up results of ACL reconstruction with the PINN-ACL CrossPin system were satisfactory. The PINN-ACL CrossPin can be considered as a useful instrument for short graft fixation. PMID:25750893

  6. Anterior interosseous nerve syndrome

    PubMed Central

    Bumer, Philipp; Meinck, Hans-Michael; Schiefer, Johannes; Weiler, Markus; Bendszus, Martin; Kele, Henrich

    2014-01-01

    Objective: We sought to determine lesion sites and spatial lesion patterns in spontaneous anterior interosseous nerve syndrome (AINS) with high-resolution magnetic resonance neurography (MRN). Methods: In 20 patients with AINS and 20 age- and sex-matched controls, MRN of median nerve fascicles was performed at 3T with large longitudinal anatomical coverage (upper arm/elbow/forearm): 135 contiguous axial slices (T2-weighted: echo time/repetition time 52/7,020 ms, time of acquisition: 15 minutes 48 seconds, in-plane resolution: 0.25 0.25 mm). Lesion classification was performed by visual inspection and by quantitative analysis of normalized T2 signal after segmentation of median nerve voxels. Results: In all patients and no controls, T2 lesions of individual fascicles were observed within upper arm median nerve trunk and strictly followed a somatotopic/internal topography: affected were those motor fascicles that will form the anterior interosseous nerve further distally while other fascicles were spared. Predominant lesion focus was at a mean distance of 14.6 5.4 cm proximal to the humeroradial joint. Discriminative power of quantitative T2 signal analysis and of qualitative lesion rating was high, with 100% sensitivity and 100% specificity (p < 0.0001). Fascicular T2 lesion patterns were rated as multifocal (n = 17), monofocal (n = 2), or indeterminate (n = 1) by 2 independent observers with strong agreement (kappa = 0.83). Conclusion: It has been difficult to prove the existence of fascicular/partial nerve lesions in spontaneous neuropathies using clinical and electrophysiologic findings. With MRN, fascicular lesions with strict somatotopic organization were observed in upper arm median nerve trunks of patients with AINS. Our data strongly support that AINS in the majority of cases is not a surgically treatable entrapment neuropathy but a multifocal mononeuropathy selectively involving, within the main trunk of the median nerve, the motor fascicles that continue distally to form the anterior interosseous nerve. PMID:24415574

  7. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrn, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries. PMID:17350782

  8. Tibialis Anterior Tendon Transfer.

    PubMed

    Mulhern, Jennifer L; Protzman, Nicole M; Brigido, Stephen A

    2016-01-01

    Tendon transfer procedures are used commonly for the correction of soft tissue imbalances and instabilities. The complete transfer and the split transfer of the tibialis anterior tendon are well-accepted methods for the treatment of idiopathic equinovarus deformity in children and adults. Throughout the literature, complete and split transfer have been shown to yield significant improvements in ankle and foot range of motion and muscle function. At present, there is insufficient evidence to recommend one procedure over the other, although the split procedure has been advocated for consistently achieving inversion to eversion muscle balance without overcorrection. PMID:26590723

  9. Repetitive jumping and sprinting until exhaustion alters hamstring reflex responses and tibial translation in males and females.

    PubMed

    Behrens, Martin; Mau-Moeller, Anett; Wassermann, Franziska; Plewka, Antje; Bader, Rainer; Bruhn, Sven

    2015-11-01

    The incidence of anterior cruciate ligament injuries is considerably higher in females than in males and the underlying mechanisms are still under debate. Research indicates that the neuromuscular system of females and males might respond differently to the same fatigue protocol due to differences in muscle activation during movement tasks. This study analyzed sex differences in hamstring reflex responses and posterior-anterior tibial translation (TT) before and after fatiguing exercise. We measured the isolated movement of the tibia relative to the femur as a consequence of mechanically induced TT in standing subjects as well as muscle activity of the hamstrings before and after repetitive jumping and sprinting until exhaustion. Muscle fatigue delayed reflex onset latencies in females and males. A reduction in reflex responses associated with an increased TT was observed after fatiguing exercise for both sexes. Data indicate that the used fatigue protocol altered the latency and magnitude of reflex responses as well as TT in females and males. Based on the results of previous research and the outcome of this study, it might be that sex-specific effects of fatigue on reflex activity and mechanical stability of the knee depend on the kind of fatiguing exercise. PMID:25941064

  10. [Anterior skull base reconstruction].

    PubMed

    Hanoun, G; Sova, M; Smrcka, M; Smrcka, V

    2006-12-01

    The reasons for transcranial operative revision of anterior cranial fossa are cerebrospinal fluid (CSF) leakage, pneumocephalus, recurrent meningitis and eventually other causes. The trauma is the most common etiology of previously mentioned pathologic statuses, rarely it can also be long-lasting intracranial hypertension. We retrospectively analyzed our 61 patients, operatively treated at Department of Neurosurgery in Brno-Bohunice between 1997 and 2005, at whom the cranionasal communication must have been treated by means of transcranial neurosurgical repair of anterior fossa skull base. Each year approximately 10-15 operations of this kind were performed. The main goal of operative solution was the water-tight closure of dural defect and cranial base by means of direct dural suture duroplasty with periostal flap, fascial flap or other graft. Each case solution was dependent on actual operative appearance of the operative field. The majority of transcranial repairs of frontal cerebral fossas were performed acutely as a part of frontobasal injury operation with haematoma, calvar impressive fractures and open cerebral injury. The minority of repairs is formed by elective operations for posttraumatic rhinnorhea and meningitis. In our announcement we also mention possible conservative treatment. PMID:17407946

  11. Dynamic knee loads during gait predict proximal tibial bone distribution.

    PubMed

    Hurwitz, D E; Sumner, D R; Andriacchi, T P; Sugar, D A

    1998-05-01

    This study tested the validity of the prediction of dynamic knee loads based on gait measurements. The relationship between the predicted loads at the knee and the distribution of bone between the medial and lateral sides of the tibia was examined. The motion and external forces and moments at the knee were measured during gait and a statically determinate muscle model was used to predict the corresponding forces on the medial and lateral tibial plateaus. In particular, the relationship between the knee adduction moment during gait and the ratio or distribution of medial to lateral tibial bone mineral content was studied. Bone mineral content was measured with dual energy X-ray absorptiometry in four regions, two proximal regions 20 mm in height, one medial and one lateral and two distal regions 20 mm in height, one medial and one lateral. The best single predictor of the medial lateral ratio of proximal bone mineral content (bone distribution) was the adduction moment (R2=0.31, p=0.003). Adding weight (negative coefficient. p=0.0004) and the ratio of the average predicted peak force on the medial plateau to the predicted peak force on the lateral plateau (positive coefficient, p=0.0033) to the regression model significantly increased the ability to predict the proximal medial lateral bone distribution (R2=0.72, p=0.0001). Distally neither the subject characteristics nor the gait moments and predicted forces were significant predictors of the bone distribution. The lack of a correlation distally may be reflective of the forces being more evenly distributed further from the tibial plateau. While it has long been suggested that the adduction moment is the primary determinate of the distribution of load between the medial and lateral plateaus, this is the first evidence of its relationship to the underlying bone distribution. PMID:9727339

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

    PubMed Central

    2008-01-01

    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). PMID:18573205

  13. Strong Association Between Tibial Plateau Bone Mineral Density and Cartilage Damage

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tibial bone mineral density (BMD) is associated with radiographic features of osteoarthritis (OA), but no study has looked at its relationship with a direct measure of cartilage damage. We hypothesize that a relative increase in medial and lateral tibial BMD will be associated with cartilage damage...

  14. Metachronous Bilateral Posterior Tibial Artery Aneurysms in Ehlers-Danlos Syndrome Type IV

    SciTech Connect

    Hagspiel, Klaus D.; Bonatti, Hugo; Sabri, Saher; Arslan, Bulent; Harthun, Nancy L.

    2011-04-15

    Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with EDS-IV who presented with metachronous bilateral aneurysms/pseudoaneurysms of the posterior tibial arteries 15 months apart. Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

  15. Popliteal artery thrombosis secondary to a tibial osteochondroma.

    PubMed

    Gruber-Szyd?o, K; Por?ba, R; Belowska-Bie?, K; Derkacz, A; Badowski, R; Andrzejak, R; Szuba, A

    2011-05-01

    Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma. PMID:21638255

  16. Tibial dyschondroplasia (osteochondrosis) in the turkey. A morphologic investigation.

    PubMed

    Poulos, P W

    1978-01-01

    Sixty-seven Broadbreasted White Turkeys, 4 to 137 days old, were included in the investigation. Some were normal, while others were limping, and some had bowed legs. Immediately after destruction of the birds, the arteries of the legs were injected with Colorpaque, using a technique introduced by the author. The proximal part of one or both tibiae were examined radiographically, macroscopically, and microscopically. The microscopic examination included histology, microangiography, and microradiography. The normal development and morphology of the proximal tibia is presented. Thereafter an account is given of development and morphology of the tibia with dyschondroplastic lesions (retained cartilages). It was found that 39 of the 67 birds had some degree of tibial dyschondroplasia. The retained cartilage was seen in the posteromedial part of the proximal tibial metaphysis. The growth plate both of the normal and abnormal birds consisted of 3 layers of cells in order from the epiphysis--the one of proliferating cells, the one of transitional cells, and the one of hypertrophied cells. A main feature in tibial dyschondroplasia is accumulation of transitional cells, which do not have a vascular supply. By microangiographic means it was possible to demonstrate that the retained cartilage is surrounded by numerous vessels, which apparently cannot get into the cartilage. The reason for the loss of normal differentiation of the cartilage cells and concomitant disturbance of the endochondral ossification is obscure. It is speculated that changes on an ultrastructural and biochemical level are responsible for the pathologic condition. When the retained cartilage reaches a certain size, degenerative changes, necrosis, and fissures occur. Complete healing of the lesion was not seen in any of the birds, but partial disappearance of the proximal or distal part of the retained cartilage took place in some birds. It was concluded that the present investigation has shed light on the development and morphology of tibial dyschondroplasia, but it has also brought forward a number of questions about etiology. There seems to be good reason to believe that dyschondroplasia in the turkey is of similar nature as dyschondroplasia in broilers and osteochondrosis in domestic mammals. PMID:233597

  17. CIR sand casting system for trans-tibial socket.

    PubMed

    Wu, Y; Casanova, H; Smith, W K; Edwards, M; Childress, D S

    2003-08-01

    The authors have developed a trans-tibial socket fabrication system based on the "dilatancy" principle, a process that has been commonly used in forming wheelchair Seating. The CIR Sand Casting System replaces plaster of Paris with sand for forming both a negative sand mould and a positive sand model, which can be modified for either thermoplastic socket formation or resin lamination. Initial clinical trials suggest that fabrication times are approximately 90 minutes from patient evaluation and casting to dynamic alignment. Compatibility with all existing prosthetic components is retained. It is believed the CIR socket fabrication system may be a competitive alternative for prosthetic service providers in developing countries. PMID:14571945

  18. Unintended Rotational Changes of the Distal Tibia After Biplane Medial Open-Wedge High Tibial Osteotomy.

    PubMed

    Jang, Ki-Mo; Lee, Jong-Hee; Park, Hyung-Jun; Kim, Jeong Lae; Han, Seung-Beom

    2016-01-01

    This study involved 35 knees undergoing biplane medial open-wedge high tibial osteotomy (OWHTO) to assess the axial rotation of the distal tibia. The distal tibiae were internally rotated by 3.0 7.1 after OWHTO. The opening width showed a Pearson correlation coefficient of -0.743 (P < .001), and the tuberosity osteotomy angle showed that of -0.678 (P < .001) with distal tibial rotation. However, changes in hip-knee-ankle angle, medial proximal tibial angle, and posterior tibial slope were not significantly correlated with the change in distal tibial rotation. In conclusion, there was an unintended tendency of increasing internal rotation of the distal tibia after biplane medial OWHTO, and this tendency was positively related to the opening width and tuberosity osteotomy angle. PMID:26387921

  19. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient.

    PubMed

    Stepanovich, Matthew T; Slakey, Joseph B

    2016-01-01

    Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury. PMID:26761925

  20. Anatomic all-inside anterior cruciate ligament reconstruction using the translateral technique.

    PubMed

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

    2013-05-01

    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. PMID:23875158

  1. Bilateral tibialis anterior muscle herniation simulating a soft tissue tumour in a young amateur football player.

    PubMed

    Ceyhan, Ali Murat; Chen, Wenchieh; Yener, Mahmut; Yildirim, Mehmet; Yesildag, Ahmet; Akkaya, Vahide Baysal

    2010-05-01

    Muscle herniation is a focal protrusion of muscle tissue through a defect in the deep fascial layer. Anterior tibial muscle is the most commonly affected muscle of the lower extremities because its fascia is the most vulnerable to trauma. Clinically it is characterized by asymptomatic or painful, skin-coloured, soft, subcutaneous nodules of various size depending on the position. The diagnosis is usually made clinically based on its typical manifestations, but ultrasonographic examination is useful for detecting the fascial defect and excluding other conditions caused by soft tissue tumours such as lipomas, angiolipomas, fibromas, schwannomas or varicosities. Although this entity is not rare, it has been less well documented in the dermatological literature. We report a case of bilateral tibialis anterior muscle herniation mimicking a soft tissue tumour in a young amateur football player. PMID:20546224

  2. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the particular developing tissue, some examples of the stimuli being chemical stimuli, and electro-magnetic stimuli. Some examples of tissue which can be produced include other ligaments in the body (hand, wrist, elbow, knee), tendon, cartilage, bone, muscle, and blood vessels.

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

    PubMed

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

    2013-01-01

    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

  4. Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

    PubMed Central

    2013-01-01

    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

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

    PubMed Central

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

    1985-01-01

    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. Images Figure 1 Figure 2 PMID:4025512

  6. ANALYSIS OF THE REPRODUCIBILITY OF TIBIAL PLATEAU FRACTURES’ CLASSIFICATION

    PubMed Central

    Albuquerque, Rodrigo Pires e; Giordano, Vincenzo; Pallottino, Alexandre; Sassine, Tannous; Canedo, Rodrigo; Pina, Juliana; do Amaral, Ney Pecegueiro

    2015-01-01

    Objective: To assess the inter-observer agreement of three tibial plateau fracture classifications: Schatzker, AO Group, and Hohl. Methods: Nine physicians of different levels of expertise (six Orthopaedic Residents – OR – and three Orthopaedic Attendings – OA) classified 50 tibial plateau fractures. Results: There was a low to moderate agreement between OR and OA on the three classification systems. A straight correlation was found between the year of Residence and an increase on the level of agreement on the AO group and Hohl classifications. This was partially seen on the Schatzker classification. Kappa ranged from 0.344 to 0.577, 0.36 to 0.499, and 0.278 to 0.465 for the Hohl, AO group, and Schatzker systems, respectively. Conclusion: With a level of 0.1, there was a significant agreement on the three classifications among the physicians. When comparing ORs to OAs, the three studied classifications show low to moderate consistency, with the Hohl classification showing the highest level of agreement between OR.

  7. Fibula-related complications during bilateral tibial lengthening

    PubMed Central

    2012-01-01

    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 (2.56.9) years. Results The average lengthening percentage was 34% (2165). The ratio of mean fibular length to tibial length was 1.05 (0.911.11) preoperatively and 0.83 (0.650.95) postoperatively. The mean proximal fibular migration (PFM) was 15 (431) mm and mean distal fibular migration (DFM) was 9.7 (024) 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. PMID:22329670

  8. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System

    PubMed Central

    Fitzgerald, Judd; Saluan, Paul; Richter, Dustin L.; Huff, Nathan; Schenck, Robert C.

    2015-01-01

    Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved reproduction of the femoral footprint and facilitates drilling of the femoral tunnel in an anatomic position. The use of the FAMP and straight reamer systems introduces its own set of potential complications, including short femoral tunnels and peroneal nerve injury. These potential complications have been addressed by drilling the femoral tunnel in a hyperflexed position, which can lead to difficulty with positioning the operative extremity, visualization, and identification of anatomic landmarks. The purpose of this case report was to review the advantages and technical aspects of using a flexible reamer system and the FAMP to achieve an anatomic ACL reconstruction while avoiding potential complications and pitfalls. Flexible reamer systems allow an additional way of uncoupling the tibial and femoral tunnels to clearly visualize and establish an anatomic starting point within the femoral footprint of the native ACL while avoiding the complications associated with knee hyperflexion and straight reamers with the far anteromedial portal. In the authors’ experience, an anatomic reconstruction of the ACL can be achieved safely using flexible reamers while avoiding some of the difficulties seen with straight reamers used in conjunction with an uncoupled, far anteromedial approach. PMID:26673860

  9. Radiographic study on the tibial insertion of the posterior cruciate ligament?

    PubMed Central

    Gali, Julio Cesar; Esquerdo, Paulo; Almagro, Marco Antonio Pires; da Silva, Phelipe Augusto Cintra

    2015-01-01

    Objective To establish the radiographic distances from posterior cruciate ligament (PCL) tibial insertions centers to the lateral and medial tibial cortex in the anteroposterior view, and from these centers to the PCL facet most proximal point on the lateral view, in order to guide anatomical tunnels drilling in PCL reconstruction and for tunnel positioning postoperative analysis. Study design Controlled laboratory study. Methods Twenty cadaver knees were evaluated. The PCL's bundles tibial insertions were identified and marked out using metal tags, and the knees were radiographed. On these radiographs, the bundles insertion sites center location relative to the tibial mediolateral measure, and the distances from the most proximal PCL facet point to the bundle's insertion were determined. All measures were calculated using the ImageJ software. Results On the anteroposterior radiographs, the mean distance from the anterolateral (AL) bundle insertion center to the medial tibial edge was 40.684.10mm; the mean distance from the posteromedial (PM) bundle insertion center to the medial tibial edge was 38.744.40mm. On the lateral radiographs, the mean distances from the PCL facet most proximal point to AL and PM bundles insertion centers were 5.491.29mm and 10.532.17mm respectively. Conclusions It was possible to establish a radiographic pattern for PCL tibial bundles insertions, which may be useful for intraoperative tunnels locations control and for postoperative tunnels positions analysis. PMID:26229941

  10. A new in vivo technique for determination of femoro-tibial and femoro-patellar 3D kinematics in total knee arthroplasty.

    PubMed

    von Eisenhart-Rothe, R; Vogl, T; Englmeier, K-H; Graichen, H

    2007-01-01

    Aim was to develop an in vivo technique which allows determination of femoro-tibial and of femoro-patellar 3D-kinematics in TKA simultaneously. The knees of 20 healthy volunteers and of eight patients with TKA (PCR, rotating platform) were investigated. Kinematics analysis was performed in an open MR-system at different flexion angles with external loads being applied. The TKA components were identified using a 3D-fitting technique, which allows an automated 3D-3D-registration of the TKA. Femoro-patellar and femoro-tibial 3D-kinematics were analyzed by image postprocessing. The validity of the postprocessing technique demonstrated a coefficient of determination of 0.98 for translation and of 0.97 for rotation. The reproducibility yielded a coefficient of variation (CV%) for patella kinematics between 0.17% (patello-femoral angle) and 6.8% (patella tilt). The femoro-tibial displacement also showed a high reproducibility with CV% of 4.0% for translation and of 7.1% for rotation. While in the healthy knees the typical screw-home mechanism was observed, a paradoxical anterior translation of the femur relative to the tibia combined with an external rotation occurred after TKA. Fifty percent of the TKA's experienced a condylar lift-off of >1mm predominately on the medial side. Regarding patellar kinematics significant changes were found in both planes in TKA with an increased patella height in the sagittal plane and patella tilt and shift in the transversal plane. The results demonstrate that the presented 3D MR-open based method is highly reproducible and valid for image acquisition and postprocessing and provides--for the first time--in vivo data of 3D-kinematics of the tibio-femoral and simultaneously of the patello-femoral joint during knee flexion. PMID:17475270

  11. Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

    PubMed Central

    2012-01-01

    Background In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. Methods A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. Results There was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees) than the intramedullary guide (−0.34 +/− 2.31 degrees) but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees) than intramedullary guide (0.50 +/− 3.80 degrees) for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. Conclusions Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane. PMID:23031403

  12. Management of tibial non-unions according to a novel treatment algorithm.

    PubMed

    Ferreira, Nando; Marais, Leonard Charles

    2015-12-01

    Tibial non-unions represent a spectrum of conditions that are challenging to treat. The optimal management remains unclear despite the frequency with which these diagnoses are encountered. The aim of this study was to determine the outcome of tibial non-unions managed according to a novel tibial non-union treatment algorithm. One hundred and eighteen consecutive patients with 122 uninfected tibial non-unions were treated according to our proposed tibial non-union treatment algorithm. All patients were followed-up clinically and radiologically for a minimum of six months after external fixator removal. Four patients were excluded because they did not complete the intended treatment process. The final study population consisted of 94 men and 24 women with a mean age of 34 years. Sixty-seven non-unions were stiff hypertrophic, 32 mobile atrophic, 16 mobile oligotrophic and one true pseudoarthrosis. Six non-unions were classified as type B1 defect non-unions. Bony union was achieved after the initial surgery in 113/122 (92.6%) tibias. Nine patients had failure of treatment. Seven persistent non-unions were successfully retreated according to the tibial non-union treatment algorithm. This resulted in final bony union in 120/122 (98.3%) tibias. The proposed tibial non-union treatment algorithm appears to produce high union rates across a diverse group of tibial non-unions. Tibial non-unions however, remain difficult to treat and should be referred to specialist units where advanced reconstructive techniques are practiced on a regular basis. PMID:26492881

  13. HOW CAN BONE TUNNEL ENLARGEMENT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY BE MEASURED? DESCRIPTION OF A TECHNIQUE

    PubMed Central

    Aguiar Leonardi, Adriano Barros de; Severino, Nilson Roberto; Junior, Aires Duarte

    2015-01-01

    To assess the presence of tibial bone tunnel enlargement after surgery to reconstruct the anterior cruciate ligament using quadruple flexor tendon grafts, and to propose a new technique for its measurement. Methods: The study involved 25 patients aged 18-43 years over a six-month period. The assessment was based on radiographs taken immediately postoperatively and in the third and sixth months of evolution after operations to reconstruct the anterior cruciate ligament using grafts from the tendons of the semitendinosus and gracilis muscles, fixed in the femur with a transverse metal screw and in the tibia with an interference screw. The radiographs were evaluated in terms of the relative value between the diameter of the tunnel and the bone, both at 2 cm below the medial tibial condyle. Results: There were significant increases in tunnel diameters: 20.56% for radiographs in anteroposterior view and 26.48% in lateral view. Enlargement was present in 48% of anteroposterior and lateral radiographs, but was present in both views in only 16% of the cases. Conclusions: Bone tunnel enlargement is a phenomenon found in the first months after surgery to reconstruct the anterior cruciate ligament. The measurement technique proposed in this study was sufficient to detect it.

  14. Removable rigid dressings versus soft dressings: a randomized, controlled study with dysvascular, trans-tibial amputees.

    PubMed

    Deutsch, Anneke; English, Rowan D; Vermeer, Tammy C; Murray, Pamela S; Condous, Michael

    2005-08-01

    This study compares a standard soft dressing (SSD) with a removable rigid dressing (RRD) in a randomized, controlled trial using 50 dysvascular trans-tibial amputees. Both dressing types were applied immediately post-operatively and were only removed for wound dressing changes. Half the subjects were allocated prospectively by ballot to either the RRD group or the SSD group. There was a strong trend indicating that primary wound healing of the stump occurred almost 2 weeks earlier in subjects using the RRD (RRD = 51.2 days +/- 19.4; SSD = 64.7 days +/- 29.5; P= 0.07; RRD: n =17; SSD: n = 14.) There were no significant differences between the other parameters measured which included time to prosthetic fitting, length of hospital stay, incidence of stump breakdown, and time taken for stump volume to stabilize. The incidence of stump damage due to falls was also recorded, the results indicating that RRDs may protect the new stump from trauma. PMID:16281728

  15. Anatomic Single Bundle Anterior Cruciate Ligament Reconstruction by Low Accessory Anteromedial Portal Technique: An In Vivo 3D CT Study

    PubMed Central

    Lee, Kwang Won; Chi, Yong Joo; Yang, Dae Suk; Kim, Ha Yong; Choy, Won Sik

    2014-01-01

    Purpose Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction. Materials and Methods The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated. Results The mean tibial tunnel position was located at 44.6%2.5% anterior from the anterior margin and 48.0%3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%2.7%/30.0%2.9%; Watanabe's method, 37.7%2.5%/26.6%2.2%; Mochizuki's method, 38.7%2.7%; Takahashi's method, 21.8%2.2%. The mean femoral tunnel obliquity was 57.76.2 in the sagittal plane and 49.95.6 in the coronal plane. Conclusions In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate. PMID:24944975

  16. Effects of jump and balance training on knee kinematics and electromyography of female basketball athletes during a single limb drop landing: pre-post intervention study

    PubMed Central

    2011-01-01

    Background Some research studies have investigated the effects of anterior cruciate ligament (ACL) injury prevention programs on knee kinematics during landing tasks; however the results were different among the studies. Even though tibial rotation is usually observed at the time of ACL injury, the effects of training programs for knee kinematics in the horizontal plane have not yet been analyzed. The purpose of this study was to determine the effects of a jump and balance training program on knee kinematics including tibial rotation as well as on electromyography of the quadriceps and hamstrings in female athletes. Methods Eight female basketball athletes participated in the experiment. All subjects performed a single limb landing at three different times: the initial test, five weeks later, and one week after completing training. The jump and balance training program lasted for five weeks. Knee kinematics and simultaneous electromyography of the rectus femoris and Hamstrings before training were compared with those measured after completing the training program. Results After training, regarding the position of the knee at foot contact, the knee flexion angle for the Post-training trial (mean (SE): 24.4 (2.1) deg) was significantly larger than that for the Pre-training trial (19.3 (2.5) deg) (p < 0.01). The absolute change during landing in knee flexion for the Post-training trial (40.2 (1.9) deg) was significantly larger than that for the Pre-training trial (34.3 (2.5) deg) (p < 0.001). Tibial rotation and the knee varus/valgus angle were not significantly different after training. A significant increase was also found in the activity of the hamstrings 50 ms before foot contact (p < 0.05). Conclusions The jump and balance training program successfully increased knee flexion and hamstring activity of female athletes during landing, and has the possibility of producing partial effects to avoid the characteristic knee position observed in ACL injury, thereby preventing injury. However, the expected changes in frontal and transverse kinematics of the knee were not observed. PMID:21752300

  17. High tibial osteotomies in the young active patient

    PubMed Central

    Traub, Shaun; Efird, Chad

    2010-01-01

    Unicompartmental changes in the knee of a young athlete remains a difficult and controversial problem in orthopaedics. Excessive premature loading of articular cartilage, most often the result of a knee injury, has been shown to result in increased degenerative changes and pain in the younger patient. Instability may also contribute to the degeneration of cartilage and must therefore be considered in the treatment of osteoarthritis in the young adult. High tibial osteotomy has been described as a treatment option for malalignment in the older, less active adult and has shown promising results in a younger, more active population. Osteotomies for instability are more controversial and should be considered in more complex injury patterns. PMID:20076957

  18. [A Problematic Case: Removal of a Broken Cannulated Tibial Nail].

    PubMed

    Langenhan, R; Reimers, N; Henke, W; Probst, A

    2015-06-01

    We present a case illustrating a simple and safe technique for the removal of a broken cannulated tibial nail after a pseudarthrosis of a lower leg shaft fracture. A 3?mm Ball-Tip guide wire was inserted into the proximal and the distal segment of the nail. A 2.5?mm tip-flattened second wire was forwarded into the distal segment pushing the Ball-Tip guide wire out of the axis and blocking it. This way the Ball-Tip could act as a hook and consecutively could be knocked back with an impactor forceps removing the complete nail. An exchange nailing was performed with a reamed AO standard nail and the further course was uneventful with a healed fracture after 12 months. PMID:25927278

  19. Bending strength and holding power of tibial locking screws.

    PubMed

    Lin, J; Lin, S J; Chiang, H; Hou, S M

    2001-04-01

    The bending strength and holding power of two types of specially designed tibial locking devices, a both-ends-threaded screw and an unthreaded bolt, were studied and compared with four types of commercially available tibial interlocking screws: Synthes, Howmedica, Richards, and Osteo AG. To test bending strength, the devices were inserted into a high molecular weight polyethylene tube and loaded at their midpoint by a materials testing machine to simulate a three point bending test. Single loading yielding strength and cyclic loading fatigue life were measured. To test holding power, the devices were inserted into tubes made of polyurethane foam, and their tips were loaded axially to measure pushout strength. The devices were tested with two different densities of foam materials and two different sizes of pilot holes. Insertion torque and stripping torque of the screws were measured first. Pushout tests were performed with each screw inserted with a tightness equal to 60% of its stripping torque. Test results showed that the yielding strength and the fatigue life were related closely to the inner diameter of the screws. The stripping torque predicted the pushout strength more reliably than did the insertion torque. All tested devices showed greater holding power in the foam with the higher density and with the smaller pilot holes. The both-ends-threaded screw had the highest pushout strength and a satisfactory fatigue strength. The unthreaded bolt had the highest fatigue strength but only fair holding power. Clinical studies of the use of these two types of locking devices are worthwhile. PMID:11302315

  20. Total knee arthroplasty after high tibial osteotomy. A systematic review

    PubMed Central

    van Raaij, Tom M; Reijman, Max; Furlan, Andrea D; Verhaar, Jan AN

    2009-01-01

    Background Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee arthroplasty. Methods A computerized search for relevant studies published up to September 2007 was performed in Medline and Embase using a search strategy that is highly sensitive to find nonrandomized studies. Included were observational studies in which patients had total knee arthroplasty performed after prior high tibial osteotomy. Studies that fulfilled these criteria, were assessed for methodologic quality by two independent reviewers using the critical appraisal of observational studies developed by Deeks and the MINORS instrument. The study characteristics and data on the intervention, follow-up, and outcome measures, were extracted using a pre-tested standardized form. Primary outcomes were: knee range of motion, knee clinical score, and revision surgery. The grade of evidence was determined using the guidelines of the GRADE working group. Results Of the 458 articles identified using our search strategy, 17 met the inclusion criteria. Fifteen studies were cohort study with a concurrent control group, one was a historical cohort study and one a case-control study. Nine studies scored 50% or more on both methodological quality assessments. Pooling of the results was not possible due to the heterogeneity of the studies, and our analysis could not raise the overall low quality of evidence. No significant differences between primary total knee arthroplasty and total knee arthroplasty after osteotomy were found for knee range of motion in four out of six studies, knee clinical scores in eight out of nine studies, and revision surgery in eight out of eight studies after a median follow-up of 5 years. Conclusion Our analysis suggests that osteotomy does not compromise subsequent knee replacement. However, the low quality of evidence precludes solid clinical conclusions. PMID:19619275

  1. Treatment of complex tibial plateau fractures using Ilizarov technique.

    PubMed

    Lalić, Ivica; Daraboš, Nikica; Stanković, Milan; Gojković, Zoran; Obradović, Mirko; Marić, Dušan

    2014-12-01

    Complex tibial plateau fractures are most commonly caused by high-energy trauma and they are often associated with severe soft tissue injuries that can frequently result in severe complications. Ilizarov external circular fixation is an ideal method of treatment for high- energy fractures of the tibial plateau when extensive soft tissue dissection and internal fixation are contraindicated. Our research included 50 consecutive patients and clinical features of the patients were evaluated during the follow up period using the following instruments: Gustillo-Anderson, Sc- hatzker and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/ OTA) classification methods. Bony results were evaluated using the Association of the Study and Application of the Method ofIlizarov (ASAMI) protocol. The mean functional recovery scores were obtained by the modified functional evaluation system of Karlstrom-Olerud. All fractures healed successfully. Circular fixators could be removed without anesthesia for type IV fractures at 16 weeks (range 12-21) and for type V-VI at 18 weeks (range 15-26) after the operation. According to ASA- MI bone results, there were 39 (78%) excellent, 7 (14%) good, 3 (6%) fair results and 1 (2%) poor result. Analysis of data obtained by the Karlstrom-Olerud functional evaluation system in this study yielded a mean value of 24.7 after six months, which implies recovery. Functional recovery at 12 months after surgery revealed satisfactory recovery with a mean value of 27.7, whereas the mean sco- re of 29.8 recorded at the last evaluation suggested good functional status. The treatment of patients with open and closed multiple intra-articular fractures of proximal tibia applying Ilizarov apparatus showed good functional outcome, which had positive impact on our patients' quality of life. PMID:25868312

  2. Evaluating Glucocorticoid Administration on Biomechanical Properties of Rats Tibial Diaphysis

    PubMed Central

    Freidouni, Mohammadjavad; Nejati, Hossein; Salimi, Maryam; Bayat, Mohammad; Amini, Abdollah; Noruzian, Mohsen; Asgharie, Mohammad Ali; Rezaian, Milad

    2015-01-01

    Background: Osteoporosis is a disease, which causes bone loss and fractures. Although glucocorticoids effectively suppress inflammation, their chronic use is accompanied by bone loss with a tendency toward secondary osteoporosis. Objectives: This study took into consideration the importance of cortical bone in the entire bone's mechanical competence. Hence, the aim of this study was to assess the effects of different protocols of glucocorticoid administration on the biomechanical properties of tibial bone diaphysis in rats compared to control and low-level laser-treated rats. Materials and Methods: This experimental study was conducted at Shahid Beheshti University of Medical Sciences, Tehran, Iran. We used systematic random sampling to divide 40 adult male rats into 8 groups with 5 rats in each group. Groups were as follows: 1) control, 2) dexamethasone (7 mg/week), 3) dexamethasone (0.7 mg/week), 4) methylprednisolone (7 mg/kg/week), 5) methylprednisolone (5 mg/kg twice weekly), 6) dexamethasone (7 mg/kg three times per week), 7) dexamethasone (0.7 mg/kg thrice per week), and 8) low-level laser-treated rats. The study periods were 4-7 weeks. At the end of the treatment periods, we examined the mechanical properties of tibial bone diaphysis. Data were analyzed by statistical analyses. Results: Glucocorticoid-treated rats showed weight loss and considerable mortality (21%). The biomechanical properties (maximum force) of glucocorticoid-treated rats in groups 4 (62 2.9), 6 (63 5.1), and 7 (60 5.3) were comparable with the control (46 1.5) and low-level laser-treated (57 3.2) rats. Conclusions: In contrast to the findings in humans and certain other species, glucocorticoid administration caused anabolic effect on the cortical bone of tibia diaphysis bone in rats. PMID:26019900

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

    PubMed

    Lubowitz, James H

    2006-08-01

    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

  4. Anterior extrapleural line: superior extension.

    PubMed

    Whalen, J P; Oliphant, M; Evans, J A

    1975-06-01

    Anatomic sections of the superior aspect of the anterior mediastinum reveal that normal structures can cause indentations upon the adjacent lung. On lateral chest films, the soft-tissue density of the anterior superior mediastinal structures contrasts with that of the normal lung, revealing a normal, undulating configuration of the anterior superior mediastinum. We have termed this the "vascular incisura," analogous to the cardiac incisura of the left lung seen inferiorly. An appreciation of normal variations within this space is essential when evaluating pathologic alterations. PMID:1093226

  5. Addition of magnesium sulphate to ropivacaine for spinal analgesia in dogs undergoing tibial plateau levelling osteotomy.

    PubMed

    Adami, C; Casoni, D; Noussitou, F; Rytz, U; Spadavecchia, C

    2016-03-01

    The aim of this blinded, randomised, prospective clinical trial was to determine whether the addition of magnesium sulphate to spinally-administered ropivacaine would improve peri-operative analgesia without impairing motor function in dogs undergoing orthopaedic surgery. Twenty client-owned dogs undergoing tibial plateau levelling osteotomy were randomly assigned to one of two treatment groups: group C (control, receiving hyperbaric ropivacaine by the spinal route) or group M (magnesium, receiving a hyperbaric combination of magnesium sulphate and ropivacaine by the spinal route). During surgery, changes in physiological variables above baseline were used to evaluate nociception. Arterial blood was collected before and after spinal injection, at four time points, to monitor plasma magnesium concentrations. Post-operatively, pain was assessed with a modified Sammarco pain score, a Glasgow pain scale and a visual analogue scale, while motor function was evaluated with a modified Tarlov scale. Assessments were performed at recovery and 1, 2 and 3?h thereafter. Fentanyl and buprenorphine were administered as rescue analgesics in the intra- and post-operative periods, respectively. Plasma magnesium concentrations did not increase after spinal injection compared to baseline. Group M required less intra-operative fentanyl, had lower Glasgow pain scores and experienced analgesia of longer duration than group C (527.0??341.0?min vs. 176.0??109.0?min). However, in group M the motor block was significantly longer, which limits the usefulness of magnesium for spinal analgesia at the investigated dose. Further research is needed to determine a clinically effective dose with shorter duration of motor block for magnesium used as an additive to spinal analgesic agents. PMID:26831174

  6. Clinical Outcomes of Tibial Components with Modular Stems Used in Primary TKA

    PubMed Central

    Pace, Thomas; Broome, Brandon; Osuji, Obi; Harman, Melinda K.

    2014-01-01

    Due to the known potential for fretting and corrosion at modular junctions in orthopaedic implants, this retrospective study evaluated radiographic and clinical outcomes of 85 primary TKA patients implanted with modular stemmed tibial components and followed up for an average of 82 months. There was low incidence of tibial radiolucent lines, excellent functional outcomes, and no complications associated with stem modularity. The findings were comparable to the historical control study involving 107 TKA with a nonmodular tibial stem design. When using surface cemented tibial components combined with a constrained polyethylene bearing, modular stems appear to be a viable option for primary TKA when adequate fixation and rotational stability are maintained. PMID:24669319

  7. [Investigation of tibial bones of the rats exposed on board "Spacelab-2":histomorphometric analysis

    NASA Technical Reports Server (NTRS)

    Durnova, G. N.; Kaplanskii, A. S.; Morey-Holton, E. R.; Vorobeva, V. N.

    1996-01-01

    Proximal metaphyses of tibial bones from the Sprague-Dowly rats exposed in US dedicated space life sciences laboratory SLS-2 for 13-14 days and sacrificed on day 13 in microgravity and within 5 hours and 14 days following recovery were the subject of histological, histochemical, and histomorphometric analyses. After the 13-day flight of SLS-2 the rats showed initial signs of osteopenia in the spongy tissue of tibial bones, secondary spongiosis affected first. Resorption of the secondary spongiosis was consequent to enhanced resorption and inhibition of osteogenesis. In rats sacrificed within 5 hours of recovery manifestations of tibial osteopenia were more evident than in rats sacrificed during the flight. Spaceflight-induced changes in tibial spongiosis were reverse by character the amount of spongy bone was fully compensated and following 14 days of readaptation to the terrestrial gravity.

  8. Anterior Knee Pain (Chondromalacia Patellae).

    ERIC Educational Resources Information Center

    Garrick, James G.

    1989-01-01

    This article presents a pragmatic approach to the definition, diagnosis, and management of anterior knee pain. Symptoms and treatment are described. Emphasis is on active involvement of the patient in the rehabilitation exercise program. (IAH)

  9. Anterior Cruciate Ligament Injury

    PubMed Central

    Vilaseca, Tomas; Chahla, Jorge; Rodriguez, Gustavo Gomez; Arroquy, Damián; Herrera, Gonzalo Perez; Orlowski, Belen; Carboni, Martín

    2015-01-01

    Objectives: The objective of this study was to analyze whether it is more frequent the presence of a decreased range of motion in the hips of recreational athletes with primary injury of the anterior cruciate ligament (ACL) than in a control group of volunteers without knee pathology. Methods: We included prospectively recreational athletes between 18 and 40 years with an acute ACL injury between January 2011 and January 2013. They were compared with a control group of volunteers recreational athletes without lower limb pathology and in the same range of age. The internal and external rotations passively prior to the point at which the pelvis movement contributes were observed. The results were statistically analyzed using t test for related samples to the hips of patients with ACL injury and t test for independent variables for comparison with the control group. Results: 48 patients with ACL injury and 53 healthy volunteers were evaluated. The ACL group was composed of 32 males and 16 females with an average age of 29.3 years. In the control group 26 males and 27 females were studied with a mean age of 26.6 years. Internal (IR) and external (ER) rotation in the LCA group was 22,9º and 55,5º respectively in the ipsilateral hip and 27,9º and 57,7º in the contralateral. In the control group a 35,9º of IR and 55,2º of ER was observed. The analysis showed an association between ACL injury and hypomotility of the hip further expense of a decrease in internal rotation. The analysis showed an association between ACL injury and hypomotility of the hip at the expense to a greater decrease in internal rotation. Conclusion: We found a statistically significant difference in the mobility of the hips in patients with ACL injury predominantly due to internal rotation, pattern that allows us to interpret this injury not only as an intrinsic etiology of the knee but also of the adjacent joints. We consider very importance to incorporate prevention activities and screening of risk factors regarding to at least high performance athletes.

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

    PubMed Central

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

    2008-01-01

    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 (Δv), restraint use, occupant position (driver vs. passenger) and principal direction of force (PDOF)] using χ2, Mantel-Haenszel χ2 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 α = 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 Δv 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. PMID:19026239

  11. Diffuse anterior retinoblastoma: current concepts

    PubMed Central

    Yang, Jing; Dang, Yalong; Zhu, Yu; Zhang, Chun

    2015-01-01

    Diffuse anterior retinoblastoma is a rare variant of retinoblastoma seeding in the area of the vitreous base and anterior chamber. Patients with diffuse anterior retinoblastoma are older than those with the classical types, with the mean age being 6.1 years. The original cells of diffuse anterior retinoblastoma are supposed to be cone precursor. Patients most commonly present with pseudouveitis, pseudohypopyon, and increased intraocular pressure. The retina under fundus examination is likely to be normal, and the clinical features mimic the inflammation progress, which can often lead to misdiagnosis. The published diffuse anterior retinoblastoma cases were diagnosed after fine-needle aspiration biopsy running the potential risk of inducing metastasis. The most common treatment for diffuse anterior retinoblastoma is enucleation followed by systematic chemotherapy according to the patients presentation and clinical course. This review summarizes the recent advances in etiology (including tumorigenesis and cell origin), pathology, diagnosis, differential diagnosis, and new treatment. The challenges of early diagnosis and prospects are also discussed. PMID:26229489

  12. Arthroscopic management of proximal tibial fractures: technical note and case series presentation

    PubMed Central

    BENEA, HOREA; TOMOAIA, GHEORGHE; MARTIN, ARTUR; BARDAS, CIPRIAN

    2015-01-01

    Background and aims The purpose of this article is to describe a new surgical method of arthroscopy assisted treatment of intraarticular proximal tibial fractures (ARIF – arthroscopic reduction and internal fixation), analyzing its efficiency and safety on a series of patients. Tibial plateau fractures affect the proximal tibial metaphyseal and articular surface, representing 1.2% of all fractures and up to 8% of all fractures in elderly. Patients and method Our case series consists of 6 patients with Schatzker types I-III tibial plateau fractures, treated in the Orthopedic and Traumatology Clinic of Cluj-Napoca from July 2012 to August 2014. Patients included in the study presented Schatzker type I-III tibial plateau fracture. Results The results obtained with the arthroscopic method were excellent in 5 cases (mean Rasmussen score 27.60 points) and good in 1 case (mean score 23.75). The radiological consolidation appeared after a mean of 12 weeks. No major complication was noted. Conclusions Diagnosis and treatment of associated lesions, shortening of hospitalization length and postoperative rehabilitation, but also the lower rate of complications, can make arthroscopic reduction and internal fixation the method of choice for the operative treatment of selected Schatzker I-III types of proximal tibial fractures. PMID:26528076

  13. Evaluation of intraoperative radioscopy on the coronal alignment of the tibial component in primary knee arthroplasty☆

    PubMed Central

    Cobra, Hugo; Hadid, Marcio Bruno; Jácome, Daniel Torres; de Sousa, Eduardo Branco; de Paula Mozella, Alan; e Albuquerque, Rodrigo Pires

    2015-01-01

    Objectives The present study had the objective of evaluating the effect of the use of intraoperative radioscopy in cases of primary knee arthroplasty, on the final alignment of the tibial component. Methods Patients who underwent total knee arthroplasty (TKA) between April 13, 2013, and April 20, 2013, were included in the study. These patients were evaluated retrospectively and two groups were identified: one in which intraoperative radioscopy was used to assess the positioning of the tibial component during the surgery and the other in which this resource was not used. Results The mean angle of alignment of the tibial component in relation to the tibial diaphysis was greater in the group without use of intraoperative radioscopy (90.82) than in the group with radioscopy (90.63), which was a statistically significant result (p < 0.05). Conclusion Use of intraoperative radioscopy during TKA produced a better mean angle of alignment between the tibial component and the tibial diaphysis, in comparison with nonuse. PMID:26535200

  14. Sagittal plane knee translation and electromyographic activity during closed and open kinetic chain exercises in anterior cruciate ligament-deficient patients and control subjects.

    PubMed

    Kvist, J; Gillquist, J

    2001-01-01

    Using electrogoniometry and electromyography, we measured tibial translation and muscle activation in 12 patients with unilateral anterior cruciate ligament injury and in 12 control subjects. Measurements were made during an active extension exercise with 0-, 4-, and 8-kg weights and during squats on two legs and on one leg where the projection of the center of gravity was placed over, behind, and in front the feet. In the uninjured subjects, tibial translation increased with increasing load except during the squat with the center of gravity behind the feet, which produced the smallest translation. For the active extension exercises, translation was greater during eccentric activity. In the anterior cruciate ligament-injured knees, all squats resulted in similar translation, which was smaller than that during the active extension exercise. The highest muscle activation was seen during squats. Hamstring muscle activity was low. Increased static laxity in the anterior cruciate ligament-deficient knee can be controlled during closed but not during open kinetic chain exercises. Coactivation of the quadriceps and gastrocnemius muscles seems to be important for knee stability, whereas hamstring muscle coactivation was insignificant. To minimize sagittal translation during nonoperative management of anterior cruciate ligament-deficient knees, closed kinetic chain exercises are preferable to open kinetic chain exercises, and importance should be attached to the spontaneous coactivation of the quadriceps and gastrocnemius muscles. PMID:11206260

  15. Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft and press-fit fixation using an anteromedial portal technique

    PubMed Central

    2012-01-01

    Background This article describes an arthroscopic anterior cruciate ligament (ACL) reconstruction technique with a quadriceps tendon autograft using an anteromedial portal technique. Methods A 5?cm quadriceps tendon graft is harvested with an adjacent 2?cm bone block. The femoral tunnel is created through a low anteromedial portal in its anatomical position. The tibial tunnel is created with a hollow burr, thus acquiring a free cylindrical bone block. The graft is then passed through the tibial tunnel and the bone block, customized at its tip, is tapped into the femoral tunnel through the anteromedial portal to provide press-fit fixation. The graft is tensioned distally and sutures are tied over a bone bridge at the distal end of the tibial tunnel. From the cylindrical bone block harvested from the tibia the proximal end is customized and gently tapped next to the graft tissue into the tibial tunnel to assure press fitting of the graft in the tibial tunnel. The distal part of the tibial tunnel is filled up with the remaining bone. All patients were observed in a prospective fashion with subjective and objective evaluation after 6?weeks, 6 and 12?months. Results Thirty patients have been evaluated at a 12?months follow-up. The technique achieved in 96.7% normal or nearly normal results for the objective IKDC. The mean subjective IKDC score was 86.1 15.8. In 96.7% the Tegner score was the same as before injury or decreased one category. A negative or 1+ Lachman test was achieved in all cases. Pivot-shift test was negative or (+) glide in 86.7%. The mean side-to-side difference elevated by instrumental laxity measurement was 1.6 1.1?mm. Full ROM has been achieved in 92.3%. The mean single one-leg-hop index was 91.9 8.0 at the follow-up. Conclusions Potential advantages include minimum bone loss specifically on the femoral side and graft fixation without implants. PMID:22925587

  16. A randomized controlled trial comparing "high-flex" vs "standard" posterior cruciate substituting polyethylene tibial inserts in total knee arthroplasty.

    PubMed

    McCalden, Richard W; MacDonald, Steven J; Bourne, Robert B; Marr, Juliana T

    2009-09-01

    The purpose of this study is to compare the range of motion and clinical outcomes of a standard posterior-stabilized (PS) vs the high-flex (HF) polyethylene tibial insert of a posterior cruciate substituting total knee arthroplasty system. One hundred patients were entered into a prospective, blinded, randomized clinical trial in which 50 patients received a Genesis II PS insert and 50 patients received a Genesis II HF insert (Smith & Nephew, Memphis, TN). At an average follow-up of 2.7 years (range, 2.3-3.1 years), there were no differences in any outcome measures (Western Ontario and McMaster Universities osteoarthritis index, Short-Form 12, Knee Society clinical rating scores, anterior knee pain). There were no differences (P = .811) in average knee flexion at 2 years (standard, 123 degrees +/- 7 degrees; HF, 124 degrees +/- 7 degrees). In summary, this prospective blinded randomized clinical trial demonstrated no differences between a PS and HF polyethylene design. Long-term evaluation will be required to comment on differences in polyethylene wear and implant longevity. PMID:19447001

  17. Loading model for the human femur taking the tension band effect of the ilio-tibial tract into account.

    PubMed

    Cordey, J; Borgeaud, M; Frankle, M; Harder, Y; Martinet, O

    1999-01-01

    A loading model permitting the application of relevant loads to the diaphysis and constructed on the basis of current knowledge of the biomechanics of the femur will be presented. This model takes into account the force acting through the ilio-tibial tract in the frontal plane and the forces acting on the condyles in the sagittal plane. There is compression on the femoral head and on the condyles and tension on the greater trochanter. Experimental verification using human cadaveric femora instrumented with strain gauges has shown that the adequate loading condition is: a line of force tangential to the femoral head a line of force tangential to the dorsal aspect of the distal junction of the diaphysis and metaphysis. Under these conditions, the calculated forces will accord well with values assessed in vivo. The model described here represents a simple procedure for experimental load application, producing realistic strain values. The proximal part of the bone is placed under tension on the dorsal aspect; the medial aspect is under compression. The strain pattern develops such that the tensile forces affect the anterior aspect distally and compression the dorsal aspect. PMID:10645366

  18. Humeral head resurfacing for fixed anterior glenohumeral dislocation

    PubMed Central

    Aldinger, P. R.; Kasten, P.; Rickert, M.; Loew, M.

    2007-01-01

    The purpose of this prospective study was to describe cementless humeral surface replacement arthroplasty (CHSRA) as a bone preserving treatment option for patients with fixed anterior glenohumeral dislocation. Ten patients with post-traumatic fixed anterior glenohumeral dislocation underwent CHSRA with a mean follow-up of 24months. All patients were evaluated clinically using the Constant score and with radiographs in two planes. There were two reoperations: one patient developed glenoid erosion and was revised and in another case redislocation occurred. Clinical or radiographical signs of implant loosening were not found. The humeral head centred in the glenoid in nine out of ten cases radiographically. The Constant score increased from 20 points preoperatively to 61 points postoperatively (p?anterior glenohumeral dislocation and bone defects of the humeral head. Good clinical results and a moderate complication rate were found in the short term. PMID:18092162

  19. Clinical Applications of Anterior Segment Optical Coherence Tomography

    PubMed Central

    Lim, Su-Ho

    2015-01-01

    Anterior segment optical coherence tomography (AS-OCT) was recently developed and has become a crucial tool in clinical practice. AS-OCT is a noncontact imaging device that provides the detailed structure of the anterior part of the eyes. In this review, the author will discuss the various clinical applications of AS-OCT, such as the normal findings, tear meniscus measurement, ocular surface disease (e.g., pterygium, pinguecula, and scleromalacia), architectural analysis after cataract surgery, post-LASIK keratectasia, Descemet's membrane detachment, evaluation of corneal graft after keratoplasty, corneal deposits (corneal dystrophies and corneal verticillata), keratitis, anterior segment tumors, and glaucoma evaluation (angle assessment, morphological analysis of the filtering bleb after trabeculectomy, or glaucoma drainage device implantation surgery). The author also presents some interesting cases demonstrated via AS-OCT. PMID:25821589

  20. Outcome of limb reconstruction system in open tibial diaphyseal fractures

    PubMed Central

    Ajmera, Anand; Verma, Ankit; Agrawal, Mukul; Jain, Saurabh; Mukherjee, Arunangshu

    2015-01-01

    Background: Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS) in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Materials and Methods: Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI) criteria. Results: Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm). The mean duration of bone transport was 13 weeks (range 8-30 weeks) with a mean time for LRS in place was 44 weeks (range 24-51 weeks). The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks) with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25), good in 12% (3/25) and fair in 4% (1/25) with union in all except 2 patients, which showed poor results (8%) with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25), good in 8% (2/25), fair in 8% (2/25). Pin tract infection was seen in 5 cases, out of which 4 being superficial, which healed to dressings and antibiotics. One patient had a deep infection which required frame removal. Conclusion: Limb reconstruction system proved to be an effective modality of treatment in cases of open fractures of the tibia with bone loss as definite modality of treatment for damage control as well as for achieving union and lengthening, simultaneously, with the advantage of early union with attainment of limb length, simple surgical technique, minimal invasive, high patient compliance, easy wound management, lesser hospitalization and the lower rate of complications like infection, deformity or shortening. PMID:26229164

  1. [The geometry of the keel determines the behaviour of the tibial tray against torsional forces in total knee replacement].

    PubMed

    Garca David, S; Cortijo Martnez, J A; Navarro Bermdez, I; Macul, F; Hinarejos, P; Puig-Verdi, L; Monllau, J C; Hernndez Hermoso, J A

    2014-01-01

    The keel design of the tibial tray is essential for the transmission of the majority of the forces to the peripheral bone structures, which have better mechanical proprieties, thus reducing the risk of loosening. The aim of the present study was to compare the behaviour of different tibial tray designs submitted to torsional forces. Four different tibial components were modelled. The 3-D reconstruction was made using the Mimics software. The solid elements were generated by SolidWorks. The finite elements study was done by Unigraphics. A torsional force of 6 Nm. applied to the lateral aspects of each tibial tray was simulated. The GENUTECH tibial tray, with peripheral trabecular bone support, showed a lower displacement and less transmitted tensions under torsional forces. The results suggest that a tibial tray with more peripheral support behaves mechanically better than the other studied designs. PMID:25037111

  2. Bioabsorbable expansion bolt fixation in anterior cruciate ligament reconstruction.

    PubMed

    Piltz, S; Steinbauer, T; Meyer, L; Plitz, W; Andress, H J; Lob, G

    2004-01-01

    The current study evaluated initial fixation strength of a bioabsorbable expansion bolt compared with interference screw fixation in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Thirty calf tibial plateaus with adjacent patella and extensor ligaments were used. Bioabsorbable poly-L-lactide interference screws were used for graft fixation in Group I, titanium screws in Group II, and bioabsorbable poly-DL-lactide expansion bolts were used in Group III. The mean force-to-failure (+/- standard deviation) in the three groups was 487 +/- 205 N, 713 +/- 218 N, and 594 +/- 224 N, respectively. The differences between Groups I and II were significant. No statistical differences were found regarding stiffness. Graft damage was significantly less in Group III compared with screw fixation. The fixation concept of an expansion bolt shows similar fixation strength and less graft damage compared with the established interference screw fixation. Because of the total absence of torque forces in contrast to bioabsorbable screws, the risk of implant breakage is minimized. PMID:15043122

  3. Histomorphometry of distraction osteogenesis in a caprine tibial lengthening model.

    PubMed

    Welch, R D; Birch, J G; Makarov, M R; Samchukov, M L

    1998-01-01

    Standardized histomorphometry of bone formation and remodeling during distraction osteogenesis (DO) has not been well characterized. Increasing the rhythm or number of incremental lengthenings performed per day is reported to enhance bone formation during limb lengthening. In 17 skeletally immature goats, unilateral tibial lengthenings to 20 or 30% of original length were performed at a rate of 0.75 mm/day and rhythms of 1, 4, or 720 times per day using standard Ilizarov external fixation and an autodistractor system. Two additional animals underwent frame application and osteotomy without lengthening and served as osteotomy healing controls. Histomorphometric indices were measured at predetermined regions from undecalcified tibial specimens. Within the distraction region, bone formation and remodeling activity were location dependent. Intramembranous bone formed linearly oriented columns of interconnecting trabecular plates of woven and lamellar type bone. Total new bone volume and bone formation indices were significantly increased within the distraction and osteotomy callus regions (Tb.BV/TV, 226% [p < 0.05]; BFR/BS, 235-650% [p < 0.01]) respectively, compared with control metaphyseal bone. Bone formation indices were greatest adjacent to the mineralization zones at the center of the distraction gap; mineral apposition rate 96% (p < 0.01); mineralized bone surfaces 277% [p < 0.001]); osteoblast surfaces 359% [p < 0.001]); and bone formation rate (650% [p < 0.01]). There was no significant difference (p < 0.14; R = 0.4) in the bone formation rate of the distracted callus compared with the osteotomy control callus. Within the original cortices of the lengthened tibiae, bone remodeling indices were significantly increased compared with osteotomy controls; activation frequency (200% [p < 0.05]); osteoclast surfaces (295% [p < 0.01]); erosion period (75%); porosity (240% [p < 0.001]). Neither the rhythm of distraction nor the percent lengthening appeared to significantly influence any morphometric parameter evaluated. Distraction osteogenesis shares many features of normal fracture gap healing. The enhanced bone formation and remodeling appeared to result more from increased recruitment and activation of bone forming and resorbing cells rather than from an increased level of individual cellular activity. PMID:9443783

  4. Fatigue strength of common tibial intramedullary nail distal locking screws

    PubMed Central

    Griffin, Lanny V; Harris, Robert M; Zubak, Joseph J

    2009-01-01

    Background Premature failure of either the nail and/or locking screws with unstable fracture patterns may lead to angulation, shortening, malunion, and IM nail migration. Up to thirty percent of all unreamed nail locking screws can break after initial weight bearing is allowed at 810 weeks if union has not occurred. The primary problem this presents is hardware removal during revision surgery. The purposes of our study was to evaluate the relative fatigue resistance of distal locking screws and bolts from representative manufacturers of tibial IM nail systems, and develop a relative risk assessment of screws and materials used. Evaluations included quantitative and qualitative measures of the relative performance of these screws. Methods Fatigue tests were conducted to simulate a comminuted fracture that was treated by IM nailing assuming that all load was carried by the screws. Each screw type was tested ten times in a single screw configuration. One screw type was tested an additional ten times in a two-screw parallel configuration. Fatigue tests were performed using a servohydraulic materials testing system and custom fixturing that simulated screws placed in the distal region of an appropriately sized tibial IM nail. Fatigue loads were estimated based on a seventy-five kilogram individual at full weight bearing. The test duration was one million cycles (roughly one year), or screw fracture, whichever occurred first. Failure analysis of a representative sample of titanium alloy and stainless steel screws included scanning electron microscopy (SEM) and quantitative metallography. Results The average fatigue life of a single screw with a diameter of 4.0 mm was 1200 cycles, which would correspond roughly to half a day of full weight bearing. Single screws with a diameter of 4.5 mm or larger have approximately a 50 percent probability of withstanding a week of weight bearing, whereas a single 5.0 mm diameter screw has greater than 90 percent probability of withstanding more than a week of weight bearing. If two small diameter screws are used, our tests showed that the probability of withstanding a week of weight bearing increases from zero to about 20 percent, which is similar to having a single 4.5 mm diameter screw providing fixation. Conclusion Our results show that selecting the system that uses the largest distal locking screws would offer the best fatigue resistance for an unstable fracture pattern subjected to full weight bearing. Furthermore, using multiple screws will substantially reduce the risk of premature hardware failure. PMID:19371438

  5. A Finite-Element Study of Metal Backing and Tibial Resection Depth in a Composite Tibia Following Total Knee Arthroplasty.

    PubMed

    Tokunaga, Susumu; Rogge, Renee D; Small, Scott R; Berend, Michael E; Ritter, Merrill A

    2016-04-01

    Prosthetic alignment, patient characteristics, and implant design are all factors in long-term survival of total knee arthroplasty (TKA), yet the level at which each of these factors contribute to implant loosening has not been fully described. Prior clinical and biomechanical studies have indicated tibial overload as a cause of early TKA revision. The purpose of this study was to determine the relationship between tibial component design and bone resection on tibial loading. Finite-element analysis (FEA) was performed after simulated implantation of metal backed (MB) and all-polyethylene (AP) TKA components in 5 and 15 mm of tibial resection into a validated intact tibia model. Proximal tibial strains significantly increased between 13% and 199% when implanted with AP components (p < 0.05). Strain significantly increased between 12% and 209% in the posterior tibial compartment with increased bone resection (p < 0.05). This study indicates elevated strains in AP implanted tibias across the entirety of the proximal tibial cortex, as well as a posterior shift in tibial loading in instances of increased resection depth. These results are consistent with trends observed in prior biomechanical studies and may associate the documented device history of tibial collapse in AP components with increased bone strain and overload beneath the prosthesis. PMID:26810930

  6. Posterior Tibial Tendon Insufficiency Results at Different Stages

    PubMed Central

    Page, Alexandra; Sung, Il-Hoon; OMalley, Martin J.; Inda, David; Choung, Steven

    2006-01-01

    The results of surgical treatment of posterior tibial tendon insufficiency (PTTI) may be different at different stages of the disease. No single study has compared the results at different stages. This comparison can be helpful to the patient and physician if the patient asks What if I wait and the disease progresses, how will my results be different? A preliminary study comparing results for stage IIa, stage IIb (advanced stage II), and stage III was performed followed by a larger study comparing IIa and IIb with 26 and 22 patients, respectively. American Orthopaedic Foot and Ankle Society (AOFAS) outcome scores as well as radiographs and functional questions were used. Nearly all patients, regardless of stage, felt they were helped by surgical treatment. However, the lowest AOFAS score was in stage III, the most advanced stage investigated in this study. In comparing stage IIa and IIb patients, stage IIb patients had a statistically higher incidence of lateral discomfort. Although statistically significant differences were not found in all comparisons, this study suggests that the results of surgical treatment for PTTI declines with increasing stage or severity of disease. PMID:18751830

  7. Nanoindentation Results from Direct Molded vs. Machined UHMWPE Tibial Bearings

    SciTech Connect

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

    1999-11-13

    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.

  8. Cementless fixation of the tibial component for the ICLH knee.

    PubMed Central

    Freeman, M A; Bradley, G W; Blaha, J D; Insler, H P

    1982-01-01

    The use of polymethylmethacrylate bone cement in joint replacement surgery is not without drawbacks. Certain hazards have been appreciated and the bone cement interface may not be as stable in the long run as was once felt. This paper reports the results in 52 knees which were replaced using the uncemented ICLH (Imperial College/London Hospital) tibial component; the average follow up was two years (range six months to four years). The results were compiled with regard to pain as well as clinical examination and X-ray evaluation. The results were comparable to those achieved in knees replaced using bone cement. Roentgenographic evaluation revealed no evidence of loosening nor sinkage of any of these prostheses. Considerations in the development of a knee prosthesis to be utilized without bone cement and the operative technique employed to implant such a prosthesis are presented. The merits of such a system are discussed. Images Figure 4. A Figure 4. B Figure 4. C Figure 5. A Figure 5. B Figure 5. C PMID:7086790

  9. Ovine Model for Critical-Size Tibial Segmental Defects

    PubMed Central

    Christou, Chris; Oliver, Rema A; Pelletier, Matthew H; Walsh, William R

    2014-01-01

    A segmental tibial defect model in a large animal can provide a basis for testing materials and techniques for use in nonunions and severe trauma. This study reports the rationale behind establishing such a model and its design and conclusions. After ethics approval of the study, aged ewes (older than 5 y; n = 12) were enrolled. A 5-cm mid diaphyseal osteoperiosteal defect was made in the left tibia and was stabilized by using an 8-mm stainless-steel cross-locked intramedullary nail. Sheep were euthanized at 12 wk after surgery and evaluated by using radiography, microCT, and soft-tissue histology techniques. Radiology confirmed a lack of hard tissue callus bridging across the defect. Volumetric analysis based on microCT showed bone growth across the 16.5-cm3 defect of 1.82 0.94 cm3. Histologic sections of the bridging tissues revealed callus originating from both the periosteal and endosteal surfaces, with fibrous tissue completing the bridging in all instances. Immunohistochemistry was used to evaluate the quality of the healing response. Clinical, radiographic, and histologic union was not achieved by 12 wk. This model may be effective for the investigation of surgical techniques and healing adjuncts for nonunion cases, where severe traumatic injury has led to significant bone loss. PMID:25402178

  10. Autocorrelation and cepstral methods for measurement of tibial cortical thickness.

    PubMed

    Wear, Keith A

    2003-06-01

    Cortical thickness of the tibia is related to stress fracture risk and overall skeletal status. Two methods are proposed for estimating tibial cortical thickness based on power spectra of ultrasonic echoes containing reflections from front and back surfaces of the cortex. The locations of the peaks in the autocorrelation function and the cepstrum are related to cortical thickness. Data were acquired on plastic plates in order to validate the methodology. These data indicate high correlations between estimated and true thickness with correlation coefficients r = 0.99, (95% confidence interval: 0.993-1.00) for the autocorrelation method and r = 0.99 (95% CI: 0.996-1.00) for the cepstral method. Data on six tibia samples in vitro indicate correlation coefficients of r = 0.92 (95% CI: 0.72-1.00) for the autocorrelation method and r = 0.85 (95% CI: 0.62-0.94) for the cepstral method. Estimates of precisions of the two methods were 0.3 +/- 0.1 mm (autocorrelation method) and 0.5 +/- 0.2 mm (cepstral method). One measurement in a human volunteer in vivo demonstrated clinical feasibility of the measurement and good agreement with cortical thickness assessed using peripheral quantitative computed tomography (QCT). This technology offers the promise of an inexpensive, fast, portable, simple, nonionizing technique for assessing skeletal status. PMID:12839177

  11. Material properties of articular cartilage in the rabbit tibial plateau

    PubMed Central

    Roemhildt, Maria L.; Coughlin, Kathryn M.; Peura, Glenn D.; Fleming, Braden C.; Beynnon, Bruce D.

    2010-01-01

    The material properties of articular cartilage in the rabbit tibial plateau were determined using biphasic indentation creep tests. Cartilage specimens from matched-pair hind limbs of rabbits approximately 4 months of age and greater than 12 months of age were tested on two locations within each compartment using a custom built materials testing apparatus. A three-way ANOVA was used to determine the effect of leg, compartment, and test location on the material properties (aggregate modulus, permeability, and Poisson's ratio) and thickness of the cartilage for each set of specimens. While no differences were observed in cartilage properties between the left and right legs, differences between compartments were found in each set of specimens. For cartilage from the adolescent group, values for aggregate modulus were 40% less in the medial compartment compared to the lateral compartment, while values for permeability and thickness were greater in the medial compartment compared to the lateral compartment (57% and 30%, respectively). Values for Poisson's ratio were 19% less in the medial compartment compared to the lateral compartment. There was also a strong trend for thickness to differ between test locations. Similar findings were observed for cartilage from the mature group with values for permeability and thickness being greater in the medial compartment compared to the lateral compartment (66% and 34%, respectively). Values for Poisson's ratio were 22% less in the medial compartment compared to the lateral compartment. PMID:16168420

  12. Tibial Lengthening: Extraarticular Calcaneotibial Screw to Prevent Ankle Equinus

    PubMed Central

    Belthur, Mohan V.; Paley, Dror; Jindal, Gaurav; Burghardt, Rolf D.; Specht, Stacy C.

    2008-01-01

    Between 2003 and 2006, we used an extraarticular, cannulated, fully threaded posterior calcaneotibial screw to prevent equinus contracture in 10 patients (four male and six female patients, 14 limbs) undergoing tibial lengthening with the intramedullary skeletal kinetic distractor. Diagnoses were fibular hemimelia (two), mesomelic dwarfism (two), posteromedial bow (one), hemihypertrophy (one), poliomyelitis (one), achondroplasia (one), posttraumatic limb-length discrepancy (one), and hypochondroplasia (one). Average age was 24.5years (range, 1554years). The screw (length, typically 125mm; diameter, 7mm) was inserted with the ankle in 10 dorsiflexion. Gastrocnemius soleus recession was performed in two patients to achieve 10 dorsiflexion. Average lengthening was 4.9cm (range, 37cm). Screws were removed after a mean 3.3months (range, 26months). Preoperative ankle range of motion was regained within 6months of screw removal. No neurovascular complications were encountered, and no patients experienced equinus contracture. We also conducted a cadaveric study in which one surgeon inserted screws in eight cadaveric legs under image intensifier control. The flexor hallucis longus muscle belly was the closest anatomic structure noted during dissection. The screw should be inserted obliquely from upper lateral edge of the calcaneus and aimed lateral in the tibia to avoid the flexor hallucis longus muscle. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18800215

  13. Anterior urethroplasty--changing concepts.

    PubMed

    Motiwala, H G; Visana, K N; Joshi, S P; Patel, P C

    1992-01-01

    The management of complex anterior urethral strictures, not amendable to dilatation or internal urethromotomy, is difficult. Our experience of treating long strictures of anterior urethra with one-stage urethroplasty in 16 cases and two-stage Johanson's in 12 cases are reviewed here. The strictures had varied etiology and many were associated with fistula, diverticulum, etc. Three cases had concomitant posterior urethral strictures and were managed by one-stage anterior and posterior urethroplasty simultaneously. The one-stage repair was done using vascularized flap of longitudinal ventral penile skin in most cases. Transverse scrotal flap and Duckket's transverse preputial flap were utilized in 2 cases each. In one-stage repair success was 100% and in two-stage repair it was 75%. Our preference is now for one-stage repair irrespective of length and number of strictures. PMID:1589924

  14. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel.

    PubMed

    Harner, Christopher D; Honkamp, Nicholas J; Ranawat, Anil S

    2008-01-01

    There has been a renewed focus on anterior cruciate ligament (ACL) insertional anatomy and its biomechanics. It has been postulated that traditional single-bundle transtibial reconstructions have placed grafts in a less anatomic location relative to the true ACL insertion site. In traditional transtibial techniques, the femoral tunnel is predetermined by the position of the tibial tunnel. It is our belief that achieving the most anatomic position for the graft requires the femoral and tibial tunnels to be drilled independently. Use of the anteromedial portal technique provides us with more flexibility in accurately placing the femoral tunnel in the true ACL insertion site as compared with the transtibial technique. Advantages include anatomic tunnel placement, easy preservation of any remaining ACL fibers when performing ACL augmentation procedures, and flexibility in performing either single- or double-bundle reconstructions in primary or revision settings. This technique is not limited by the choice of graft or fixation and offers the advantage of true parallel screw placement through the same portal as that used for tunnel drilling in the case of interference fixation. PMID:18188873

  15. The effects of knee joint kinematics on anterior cruciate ligament injury and articular cartilage damage.

    PubMed

    Orsi, Alexander D; Chakravarthy, Srinath; Canavan, Paul K; Peña, Estefanía; Goebel, Ruben; Vaziri, Askhan; Nayeb-Hashemi, Hamid

    2016-04-01

    This study determined which knee joint motions lead to anterior cruciate ligament (ACL) rupture with the knee at 25° of flexion. The knee was subjected to internal and external rotations, as well as varus and valgus motions. A failure locus representing the relationship between these motions and ACL rupture was established using finite element simulations. This study also considered possible concomitant injuries to the tibial articular cartilage prior to ACL injury. The posterolateral bundle of the ACL demonstrated higher rupture susceptibility than the anteromedial bundle. The average varus angular displacement required for ACL failure was 46.6% lower compared to the average valgus angular displacement. Femoral external rotation decreased the frontal plane angle required for ACL failure by 27.5% compared to internal rotation. Tibial articular cartilage damage initiated prior to ACL failure in all valgus simulations. The results from this investigation agreed well with other experimental and analytical investigations. This study provides a greater understanding of the various knee joint motion combinations leading to ACL injury and articular cartilage damage. PMID:26068032

  16. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

    PubMed Central

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

  17. Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management

    PubMed Central

    Chen, Hong-Wei; Chen, Chang-Qing; Yi, Xian-Hong

    2015-01-01

    Purpose: To establish a classification system for the different types of posterior tibial plateau fractures (PTPF), and to explore the fracture patterns and early results of treatment. Methods: 39 PTPFs patients who received surgeries through posteromedial or (and) posterolateral knee approaches were analyzed retrospectively. Results: There were 5 types of PTPFs identified in the new classification system: posteromedial split fracture (type I, 7 patients), posterolateral split fracture (type II, 5 patients), posterolateral depression fracture (type III, 11 patients), posterolateral split and depression fracture (type IV, 2 patients), and posteromedial split combined with posterolateral depression fracture (type V, 14 patients). All patients underwent surgeries safely without complications. The average follow up was 18.1 months (12-30 months). The average weight-bearing durations were 15.6 weeks (12-20 weeks). Based on Rasmussen functional scoring system, 20 cases were regarded as excellent, 14 were good, 5 were fair, and 0 was poor. There was significant change in the Rasmussen functional score before (8.38 2.87) and after surgery (24.20 3.44). According to Rasmussen radiology system, 28 cases were excellent, 8 cases were good, 3 were fair, and none was poor. There was also a significant difference detected between pre-operation (6.77 2.27) and post-operation (16.41 2.65). Conclusion: This study presents a new classification system for the different types of PTPFs based on the treatment. The classification is clinically relevant and can be used to guide the surgical management. PMID:25785019

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

    PubMed

    Nuccion, S L; Hame, S L

    2001-02-01

    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

  19. Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament.

    PubMed

    Fleming, B; Beynnon, B D; Johnson, R J; McLeod, W D; Pope, M H

    1993-01-01

    This study was designed to compare the displacement patterns of an isometer, used to determine graft placement during reconstruction, with the actual tensions on an anterior cruciate ligament substitute. In cadaveric specimens, a Kevlar anterior cruciate ligament substitute was implanted in three separate femoral sites, each of which was subsequently fixed to two different tibial sites. The initial tension of the Kevlar substitute was set to 22 or 33 N at 20 degrees of knee flexion. The displacement patterns for each position were recorded during passive flexion-extension using the isometer. Using a custom-designed tensiometer, the tensile forces on the substitute after rigid fixation at the tibia and femur were measured. During passive flexion-extension, the maximum change in tension of the anterior cruciate ligament substitute, measured by the tensiometer, was correlated with the maximum change in displacement between attachment sites, measured by the isometer. The coefficient of determination was equal to 0.15, indicating that the isometer may not accurately predict the tensions developed in the substitute. PMID:8427374

  20. Surface damage analysis of retrieved highly crosslinked polyethylene tibial components after short-term implantation.

    PubMed

    Willie, B M; Foot, L J; Prall, M W; Bloebaum, R D

    2008-04-01

    The use of highly crosslinked polyethylene (PE) in the knee remains controversial, because of reduced fatigue fracture properties of the material. The current study investigated postmelt surface damage as well as potential contributors to this damage in retrieved highly crosslinked PE tibial components, after short-term in vivo durations. Retrieved conventional PE tibial components were examined for comparison, as well as unused time zero highly crosslinked and conventional PE tibial components for inherent manufacturing surface characterization. Predominant surface damage modes on highly crosslinked PE components were machine mark loss and abrasion, while conventional PE components primarily had machine mark loss, abrasion, and delamination. In vivo duration, PE thickness, and conformity of the design were significant predictors of surface damage on retrieved conventional PE components. Donor weight and the conformity of the design were significant predictors of surface damage on retrieved highly crosslinked PE components. This retrieval data on highly crosslinked PE tibial components suggest that in vivo wear occurred, observed as postmelt surface damage. The highly crosslinked Durasul material examined in this retrieval study appeared to outperform the conventional PE components made from 4150 resin, ram-extruded and gamma-sterilized in air, but not the conventional components made from 1020 resin, compression molding and gamma sterilization in nitrogen. Early retrieval data of highly crosslinked PE tibial components are important to serve as a benchmark to be compared with future longer-term retrieval studies investigating whether surface damage translates to clinically relevant particulate wear debris generation and PE clinical performance. PMID:17806108

  1. Comparison of the tibial mechanical joint orientation angles in dogs with cranial cruciate ligament rupture

    PubMed Central

    Fuller, Mark C.; Kapatkin, Amy S.; Bruecker, Kenneth A.; Holsworth, Ian G.; Kass, Philip H.; Hayashi, Kei

    2014-01-01

    Use of the tibial mechanical joint orientation angles is now the standard of care for evaluating tibial deformities, although they have not been used to evaluate dogs with cranial cruciate ligament (CrCL) rupture. The objective of this study was to compare the tibial mechanical joint orientation angles and tibial plateau angle (TPA) between dogs with bilateral CrCL rupture (BR) and unilateral CrCL rupture with (UR-SR) and without subsequent contralateral CrCL rupture (UR-w/o-SR) as risk factors for subsequent contralateral CrCL rupture. Twenty dogs (21.7%) were classified as BR, 38 (41.3%) were classified as UR-SR, and 34 (37.0%) were classified as UR-w/o-SR. The tibial mechanical joint orientation angles and TPA, in the range studied (< 35), were not statistically different for dogs with BR, UR-SR, and UR-w/o-SR, and were not significant risk factors for subsequent contralateral CrCL rupture. PMID:25082991

  2. Posterior tibial nerve block. A new approach using the bony landmark of the sustentaculum tali.

    PubMed

    Wassef, M R

    1991-10-01

    A local analgesic block of the posterior tibial nerve, using a new subcalcaneal approach, is described. The point of insertion of the needle is defined in relation to a bony prominence below the medial malleolus, the sustentaculum tali, to which the posterior tibial nerve bears a constant relationship. Twenty patients given a posterior tibial block using the subcalcaneal approach were compared with 20 patients in whom a traditional retrotibial approach was used. In this technique the major landmark for needle insertion is the posterior tibial artery. In all patients the techniques formed part of an ankle block for foot surgery. Eighty-five to 90% of patients had peripheral vascular disease and in 60-65% the posterior tibial artery was not palpable. In the group of patients without palpable pulses, the subcalcaneal approach had a success rate of 100%, whereas all those having the retrotibial approach required additional local analgesic supplements (p less than 0.001). The subcalcaneal approach is simple and is particularly recommended for patients with peripheral vascular disease. PMID:1951998

  3. TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft

    PubMed Central

    Nancoo, Tamara J.; Lord, Breck; Yasen, Sam K.; Smith, James O.; Risebury, Michael J.; Wilson, Adrian J.

    2013-01-01

    Surgical reconstruction of the posterior cruciate ligament (PCL) is technically demanding. Potential challenges include visualization of the tibial footprint and drilling of the tibial tunnel without damaging posterior neurovascular structures, as well as graft selection, deployment, tensioning, and fixation. We present a novel TransMedial all-inside arthroscopic technique (technique designed by A. J. Wilson with support from Arthrex) using a single hamstring tendon graft, fixed with adjustable cortical suspensory devices. The technique simplifies the difficult steps encountered during PCL reconstruction and is safe and reproducible. All arthroscopic viewing is accomplished from the lateral portal, and femoral socket preparation is performed from the medial side with specially contoured instruments, which allow accurate marking, measuring, and anatomic positioning of the graft. The quadrupled semitendinosus graft can be augmented with composite polymer tape for increased strength and initial stability. We use outside-in drilling to create retrograde femoral and tibial sockets. Cortical suspensory fixation on the tibial side can be supplemented with anchor fixation. We use an arthroscopic tibial inlay technique that better approximates native knee anatomy. This also avoids the killer turn, a problem seen in transtibial PCL reconstruction techniques, which theoretically induces graft laxity due to abrasion with cyclic loading. This technique can be further adapted to allow a modified double-bundle or TriLink graft (technique designed by A. J. Wilson with support from Arthrex.). PMID:24400186

  4. Anatomic anterior cruciate ligament reconstruction with a flexible reamer system and 70 arthroscope.

    PubMed

    Rasmussen, Jeffrey F; Lavery, Kyle P; Dhawan, Aman

    2013-01-01

    Anterior cruciate ligament (ACL) reconstruction techniques continue to evolve as surgeons seek to improve surgical process and outcome measures. On the basis of published data showing improved biomechanics, many surgeons now attempt to better re-create native ACL anatomy in reconstruction. Use of flexible reamer technology and a 70 arthroscope allows for excellent visualization of the native ACL anatomy, as well as precise and independent drilling of the tibial and femoral reconstruction tunnels, while offering several surgical and technical advantages compared with other drilling techniques. This technical note with accompanying video describes our use of the Smith & Nephew Clancy anatomic cruciate guide/flexible drill system (Smith & Nephew, London, England) with a 70 arthroscope. PMID:24400174

  5. Arthroscopic Suture Fixation in Femoral-Sided Avulsion Fracture of Anterior Cruciate Ligament

    PubMed Central

    Prasathaporn, Niti; Umprai, Vantawat; Laohathaimongkol, Thongchai; Kuptniratsaikul, Somsak; Kongrukgreatiyos, Kitiphong

    2015-01-01

    A femoral-sided avulsion fracture of the anterior cruciate ligament (ACL) is a rare and challenging condition. Most reported cases have occurred in childhood or adolescence. Many techniques of ACL repair have been reported, and in recent years, techniques in arthroscopic surgery have been developed and have become ever more popular with orthopaedic surgeons. We created a technique of arthroscopic ACL repair with suture anchor fixation for a femoral-sided ACL avulsion fracture. This technique saves the natural ACL stump. It is available for cases in which creation of a tibial tunnel is not allowed. Moreover, it does not require a skin incision for fixation on the far femoral cortex and, therefore, does not require a second operation to remove the fixation device. The arthroscopic technique also has a good cosmetic outcome. PMID:26258035

  6. Anatomic Factors that May Predispose Female Athletes to Anterior Cruciate Ligament Injury.

    PubMed

    Cheung, Edward C; Boguszewski, Daniel V; Joshi, Nirav B; Wang, Dean; McAllister, David R

    2015-01-01

    Female athletes are 2 to 10 times more likely to injure their anterior cruciate ligaments (ACL) than male athletes. There has been greater recognition of this gender discrepancy because female participation in competitive athletics has increased. Previous investigators have divided risk factors into hormonal, neuromuscular response, and anatomic subgroups. Gender variation within these groups may help explain the higher incidence of ACL injury in women. The purpose of this article is to review research examining female-specific anatomy that may predispose women to ACL injury. Specifically, we discuss how women may have increased tibial and meniscal slopes, narrower femoral notches, and smaller ACL, which may place the ACL at risk from injury. These anatomic factors, combined with other female-specific risk factors, may help physicians and researchers better understand why women appear to be more prone to ACL injury. PMID:26359837

  7. Arthrose due au genu varum: traitement par osteotomie tibiale de valgisation

    PubMed Central

    Moussa, Abdou Kadri; Lukulunga, Loubet Unyendje; Mahfoud, Mustapha; El Bardouni, Ahmed; Ismail, Farid; Kharmaz, Mohamed; Berrada, Mohammed Saleh; El Yaacoubi, Moradh

    2014-01-01

    Le traitement du genu varum est le plus souvent conservateur (ostéotomie tibiale de valgisation) permettant de corriger le trouble architectural afin de rétablir l'axe physiologique du membre inférieur. Le but de l’étude était d’évaluer les résultats du traitement et comparer à ceux de la littérature. Il s'est agi d'une étude rétrospective portant sur des patients présentant un genu varum qui s'est déroulée dans le Service de Chirurgie Orthopédique et Traumatologie de CHU Ibn SINA de RABAT, sur une période de 9 ans (2000 au 31 Décembre 2008). Nous avons inclus dans notre étude: les patients qui avaient un genu-varum clinique avec examen radiographique standard ainsi qu'un pangonogramme; traités par différents procédés d'ostéotomie tibiale de valgisation; avec un suivis d’ au moins deux ans. Nos critères d’évaluation ont été appréciés selon le score HSS. Nous avons colligé 115 cas de genu-varum par ostéotomie de valgisation. L’âge de nos patients variait entre 40 et 69 ans, avec une moyenne de 53 ans. Le pic de fréquence se situait entre 52et 63 ans. Le sexe féminin prédominait avec 87 cas (75,6%) avec un sex ratio 3,1. Un Indice de masse corporelle supérieur à 30 a été noté dans 44 cas (38%). Quant aux antécédents chirurgicaux,18 patients de la série (soit 14%) ont été opérés pour le genu varum d'un autre genou. Le délai de consultation a varié entre 4 mois à 6 ans, avec une moyenne de 2 ans. La douleur était le principal motif de consultation et était de siège médial dans 70% des cas et bicompartimental dans 30% cas. Il s'agissait d'une douleur mécanique dans 76% des cas, mixte 21% des cas et inflammatoire 4% des cas. La déformation du genou appréciée par l’écart intercondylien a été en moyenne de 8,7 cm avec des extrêmes de 3 cm et 33cm. Le bilan de l'imagerie médicale reposait essentiellement sur les radiographies standards du genou de face et de profil, ainsi que la goniométrie. Ces clichés nous ont permis de classer l'arthrose du genou selon Ahlbäck. 72,5% des patients, présentaient une arthrose débutante. Le pangonogramme a été réalisé pour mesurer la déviation axiale du génu varum. La déviation angulaire: HKA (angle entre le centre de la tête fémorale et le milieu de la cheville) préopératoire a varié entre 163° et 176°, soit une moyenne de 175,46°. Une correction moyenne de déviation de 11,3° a été réalisée avec des extrêmes de 7 à 19°. Cet angle de correction (DAC) qui variait de 7 à 19° a été supérieur à 15° dans 57,39%s inférieur à 15° chez 38%. 27,4% des patients avaient une déviation angulaire importante avec une arthrose avancée. Après un bilan préopératoire et une planification opératoire 73% des patients ont été opérés sous anesthésie loco-régionale. Pour l'ostéotomie tibiale de fermeture, la voie d'abord a été la voie de Gernez antérolatérale, utilisée chez 56 cas (48,6%), l'ostéotomie tibiale d'ouverture (la voie d'abord était Gernez antéro-médiale) effectuée dans 20 cas (17,3%);et l'ostéotomie curviplane, a été réalisée par une voie d'abord longitudinale médiane dans 39%. Les ostéosynthèses ont été réalisées dans 51 cas (44,3%) par les agrafes de Blount, dans 54 cas (46,9%) par la plaque en T ou en L et dans 11 cas par une plaque en col de cygne. En per-opératoire nous avons enregistré deux (02) cas de fractures du plateau tibial médial, en post-opératoire on a eu 1 cas d'infection superficielle et comme complications tardives une raideur du genou (18,2%) et 3,4% de pseudarthrose, une récidive du génu varum dans 19,1% (n = 22) après 3 années de recul. Les résultats du traitement ont été bons dans 78,4% selon le score HSS. L'OTV sur genu varum a été réalisé chez des patients relativement âgés avec la prédominance du sexe féminin. Les techniques utilisées dépendaient de la préférence du chirurgien. Les résultats sont probants malgré la fréquence des récidives. Quelle que soit la technique utilisée les résultats sont satisfaisants, et malgré l’âge élevé l'OTV pourrait être une alternative intéressante et toujours d'actualité dans nos pays où la population est à majorité analphabète avec un niveau socioéconomique bas. PMID:25810807

  8. Cortical tibial osteoperiosteal flap technique to achieve bony bridge in transtibial amputation: experience in nine adult patients.

    PubMed

    Mongon, Mauricio Leal; Piva, Felipe Alberto; Mistro Neto, Sylvio; Carvalho, Jose Andre; Belangero, William Dias; Livani, Bruno

    2013-04-01

    Amputation, especially of the lower limbs, is a surgical procedure that gives excellent results when conducted under the appropriate conditions. In 1949 Ertl developed a technique for transtibial osteomyoplastic amputation which restored the intraosseous pressure through canal obliteration and expanded the area of terminal support through a bony bridge between the fibula and distal tibia. The aim of this study was to investigate the effectiveness of a modification of the original Ertl's technique in which a cortical osteoperiosteal flap created from the tibia is used to form a bony bridge during transtibial amputation in adults. Nine patients underwent leg amputations with the cortical tibial osteoperiosteal flap technique for reconstruction of the stump. The average duration of follow-up was 30.8 (range, 18-41) months. The post-surgery examination included a clinical examination and radiography. A 6-min walk test (Enright in Respir Care 48(8):783-785, 2003) was performed in the 32nd week after amputation. At 24th week post-surgery, all patients had stumps that were painless and able to bear full weight through the end. The creation of a cortical osteoperiosteal flap from the tibia to the fibula during transtibial amputation is a safe and effective technique that provides a strong and painless terminal weight-bearing stump. This constitutes a useful option for young patients, athletes, and patients with high physical demands. PMID:23371841

  9. Pulsed electromagnetic stimulation in nonunion of tibial diaphyseal fractures

    PubMed Central

    Gupta, Anil Kumar; Srivastava, Kailash Prasad; Avasthi, Sachin

    2009-01-01

    Background: Nonunion of long bones is a difficult clinical problem and challenges the clinical acumen of surgeons. Multiple surgical or nonsurgical modalities have been used to treat nonunions. Noninvasive pulsed electromagnetic stimulation is an entity known to affect the piezoelectric phenomenon of bone forming cells. We conducted a study on 45 long-bone fractures of tibia treated by pulsed electromagnetic stimulation, which are analyzed and reported. Materials and Methods: A total of 45 tibial fractures with established atrophic nonunion were enrolled between 1981 and 1988. All the patients had abnormal mobility and no or minimal gap at fracture site with no evidence of callus formation across the fracture site. The patients' age ranged between 24 and 68 years; 40 were men and 5 were women. All patients having evidence of infection, implant in situ, and gap nonunions were excluded from study. Pulsed electromagnetic stimulation was given using above-knee plaster of Paris cast (0.008 Weber/m2 magnetic field was created for 12 h/day). The average duration for pulsed electromagnetic stimulation (PEMS) therapy was 8.35 weeks, with the range being 612 weeks. The cases were evaluated at 6 weeks and subsequently every 6-weekly interval for clinical and radiological union. The withdrawal of therapy was decided as per clinicoradiological evidence of union. Results: All but three patients showed evidence of union. About 35% (n = 16) cases showed union in 10 weeks, and 85%(n = 38) cases showed union in 4 months. The average duration of therapy using PEMS was 8.350.48 weeks, and the average duration of immobilization was 3.02 0.22 months. Three cases that did not show evidence of union were poorly compliant for the apparatus of PEMS. Conclusion: PEMS is a useful noninvasive modality of treatment for difficult nonunion of long bones. PMID:19838364

  10. Topographic distribution of the tibial somatosensory evoked potential using coherence.

    PubMed

    Melges, D B; Infantosi, A F C; Miranda de S, A M F L

    2008-12-01

    The objective of the present study was to determine the adequate cortical regions based on the signal-to-noise ratio (SNR) for somatosensory evoked potential (SEP) recording. This investigation was carried out using magnitude-squared coherence (MSC), a frequency domain objective response detection technique. Electroencephalographic signals were collected (International 10-20 System) from 38 volunteers, without history of neurological pathology, during somatosensory stimulation. Stimuli were applied to the right posterior tibial nerve at the rate of 5 Hz and intensity slightly above the motor threshold. Response detection was based on rejecting the null hypothesis of response absence (significance level alpha= 0.05 and M = 500 epochs). The best detection rates (maximum percentage of volunteers for whom the response was detected for the frequencies between 4.8 and 72 Hz) were obtained for the parietal and central leads mid-sagittal and ipsilateral to the stimulated leg: C4 (87%), P4 (82%), Cz (89%), and Pz (89%). The P37-N45 time-components of the SEP can also be observed in these leads. The other leads, including the central and parietal contralateral and the frontal and fronto-polar leads, presented low detection capacity. If only contralateral leads were considered, the centro-parietal region (C3 and P3) was among the best regions for response detection, presenting a correspondent well-defined N37; however, this was not observed in some volunteers. The results of the present study showed that the central and parietal regions, especially sagittal and ipsilateral to the stimuli, presented the best SNR in the gamma range. Furthermore, these findings suggest that the MSC can be a useful tool for monitoring purposes. PMID:19148367

  11. Management of distal tibial intra-articular fractures with circular external fixation

    PubMed Central

    Lovisetti, G.; Agus, M. A.; Pace, F.; Capitani, D.

    2009-01-01

    The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures. PMID:19296203

  12. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings.

    PubMed

    Reinitz, Steven D; Currier, Barbara H; Van Citters, Douglas W; Levine, Rayna A; Collier, John P

    2015-04-01

    This investigation analyzed retrieved sequentially crosslinked and annealed (SXL) ultra-high molecular weight polyethylene bearings to determine whether the material is chemically stable in vivo. A series of retrieved tibial and acetabular components were analyzed for changes in ketone oxidation, crosslink density, and free radical concentration. Oxidation was observed to increase with in vivo duration, and the rate of oxidation in tibial inserts was significantly greater than in acetabular liners. SXL acetabular bearings oxidized at a rate comparable to gamma-sterilized liners, while SXL tibial inserts oxidized at a significantly faster rate than their gamma-sterilized counterparts. A significant decrease in crosslink density with increased mean ketone oxidation index was observed, suggesting that in vivo oxidation may be causing material degradation. Furthermore, a subsurface whitened damage region was also found in a subset of the bearings, indicating the possibility of a clinically relevant decrease in mechanical properties of these components. PMID:24956572

  13. Cannulated screw and hexapodal fixator reconstruction for compound upper tibial fractures

    PubMed Central

    Uzun, Metin; Bilen, Fikri Erkal; Eralp, Levent

    2014-01-01

    Objectives: The aim of the treatment of tibial plateau fractures is to obtain a pain-free and fully functional knee with closed reduction, percutaneous cannulated screw fixation and hexapodal external fixator reconstruction for high energy compound upper tibial fractures. Methods: Patients with comminuted tibial plateau fractures underwent closed reduction, percutaneous fixation with cannulated screws, and reconstruction with hexapodal external fixator. The follow-up period was 24 months. Results: The clinical and radiological results were good or excellent. The average knee flexion was 125. Conclusion: Our results are successful in the initial stage, however, it should be pointed out that during the long term follow-up osteoarthritis may develop leading to worsening of the condition. Level of Evidence IV, Case Series. PMID:24644420

  14. A Qualitative Study of Recovery from Type III-B and III-C Tibial Fractures

    PubMed Central

    Shauver, Melissa S.; Aravind, Maya S.; Chung, Kevin C.

    2011-01-01

    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. PMID:20948418

  15. Management of distal tibial intra-articular fractures with circular external fixation.

    PubMed

    Lovisetti, G; Agus, M A; Pace, F; Capitani, D; Sala, F

    2009-04-01

    The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures. PMID:19296203

  16. Extramedullary versus intramedullary tibial alignment technique in total knee arthroplasty: A meta-analysis of randomized controlled trials

    PubMed Central

    Zeng, Huan Bei; Ying, Xiao Zhou; Chen, Guang Jun; Yang, Xia Qing; Lin, Duo Duo; Li, Zhi Jie; Liu, Hai Xiao

    2015-01-01

    The aim of this study was to establish whether the use of an extramedullary or intramedullary tibial cutting guide leads to superior mechanical leg axis and implant positioning. A meta-analysis of six randomized controlled trials including 350 knees was performed. For the mechanical axis, frontal tibial component angle and tibial slope, there were no significant differences in the mean values or the number of outliers (±3°) between the extramedullary and intramedullary groups. A reduced tourniquet time was associated with the intramedullary guide. No significant difference in the complication rate was noted between the two groups. Neither extramedullary nor intramedullary tibial alignment was more accurate in facilitating the tibial cut. Use of an intramedullary guide results in a shorter tourniquet time and exhibits a similar complication rate as the extramedullary guide. PMID:26598086

  17. Return of functional mobility after an open tibial fracture: a sensor-based longitudinal cohort study using the Hamlyn Mobility Score.

    PubMed

    Kwasnicki, R M; Hettiaratchy, S; Okogbaa, J; Lo, B; Yang, G-Z; Darzi, A

    2015-08-01

    In this study we quantified and characterised the return of functional mobility following open tibial fracture using the Hamlyn Mobility Score. A total of 20 patients who had undergone reconstruction following this fracture were reviewed at three-month intervals for one year. An ear-worn movement sensor was used to assess their mobility and gait. The Hamlyn Mobility Score and its constituent kinematic features were calculated longitudinally, allowing analysis of mobility during recovery and between patients with varying grades of fracture. The mean score improved throughout the study period. Patients with more severe fractures recovered at a slower rate; those with a grade I Gustilo-Anderson fracture completing most of their recovery within three months, those with a grade II fracture within six months and those with a grade III fracture within nine months. Analysis of gait showed that the quality of walking continued to improve up to 12 months post-operatively, whereas the capacity to walk, as measured by the six-minute walking test, plateaued after six months. Late complications occurred in two patients, in whom the trajectory of recovery deviated by > 0.5 standard deviations below that of the remaining patients. This is the first objective, longitudinal assessment of functional recovery in patients with an open tibial fracture, providing some clarification of the differences in prognosis and recovery associated with different grades of fracture. PMID:26224831

  18. Symptomatic Anterior Cervical Osteophyte Causing Dysphagia: Case Report, Imaging, and Review of the Literature

    PubMed Central

    Sung, Kwang; Tharin, Suzanne

    2016-01-01

    Anterior cervical osteophytes are found in 20-30% of elderly patients. Rarely, severe osteophytes can cause dysphagia, dysphonia, and dyspnea. Here, we illustrate a case of severe dysphagia caused by a large post-traumatic osteophyte with oropharyngeal swallow study showing a significant mass effect on the pharynx and resolution following osteophytectomy. We also review the literature regarding the etiology, diagnosis, and treatment of symptomatic anterior cervical osteophytes. 

  19. Intra-articular Osteotomy for Correction of Malunions and Nonunions of the Tibial Pilon.

    PubMed

    Rammelt, Stefan; Zwipp, Hans

    2016-03-01

    Malunions of the tibial pilon lead to painful posttraumatic ankle arthritis and malposition of the hindfoot with severe functional disability. Most will need corrective ankle fusion as a salvage procedure. Joint-preserving correction with secondary anatomic reconstruction for intra-articular malunions is possible only in carefully selected patients with intact cartilage, sufficient bone quality, residual function, and good compliance. Osteotomies of solid malunions are planned according to preoperative computed tomography scans. Bone grafting is needed after resection of a fibrous nonunion or sclerotic or necrotic bone. Especially in young patients, anatomic reconstruction of malunited tibial pilon fractures is a viable treatment alternative. PMID:26915779

  20. Management of Aseptic Tibial and Femoral Diaphyseal Nonunions Without Bony Defects.

    PubMed

    Brinker, Mark R; O'Connor, Daniel P

    2016-01-01

    An evidence-based description of aseptic tibial and femoral diaphyseal nonunions without segmental defects is based on a systematic search of MEDLINE. Aseptic nonunion of the femoral or tibial diaphysis without segmental defects and with an in situ nail, treated with reamed exchange nailing or augmentative plating and bone grafting, has consistently high union rates. Aseptic nonunion without segmental defects and with in situ plate and screw fixation is best managed with revision plate and screw fixation and autogenous bone graft. Various techniques and methods of biological stimulation have relatively high union rates. PMID:26614922

  1. Tibial tuberosity advancement in two cats with cranial cruciate ligament deficiency.

    PubMed

    Perry, K; Fitzpatrick, N

    2010-01-01

    Two Domestic Shorthaired cats were diagnosed with longstanding lameness attributed to cranial cruciate ligament deficiency without any history of trauma. One cat had a previous operation in which the lateral nylon suture technique was used, and the other cat was affected by a partial tear of the cranial cruciate ligament. Tibial tuberosity advancement was carried out in both patients, which resulted in long-term resolution of lameness for both. The results of these cases concur with previous studies performed on canine patients in terms of viability of technical application and satisfactory return to weight bearing postoperatively. Further investigation of tibial tuberosity advancement in feline patients is justified. PMID:20422116

  2. Update on anterior ankle impingement.

    PubMed

    Vaseenon, Tanawat; Amendola, Annunziato

    2012-06-01

    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

  3. Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

  4. Success of High Tibial Osteotomy in the United States Military

    PubMed Central

    Waterman, Brian R.; Hoffmann, Jeffrey D.; Laughlin, Matthew D.; Burks, Robert; Pallis, Mark P.; Tokish, John M.; Belmont, Philip J.

    2015-01-01

    Background: Historically, high tibial osteotomy (HTO) has been performed to treat isolated medial gonarthrosis with varus deformity. Purpose: To evaluate the occupational outcomes of HTO in a high-demand military cohort. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective analysis of active duty service members undergoing HTO for coronal plane malalignment and/or intra-articular pathology was performed using the Military Health System between 2003 and 2011. Demographic parameters and surgical variables, including rates of perioperative complications, secondary surgery, activity limitations, and medical discharge, were extracted from electronic medical records. For the current study, cumulative failure was defined as conversion to knee arthroplasty or postoperative medical discharge for persistent knee dysfunction. Univariate and multivariate analyses were performed to identify statistical associations with cumulative failure after HTO. Results: A total of 181 service members (202 HTOs) were identified at an average follow-up of 47.5 months (range, 24-96 months). Mean age was 35.7 years (range, 19-55 years), and the majority were men (93%) and of enlisted rank (78%). All index procedures utilized a valgus-producing, opening wedge technique. Concomitant or staged procedures were performed in 87 patients (48%), including 40 ligamentous, 48 meniscal, and 48 chondral procedures. Complications occurred in 19.3% of knees (n = 39), with unplanned reoperation in 26 knees (12.8%). Fifty-three patients (40.7%) had minor activity limitations during military duty postoperatively. Eleven knees (5.4%) underwent conversion to total knee arthroplasty. The cumulative failure rate was 28.2% (n = 51) at 2- to 8-year follow-up. Patient age younger than 30 years at the time of surgery was associated with an independently higher risk of failure, whereas sex, concomitant/staged procedures, and perioperative complications were not significantly associated with subsequent failure. Conclusion: At short- to midterm follow-up, nearly 72% of all service members undergoing HTO returned to military duty and were free from conversion knee arthroplasty. PMID:26665031

  5. Incidence of Deep Venous Thrombosis After Tibial Tubercle Osteotomy

    PubMed Central

    Tanaka, Miho J.; Munch, Jacqueline L.; Slater, Alissa J.; Nguyen, Joseph T.; Shubin Stein, Beth E.

    2014-01-01

    Background: Tibial tubercle osteotomy (TTO) is performed in a predominantly young and often female population due to the prevalence of patellofemoral disorders in this group. While considered a procedure that falls within the realm of sports surgeries, the procedure can carry significant morbidity, including infection, fracture, and deep vein thrombosis (DVT). The incidence of postoperative DVT in this population has not been described in the literature, although it has been mentioned anecdotally, and current guidelines do not address the issue of DVT prophylaxis in postoperative TTO patients. Purpose: To describe the incidence of DVT after TTO and identify any predisposing factors. Study Design: Case series; Level of evidence, 4. Methods: Subjects who had undergone TTO by the senior author from 2002 to 2013 were identified, and a retrospective chart review was performed. Those who presented with symptomatic DVT confirmed with ultrasonography were reported. Demographic data, as well as potential risk factors such as body mass index, family history of bleeding/clotting disorders, duration of the nonweightbearing period, total tourniquet time, use of contraceptive medication, smoking status, and use of anticoagulants, were collected from the chart and analyzed for correlation with development of DVT. Results: A total of 156 patients were included in this study. Six patients were found to have developed symptomatic DVT during the first 6 weeks after surgery. The mean age at the time of surgery in the DVT group was 34.94 6.57 years, compared with 26.26 10.20 years in the non-DVT group (P = .04). Due to the small number of patients with positive findings, there was no statistically significant correlation between the development of DVT and factors such as nonweightbearing duration, tourniquet time, or the use of contraceptives. Conclusion: The incidence of postoperative DVT in arthroscopic and sports procedures has been thought to be low. This case series reported a rate of 3.8% with symptomatic DVT after TTO, and patients diagnosed with DVT were significantly older than unaffected patients. It is anticipated that the actual rate including asymptomatic DVT would be higher, as only 60% of patients with DVT are symptomatic. More studies are needed to define the actual incidence in this population. Given the number of common risk factors in this population, including nonweightbearing duration and the use of oral contraceptive pills, future studies may show the advantage of chemical prophylaxis for DVT in this group. PMID:26535355

  6. Outcome of transtibial AperFix system in anterior cruciate ligament injuries

    PubMed Central

    Grmeli, Gkay; Grmeli, C Ay?e; Karakaplan, Mustafa; Korkmaz, M Fatih; Dili?k?k, U?ur; Gzkara, Harika

    2015-01-01

    Background: The anterior cruciate ligament (ACL) is one of the major stabilizing factor of the knee that resist anterior translation, valgus and varus forces. ACL is the most commonly ruptured ligament of the knee. The graft fixation to bone is considered to be the weakest link of the reconstruction. According to the parallel forces to the tibial drill hole and the quality of tibial metaphyseal bone is inferior to femoral bone stock, graft fixation to the tibia is more difficult to secure. AperFix system (Cayenne Medical, Inc., Scottsdale, Arizona, USA) which consists femoral and tibial component that includes bioinert polymer polyetheretherketone (PEEK) is one of the new choice for ACL reconstruction surgery. aim of this study was to assess the clinical outcomes and fixation durability of the AperFix (Cayenne Madical, Inc., Scottsdale, Arizona, USA) system and to determine the effect of patient's age in arthroscopic reconstruction of the anterior cruciate ligament. Materials and Methods: Patients with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. Femoral tunnel widening was assessed by computer tomography scans. Early postoperative and last followup radiographs were compared. Results: Fifty one patients were evaluated with mean followup of 29 months (range 2534 months). Mean age at the surgery was 26.5 7.2 years. Lysholm, Cincinati and Tegner activity scales were significantly higher from preoperative scores (Lysholm scores: Preoperative: 51.4 17.2, postoperative: 88.6 7.7 [P < 0.001]; Tegner activity scores: Preoperative 3.3 1.38, postoperative: 5.3 1.6 [P < 0.001]; Cincinati scores: Preoperative: 44.3 17, postoperative: 81.3 13.9 [P < 0.001]). The mean femoral tunnel diameter increased significantly from 9.94 0.79 mm postoperatively to 10.79 0.95 mm (P < 0.05). The mean ROM deficit (involved vs. contra knee) was ?7.2 16 (P < 0.001). There was no significant difference for knee score, ROM deficits (<30 years: ?7.3 15 and >30 years ?7.06 19) and femoral tunnel enlargement (<30 years: 0.83 0.52 and >30 years 0.87 0.43) of the patients with below and above 30 year. There was no significant difference for knee scores and femoral tunnel enlargement between patients with meniscal injuries and dont have meniscus lesions. Conclusion: The AperFix system gives satisfactory clinical and radiological results with low complication rate. However, long term clinical and radiological results are needed to decide the ideal anterior cruciate ligament reconstruction method. PMID:26015602

  7. Supraciliary keyhole craniotomy for anterior frontal lesions in children.

    PubMed

    Benifla, Mony; Merkin, Vladimir; Rosenthal, Guy; Shoshan, Yigal; Melamed, Israel

    2016-04-01

    Treatment for anterior frontal space occupying lesions such as epidural hematoma, vascular malformations or brain tumors, have typically involved invasive craniotomies. This method often requires large incisions with wide exposure and may be associated with high morbidity rates. The basis for the "keyhole" method is that a minimally invasive craniotomy is often sufficient for exposing large areas deep in tissue, and may limit exposure and decrease surgically related morbidity while enabling adequate removal and decompression. The supraciliary method includes a cut above the eyebrow and a small craniotomy to uncover the base of the frontal lobe and the orbital roof. We demonstrate our experience with this method. We identified children who were operated via the supraciliary approach between January 2009 and December 2013, and gathered their pre- and post-operative clinical and radiological statistics. Fourteen patients were identified. Pathologies included tumors, abscesses and epidural hematomas. Nine were operated due to epidural hematoma, two due to tumors, two due to brain abscesses, and one for anterior encephalocele. No significant peri-operative or post-operative complications were observed. Long-term follow-up shows that the surgical scars were nearly invisible. The supraciliary approach is a safe, effective and elegant technique for treating lesions in the anterior skull base. The method should be weighed alongside traditional methods on a case-by-case basis. PMID:26758703

  8. Effect of opening-wedge high tibial osteotomy on the three-dimensional kinematics of the knee.

    PubMed

    d'Entremont, A G; McCormack, R G; Horlick, S G D; Stone, T B; Manzary, M M; Wilson, D R

    2014-09-01

    Although it is clear that opening-wedge high tibial osteotomy (HTO) changes alignment in the coronal plane, which is its objective, it is not clear how this procedure affects knee kinematics throughout the range of joint movement and in other planes. Our research question was: how does opening-wedge HTO change three-dimensional tibiofemoral and patellofemoral kinematics in loaded flexion in patients with varus deformity?Three-dimensional kinematics were assessed over 0 to 60 of loaded flexion using an MRI method before and after opening-wedge HTO in a cohort of 13 men (14 knees). Results obtained from an iterative statistical model found that at six and 12 months after operation, opening-wedge HTO caused increased anterior translation of the tibia (mean 2.6 mm, p < 0.001), decreased proximal translation of the patella (mean -2.2 mm, p < 0.001), decreased patellar spin (mean -1.4, p < 0.05), increased patellar tilt (mean 2.2, p < 0.05) and changed three other parameters. The mean Western Ontario and McMaster Universities Arthritis Index improved significantly (p < 0.001) from 49.6 (standard deviation (sd) 16.4) pre-operatively to a mean of 28.2 (sd 16.6) at six months and a mean of 22.5 (sd 14.4) at 12 months. The three-dimensional kinematic changes found may be important in explaining inconsistency in clinical outcomes, and suggest that measures in addition to coronal plane alignment should be considered. PMID:25183593

  9. Effects of primary selective laser trabeculoplasty on anterior segment parameters

    PubMed Central

    Guven Yilmaz, Suzan; Palamar, Melis; Yusifov, Emil; Ates, Halil; Egrilmez, Sait; Yagci, Ayse

    2015-01-01

    AIM To investigate the effects of selective laser trabeculoplasty (SLT) on the main numerical parameters of anterior segment with Pentacam rotating Scheimpflug camera in patients with ocular hypertension (OHT) and primary open angle glaucoma (POAG). METHODS Pentacam measurements of 45 eyes of 25 (15 females and 10 males) patients (12 with OHT, 13 with POAG) before and after SLT were obtained. Measurements were taken before and 1 and 3mo after SLT. Pentacam parameters were compared between OHT and POAG patients, and age groups (60y and older, and younger than 60y). RESULTS The mean age of the patients was 57.8±13.9 (range 20-77y). Twelve patients (48%) were younger than 60y, while 13 patients (52%) were 60y and older. Measurements of pre-SLT and post-SLT 1mo were significantly different for the parameters of central corneal thickness (CCT) and anterior chamber volume (ACV) (P<0.05). These parameters returned back to pre-SLT values at post-SLT 3mo. Decrease of ACV at post-SLT 1mo was significantly higher in younger than 60y group than 60y and older group. There was no statistically significant difference in Pentacam parameters between OHT and POAG patients at pre- and post-treatment measurements (P>0.05). CONCLUSION SLT leads to significant increase in CCT and decrease in ACV at the 1st month of the procedure. Effects of SLT on these anterior segment parameters, especially for CCT that interferes IOP measurement, should be considered to ensure accurate clinical interpretation. PMID:26558208

  10. Anatomical Variations of Anterior Communicating Artery

    PubMed Central

    Kardile, Poorwa Baburao; Ughade, Jaideo Manohar; Pandit, Sudhir Vishnupant; Ughade, Manohar Namdeo

    2013-01-01

    Introduction: The Circle of Willis is a vascular network formed at the base of skull in the interpeduncular fossa. Its anterior part is formed by the anterior cerebral artery, from either side. Anterior communicating artery connects the right and left anterior cerebral arteries. Posteriorly, the basilar artery divides into right and left posterior cerebral arteries and each joins to ipsilateral internal carotid artery through a posterior communicating artery. Anterior communicating artery, an important component of circle of Willis, acts as collateral channel to stabilize blood flow. In the present study, anatomical variations in the anterior communicating artery were noted. Material and Methods: One hundred apparently normal formalin fixed brain specimens were collected from human cadavers. Normal anatomical pattern and variations of anterior communicating artery were studied. The anterior communicating arteries were then coloured, photographed, numbered and the abnormalities, if any, were noted. Result: Thity eight variant anterior communicating arteries were noted. The most common variation observed in the anterior communicating artery was its duplication in 10 subjects, followed by its absence in 8 subjects. Some variations like plexus formation, median artery were found in adults, because of persistence of embryonic pattern. Conclusion: Knowledge on variations in the anterior communicating artery is of clinical significance, as it is one of the components of circle of Willis which stabilizes cerebral blood flow when principle conduits fail. PMID:24551604

  11. RADIOLOGICAL ANALYSIS OF BONE TUNNEL POSITION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY: COMPARISON BETWEEN THE OPEN TECHNIQUE AND ARTHROSCOPY VIA AN ANTEROMEDIAL PORTAL

    PubMed Central

    Dambrós, Jean Marcel; Florêncio, Rodrigo; Júnior, Osmar Valadão Lopes; Kuhn, André; Saggin, José; de Freitas Spinelli, Leandro

    2015-01-01

    Objectives: To evaluate and compare bone tunnel positioning in anterior cruciate ligament (ACL) reconstruction surgery using the arthroscopic technique and the open technique consisting of arthrotomy. Method: A comparative retrospective study on 70 patients with ACL lesions was conducted. Thirty-five patients underwent ACL reconstruction by means of the open technique and 35 by means of the arthroscopic technique using an anteromedial portal. All the patients underwent ACL reconstruction using an autologous graft from the middle third of the patellar tendon, fixed using interference screws. The postoperative radiographs were reviewed and the positioning of the femoral tunnel was evaluated using the methods proposed by Harner et al. and Aglietti et al., while the tibial tunnel was assessed using the method proposed by Rauschning and Stäubli. Results: Fifty-four of the patients were male and 16 were female. Their mean age at the time of the procedure was 34 years and 3 months, with a range from 17 to 58 years. The arthroscopic technique was shown to be more accurate than the open technique for positioning both the femoral and the tibial bone tunnels. Conclusions: Radiological analysis on the knees subjected to ACL reconstruction showed that the positioning of both the femoral and the tibial bone tunnels presented less variation when the surgery was performed arthroscopically.

  12. Management and complications of anterior cruciate ligament injuries in skeletally immature patients: survey of the Herodicus Society and The ACL Study Group.

    PubMed

    Kocher, Mininder S; Saxon, Hillary S; Hovis, W David; Hawkins, Richard J

    2002-01-01

    Expert opinion regarding experience with the management and complications of pediatric anterior cruciate ligament (ACL) injuries was studied by surveying members of The Herodicus Society and The ACL Study Group. There was large practice variation in initial management and ACL reconstruction technique. There were 15 reported cases of growth disturbance: 8 cases of distal femoral valgus deformity with arrest of the lateral distal femoral physis, 3 cases of tibial recurvatum with arrest of the tibial tubercle apophysis, 2 cases of genu valgum without arrest, and 2 cases of leg length discrepancy. Associated factors included fixation hardware across the lateral distal femoral physis in 3 cases, bone plugs of a patellar tendon graft across the distal femoral physis in 3 cases, large (12 mm) tunnels in 2 cases, fixation hardware across the tibial tubercle apophysis in 3 cases, lateral extra-articular tenodesis in 2 cases, and over-the-top femoral position in 1 case. Based on this experience, we recommend a guarded approach to ACL reconstruction in the skeletally immature patient with careful attention to technique and follow-up. PMID:12131440

  13. Hexapod external fixator closed distraction in the management of stiff hypertrophic tibial nonunions.

    PubMed

    Ferreira, N; Marais, L C; Aldous, C

    2015-10-01

    Tibial nonunion represents a spectrum of conditions which are challenging to treat, and optimal management remains unclear despite its high rate of incidence. We present 44 consecutive patients with 46 stiff tibial nonunions, treated with hexapod external fixators and distraction to achieve union and gradual deformity correction. There were 31 men and 13 women with a mean age of 35 years (18 to 68) and a mean follow-up of 12 months (6 to 40). No tibial osteotomies or bone graft procedures were performed. Bony union was achieved after the initial surgery in 41 (89.1%) tibias. Four persistent nonunions united after repeat treatment with closed hexapod distraction, resulting in bony union in 45 (97.8%) patients. The mean time to union was 23 weeks (11 to 49). Leg-length was restored to within 1 cm of the contralateral side in all tibias. Mechanical alignment was restored to within 5 of normal in 42 (91.3%) tibias. Closed distraction of stiff tibial nonunions can predictably lead to union without further surgery or bone graft. In addition to generating the required distraction to achieve union, hexapod circular external fixators can accurately correct concurrent deformities and limb-length discrepancies. PMID:26430019

  14. Thiram-Induced Changes in the Expression of Genes Relating to Vascularization and Tibial Dyschondroplasia.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tibial dyschondroplasia (TD), a major metabolic cartilage disease in poultry, is characterized by the distension of proximal growth plates of tibia which fail to form bone, lack blood vessels, and contain nonviable cells. Thiram, a carbamate pesticide, when fed to young broiler chicks induces TD wi...

  15. Serum chemistry and histopathology of broiler femoral head necrosis and tibial dyschondroplasia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Femoral head necrosis (FHN) and tibial dyschondroplasia (TD) are two major leg problems in young meat type poultry which cause lameness, bone deformity and infections. Whereas FHN results from disarticulation of the femoral growth plate from the articular cartilage, TD lesions are characterized by i...

  16. Posterior tibial nerve stimulation for treating neurologic bladder in women: a randomized clinical trial.

    PubMed

    Eftekhar, Tahereh; Teimoory, Nastaran; Miri, Elahe; Nikfallah, Abolghasem; Naeimi, Mahsa; Ghajarzadeh, Mahsa

    2014-01-01

    Overactive bladder (OAB) is a disabling disorder. Treatment of cases with OAB includes behavioral, pharmacological, surgical interventions and peripheral electrical stimulation. The goal of this study was to determine effects of posterior tibial nerve stimulation on sexual function and pelvic disorders in women with Overactive bladder (OAB). Fifty women were randomly assigned to PTNS (posterior tibial nerve stimulation) plus tolterodine or tolterodine alone treatment. Tolterodine group received 4 mg tolterodine daily for three months while the other group received this treatment plus percutaneous tibial nerve stimulation for 12 consequence weeks. Two in PTNS group and 8 in the control group withdrew from the study. Age, education level, and occupation status were not significantly different between two groups. Mean total FSFI and its subscales were not significantly different before and after treatment between two groups. Urine leakage associated with a feeling of urgency and loss of stool or gas from the rectum beyond patient's control became significantly different after treatment between two groups. Posterior tibial nerve stimulation could help urinary problems in women with a neurologic bladder. PMID:25415813

  17. Neuroanatomy of the complex tibial organ of Stenopelmatus (Orthoptera: Ensifera: Stenopelmatidae).

    PubMed

    Strauss, Johannes; Lakes-Harlan, Reinhard

    2008-11-01

    Stenopelmatidae (or "Jerusalem crickets") belong to the atympanate Ensifera, lacking hearing organs in the foreleg tibiae. Their phylogenetic position is controversial, either as a taxon in Tettigonioidea or within the clade of Gryllacridoidea. Similarly, the origin of tibial auditory systems in Ensifera is controversial. Therefore, we investigated the neuronal structures of the proximal tibiae of Stenopelmatus spec. with the hypothesis that internal sensory structures are similar to those in tympanate Ensifera. In Stenopelmatus the complex tibial organ consists of three neuronal parts: the subgenual organ, the intermediate organ, and a third part with linearly arranged neurons. This tripartite organization is also found in tympanate Ensifera, verifying our hypothesis. The third part of the sense organ found in Stenopelmatus can be regarded by the criterion of position as homologous to auditory receptors of hearing Tettigonioidea. This crista acustica homolog is found serially in all thoracic leg pairs and contains 20 +/- 2 chordotonal neurons in the foreleg. The tibial organ was shown to be responsive to vibration, with a broad threshold of about 0.06 ms(-2) in a frequency range from 100-600 Hz. The central projection of tibial sensory neurons terminates into two equally sized lobes in the primary sensory neuropil, the medial ventral association center. The data are discussed comparatively to those of other Ensifera and mapped phylogenetically onto recently proposed phylogenies for Ensifera. The crista acustica homolog could represent a neuronal rudiment of a secondarily reduced ear, but neuronal features are also consistent with an evolutionary preadaptation. PMID:18729154

  18. Compression of the Popliteal Artery after Posterior Cruciate Ligament Reconstruction Using the Tibial Inlay Technique

    PubMed Central

    Seo, Seung Suk; Kim, Do Hun; Park, Byung Yoon

    2015-01-01

    Popliteal artery compression rarely occurs after posterior cruciate ligament (PCL) reconstruction using the tibial inlay technique that allows for direct visualization of the surgical field. However, we experienced a popliteal artery compression after PCL reconstruction performed using the technique, which eventually required re-operation. Here, we report this rare case and discuss reasons of popliteal artery compression. PMID:26673356

  19. Matched-pair analysis of all-polyethylene versus metal-backed tibial components.

    PubMed

    Udomkiat, P; Dorr, L D; Long, W

    2001-09-01

    Forty-eight matched pairs of osteoarthritic knees from patients who underwent primary total knee arthroplasty with a round-on-round, Apollo Knee System were studied to evaluate the outcome between all-polyethylene and metal-backed tibial components. Patients were matched for patient factors, preoperative deformities, cruciate salvage or sacrifice, and surgical technique. At the last follow-up (average, 38.4 months), there was no statistically significant difference in terms of knee scores, patient self-assessment, and radiographic outcomes. No component required revision, and no revisions were pending. Maintenance of these results over time would project into better long-term success for all-polyethylene tibial components because of the amount of wear and osteolysis with current modular metal-backed tibial components. We advocate the use of a more cost-effective all-polyethylene tibial component in elderly patients (>70 years old) who are not likely to need the versatility of exchange of a modular polyethylene insert because of wear. PMID:11547366

  20. TIBIAL PLATEAU PROXIMAL AND DISTAL BONE BEHAVE SIMILARLY: BOTH ARE ASSOCIATED WITH FEATURES OF KNEE OSTEOARTHRITIS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is a growing imperative to understand how changes in peri-articular bone relate to pathological progression of knee osteoarthritis (KOA). Peri-articular bone density can be measured using dual x-ray absorptiometry (DXA). The medial:lateral tibial BMD ratio (M:L BMD) is associated with MRI and...

  1. Baseline Vitamin D Status is Predictive of Longitudinal Change in Tibial BMD in Knee Osteoarthritis (OA)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    With its lack of effective treatment and high prevalence, the public health impact of OA is substantial. Peri-articular bone in OA can be evaluated with the medial:lateral tibial BMD ratio (M:L BMD) obtained from dual x-ray absorptiometry (DXA). Higher M:L BMD is associated with medial OA features...

  2. Subcortical P30 potential following tibial nerve stimulation: detection and normative data.

    PubMed

    Tinazzi, M; Zanette, G; Polo, A; Bonato, C; Manganotti, P; Fiaschi, A; Mauguire, F

    1995-12-01

    Stimulation of the tibial nerve evokes a P30 far-field potential over the scalp which, like the median nerve P14, probably originates in the vicinity of the cervico-medullary junction. Unlike the P14 potential, P30 recording has not been systematically performed in clinical practice, probably because of doubts about the generator of the potential and the possibility of consistently recording it on the scalp after the unilateral stimulation of the tibial nerve. In this study, we tested the reliability of the tibial nerve scalp far-field P30 potential in 34 normal subjects using different montages, of which the Fpz-Cv6 derivation gave the highest signal to noise ratio, making it possible to obtain a P30 potential peaking at 29.2 +/- 1.6 msec in all normal subjects. This suggests that this component should to be included in the routine recording of tibial nerve SEPs in order to evaluate the spinal and intracranial conduction of the somatosensory pathway separately. PMID:8838788

  3. Patellar tendon and tibial tubercle reconstruction using quadriceps tendon with patellar bone plug autograft.

    PubMed

    Edwards, T B; Lewis, J E; Guanche, C A

    1997-05-01

    This report describes a technique for the reconstruction of a patellar tendon-tibial tubercle deficiency. This technique uses an easy-to-harvest, low-morbidity graft (autogenous quadriceps tendon), while allowing aggressive rehabilitation as a result of the strength of the graft. PMID:9258831

  4. Tibial Inlay Technique Using Hamstring Graft for Posterior Cruciate Ligament Reconstruction and Remnant Revision

    PubMed Central

    Laupattarakasem, Wiroon; Boonard, Manusak; Laupattarakasem, Pat; Kosuwon, Weerachai

    2012-01-01

    The posterior tibial inlay technique is currently accepted as a standard operation for the posterior cruciate ligamentdeficient 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., bonepatellar tendonbone or quadriceps tendonbone) 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. PMID:23767002

  5. Age changes in the tibial and plantar nerves of the rat.

    PubMed Central

    Sharma, A K; Bajada, S; Thomas, P K

    1980-01-01

    Observations have been made on the changes in the myelinated fibres of the rat tibial and plantar nerves between 2 and 24 months of age. There is an initial rapid increase in fibre diameter followed by a later more gradual increase, which ceases after approximately 9 months of age in the tibial nerve but which continues for longer in the medial plantar nerve. The fibre size distribution remains substantially unimodal throughout. In both nerves maximal and average fibre diameter become reduced by 24 months. Total fibre number shows considerable variability between animals, but no definite systematic alteration with age is detectable. Teased fibre preparations demonstrate a low level of abnormality in the tibial nerve until after 18 months of age, but by 24 months approximately 30% of fibres display abnormalities. Although both paranodal and segmental demyelination and remyelination, and axonal degeneration and regeneration occur, the latter type of change predominates. By contrast, in the lateral plantar nerve paranodal and segmental demyelination become detectable to a significant extent from 6 months of age. Axonal degeneration and regeneration also become evident after 15 months, and by 24 months of age 55% of fibres show abnormalities. The possible explanation of these changes is discussed, as is their relevance to the frequent use of the tibial nerve for studies on experimental neuropathies. PMID:7400044

  6. Neuroanatomy of the complex tibial organ in the splay-footed cricket Comicus calcaris Irish 1986 (Orthoptera: Ensifera: Schizodactylidae).

    PubMed

    Strauss, Johannes; Lakes-Harlan, Reinhard

    2010-11-15

    The subgenual chordotonal organ complex in insects is modified in ensiferan taxa like Gryllidae and Tettigoniidae into hearing organs with specific sets of auditory receptors. Here, this sensory organ complex is documented in the nonhearing splay-footed cricket Comicus calcaris. The tibial chordotonal organ consists of three parts: the subgenual organ, the intermediate organ, and the crista acustica homolog. The latter is an array of linearly organized neurons homologous to auditory receptors in the tibial hearing organs of Tettigoniidae. The tibial organ is structurally similar in all three leg pairs, with similar neuron numbers in the fore- and midleg, but lower numbers in the hindleg. The foreleg crista acustica homolog consists of 344 neurons, the highest number in an atympanate Ensiferan. Additionally, an accessory chordotonal organ with 155 neurons innervated by nerve 5B1 is present in the foreleg. The central projection of the tibial organreveals ipsilateral sensory terminals in the primary sensory neuropil, the medial ventral association center with terminations close to the midline. As determined from extracellular recordings, the entire tibial organ is vibrosensitive. The organization of the tibial organ is compared to other ensiferan auditory and nonauditory tibial organs. Spatial orientation of neurons in the crista acustica homolog is not reminiscent of auditory structures, and the neuroanatomy is discussed with respect to stridulation behavior and the evolutionary origin of hearing in Ensifera. PMID:20886622

  7. Increased Posterior Tibial Slope and its Association with ACL Rupture in the Pediatric Population

    PubMed Central

    O'Malley, Michael P.; Milewski, Matthew David; Solomito, Matthew; Erwteman, Andrew; Nissen, Carl W.

    2014-01-01

    Objectives: Particular interest has been placed in identifying risk factors for sports related injuries in younger populations. In regards to the relationship between posterior sagittal slope of the tibia as a potential risk factor for ACL injury in the pediatric population, studies at this time remain limited.The purpose of our study is to investigate this relationship between posterior tibial slope and ACL rupture in the pediatric population. Our null hypothesis states that an increased posterior tibial slope does not serve as a contributing risk factor for ACL rupture in pediatric patients with open physes. Methods: A retrospective case-control study was performed at an academic pediatric sports medicine center comparing a target population of skeletally immature patients with an ACL rupture with an age-matched control group. Posterior tibial slope was then measured on plain lateral radiographs in both groups by blinded readers (Figure 1), at two separate time intervals, utilizing a previously examined and accepted technique. Results: Thirty two patients were included in the ACL rupture with open physes group (average age 13 years old, range 9-17) and compared to 32 patients in the control group (average age 13 years old, range 9-16). These groups were also similar in regards to male:female and left:right distribution. The mean posterior tibial slope in the ACL injured population was 10.0 3 versus 8.5 3 in the control group. Statistical significance was seen in comparing slope measurements between the ACL injury and control groups in two of the three readers (Readers 1 and 3) at both time points (Reader 1: p = 0.0348, p = 0.0051; Reader 3: p = 0.0009, p = .0059). Intra-rater proved superior with values correlating with moderate-to-good reliability (Reader 1 ICC = 0.7387, Reader 2 ICC = 0.8853, Reader 3 ICC = 0.5316), while inter-rater values corresponded with fair-to-moderate reliability (Measure 1 ICC = 0.4657, Measure 2 ICC = 0.5146). The average female posterior tibial slope was 9.5 (range of 3-14) and similar to the posterior tibial slope for males, which was 9.8 (range of 2-16). Conclusion: The authors reject the null hypothesis and these results uphold that an increased posterior tibial slope serves as a possible risk factor for ACL rupture in a skeletally immature population.

  8. Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla

    PubMed Central

    Rao (Janardhan), Sruthi; Kotrashetti, S. M.; Lingaraj, J. B.; Pinto, P. X.; Keluskar, K. M.; Jain, Siddharth; Sone, Piyush; Rao, Santhosh

    2013-01-01

    Orthognathic surgery and distraction osteogenesis play a prime role in the correction of maxillary hypoplasia in patients with cleft lip and palate (CLP). Advancement of the anterior maxilla alone without interfering with the velopharyngeal sphincter may be advantageous in cleft patients, who more commonly have speech deficits and dental crowding. We present a case series of anterior maxillary segmental distraction for maxillary hypoplasia in 5 CLP patients with a one-year follow-up. A custom-made tooth-borne distraction device with a hyrax screw positioned anteroposteriorly was used. The evaluation comprised of hard and soft tissue analysis and speech assessment. A stable occlusion with positive overjet and correction of dental-crowding without extraction was achieved at one year post-distraction. Facial profile and lip support improved. There was no deterioration in speech. PMID:23984033

  9. Organic Mood Disorder Following Left Anterior Temporal Lobectomy with Amygdalohippocampectomy

    PubMed Central

    Haridas, Nishanth J.; Kalayil, Rajeesh V.; Tharayil, Harish M.; Rappai, Mary P.

    2015-01-01

    One third of patients with antiepileptic-resistant temporal lobe epilepsy (TLE) will have to undergo surgery for a better seizure control. Anterior temporal lobectomy (ATL) is done for mesial temporal sclerosis that is the most common histopathological lesion associated with TLE. Psychiatric manifestations following ATL are not uncommon with depressive symptoms more common with left ATL and manic symptoms following right ATL. Mr. A is a 42-year-old left cerebral dominant (Confirmed by WADA test) male with no past history of psychiatric illness who had undergone anterior temporal lobectomy with amygdalohippocampectomy. He started having manic episodes post operatively which subsided with antipsychotics. He had multiple such episodes over the next 13 years with minimal inter episodic symptoms. This is a rare instance of manic symptoms following left-sided ATL that emphasizes the need for better understanding of the cerebral laterality of affective symptoms. PMID:26702178

  10. Organic Mood Disorder Following Left Anterior Temporal Lobectomy with Amygdalohippocampectomy.

    PubMed

    Haridas, Nishanth J; Kalayil, Rajeesh V; Tharayil, Harish M; Rappai, Mary P

    2015-01-01

    One third of patients with antiepileptic-resistant temporal lobe epilepsy (TLE) will have to undergo surgery for a better seizure control. Anterior temporal lobectomy (ATL) is done for mesial temporal sclerosis that is the most common histopathological lesion associated with TLE. Psychiatric manifestations following ATL are not uncommon with depressive symptoms more common with left ATL and manic symptoms following right ATL. Mr. A is a 42-year-old left cerebral dominant (Confirmed by WADA test) male with no past history of psychiatric illness who had undergone anterior temporal lobectomy with amygdalohippocampectomy. He started having manic episodes post operatively which subsided with antipsychotics. He had multiple such episodes over the next 13 years with minimal inter episodic symptoms. This is a rare instance of manic symptoms following left-sided ATL that emphasizes the need for better understanding of the cerebral laterality of affective symptoms. PMID:26702178

  11. Endoscopic transnasal approach to anterior and middle cranial base lesions.

    PubMed

    Tan, Sien Hui; Brand, Yves; Prepageran, Narayanan; Waran, Vicknes

    2015-01-01

    We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative. PMID:26448224

  12. Effect of Varying Hamstring Tension on Anterior Cruciate Ligament Strain During in Vitro Impulsive Knee Flexion and Compression Loading

    PubMed Central

    Withrow, Thomas J.; Huston, Laura J.; Wojtys, Edward M.; Ashton-Miller, James A.

    2008-01-01

    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. PMID:18381320

  13. Anterior femoroacetabular impingement: an update.

    PubMed

    Lequesne, Michel; Bellache, Laurence

    2012-05-01

    Anterior femoroacetabular impingement can cause early hip osteoarthritis. The typical patient is an adult younger than 50 years of age, often with a history of sporting activities. The main symptom is intermittent pain triggered by static flexion (low seats) or dynamic flexion (during sporting or occupational activities that require repeated hip flexion). The characteristic physical finding is pain triggered by placing the hip in internal rotation and 70 to 110 of flexion. In additional to anteroposterior and false-profile radiographs, lateral Dunn or Ducroquet views should be obtained on both sides to visualize the anterior part of the head-neck junction. Instead of being concave, the head-neck junction is either flat or convex, causing a cam effect that damages the labrum and anterosuperior cartilage. Non-sphericity of the femoral head with an anterior ovoid bulge induces a similar cam effect. In pincer impingement, which is less common, over-coverage by the anterosuperior acetabular rim pinches the labrum between the rim and the femoral head-neck junction when the hip is flexed. Pincer impingement is related to acetabular retroversion or protrusion. Arthrography coupled with computed tomography or magnetic resonance imaging visualizes the morphological abnormalities (e.g., ovoid shape of the femoral head or retroversion of the acetabulum) and detects secondary lesions such as labral tears or separation or damage to the anterosuperior cartilage. Arthroscopy allows removal of the damaged labrum and correction of the morphological abnormalities via femoroplasty to restore the normal concave shape of the neck and/or acetabuloplasty to eliminate over-coverage. Short- or mid-term results are satisfactory in 75 to 80% of patients. However, the presence of degenerative lesions in about two-thirds of patients at the time of arthroplastic surgery limits the probability of achieving good long-term results. PMID:22281229

  14. Micromotion in knee arthroplasty. A roentgen stereophotogrammetric analysis of tibial component fixation.

    PubMed

    Ryd, L

    1986-01-01

    The modern era of endoprosthetic joint replacement started with the introduction of acrylic cement to improve component fixation. Long-term results have, however, indicated that prosthetic fixation remains critical; loosening at the bone-cement interface has become an important problem. Research in recent years has focused on attempts to achieve better fixation by improving cementing techniques, improving prosthetic design by, for example, adding metal support of polyethylene components and by exploring alternative ways to bond prosthetic components to bone without cement. The mechanical integrity of the bone-cement interface has been studied under laboratory conditions. Because of the in-vivo reaction of bone, with the interposition of a fibrous tissue layer at the interface, such studies are not totally valid. Studies on autopsy material, more closely resembling the in-vivo situation, are few and there has been only one previous study like the present one. In this study, roentgen stereophotogrammetric analysis (RSA) was evaluated and found to have an accuracy ten times better than conventional radiography. This accuracy was judged adequate for studies of micromotion. In this work, two types of micromotion of the tibial component were studied; migration, i.e. gradual motion over time, and inducible displacement, i.e. instant motion in response to external forces. Ninety-six knee arthroplasties for gonarthrosis, representing four different types of fixation were studied by roentgen stereophotogrammetric analysis (RSA). Eighty-nine arthroplasties were clinically successful. The follow-up ranged from two to five years. Full post-operative weight-bearing was allowed for all patients, except those operated with a Freeman-Samuelson prosthesis, who were adviced to use crutches for six weeks and partial weight-bearing for another six weeks. Fifty-one conventionally cemented all-polyethylene prostheses, 27 total and 24 unicompartmental, represented a baseline series. Migration was found for all prostheses, with a mean maximum deflection of 1.2 and 0.9 mm, respectively, after four years. In both groups, the major part of the migration occurred during the first year, after which the majority of the components did not migrate further. Some prostheses, with larger migration during the first year, continued to migrate throughout the investigation. None of the total, but the majority of the unicompartmental prostheses showed signs of cold flow within the polyethylene. All prostheses showed reversible inducible displacement, the maximum deflection ranging from 0.2 to 1.0 mm.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:3461667

  15. Fatigue load of current tibial intramedullary nail designs: a simulated study.

    PubMed

    Wagner, Mark; Liu, Qi; Ellis, Thomas J

    2011-06-01

    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

  16. Surface pretreatment for prolonged survival of cemented tibial prosthesis components: full- vs. surface-cementation technique

    PubMed Central

    Marx, Rudolf; Qunaibi, Mutaz; Wirtz, Dieter Christian; Niethard, Fritz Uwe; Mumme, Thorsten

    2005-01-01

    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. PMID:16262888

  17. Normative ground reaction force data for able-bodied and trans-tibial amputee children during running.

    PubMed

    Engsberg, J R; Lee, A G; Tedford, K G; Harder, J A

    1993-08-01

    The purpose of this investigation was to develop normative ground reaction force data for able-bodied (AB) and trans-tibial amputee (TTA) children during running. Two hundred AB (mean age 9.4 years, range 7-12) and 21 TTA (mean age 11.1 years, range 5-17) children ran (2.2 m/s +/- 10%) over a force platform. Ground reaction force data were normalized, averaged within groups and plotted to produce force-time curves characterizing the different leg types (i.e. able-bodied, non-prosthetic and prosthetic). In addition, discrete variables characterizing the leg type differences were determined. One way ANOVA determined significant differences between variables and a TukeyB Post Hoc analysis defined which variables were significantly different (p < 0.05). Results generally indicated differences between the three leg types with the non-prosthetic leg indicating greater forces than the prosthetic and AB legs. The results of this investigation provide normative ground reaction force data for both AB and TTA children during running and can be used for comparison with other groups of children. PMID:8233773

  18. 75 MHz Ultrasound Biomicroscopy of Anterior Segment of Eye

    PubMed Central

    Silverman, Ronald H.; Cannata, Jonathan; Shung, K. Kirk; Gal, Omer; Patel, Monica; Lloyd, Harriet O.; Feleppa, Ernest J.; Coleman, D. Jackson

    2006-01-01

    Very high frequency ultrasound (3550 MHz) has had a significant impact upon clinical imaging of the anterior segment of the eye, offering an axial resolution as small as 30 ?m. Higher frequencies, while potentially offering even finer resolution, are more affected by absorption in ocular tissues and even in the fluid coupling medium. Our aim was to develop and apply improved transducer technology utilizing frequencies beyond those routinely used for ultrasound biomicroscopy of the eye. A 75-MHz lithium niobate transducer with 2 mm aperture and 6 mm focal length was fabricated. We scanned the ciliary body and cornea of a human eye six years post-LASIK. Spectral parameter images were produced from the midband fit to local calibrated power spectra. Images were compared with those produced using a 35 MHz lithium niobate transducer of similar fractional bandwidth and focal ratio. The 75-MHz transducer was found to have a fractional bandwidth (?6 dB) of 61%. Images of the post-LASIK cornea showed higher stromal backscatter at 75 MHz than at 35 MHz. The improved lateral resolution resulted in better visualization of discontinuities in Bowmans layer, indicative of microfolds or breaks occurring at the time of surgery. The LASIK surface was evident as a discontinuity in stromal backscatter between the stromal component of the flap and the residual stroma. The iris and ciliary body were visualized despite attenuation by the overlying sclera. Very high frequency ultrasound imaging of the anterior segment of the eye has been restricted to the 3550 MHz band for over a decade. We showed that higher frequencies can be used in vivo to image the cornea and anterior segment. This improvement in resolution and high sensitivity to backscatter from the corneal stroma will provide benefits in clinical diagnostic imaging of the anterior segment. PMID:17147058

  19. Ultrasound elasticity imaging of human posterior tibial tendon

    NASA Astrophysics Data System (ADS)

    Gao, Liang

    Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, it could be used to quantify the severity of tendonosis and help determine the appropriate treatment. Ultrasound elasticity imaging (UEI) is a real-time, noninvasive technique to objectively measure mechanical properties in soft tissue. It consists of acquiring a sequence of ultrasound frames and applying speckle tracking to estimate displacement and strain at each pixel. The goals of my dissertation were to 1) use acoustic simulations to investigate the performance of UEI during tendon deformation with different geometries; 2) develop and validate UEI as a potentially noninvasive technique for quantifying tendon mechanical properties in human cadaver experiments; 3) design a platform for UEI to measure mechanical properties of the PTT in vivo and determine whether there are detectable and quantifiable differences between healthy and diseased tendons. First, ultrasound simulations of tendon deformation were performed using an acoustic modeling program. The effects of different tendon geometries (cylinder and curved cylinder) on the performance of UEI were investigated. Modeling results indicated that UEI accurately estimated the strain in the cylinder geometry, but underestimated in the curved cylinder. The simulation also predicted that the out-of-the-plane motion of the PTT would cause a non-uniform strain pattern within incompressible homogeneous isotropic material. However, to average within a small region of interest determined by principal component analysis (PCA) would improve the estimation. Next, UEI was performed on five human cadaver feet mounted in a materials testing system (MTS) while the PTT was attached to a force actuator. A portable ultrasound scanner collected 2D data during loading cycles. Young's modulus was calculated from the strain, loading force and cross sectional area of the PTT. Average Young's modulus for the five tendons was (0.45+/-0.16GPa) using UEI. This was consistent with simultaneous measurements made by the MTS across the whole tendon (0.52+/-0.18GPa). We also calculated the scaling factor (0.12+/-0.01) between the load on the PTT and the inversion force at the forefoot, a measurable quantity in vivo. This study suggests that UEI could be a reliable in vivo technique for estimating the mechanical properties of the human PTT. Finally, we built a custom ankle inversion platform for in vivo imaging of human subjects (eight healthy volunteers and nine advanced PTTD patients). We found non-linear elastic properties of the PTTD, which could be quantified by the slope between the elastic modulus (E) and the inversion force (F). This slope (DeltaE/DeltaF), or Non-linear Elasticity Parameter (NEP), was significantly different for the two groups: 0.16+/-0.20 MPa/N for healthy tendons and 0.45+/-0.43 MPa/N for PTTD tendons. A receiver operating characteristic (ROC) curve revealed an area under the curve (AUC) of 0.83+/-0.07, which indicated that the classifier system is valid. In summary, the acoustic modeling, cadaveric studies, and in vivo experiments together demonstrated that UEI accurately quantifies tendon mechanical properties. As a valuable clinical tool, UEI also has the potential to help guide treatment decisions for advanced PTTD and other tendinopathies.

  20. Human parathyroid hormone-(1-38) restores cancellous bone to the immobilized, osteopenic proximal tibial metaphysis in rats

    NASA Technical Reports Server (NTRS)

    Ma, Y. F.; Jee, W. S. S.; Ke, H. Z.; Lin, B. Y.; Liang, X. G.; Li, M.; Yamamoto, N.

    1994-01-01

    The purpose of this study was to determine if human parathyroid hormone-(1-38) (PTH) can restore cancellous bone mass to the established osteopenic, immobilized proximal tibial metaphyses (PTM) of female rats. The right hindlimbs of six-month-old female Sprague-Dawley rats were immobilized by bandaging the right hindlimbs to the abdomen. After 30 days of right hindlimb immobilization (RHLI), the rats were subcutaneously injected with 200 microgram hPTH(1-38)/kg/day for 15 (short-term) or 75 (longer-term) days. Static bone histomorphometry was performed on the primary spongiosa, while both static and dynamic histomorphometry were performed on the secondary spongiosa of the right PTM. Immobilization for 30 days without treatment decreased trabecular bone area, number and thickness in both primary and secondary spongiosa, and induced an increase in eroded perimeter and a decrease in tissue referent-bone formation rate (BFR/TV) in the secondary spongios. These changes reached a new steady state thereafter. Treatment with 200 microgram hPTH(1-38)/kg/day for 15 days, beginning at 30 days post immobilization (IM), significantly increased trabecular bone area, thickness and number in both primary and secondary spongiosa despite continuous IM when compared to the age-related and IM controls. The short-term (15 days) PTH treatment significantly increased labeling perimeter, mineral apposition rate and BFR/TV in the secondary spongiosa and stimulated longitudinal bone growth as compared to the age-related and IM controls. PTH treatment for longer-term (75 days) further increased trabecular bone area, thickness and number as compared to aging and IM controls and short-term (15 days) PTH treated groups. The bone formation indices in the secondary spongiosa of these longer-term treated rats were lower than that of short-term (15 days) PTH treated group, but they were still higher than those of IM and age-related controls. Our findings indicate that PTH treatment stimulates cancellous bone formation, restores and adds extra cancellous bone to the established, disuse-osteopenic proximal tibial metaphysis of continuously RHLI female rats. These results suggest that PTH may be a useful agent in treatment disuse-induced osteoporosis in humans.

  1. Development and Validation of an Instrument to Predict Functional Recovery in Tibial Fracture Patients: The Somatic Pre-Occupation and Coping (SPOC) Questionnaire

    PubMed Central

    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

    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. PMID:22011635

  2. Painful pretibial pseudocyst at bioabsorbable interference screw aperture two years after anterior cruciate ligament reconstruction.

    PubMed

    Shen, Michael Xuanrong; Sathappan, S S

    2013-10-01

    We report the case of a patient with a painful subcutaneous nodule, measuring 13 mm 17 mm, at the pretibial graft aperture site, which presented two years after a successful anterior cruciate ligament reconstruction with an autologous hamstring graft. A bioabsorbable poly-L-lactide interference screw was used for graft fixation at the tibial aperture. The patient underwent surgical excision of the lesion and curettage at the tunnel aperture. Grossly, extruded fragments of the screw and a thick pseudocapsule of surrounding tissue were excised. There was no communication between the tunnel aperture and the knee joint. The graft was also intact. Histological analysis revealed fragments of the bioabsorbable material in association with fibrous and granulomatous chronic inflammatory cells. This was consistent with a foreign body reaction. The patient subsequently recovered and resumed preinjury level of activity. To the best of our knowledge, this is the first report describing a nodular granulomatous type reaction to foreign bioabsorbable poly-L-lactide screw material subsequent to an anterior cruciate reconstruction surgery. PMID:24154591

  3. Genomics and anterior segment dysgenesis: a review.

    PubMed

    Ito, Yoko A; Walter, Michael A

    2014-01-01

    Anterior segment dysgenesis refers to a spectrum of disorders affecting structures in the anterior segment of the eye including the iris, cornea and trabecular meshwork. Approximately 50% of patients with anterior segment dysgenesis develop glaucoma. Traditional genetic methods using linkage analysis and family-based studies have identified numerous disease-causing genes such as PAX6, FOXC1 and PITX2. Despite these advances, phenotypic and genotypic heterogeneity pose continuing challenges to understand the mechanisms underlying the complexity of anterior segment dysgenesis disorders. Genomic methods, such as genome-wide association studies, are potentially an effective tool to understand anterior segment dysgenesis and the individual susceptibility to the development of glaucoma. In this review, we provide the rationale, as well as the challenges, to utilizing genomic methods to examine anterior segment dysgenesis disorders. PMID:24433355

  4. Correlation of Radiographic Patellofemoral Indices with Tibial Tubercle Transfer Distance in Fulkerson Osteotomy Pl

    PubMed Central

    Edwards, Alan; Larson, Evan; Albright, John

    2014-01-01

    Background A laterally tracking patella is commonly seen in patients with chronic recurrent lateral patellar dislocations. Clinical appearance of the J-sign occurs when the patella is congruent with the trochlear groove in flexion and moves over the lateral border of the femoral condyle as the lower leg reaches complete extension. A Fulkerson osteotomy procedure corrects this maltracking of the patella by medially transferring the tibial tubercle. There are many radiographic patellofemoral indices that can be used describe this incongruence about the patelloformal joint. The current literature supports the use of the tibial tubercle-trochlear groove (TT- TG) index in determining the appropriate amount medialization of the extensor mechanism. However there is little agreement in how far to transfer the tibial tubercle to best achieve maximum patello- femoral congruency. It is the senior author's belief that lateral patellar edge (LPE) measure on voluntary quadriceps active hyperextension MRI scan has the strongest correlation with final operative tibial tubercle transfer distance needed to achieve maximum patellofemoral congruency. Purpose The purpose of this study was to show that the voluntary quadriceps active hyperextension MRI measurement of lateral patellar edge (LPE) has the strongest correlation with tibial tubercle transfer distance required to achieve maxium patellofemoral congruency intraoperatively in the terminal 30 degrees of active knee extension compared to all other patellofemoral indices measured on axial MRI scans with the knee in voluntary active knee extension to 30 degrees of flexion, passive full extension, and voluntary quadriceps active hyperextension. Study Design Retrospective case series via review of the electronic medical record. Methods Forty-three Fulkerson osteotomy patient charts were reviewed retrospectively. Three different pre-operative axial MRI views were then examined and measured for Tibial Tubercle- Troch-lear Groove (tt-tg), lateral patellar edge (LPE), bisect offset (BSO), and lateral patellar displacement (LPD). Each patient had three MRIs: one with the knee resting in extension, one in voluntary quadriceps active hyperextension, and one in voluntary quadriceps active 30 degree flexion. Statistics were then calculated using Statistical Package for the Social Sciences (SPSS) (IBM corp). Results Tibial tubercle transfer distances required to achieve congruency intraoperatively correlated moderately (0.500-0.300) and were statistically significant (alpha. 050) for passive extension MRI measurement of TT-TG (Pearson- 0.403, alpha 0.010) and LPD (Pearson. 362, alpha 0.022); voluntary quadriceps active hyperextension TT-TG (Pearson 0.487, alpha, 0.001); voluntary quadriceps active flexion TT-TG (Pearson. 548, alpha< 0.001), LPE (Pearson. 332, alpha 0.029), and LPD (Pearson 0.446 alpha. 003). Conclusion The hypothesis that voluntary quadriceps active hyperextension MRI LPE measurement best correlated with tibial tubercle transfer distance was incorrect. The data collected showed correlation and statistical significance for voluntary quadriceps active flexion LPE with required tibal tubercle transfer distance (Pearson 0.34, alpha 0.026). The MRI measurement that best correlated with tibial tubercle transfer distance was voluntary quadriceps active flexion measure of TT-TG (Pearson. 556, alpha< 0.001). PMID:25328455

  5. [FUNCTIONAL PLASTIC OF ANTERIOR ABDOMINAL WALL HERNIAS].

    PubMed

    Grubnik, V V; Parfentyeva, N D; Parfentyev, R S

    2015-07-01

    In order to improve the treatment efficacy of postoperative anterior abdominal wall hernias the method of plastic with restoration of anatomical and physiological properties of the muscles of the anterior abdominal wall was used. After the intervention by the improved method, regardless of the location of the hernia defect yielded promising results for the conservation of anterior abdominal wall muscle function in 75% of cases completely restored functional ability of muscles recti abdomini. PMID:26591212

  6. Anterior Cruciate: Methods of Physical Examination

    PubMed Central

    Grant, John; Kirby, R. Lee

    1982-01-01

    Tear of the anterior cruciate ligament is a common, serious injury. Since the long-range consequences of uncorrected anterior cruciate incompetence are better understood, and surgical and rehabilitative measures improved, early accurate diagnosis is increasingly important. Besides a careful history, diagnosis requires the use of specific physical examination methods to reproduce the symptomatic subluxation (anterior shift or internal rotation) and to assess functional performance of the knee. ImagesFig. 1Fig. 2Fig. 3 PMID:21286055

  7. Concomitant anterior and posterior infantile perianal protrusions.

    PubMed

    Leung, Alexander K C

    2010-02-01

    Infantile perianal protrusion is characterized by asymptomatic pyramidal protrusion with a rose-red or purplish red surface along the midline, usually anterior to the anus. The protrusion is usually solitary. Two girls are reported with concomitant anterior and posterior infantile perianal pyramidal protrusions and a history of constipation. The occurrence of concomitant anterior and posterior infantile perianal pyramidal protrusions has not been reported previously. PMID:20191927

  8. Tibial changes in experimental disuse osteoporosis in the monkey

    NASA Technical Reports Server (NTRS)

    Young, D. R.; Niklowitz, W. J.; Steele, C. R.

    1983-01-01

    The mechanical properties and structural changes in the monkey tibia with disuse osteoporosis and during subsequent recovery are investigated. Bone mending stiffness is evaluated in relation to microscopic changes in cortical bone and Norland bone mineral analysis. Restraint in the semireclined position is found to produce regional losses of bone most obviously in the anterior-proximal tibiae. After six months of restraint, the greatest losses of bone mineral in the proximal tibiae range from 23 percent to 31 percent; the largest changes in bone stiffness range from 36 percent to 40 percent. Approximately eight and one-half months of recovery are required to restore the normal bending properties. Even after 15 months of recovery, however, the bone mineral content does not necessarily return to normal levels. Histologically, resorption cavities in cortical bone are seen within one month of restraint; by two and one-half months of restraint there are large resorption cavities subperiosteally, endosteally, and intracortically. After 15 months of recovery, the cortex consists mainly of first-generation haversian systems. After 40 months, the cortex appears normal, with numerous secondary and tertiary generations of haversian systems.

  9. [Minitracheotomy in treating upper airway obstruction after anterior cervical fusion].

    PubMed

    Arimune, Mutsuaki; Sanjou, Hiroyasu; Yamada, Tokuhiro; Yabe, Mitsuhide; Miyake, Hitoshi

    2004-10-01

    Respiratory disturbance occurs sometimes after anterior cervical fusion. This is often a result of upper airway obstruction due to prevertebral soft tissue swelling. Therefore we used cricothyrotomy tubes (Mini-Trach) in two patients with postoperative upper airway obstruction and performed assist-ventilation via the tubes. After starting to ventilate through Mini-Trach II, respiratory disturbance disappeared soon and respiration improved markedly. Mini-Trach II is an effective device to use in patients with post-operative respiratory disturbance due to prevertebral soft tissue swelling. PMID:15552958

  10. [The closed fracture of femur after revascularization osteotrefination in patient with atherosclerotic occlusion of the tibials arteries].

    PubMed

    Kabirov, A V; Panfikov, S D; Kislov, E E

    2004-01-01

    In this article is represented the case of revascularization osteotrefination in patient with atherosclerotic occlusion of the tibials arteries which was complicated by the closed fracture of femur in late postoperative period. PMID:15627144

  11. The effect of polyethylene creep on tibial insert locking screw loosening and back-out in prosthetic knee joints.

    PubMed

    Sanders, Anthony P; Raeymaekers, Bart

    2014-10-01

    A prosthetic knee joint typically comprises a cobalt-chromium femoral component that articulates with a polyethylene tibial insert. A locking screw may be used to prevent micromotion and dislodgement of the tibial insert from the tibial tray. Screw loosening and back-out have been reported, but the mechanism that causes screw loosening is currently not well understood. In this paper, we experimentally evaluate the effect of polyethylene creep on the preload of the locking screw. We find that the preload decreases significantly as a result of polyethylene creep, which reduces the torque required to loosen the locking screw. The torque applied to the tibial insert due to internal/external rotation within the knee joint during gait could thus drive locking screw loosening and back-out. The results are very similar for different types of polyethylene. PMID:24997426

  12. MDCT and MRI for the diagnosis of complex fractures of the tibial plateau: A case control study

    PubMed Central

    XU, YUNQIN; LI, QIANG; SU, PEIHUA; SHEN, TUGANG; ZHU, YAZHONG

    2014-01-01

    The aim of this study was to evaluate the clinical value of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI) in the diagnosis and treatment of complex fractures of the tibial plateau. A total of 71 patients with complex fractures of the tibial plateau (estimated Schatzker classifications III, V and VI) were included in this study. The X-ray, MDCT and MRI data obtained from the patients were analyzed. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse, cruciate ligament tibial avulsion fracture, degree of fracture comminution and degree of fracture displacement (P<0.01). MRI was the most sensitive method in the diagnosis of injuries of the cruciate and collateral ligaments, menisci and cartilage peeling of the articular surfaces (P<0.01). MDCT and MRI were demonstrated to be more sensitive than X-rays for the diagnosis of insidious damage around the knee. PMID:24348790

  13. [Hallux flexus--the result of posttraumatic entrapment of the flexor hallucis longus tendon in the tibial fracture site].

    PubMed

    Burda, R; Morochovic, R; Kitka, M

    2010-08-01

    Entrapment of flexor hallucis longus after tibial fracture is very rare. We present a case of entrapment of flexor hallucis longus in a case of 36 years old male, who sustain an open tibial fracture. Fracture was stabilised with intramedullary nail. As a conseqence of entrapment of FHL hallux flexus was presented. After release of FHL in musculotendinous junction full range of motion in interphalangaela joint of hallux was obtained. PMID:20925266

  14. Anterior Cruciate Ligament Reconstruction Using a Flexible Reamer System: Technique and Pitfalls.

    PubMed

    Fitzgerald, Judd; Saluan, Paul; Richter, Dustin L; Huff, Nathan; Schenck, Robert C

    2015-07-01

    Anatomic reconstruction of the anterior cruciate ligament (ACL) has been shown to improve stability of the knee, particularly rotational stability, potentially leading to superior clinical outcomes and a shorter return to sport. Nonanatomic ACL reconstruction has been linked to graft failure and abnormal cartilage loading thought to contribute to progression of degenerative joint disease. Use of the far anteromedial portal (FAMP) to uncouple the tibial and femoral tunnels has led to improved reproduction of the femoral footprint and facilitates drilling of the femoral tunnel in an anatomic position. The use of the FAMP and straight reamer systems introduces its own set of potential complications, including short femoral tunnels and peroneal nerve injury. These potential complications have been addressed by drilling the femoral tunnel in a hyperflexed position, which can lead to difficulty with positioning the operative extremity, visualization, and identification of anatomic landmarks. The purpose of this case report was to review the advantages and technical aspects of using a flexible reamer system and the FAMP to achieve an anatomic ACL reconstruction while avoiding potential complications and pitfalls. Flexible reamer systems allow an additional way of uncoupling the tibial and femoral tunnels to clearly visualize and establish an anatomic starting point within the femoral footprint of the native ACL while avoiding the complications associated with knee hyperflexion and straight reamers with the far anteromedial portal. In the authors' experience, an anatomic reconstruction of the ACL can be achieved safely using flexible reamers while avoiding some of the difficulties seen with straight reamers used in conjunction with an uncoupled, far anteromedial approach. PMID:26673860

  15. Anterior Cruciate Ligament Graft Isometry Is Affected by the Orientation of the Femoral Tunnel.

    PubMed

    Ebersole, Gregg M; Eckerle, Paul; Farrow, Lutul D; Cutuk, Adnan; Bledsoe, Gary; Kaar, Scott

    2016-04-01

    Purpose The purpose of this study was to compare anterior cruciate ligament (ACL) graft length and tension throughout knee range of motion with transtibial, anteromedial (AM) portal, and all-epiphyseal drilling techniques with suspensory and apical femoral fixation. Methods The three different femoral tunnel drilling techniques using the same intra-articular starting point within the center of the femoral footprint were performed on fresh-frozen cadaveric specimens. All groups underwent standard tibial drilling in the center of the ACL tibial footprint. FiberWire (Arthrex Inc., Naples, FL) was used to simulate anatomic single bundle reconstructions. Changes in graft length and tension were measured at knee flexion angles of 0, 30, 60, 90, 120, and 135 degrees. Results Graft length and tension decreased from 0 through 60 degrees and subsequently increased from 90 to 135 degrees for all groups. The transtibial, AM portal suspensory, and apical fixation groups were similar. However, the all-epiphyseal tunnel with suspensory fixation had a significantly increased change in length (90, 120, and 135 degrees) and tension (120 and 135 degrees). Conclusion Transtibial and AM portal suspensory fixation and apical fixation demonstrate similar changes in length and tension throughout knee range of motion. The all-epiphyseal tunnel with suspensory fixation was associated with greater length and tension changes at higher degrees of knee flexion. All techniques demonstrated decreased graft length and tension with knee flexion to 60 degrees after which they increased with further knee flexion. Clinical Relevance ACL graft length and tension change throughout knee range of motion and also depend on femoral tunnel orientation and fixation type. The use of an all-epiphyseal tunnel with suspensory fixation should be studied further for evidence of graft elongation. PMID:26190786

  16. Extracting a large live freely floating cysticercosis cyst from the anterior chamber of the eye using visco expression technique: A case report.

    PubMed

    Singh, Satya Prakash; Rana, Jagriti; Dukre, Jagdish; Singh, Premala Anthony

    2016-01-01

    Ocular involvement by cysticercosis is uncommon and rare in the anterior chamber. It can give rise to iridocyclitis which can be potentially blinding to the patient. The management is usually surgical. We report a case of 18-year-old girl with large cysticercosis cyst in the anterior chamber. The cyst was removed intact by viscoexpression technique from the anterior chamber of the eye and the patient achieved visual acuity of 6/9 post-operatively. PMID:26949361

  17. Extracting a large live freely floating cysticercosis cyst from the anterior chamber of the eye using visco expression technique: A case report

    PubMed Central

    Singh, Satya Prakash; Rana, Jagriti; Dukre, Jagdish; Singh, Premala Anthony

    2015-01-01

    Ocular involvement by cysticercosis is uncommon and rare in the anterior chamber. It can give rise to iridocyclitis which can be potentially blinding to the patient. The management is usually surgical. We report a case of 18-year-old girl with large cysticercosis cyst in the anterior chamber. The cyst was removed intact by viscoexpression technique from the anterior chamber of the eye and the patient achieved visual acuity of 6/9 post-operatively.

  18. Combined distal tibial rotational osteotomy and proximal growth plate modulation for treatment of infantile Blounts disease

    PubMed Central

    Abdelgawad, Amr A

    2013-01-01

    Infantile Blounts disease is a condition that causes genu varum and internal tibial torsion. Treatment options include observation, orthotics, corrective osteotomy, elevation of the medial tibial plateau, resection of a physeal bar, lateral hemi-epiphysiodesis, and guided growth of the proximal tibial physis. Each of these treatment options has its disadvantages. Treating the coronal deformity alone (genu varum) will result in persistence of the internal tibial torsion (the axial deformity). In this report, we describe the combination of lateral growth modulation and distal tibial external rotation osteotomy to correct all the elements of the disease. This has not been described before for treatment of Blounts disease. Both coronal and axial deformities were corrected in this patient. We propose this combination (rather than the lateral growth modulation alone) as the method of treatment for early stages of Blounts disease as it corrects both elements of the disease and in the same time avoids the complications of proximal tibial osteotomy. PMID:23610758

  19. Increase in the Tibial Slope Reduces Wear after Medial Unicompartmental Fixed-Bearing Arthroplasty of the Knee

    PubMed Central

    Schrder, Christian; Steinbrck, Arnd; Pietschmann, Matthias F.; Jansson, Volkmar; Mller, Peter E.

    2015-01-01

    Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of a medial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental knee prosthesis (Univation) in vitro with a customised, four-station, and servohydraulic knee wear simulator, which exactly reproduced the walking cycle (International Organisation for Standardisation (ISO) 14243-1:2002(E)). The medial prostheses were inserted with 3 different posterior tibial slopes: 0, 4, and 8 (n = 3 in each group). Results. The wear rate decreased significantly between 0 and 4 slope from 10.4 (SD 0.62) mg/million cycles to 3.22 (SD 1.71) mg/million cycles. Increasing the tibial slope to 8 did not significantly change the wear rate. Discussion. As an increase in the tibial slope reduced the wear rate in a fixed-bearing prosthesis, a higher tibial slope should be recommended. However, other factors that are influenced by the tibial slope (e.g., the tension of the ligament) must also be considered. PMID:25654123

  20. Revision of tibial TKA components: bone loss is independent of cementing type and technique: an in vitro cadaver study

    PubMed Central

    2011-01-01

    Background Different bone cements and various cementation techniques can lead to different bone loss in revision surgery. We investigated the degree of tibial bone loss depending on different cements and techniques. Methods 30 tibia specimens were matched into three groups (10 each). In all cases Genesis II tibia component were implanted. In two groups, the tibia base plate alone was cemented with Palacos® R+G and Refobacin® Bone Cement R. In the third group, both tibial base plate and tibial stem were cemented with Palacos® R+G. Afterwards, the specimens were axial loaded with 2000 N for 10,000 cycles. Tibial components were explanted and the required time to explantation was recorded. Bone loss after explantation was measured by CT. Results On CT, there was no significant difference in bone loss between cementing techniques (p = 0.077; 95% CI -1.14 - 21.03) or the cements themselves (p = 0.345; 95% CI -6.05 - 16.70). The required time to explantation was 170.6 ± 54.89, 228.7 ± 84.5, and 145.7 ± 73.0 seconds in the first, second, and third groups, respectively. Conclusions Cement technique and type do not influence tibial bone loss in simulated revision surgery of the tibial component in knee arthroplasty. PMID:21219621

  1. Enhanced Bone-Tendon-Bone Approach for Open Anterior Cruciate Ligament Replacement With Conservation of the Joint Capsule

    PubMed Central

    Walter, Sebastian Gottfried; Thomas, Tom Sascha; Tafuro, Luca; Thomas, Wolfram

    2015-01-01

    Arthroscopic procedures for ruptured anterior cruciate ligament (ACL) tears are a common standard. However, there are strong alternatives to this standard. The purpose of this study is to present a precise, fast, and minimally invasive but open procedure for reconstruction of the ruptured ACL. The torn ACL is substituted by a widely used bone–patellar tendon–bone (BPTB) autograft. After the BPTB graft has been harvested, the Hoffa body is exposed and mobilized ventrally. The surgeon then has a free view of the remnants of the torn ACL, which are to be removed completely. Through the tibial and femoral footprints of the ACL, a tunnel is drilled under a direct view, thus ensuring optimal anatomic positioning of the BPTB graft. The described approach is simple in handling and advantageous because all steps are performed under a direct view, which improves overall precision and intraoperative functional control. PMID:26900562

  2. Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal

    PubMed Central

    Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

    2013-01-01

    Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

  3. Hybrid external fixation in complex tibial plateau and plafond fractures: an Australian audit of outcomes.

    PubMed

    Piper, K J; Won, H Y; Ellis, A M

    2005-01-01

    Hybrid external fixators are useful for the management of complex tibial plateau and plafond fractures, as they provide rigid fixation with relatively minimal soft tissue disruption. We reviewed the outcomes of patients with proximal (plateau) and distal (plafond) tibial fractures who were treated with hybrid frames at the Royal North Shore Hospital from 1998 to 2001. Twenty-four patients were identified from the hospital operating records and chart, X-ray and clinical reviews were performed. Follow-up periods averaged 13 months. Fractures were classified using the Ruedi classification for ankle fractures, and the Schatzker classification for the knee fractures. Clinical outcome was assessed using the Iowa knee score and the AOFAS ankle score. As one of the first Australian audits our outcomes were consistent with international standards. PMID:15589938

  4. Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture.

    PubMed

    Zelle, Boris A; Heaberlin, James R; Murray, Matthew C

    2015-01-01

    Isolated posterolateral corner (PLC) injuries are rarely seen with tibial plateau fractures and can be missed during the initial assessment. The objective of this paper is to present a case of a Schatzker type 2 tibial plateau fracture with associated isolated PLC injury and give a discussion on physical exam, diagnostic studies, and treatment options. A twenty-five-year-old female sustained a concomitant Schatzker type 2 fracture and PLC injury. Magnetic Resonance Imaging showed an isolated PLC disruption. Open reduction-internal fixation was performed with subsequent PLC repair. At sixteen months postoperatively, the patient had full range of motion and strength of her knee and no signs of laxity. This case emphasizes the importance of physical exam and appropriate imaging modalities in order to diagnose and treat this significant injury in a prompt fashion. In this case, surgical fracture fixation and subsequent repair of the PLC provided a good clinical outcome. PMID:26600961

  5. Late flexor digitorum longus tendon rupture after transfer for posterior tibial tendon insufficiency: a case report.

    PubMed

    Ouzounian, T J

    1995-08-01

    A 64-year-old woman was treated for an idiopathic complete rupture of the posterior tibial tendon with transfer of the flexor digitorum longus tendon to the navicular. After an initial excellent result, she returned 41 months later after experiencing a sudden pop in the medial retromalleolar area, followed by progressive medial ankle pain. At reoperation, a complete rupture of the flexor digitorum longus tendon was noted at its insertion into the navicular. Reconstruction was performed utilizing a sliding lengthening of the flexor digitorum longus tendon and reattachment to the navicular with a suture anchor. Clinical improvement was noted at the 12-month follow-up evaluation. This case presentation is of clinical interest, as late acute failure of a flexor digitorum longus tendon transfer for posterior tibial tendon rupture has not been reported previously. PMID:8520667

  6. External fixation as a primary and definitive treatment for tibial diaphyseal fractures.

    PubMed

    Beltsios, Michail; Savvidou, Olga; Kovanis, John; Alexandropoulos, Panagiotis; Papagelopoulos, Panagiotis

    2009-10-01

    The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment for open tibial fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured patients. Two hundred and twenty-three tibial shaft fractures (212 patients) were treated. In open fractures, union was achieved in 25weeks, while in closed in 21. There were 18 nonunions, 21 delayed unions, 4 malunions, 58 pin infections and 3 osteomyelitis. A reoperation was performed in 42 patients. Fat embolism was diagnosed in three patients, pulmonary embolism in five and deep venous thrombosis in 14. The external fixator was definitive treatment in 87.27%. Unilateral external fixators can be used as primary and definitive treatment for complicated tibia shaft fractures. Re-operation or change of the method must be performed only when there is a delay in callus formation. PMID:19714440

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

    PubMed

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

    2007-04-01

    The main goal of the present study was to estimate the ankle joint angle from the peroneal and tibial electroneurography (ENG) recordings. Two single-channel cuff electrodes for recording ENG were placed on the proximal part of rabbit peroneal and tibial nerves respectively and static positioning and ramp-and-hold stretches were performed to characterize the static and dynamic ENG responses. An ENG model, consisting of static and dynamic parts, was constructed to relate ENG to ankle angle trajectory and an inverse ENG model was derived to predict ankle angle. The results showed that the new model could accurately estimate large-range ankle angles during and after ramp-and-hold movements. Our study provides a basis for implementing joint angle tracing without using artificial angle sensors. PMID:17273879

  8. Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture

    PubMed Central

    Zelle, Boris A.; Heaberlin, James R.; Murray, Matthew C.

    2015-01-01

    Isolated posterolateral corner (PLC) injuries are rarely seen with tibial plateau fractures and can be missed during the initial assessment. The objective of this paper is to present a case of a Schatzker type 2 tibial plateau fracture with associated isolated PLC injury and give a discussion on physical exam, diagnostic studies, and treatment options. A twenty-five-year-old female sustained a concomitant Schatzker type 2 fracture and PLC injury. Magnetic Resonance Imaging showed an isolated PLC disruption. Open reduction-internal fixation was performed with subsequent PLC repair. At sixteen months postoperatively, the patient had full range of motion and strength of her knee and no signs of laxity. This case emphasizes the importance of physical exam and appropriate imaging modalities in order to diagnose and treat this significant injury in a prompt fashion. In this case, surgical fracture fixation and subsequent repair of the PLC provided a good clinical outcome. PMID:26600961

  9. The effect of screw type on the fixation of depressed fragments in tibial plateau fractures.

    PubMed

    Cooper, H J; Kummer, F J; Egol, K A; Koval, K J

    The ability of various screw types to stabilize depressed tibial plateau fractures was determined in a biomechanical study using a Sawbones model. Two sizes of both cancellous and cortical screws were evaluated for both supportfrom below and through the depressed fragment. As a general trend, cancellous bone screws provided a greater resistance to fragment displacement than cortical bone screws, and screws with a smaller thread diameter provided greater resistance to displacement than screws of the same thread type with a larger diameter. These results agree with the accepted standard that cancellous screws provide better fixation for tibial plateau fractures, but also are counterintuitive in that smaller screws provided greater fixation than larger screws of the same type. PMID:12003357

  10. The Role of All-Polyethylene Tibial Components in Modern TKA.

    PubMed

    Doran, James; Yu, Stephen; Smith, Daniel; Iorio, Richard

    2015-10-01

    In the modern era of total knee arthroplasty (TKA), a majority of orthopedic surgeons utilize metal-backed tibial (MBT) components rather than nonmodular designs, such as all-polyethylene tibial (APT) components. Interestingly, current clinical evidence does not explain this disproportionate practice by surgeons. The shift in surgeon preference from APT to MBT components occurred in the 1980s following unfavorable results from early studies with APT. However, results from current studies that have revisited the APT versus MBT component comparison demonstrate similar implant survivorship and patient outcomes. Despite equivalent survivorship and improved cost-efficiency, APT components have not achieved equivalent utilization rates with MBT. This review of the current literature, as well as the advantages and disadvantages of APT components, will outline a rationale for the role of APT components in today's cost-driven, outcomes-oriented, patient-centered health-care system. PMID:26086937

  11. Effects of incision closure method on infection prevalence following tibial plateau leveling osteotomy in dogs.

    PubMed

    Atwood, Chase; Maxwell, Mac; Butler, Ryan; Wills, Robert

    2015-04-01

    The goal of this study was to retrospectively investigate the effect of incisional closure with either stainless steel skin staples or intradermal poliglecaprone 25 on the prevalence of surgical site infection following tibial plateau leveling osteotomy in dogs. Medical records were reviewed for dogs treated with unilateral tibial plateau leveling osteotomy at Memphis Veterinary Specialists between 2006 and 2013. Procedures (n = 306) from 242 dogs were included in the study. The association of potential risk factors with the occurrence of postoperative infection was assessed using logistic regression. A value of P < 0.05 was considered significant. Weight and administration of postoperative antimicrobials were found to significantly influence surgical site infection prevalence. No significant association was noted between closure method and prevalence of postoperative infection. PMID:25829557

  12. Effects of incision closure method on infection prevalence following tibial plateau leveling osteotomy in dogs

    PubMed Central

    Atwood, Chase; Maxwell, Mac; Butler, Ryan; Wills, Robert

    2015-01-01

    The goal of this study was to retrospectively investigate the effect of incisional closure with either stainless steel skin staples or intradermal poliglecaprone 25 on the prevalence of surgical site infection following tibial plateau leveling osteotomy in dogs. Medical records were reviewed for dogs treated with unilateral tibial plateau leveling osteotomy at Memphis Veterinary Specialists between 2006 and 2013. Procedures (n = 306) from 242 dogs were included in the study. The association of potential risk factors with the occurrence of postoperative infection was assessed using logistic regression. A value of P < 0.05 was considered significant. Weight and administration of postoperative antimicrobials were found to significantly influence surgical site infection prevalence. No significant association was noted between closure method and prevalence of postoperative infection. PMID:25829557

  13. Arthroscopic-Assisted Reduction and Percutaneous Fixation of Tibial Plateau Fractures

    PubMed Central

    Hartigan, David E.; McCarthy, Mark A.; Krych, Aaron J.; Levy, Bruce A.

    2015-01-01

    Tibial plateau fractures present a difficult range of fractures to treat. Arthroscopy allows for a less invasive option when compared with arthrotomy. Furthermore, visualization of the articular surface arthroscopically can allow for a precise reduction and assessment of any concomitant injuries to the articular cartilage and meniscus. By use of arthroscopy, unicondylar lateral plateaus were traditionally approached through a laterally based metaphyseal window. However, in carefully selected patients and fracture patterns, a medially based, arthroscopic-assisted approach can create long bony tunnels for subchondral support and allow for greater ease in fracture reduction. We present our technique using a medial approach for arthroscopic-assisted fixation of lateral tibial plateau fractures. PMID:25973374

  14. Tibial plateau leveling osteotomy in a cape clawless otter (Aonyx capensis) with cranial cruciate ligament ruptures.

    PubMed

    Molter, Christine M; Jackson, Joshua; Clippinger, Tracy L; Sutherland-Smith, Meg

    2015-03-01

    A 13-yr-old female Cape clawless otter (Aonyx capensis) presented with an acute mild right pelvic limb lameness that progressed to a non-weight-bearing lameness. Diagnosis of a ruptured cranial cruciate ligament (CCL) was made based on positive cranial drawer during physical examination and was supported by radiographs. A surgical repair with a tibial plateau leveling osteotomy (TPLO) and bone anchor with an OrthoFiber suture was performed. The tibial plateau angle was reduced from 30 to 5 degrees. The otter returned to normal function after 12 wk of exercise restriction. Twelve months after surgery, the left CCL ruptured and a TPLO was performed. No complications developed after either surgery, and the otter had an excellent return to function. This is the first report of a cranial cruciate ligament rupture and TPLO procedure in a mustelid, supporting its application to noncanid and felid species. PMID:25831598

  15. An experimental approach to determining fatigue crack size in polyethylene tibial inserts.

    PubMed

    Lockard, Carly A; Sanders, Anthony P; Raeymaekers, Bart

    2016-02-01

    A major limiting factor to the longevity of prosthetic knee joints is fatigue crack damage of the polyethylene tibial insert. Existing methods to quantify fatigue crack damage have several shortcomings, including limited resolution, destructive testing approach, and high cost. We propose an alternative fatigue crack damage visualization and measurement method that addresses the shortcomings of existing methods. This new method is based on trans-illumination and differs from previously described methods in its ability to non-destructively measure subsurface fatigue crack damage while using a simple and cost-effective bench-top set-up. We have evaluated this method to measure fatigue crack damage in two tibial inserts. This new method improves on existing image-based techniques due to its usability for subsurface damage measurement and its decreased reliance on subjective damage identification and measurement. PMID:26451704

  16. Cervical squamous cell carcinoma with isolated tibial metastasis: A case report and review of the literature

    PubMed Central

    YUAN, FANG; ZHANG, CHUNMEI; CUI, ZHUMEI; LI, XIANG; LI, XIA; LIN, WEI; YANG, XINGSHENG

    2014-01-01

    Bone metastasis resulting from carcinoma of the cervix is rare, particularly in the isolated distal appendicular bone. A 43-year-old female was diagnosed with a right tibial tumor with progressive right knee pain for three months, which was diagnosed as poorly differentiated metastatic squamous cell carcinoma, and further confirmed by biopsy of the proximal tibia. The patient was diagnosed with cervical squamous cell carcinoma with tibial metastasis following further examination, despite a lack of gynecological symptoms. In contrast to the poor outcome commonly observed in patients with bone metastasis, the patient survived and remained disease-free 41 months after surgical excision of the metastatic tumor and radical hysterectomy followed by chemoradiotherapy. The present case is one of the few documented cases of metastasis to the tibia arising from carcinoma of the uterine cervix and may be the first regarding isolated metastasis at this site. PMID:25364422

  17. [Dysphagia in patients undergoing anterior cervical surgery].

    PubMed

    Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Martinato, Geraldo; Riegel, Rafael Ernesto

    2004-06-01

    Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varies depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery. PMID:15273851

  18. Totally thrombosed giant anterior communicating artery aneurysm

    PubMed Central

    Kumar, V. R. Roopesh; Madhugiri, Venkatesh S.; Sasidharan, Gopalakrishnan M.; Gundamaneni, Sudheer Kumar; Yadav, Awdhesh Kumar; Verma, Surendra Kumar

    2015-01-01

    Giant anterior communicating artery aneurysms are rare. Apatient presented with visual dysfunction, gait ataxia and urinary incontinence. MRI showed a giant suprasellar mass. At surgery, the lesion was identified as being an aneurysm arising from the anterior communicating artery. The difficulty in preoperative diagnosis and relevant literature are reviewed. PMID:25883491

  19. Rhabdomyolysis after tourniquet use in proximal tibial osteotomy: a case report and review of the literature.

    PubMed

    Trkmen, ?smail; Esenkaya, ?rfan; Unay, Koray; Akal, Mehmet Akif

    2015-01-01

    Rhabdomyolysis following pneumotic tourniquet use is an extremely rare complication. In this case report, we aimed to present an unusual tourniquet complication following proximal tibial osteotomy. A 55-year-old female patient was operated on for genu varum in our clinic. Postoperatively, an anuria developed, and liver and kidney function test levels increased. The patient was diagnosed with acute rhabdomyolysis, and an aggressive treatment was begun. PMID:26200417

  20. Internal tibial torsion correction study. [measurements of strain for corrective rotation of stressed tibia

    NASA Technical Reports Server (NTRS)

    Cantu, J. M.; Madigan, C. M.

    1974-01-01

    A quantitative study of internal torsion in the entire tibial bone was performed by using strain gauges to measure the amount of deformation occuring at different locations. Comparison of strain measurements with physical dimensions of the bone produced the modulus of rigidity and its behavior under increased torque. Computerized analysis of the stress distribution shows that more strain occurs near the torqued ends of the bones where also most of the twisting and fracturing takes place.

  1. Declining tibial curvature parallels ?6150 years of decreasing mobility in Central European agriculturalists.

    PubMed

    Macintosh, Alison A; Davies, Thomas G; Pinhasi, Ron; Stock, Jay T

    2015-06-01

    Long bones respond to mechanical loading through functional adaptation in a suite of morphological characteristics that together ensure structural competence to in vivo loading. As such, adult bone structure is often used to make inferences about past behavior from archaeological remains. However, such biomechanical approaches often investigate change in just one aspect of morphology, typically cross-sectional morphology or trabecular structure. The relationship between longitudinal bone curvature and mobility patterns is less well understood, particularly in the tibia, and it is unknown how tibial curvature and diaphyseal cross-sectional geometry interact to meet the structural requirements of loading. This study examines tibial curvature and its relationship with diaphyseal cross-sectional geometry (CSG) and body size in preindustrial Central Europeans spanning ?6150 years following the introduction of agriculture in the region. Anteroposterior centroid displacement from the proximo-distal longitudinal axis was quantified at nine diaphyseal section locations (collectively representative of diaphyseal curvature) in 216 tibial three-dimensional laser scans. Results documented significant and corresponding temporal declines in midshaft centroid displacement and CSG properties. Significant correlations were found between mid-diaphyseal centroid displacement and all mobility-related CSG properties, while the relationship weakened toward the diaphyseal ends. No significant relationship was found between centroid displacement and body size variables with the exception of the most distal section location. Results support a relationship between tibial curvature and cross-sectional geometry among prehistoric Central European agricultural populations, and suggest that changes in mechanical loading may have influenced a suite of morphological features related to bone adaptation in the lower limb. PMID:25677783

  2. Autograft Transfer from the Ipsilateral Femoral Condyle in Depressed Tibial Plateau Fractures

    PubMed Central

    Sferopoulos, N.K

    2014-01-01

    Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes. Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts). Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group. Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes. PMID:25317215

  3. Acrylamide disrupts elemental composition and water content of rat tibial nerve. III. Recovery.

    PubMed

    LoPachin, R M; Lehning, E J; Castiglia, C M; Saubermann, A J

    1993-09-01

    We have previously demonstrated that subacute and subchronic acrylamide (ACR) intoxication are associated with a loss of subcellular elemental regulation in myelinated axons and Schwann cells of rat tibial nerve (LoPachin et al., Toxicol. Appl. Pharmacol. 115, 21-34, 1992; LoPachin et al., Toxicol. Appl. Pharmacol. 115, 35-43, 1992). In the present study, rats were allowed to recover partially from subchronic oral ACR intoxication (2.8 mM in drinking water for approximately 30 days). Elemental composition and water content of tibial nerve myelinated axons and Schwann cells were measured by electron probe X-ray microanalysis. Results show that K and Cl concentrations in larger tibial nerve axons were shifted toward normal values or above. For the most part, small axons also exhibited elemental changes that reflected recovery from ACR intoxication. Mitochondria displayed elemental changes that were similar to corresponding axoplasm. Schwann cells in tibial nerve of recovering animals had altered Na, P, Cl, K, and Mg concentrations that were similar in magnitude and extent to those occurring during ACR intoxication. In contrast, myelin displayed few changes. These results suggest that the recovery process following ACR intoxication is associated with characteristic changes in subaxonal elemental composition that might be related to repair mechanisms. That recovery-related elemental changes differ from those associated with intoxication provides additional support for the hypothesis (LoPachin et al., Toxicol. Appl. Pharmacol. 115, 21-34, 1992) that perturbation of elemental regulation is a specific component of ACR neurotoxicity. The observation of persistent Schwann cell disruption during recovery might reflect either long-term secondary consequences or delayed recovery from direct injury. Further studies are necessary to resolve this issue. PMID:8378932

  4. Metrology to quantify wear and creep of polyethylene tibial knee inserts.

    PubMed

    Muratoglu, Orhun K; Perinchief, Rebecca S; Bragdon, Charles R; O'Connor, Daniel O; Konrad, Reto; Harris, William H

    2003-05-01

    Assessment of damage on articular surfaces of ultrahigh molecular weight polyethylene tibial knee inserts primarily has been limited to qualitative methods, such as visual observation and classification of features such as pitting, delamination, and subsurface cracking. Semiquantitative methods also have been proposed to determine the linear penetration and volume of the scar that forms on articular surfaces of tibial knee inserts. The current authors report a new metrologic method that uses a coordinate measuring machine to quantify the dimensions of this scar. The articular surface of the insert is digitized with the coordinate measuring machine before and after regular intervals of testing on a knee simulator. The volume and linear penetration of the scar are calculated by mathematically taking the difference between the digitized surface maps of the worn and unworn articular surfaces. Three conventional polyethylene tibial knee inserts of a posterior cruciate-sparing design were subjected to five million cycles of normal gait on a displacement-driven knee wear simulator in bovine serum. A metrologic method was used to calculate creep and wear contributions to the scar formation on each tibial plateau. Weight loss of the inserts was determined gravimetrically with the appropriate correction for fluid absorption. The total average wear volume was 43 +/- 9 and 41 +/- 4 mm3 measured by the metrologic and gravimetric methods, respectively. The wear rate averaged 8.3 +/- 0.9 and 8.5 +/- 1.6 mm3 per million cycles measured by the metrologic and gravimetric methods, respectively. These comparisons reflected strong agreement between the metrologic and gravimetric methods. PMID:12771826

  5. Knee stability, athletic performance and sport-specific tasks in non-professional soccer players after ACL reconstruction: comparing trans-tibial and antero-medial portal techniques

    PubMed Central

    Tudisco, Cosimo; Bisicchia, Salvatore; Cosentino, Andrea; Chiozzi, Federica; Piva, Massimo

    2015-01-01

    Summary Background a wrong position of bone tunnels, in particular on the femur, is one of the most frequent causes of a failed anterior cruciate ligament (ACL) reconstruction. Several studies demonstrated that drilling the femoral tunnel through the antero-medial portal (AMP) allows a more anatomical placement on the lateral femoral condyle and higher knee stability, compared to trans-tibial (TT) technique. The aim of this study was to retrospectively evaluate two groups of soccer players operated on for ACL reconstruction according to either one of these two techniques. Methods two groups of non-professional soccer players operated on for a single bundle ACL reconstruction with hamstrings autograft using either a TT (20 patients) or an AMP (23 patients) technique were retrospectively evaluated with KT-1000 arthrometer, manual pivot shift test, isokinetic test, the incremental treadmill-running test, athletic and sport specific tasks, and knee scores (IKDC, Lysholm and KOOS). Results the AMP group showed better results at pivot shift test and KOOS, but lower flexion angles at single leg squat test. There were no differences in all the other considered outcomes. Conclusions the better rotational stability of the knee achieved in AMP group did not lead to significantly better clinical and functional results in our patients. Level of evidence III. Treatment study Case-control study. PMID:26605191

  6. Mechanics of post-cam engagement during simulated dynamic activity.

    PubMed

    Fitzpatrick, Clare K; Clary, Chadd W; Cyr, Adam J; Maletsky, Lorin P; Rullkoetter, Paul J

    2013-09-01

    Posterior-stabilized (PS) total knee arthroplasty (TKA) components employ a tibial post and femoral cam mechanism to guide anteroposterior knee motion in lieu of the posterior cruciate ligament. Some PS TKA patients report a clicking sensation when the post and cam engage, while severe wear and fracture of the post; we hypothesize that these complications are associated with excessive impact velocity at engagement. We evaluated the effect of implant design on engagement dynamics of the post-cam mechanism and resulting polyethylene stresses during dynamic activity. In vitro simulation of a knee bend activity was performed for four cadaveric specimens implanted with PS TKA components. Post-cam engagement velocity and flexion angle at initial contact were determined. The experimental data were used to validate computational predictions of PS mechanics using the same loading conditions. A lower limb model was subsequently utilized to compare engagement mechanics of eight TKA designs, relating differences between implants to geometric design features. Flexion angle and post-cam velocity at engagement demonstrated considerable ranges among designs (23-89, and 0.05-0.22 mm/, respectively). Post-cam velocity was correlated (r = 0.89) with tibiofemoral condylar design features. Condylar geometry, in addition to post-cam geometry, played a significant role in minimizing engagement velocity and forces and stresses in the post. This analysis guides selection and design of PS implants that facilitate smooth post-cam engagement and reduce edge loading of the post. PMID:23606458

  7. Mechanics of post-cam engagement during simulated dynamic activity

    PubMed Central

    Fitzpatrick, Clare K; Clary, Chadd W; Cyr, Adam J; Maletsky, Lorin P; Rullkoetter, Paul J

    2013-01-01

    Posterior-stabilized (PS) total knee arthroplasty (TKA) components employ a tibial post and femoral cam mechanism to guide anteroposterior knee motion in lieu of the posterior cruciate ligament. Some PS TKA patients report a clicking sensation when the post and cam engage, while severe wear and fracture of the post; we hypothesize that these complications are associated with excessive impact velocity at engagement. We evaluated the effect of implant design on engagement dynamics of the post-cam mechanism and resulting polyethylene stresses during dynamic activity. In vitro simulation of a knee bend activity was performed for four cadaveric specimens implanted with PS TKA components. Post-cam engagement velocity and flexion angle at initial contact were determined. The experimental data were used to validate computational predictions of PS mechanics using the same loading conditions. A lower limb model was subsequently utilized to compare engagement mechanics of eight TKA designs, relating differences between implants to geometric design features. Flexion angle and post-cam velocity at engagement demonstrated considerable ranges among designs (2389, and 0.050.22?mm/, respectively). Post-cam velocity was correlated (r?=?0.89) with tibiofemoral condylar design features. Condylar geometry, in addition to post-cam geometry, played a significant role in minimizing engagement velocity and forces and stresses in the post. This analysis guides selection and design of PS implants that facilitate smooth post-cam engagement and reduce edge loading of the post. PMID:23606458

  8. The Correlation of Tunnel Position, Orientation and Tunnel Enlargement in Outside-in Single-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Ko, Young Won; Rhee, Seung Jun; Kim, In Woo

    2015-01-01

    Purpose Tunnel widening after anterior cruciate ligament (ACL) reconstruction is a frequently described phenomenon. The possible etiology is multi-factorial with some mechanical and biological factors. Among those, we intended to determine the relation between the location and orientation of the femoral tunnel and the femoral tunnel enlargement after outside-in single-bundle ACL reconstruction. Materials and Methods A retrospective study including 42 patients who received single-bundle ACL reconstruction with the outside-in technique was conducted. Femoral and tibial tunnel locations were evaluated with the quadrant method and bird's-eye view using volume-rendering computed tomography. The angle and diameter of bone tunnel and the degree of tunnel enlargement were evaluated using standard radiographs. Results The degree of femoral tunnel enlargements were 42% and 36% on the anteroposterior (AP) and lateral radiographs, respectively, and the degree of tibial tunnel enlargements were 22% and 23%, respectively. Shallower location of the femoral tunnel was significantly correlated with greater femoral tunnel enlargement on the AP radiograph (r=0.998, p=0.004) and the lateral radiograph (r=0.72, p=0.005) as was the higher location of the femoral tunnel on the AP radiograph (r=-0.47, p=0.01) and the lateral radiograph (r=-0.36, p=0.009) at 12 months after surgery. Conclusions This study revealed that more anterior and higher location and more horizontal orientation of the femoral tunnel in coronal plane could result in widening of the femoral tunnel in outside-in single-bundle ACL reconstruction. PMID:26672479

  9. Anterior capsulotomy using the CO2 laser

    NASA Astrophysics Data System (ADS)

    Barak, Adiel; Ma-Naim, Tova; Rosner, Mordechai; Eyal, Ophir; Belkin, Michael

    1998-06-01

    Continuous circular capsulorhexis (CCC) is the preferred technique for removal of the anterior capsule during cataract surgery due to this technique assuring accurate centration of the intraocular lens. During modern cataract surgery, especially with small or foldable intra ocular lenses, centration of the lens is obligatory. Radial tears at the margin of an anterior capsulotomy may be associated with the exit of at least one loop of an intraocular lens out of the capsular bag ('pea pod' effect) and its subsequent decentration. The anterior capsule is more likely to ream intact if the continuous circular capsulorhexis (CCC) technique is used. Although manual capsulorhexis is an ideal anterior capsulectomy technique for adults, many ophthalmologists are still uncomfortable with it and find it difficult to perform, especially in complicated cases such as these done behind small pupil, cataract extraction in children and pseudoexfoliation syndrome. We have developed a technique using a CO2 laser system for safe anterior capsulotomy and tested it in animal eyes.

  10. Atraumatic Anterior Dislocation of the Hip Joint

    PubMed Central

    Ohtsuru, Tadahiko; Morita, Yasuyuki; Murata, Yasuaki; Itou, Junya; Morita, Yuji; Munakata, Yutaro; Kato, Yoshiharu

    2015-01-01

    Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case. PMID:26819791

  11. Evaluation of factors affecting tibial bone strain after unicompartmental knee replacement

    PubMed Central

    Pegg, E.C; Walter, J.; Mellon, S.J.; Pandit, H.G.; Murray, D.W.; D'Lima, D.D.; Fregly, B.J.; Gill, H.S.

    2013-01-01

    Persistent pain is an important cause of patient dissatisfaction after unicompartmental knee replacement (UKR) and has been correlated with localised tibial strain. However, the factors that influence these strains are not well understood. To address this issue, we created finite element models to examine the effect on tibial strain of: (1) muscle forces (estimated using instrumented knee data) acting on attachment sites on the proximal tibia, (2) UKR implantation, (3) loading position, and (4) changes in gait pattern. Muscle forces acting on the tibia had no significant influence on strains within the periprosthetic region, but UKR implantation increased strain by 20%. Strain also significantly increased if the region of load application was moved >3 mm medially. The strain within the periprosthetic region was found to be dependent on gait pattern and was influenced by both medial and lateral loads, with the medial load having a greater effect (regression coefficients: medial=0.74, lateral=0.30). These findings suggest that tibial strain is increased after UKR and may be a cause of pain. It may be possible to reduce pain through modification of surgical factors or through altered gait patterns. PMID:23192787

  12. Reconstruction of composite tibial defect with free flaps and ipsilateral vascularized fibular transposition.

    PubMed

    Chung, Duke Whan; Han, Chung Soo; Lee, Jae Hoon

    2011-07-01

    Composite defects of the tibia following open fractures are among the most challenging of clinical problems. The aim of this study is to report the results of treatment using a free flap procedure followed by ipsilateral vascularized fibular transposition (IVFT) for reconstruction of composite tibial defects. Ten patients underwent a free flap procedure followed by IVFT and plating. The mean size of the flaps was 12.1 6 cm(2). The mean length of bone defect was 5.35 cm. IVFT were performed 4.3 months following the free flap. Patients were followed for an average of 3.4 years. All flaps survived. The average time to union of the proximal and distal ends was 5.2 and 6.7 months, respectively. There were neither stress fractures of the transferred fibula nor recurrent infections. One patient demonstrated a medial angulation of 8 in the reconstructed tibia but experienced no difficulties in activities of daily living. At the last follow-up time point, all patients were able to walk without an assist device and were satisfied with the preservation of the injured lower extremity. Free flap procedures followed by IVFT for the treatment of composite tibial defects may reduce complications at the recipient site and infections, such as osteomyelitis. The plating technique combined with IVFT allowed bone union without additional operations or stress fractures in our series. We suggest that staged free flap and IVFT is useful for the treatment of composite segmental tibial defects. PMID:21618277

  13. Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode

    NASA Astrophysics Data System (ADS)

    Schiefer, M. A.; Freeberg, M.; Pinault, G. J. C.; Anderson, J.; Hoyen, H.; Tyler, D. J.; Triolo, R. J.

    2013-10-01

    Objective. Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. Approach. During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. Main results. With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. Significance. Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.

  14. Ionising radiation exposure in patients with circular frame treatment of distal tibial fractures.

    PubMed

    Bryant, H; Dearden, P M C; Harwood, P J; Wood, T J; Sharma, H K

    2015-08-01

    Total radiation exposure accumulated during circular frame treatment of distal tibial fractures was quantified in 47 patients treated by a single surgeon from February 2007 until Oct 2010. The radiation exposures for all relevant radiology procedures for the distal tibial injury were included to estimate the radiation risk to the patient. The median time of treatment in the frame was 169 days (range 105-368 days). Patients underwent a median of 13 sets of plain radiographs; at least one intra operative exposure and 16 patients underwent CT scanning. The median total effective dose per patient from time of injury to discharge was 0.025mSv (interquartile range 0.013-0.162 and minimum to maximum 0.01-0.53). The only variable shown to be an independent predictor of cumulative radiation dose on multivariate analysis was the use of CT scanning. This was associated with a 13-fold increase in overall exposure. Radiation exposure during treatment of distal tibial fractures with a circular frame in this group was well within accepted safe limits. The fact that use of CT was the only significant predictor of overall exposure serves as a reminder to individually assess the risk and utility of radiological investigations on an individual basis. This is consistent with the UK legal requirements for justification of all X-ray imaging, as set out in the Ionising Radiation (Medical Exposure) Regulations 2000 [1]. PMID:25986665

  15. Complications associated with tibial plateau leveling osteotomy: A retrospective of 1519 procedures

    PubMed Central

    Coletti, Thomas J.; Anderson, Mark; Gorse, Mary Jean; Madsen, Richard

    2014-01-01

    This retrospective study identified complications associated with tibial plateau leveling osteotomy (TPLO) and predisposing factors for these complications in a large population of dogs from a metropolitan area with cruciate ligament deficiency. There were 943 dogs that underwent unilateral TPLO and 288 with staged bilateral TPLO for a total of 1519 procedures. There were 47 cases with at least 1 major complication and 126 cases with at least 1 minor complication but no major complications. The total complication rate (major or minor) was 11.4% [95% confidence interval (CI) estimate: 9.8%, 13.2%]; the major complication rate was 3.1% (95% CI: 2.3%, 4.1%); and the minor complication rate was 8.3% (95% CI: 7.0%, 9.8%). Factors associated with development of complications included being a German shepherd dog [odds ratio (OR): 3.2], tibial plateau angle > 30° (OR: 1.6), and heavier weights (for every 4.5 kg increase in body weight the OR increased by 1.10). Tibial plateau leveling osteotomy is a common treatment for dogs with cruciate ligament deficiency and has a low complication rate. PMID:24587508

  16. Comparison of tibial plateau angles in small and large breed dogs

    PubMed Central

    Su, Lillian; Townsend, Katy L.; Au, Jennifer; Wittum, Thomas E.

    2015-01-01

    Cranial cruciate ligament (CCL) disease can affect dogs of all sizes. The literature describing tibial plateau angle (TPA) in small breed dogs is limited. A retrospective study was conducted in unselected dogs presented for stifle or tibial examination to compare TPA in small breed dogs (n = 146 dogs, 185 stifles) versus large breed dogs (n = 200 dogs, 265 stifles). Small breed dogs had a mean TPA 3.1° ± 0.6° higher than large breed dogs. There were higher TPAs in spayed females and castrated males for all dogs compared with intact males (3.6° ± 1.0° and 2.7° ± 1.0°, respectively). Dogs with unilateral and bilateral CCL disease had higher TPAs compared to dogs with intact CCLs (2.0° ± 0.7° and 2.5° ± 0.8°, respectively). Tibial morphology differs between large and small breed dogs; however, the significance of the impact of TPA on CCL disease in small breed dogs is unknown. PMID:26028684

  17. Influence of loading and activity on the primary stability of cementless tibial trays.

    PubMed

    Taylor, Mark; Barrett, David S; Deffenbaugh, Daren

    2012-09-01

    Several potential advantages exist for cementless tibial fixation including preservation of bone stock and increased longevity of fixation. However, clinical results have been variable, with reports of extensive radiolucent lines, rapid early migration, and aseptic loosening. The primary stability of an implant depends on the micromotion of the bone-implant interface, which depends on the kinematics and kinetics of the replaced joint. Finite element analysis was used to examine the micromotion for different activities (walking, stair ascent, stair descent, stand-to-sit, and deep knee bend) for three commercially available tibial tray designs. Similar trends were observed for all three designs across the range of activities. Stair ascent and descent generated the highest micromotions, closely followed by level gait. Across these activities, the mean peak (maximum) micromotions measured across the entire resected surface ranged from 64 to 78 (186-239)?m for PFC Sigma, 61-72 (199-251)?m for LCS Complete Duofix, and 92-106 (229-264)?m for LCS Complete. The peak micromotions did not necessarily occur at the peak loads. For instance, the peak micromotions for level walking occurred when there were low axial forces, but moderate varus-valgus moments. This highlights the need to examine the whole gait cycle to properly determine the initial stability of tibial tray designs. By exploring a range of activities and interrogating the entire resected surface, it is possible to differentiate between the relative performance of different implant designs. PMID:22267212

  18. Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies

    PubMed Central

    Samani, Seyed Salman; Kachooei, Amir Reza; Ebrahimzadeh, Mohammad Hosein; Omidi Kashani, Farzad; Mahdavian Naghashzargar, Reza; Razi, Shiva

    2013-01-01

    Background Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate. Objectives This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia. Patients and Methods In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered. Results The mean follow-up time was 9.33 ± 1.87 month. The average age was 45.13 ± 7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery. Conclusions The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies. PMID:24083009

  19. Literature review of the possible advantages of silicon liner socket use in trans-tibial prostheses.

    PubMed

    Baars, E C T; Geertzen, J H B

    2005-04-01

    The silicon liner socket has been used in the trans-tibial prosthesis since the 1980s. Silicon liner sockets are sleeves of silicon material that are rolled onto the stump and fix the prosthesis to it. The producers of the liners propagate many advantages in their use i.e. better suspension of the prosthesis, protection of the stump skin and improved cosmetic appearance. This review was performed to find objective documentation in the literature in support of the advantages in prosthetic fitting and use of silicon liners. A medline search was performed with the key words: "silicon liner socket, Icelandic Roll On Silicon Socket (ICEROSS), trans-tibial prosthesis, lower leg prosthesis and stump sockets". Six articles remained after application of the selection criteria. In two studies clinical examination was done while in the rest questionnaires were used to collect data. The indication for amputation varied from vascular insufficiency, diabetes mellitus and infection to trauma. Most studies mentioned improved prosthetic suspension compared to the conventional supracondylar fitting. Also the walking performance improved with less use of walking aids. There were reports of positive but also negative effects on the skin such as excessive perspiration and itching. Patients had a general preference in prosthetic appearance in favour of the prosthesis with a silicon liner. Further research is needed with the use of objective clinical parameters and a homogenous study group objectively to find advantages in the use of the silicon liner socket in the trans-tibial prosthesis. PMID:16180375

  20. Computer assisted versus conventional cemented total knee prostheses alignment accuracy and micromotion of the tibial component.

    PubMed

    van Strien, Thisbe; van der Linden-van der Zwaag, Enrike; Kaptein, Bart; van Erkel, Arjan; Valstar, Edward; Nelissen, Rob

    2009-10-01

    We evaluated the influence of CT-free or CT-based computer assisted orthopaedic surgery (CAOS) on the alignment of total knee prostheses (TK) and micromotion of tibial components. This randomised study compared 19 CT-free, 17 CT-based CAOS TK, and a matched control group of 21 conventionally placed TK. Using Roentgen stereophotogrammetric analysis (RSA) the migration was measured. The alignment and component positions were measured on radiographs. No significant difference in leg and tibial component alignment was present between the three groups. A significant difference was found for micromotion in subsidence, with the conventional group having a mean of 0.16 mm, compared to the CT-free group at 0.01 mm and the CT-based group at -0.05 mm. No clinical significant difference in alignment was found between CAOS and conventionally operated TK. More subsidence of the tibial component was seen in the conventional group compared to both CAOS groups at two year follow-up. PMID:18758777

  1. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanical study and operative technique.

    PubMed

    Ali, A M; Yang, L; Hashmi, M; Saleh, M

    2001-12-01

    The two main challenges in the management of bicondylar tibial plateau fractures are: Firstly, the compromised skin and soft tissue envelope which invite a high rate of complications following attempted open reduction and dual plating. Secondly, poor bone quality and comminuted fracture patterns, which create difficulty in achieving stable fixation. Although dual plating is considered to be the best mechanical method of stabilizing these complex fractures, there remains concern regarding the high rate of complications associated with extensive soft tissue dissection, required for the insertion of these plates in an already compromised knee. The Sheffield Hybrid fixator (SHF) technique offers a solution to the two main problems of these difficult fractures by minimizing soft tissue dissection, since bone fragments are reduced and fixed percutaneously, and providing superior cancellous bone purchase with beam loading stabilization for comminuted fractures. Our biomechanical testing showed the SHF with four tensioned wires to be as strong as dual plating and able to provide adequate mechanical stability in the fixation of bicondylar tibial plateau fractures. This was confirmed clinically by a prospective review of the use of the SHF at our centre, for managing complex and high-energy tibial plateau fractures with a good final outcome and no cases of deep infection or septic arthritis. PMID:11812481

  2. The role of the design of tibial components and stems in knee replacement.

    PubMed

    Scott, C E H; Biant, L C

    2012-08-01

    Stems improve the mechanical stability of tibial components in total knee replacement (TKR), but come at a cost of stress shielding along their length. Their advantages include resistance to shear, reduced tibial lift-off and increased stability by reducing micromotion. Longer stems may have disadvantages including stress shielding along the length of the stem with associated reduction in bone density and a theoretical risk of subsidence and loosening, peri-prosthetic fracture and end-of-stem pain. These features make long stems unattractive in the primary TKR setting, but often desirable in revision surgery with bone loss and instability. In the revision scenario, stems are beneficial in order to convey structural stability to the construct and protect the reconstruction of bony defects. Cemented and uncemented long stemmed implants have different roles depending on the nature of the bone loss involved. This review discusses the biomechanics of the design of tibial components and stems to inform the selection of the component and the technique of implantation. PMID:22844039

  3. Extended anterolateral approach for treatment of posterolateral tibial plateau fractures improves operative procedure and patient prognosis

    PubMed Central

    Chen, Hong-Wei; Luo, Cong-Feng

    2015-01-01

    Purpose: The treatment of posterolateral tibial plateau fracture remains controversial and challenging. Several approaches for this fracture have been applied for direct exposure and support plate fixation. However, several structures are to be at risk via posterior approach, which may affect exposure and plate application. To solve this problem, an extended anterolateral approach was developed and reported. Methods: 15 patients with posterolateral tibial plateau fractures treated with this approach were reviewed. The primary outcomes, such as Rasmussen functional score, and the secondary outcomes, such as knee deformity, postoperative infection, as well as complications were evaluated. Results: All 15 cases have been followed up for 12 to 30 months (19.7 months at average). Rasmussen functional score after surgeries was 25.0 2.8 points. A score ? 27 points was considered as excellent (ten patients), a score of 20-26 points (four patients) was considered as good; and a score of 10-19 points (one patient) was considered as fair. Anatomic reductions were obtained in 14 patients, but a 3 mm gap was found in one patient. For all patients, there were no wound complications, nonunion, valgus knee deformities, plate loosening or breakages, or fracture re-displacements. No vascular or neural injuries occurred in any patient. Conclusion: The extended anterolateral approach provides excellent visualization, which can facilitate the internal fixation and reduction of posterolateral tibial plateau fractures, and shows encouraging results. PMID:26550316

  4. Ameloblastoma of the anterior mandible

    PubMed Central

    Hariram; Mohammad, Shadab; Malkunje, Laxman R.; Singh, Nimisha; Das, Sugata; Mehta, Gagan

    2014-01-01

    Ameloblastoma or adamantinoma is the rarest of the three forms of tumor of the odontogenic type. They are benign, locally aggressive neoplasms arising from ameloblasts, which typically occur at the angle of the mandible, and are often associated with an un-erupted tooth and must, therefore, be differentiated from a dentigerous cyst which will be centered on the crown. When in the maxilla (less common), they are located in the premolar region, and can extend up in the maxillary sinus. Ameloblastoma is reported to constitute about 1-3% of tumors and cysts of the jaws. The tumor is by far more common in the mandible than in the maxilla and shows predilection for various parts of the mandible in different racial groups. The relative frequency of the mandible to maxilla is reported as varying from 80-20% to 99-1%. Here, we are representing a case of ameloblastoma of anterior mandible which was considered as a rare site of occurrence. PMID:25298718

  5. Anterior Cruciate Ligament Graft Choices

    PubMed Central

    Macaulay, Alec A.; Perfetti, Dean C.; Levine, William N.

    2012-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is a common surgical procedure; however, there is no consensus to what the best graft option is to replace the injured ACL. The main options available consist of allografts and autografts, which include patellar tendon, hamstring tendon, and quadriceps tendon autografts. Evidence Acquisition: The PubMed database was searched in August 2010 for English-language articles pertaining to ACL grafts. Results: Postoperative outcome variables were analyzed to determine similarities and differences among the different graft options. These variables include stability, strength, function, return to sports, patient satisfaction, complications, and cost. Conclusions: Both allografts and the 3 main options for autografts can provide excellent results in ACL reconstruction and lead to a high percentage of satisfied patients. However, differences exist among the graft choices. Both the similarities and the differences are important to discuss with a patient who will be undergoing ACL reconstruction so that he or she has the best information available when making a choice of graft. PMID:23016071

  6. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments

    PubMed Central

    Franklyn, Melanie; Oakes, Barry

    2015-01-01

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient’s history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order to facilitate healing and prevent future re-occurrence. PMID:26396934

  7. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments.

    PubMed

    Franklyn, Melanie; Oakes, Barry

    2015-09-18

    Medial tibial stress syndrome (MTSS) is a debilitating overuse injury of the tibia sustained by individuals who perform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging (MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density (BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture (TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order to facilitate healing and prevent future re-occurrence. PMID:26396934

  8. All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament

    PubMed Central

    Gwinner, Clemens; Hoburg, Arnd; Wilde, Sophie; Schatka, Imke; Krapohl, Björn Dirk; Jung, Tobias M.

    2016-01-01

    Background: The posterior cruciate ligament (PCL) avulsion fracture from its tibial insertion is a rare condition. Despite the further technical advent in refixation of avulsion fractures, the reported failure rate of current approaches remains high and the optimal surgical technique has not been elucidated yet. The purpose of the current study is to present an all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the PCL and initial clinical outcomes. Methods: Patients underwent a thorough clinical and radiological examination of both knees at 3, 6, 12, 18, and if possible also at 24 months. Clinical evaluation included subjective and objective IKDC 2000, Lysholm score, and KOOS score. Radiographic imaging studies included CT scans for assessment of osseous integration and anatomic reduction of the bony avulsion. In addition to that posterior stress radiographs of both knees using the Telos device (Arthrex, Naples, USA) were conducted to measure posterior tibial translation. Results: A total of four patients (1 female, 3 male; ø 38 (± 18) years), who underwent arthroscopic refixation of a PCL avulsion fracture using the Tight Rope device were enrolled in this study. Mean follow up was 22 [18–24] months. The mean subjective IKDC was 72.6% (± 9.9%). Regarding the objective IKDC three patients accounted for grade A, one patient for grade C. The Lysholm score yielded 82 (± 6.9) points. The KOOS score reached 75% (± 13%; symptoms 76%, pain 81%, function 76%, sports 66%, QoL 64%). All patients showed complete osseous integration and anatomic reduction of the bony avulsion. The mean posterior tibial translation at final follow up was 2.8 [0–7] mm. Conclusions: All-arthroscopic treatment of tibial avulsion fractures of the posterior cruciate ligament provides satisfactory clinical results in a preliminary patient cohort. It is a reproducible technique, which minimizes soft tissue damage and obviates a second surgery for hardware removal. Further clinical studies with larger patient cohorts and a control group are needed to further confirm these preliminary results. PMID:26816668

  9. [Implant-free replacement of the anterior cruciate ligament with the double bundle technique: a modification of Pssler's operation technique].

    PubMed

    Boszotta, H

    2010-07-01

    Reconstruction of the anterior cruciate ligament using the double bundle technique provides better covering of the anatomic insertion site areas and fiber length change behavior. Biomechanical studies and intraoperative measurements with computer navigation systems document increased stability in particular due to rotational stability. To date the impact of the posterolateral bundle is questioned and clinical studies have reported divergent outcomes. In favor of enhanced rotational stability, some techniques leave the basic principles of aperture or central graft fixation, decreasing primary stability and running the risk of tunnel widening especially on the femoral site. Additional use of interference screws means increased implants and costs and bone void in cases of revision is challenging. A technique for anatomic double-bundle reconstruction without the use of implants is presented, which allows for femoral aperture fixation with high primary stability of both bundles. In terms of the knot/press-fit technique of Paessler in the U-shaped tendons, a knot is created at the free end, which serves as a rigid press-fit anchoring in bottleneck shaped femoral drill holes at the insertion site of the anteromedial and posterolateral bundles. The drill holes are prepared in flexion of 110-115 degrees using common offset and target drill devices. Mersilen tapes are applied to introduce the grafts from femoral to tibial and to fix the tendons over a bony bridge on the tibial site after preconditioning. The gracilis tendon mimics the posterolateral bundle and is fixed in 20 degrees of flexion, the semi- tendinosus tendon is used for the anteromedial bundle and is fixed in 40 degrees of flexion. The advantages of the presented technique are the central, rigid femoral anchoring without hardware, the thin bone tunnels which show no tunnel widening and allow for an optimal bone tendon contact to enhance bony ingrowth. The technique is cost-efficient and provides anatomic double bundle reconstruction of the anterior cruciate ligament. The sacrifice of hardware ensures easy revisions. The disadvantages are the peripheral tibial fixation, the preparation of the tendons needs tendon length and the creation of tendon knots providing high stability requires practice. The two femoral bone tunnels have proved to be safe regarding the stability of the lateral femoral condyle. PMID:20567798

  10. Radiographic results of an accelerometer-based, handheld surgical navigation system for the tibial resection in total knee arthroplasty.

    PubMed

    Nam, Denis; Cross, Michael; Deshmane, Prashant; Jerabek, Seth; Kang, Michael; Mayman, David J

    2011-10-01

    In total knee arthroplasty (TKA), intramedullary and extramedullary tibial alignment guides are not proven to be highly accurate in obtaining alignment perpendicular to the mechanical axis in the coronal plane. The objective of this study was to determine the accuracy of an accelerometer-based, handheld surgical navigation system in obtaining a postoperative tibial component alignment within 2 of the intraoperative goal in both the coronal and sagittal planes. A total of 151 TKAs were performed by 2 surgeons using a handheld surgical navigation system to perform the tibial resection. Postoperatively, standing anteroposterior hip-to-ankle radiographs and lateral knee-to-ankle radiographs were performed to determine the varus/valgus alignment and the posterior slope of the tibial components relative to the mechanical axis in both the coronal and sagittal planes. Findings showed that 95.3% of the tibial components were placed within 2 of the intraoperative goal in the coronal plane and 96.1% of the components were placed within 2 of the intraoperative goal in the sagittal plane. Overall, mean postoperative lower-extremity alignment was -0.32.1, with 97% of patients having an alignment within 3 of a neutral mechanical axis. The handheld surgical navigation system improves the accuracy of the tibial resection and subsequent tibial component alignment in TKA. It is able to combine the accuracy of computer-assisted surgery systems with the ease of use and familiarity of conventional, extramedullary alignment systems, and the ability to adjust both the coronal and sagittal alignments intraoperatively may prove clinically useful in TKA. PMID:21956055

  11. Bimanual anterior segment revision surgery for anterior capsule contraction syndrome associated with anterior flexion of intraocular lens haptics

    PubMed Central

    Zinkernagel, M; Papazoglou, A; Patel, C K

    2013-01-01

    Purpose To report the incidence of anterior capsule contraction syndrome (ACCS) and to present a novel minimally invasive bimanual technique for anterior segment revision surgery associated with ACCS with anterior flexion of the intraocular lens haptics. Methods A consecutive cohort of 268 eyes of 161 patients undergoing phacoemulsification and implantation of the same type of hydrophilic acrylic aspheric intraocular lens cohort were analysed and a novel technique of minimally invasive bimanual technique for anterior segment revision surgery is described. Results We identified four eyes (1.5%) of three patients with advanced ACCS. Successful restoration of a clear visual axis with minimal induction of astigmatism and rapid visual rehabilitation was achieved in all four cases. Conclusion This technique is a safe and minimally invasive alternative to laser or vitrector-cut capsulotomy to restore a clear visual axis. In cases of advanced ACCS, it offers the option for haptic reposition or amputation. PMID:24037236

  12. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  13. Trypan blue dye for anterior segment surgeries

    PubMed Central

    Jhanji, V; Chan, E; Das, S; Zhang, H; Vajpayee, R B

    2011-01-01

    Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy and corneal transplantation. This review will discuss the techniques and outcome of TB dye-assisted anterior segment surgeries. PMID:21681214

  14. The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures.

    PubMed

    Page, Piers R J; Trickett, Ryan W; Rahman, Shakeel M; Walters, Angharad; Pinder, Leila M; Brooks, Caroline J; Hutchings, Hayley; Pallister, Ian

    2015-07-01

    Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere. This retrospective cohort study utilising secure anonymised information linkage (SAIL), a novel databank of anonymised nationally pooled health records, recruited patients over 18 years of age sustaining severe open lower limb fractures managed primarily or secondarily at our centre and who had data available in the SAIL databank. 101 patients met inclusion criteria and 90 of these had records in the SAIL databank. The number of days in hospital, number of primary care attendances, number of outpatient attendances and number of emergency department attendances in the years prior and subsequent to injury were recorded. Patients sustaining open fractures had significantly different healthcare utilisation in the year after injury when compared with the year before, in terms of days spent in hospital (23.42 vs. 1.70, p=0.000), outpatient attendances (11.98 vs. 1.05, p=0.000), primary care attendances (29.48 vs. 11.99, p=0.000) and emergency department presentations (0.2 vs. 0.01, p=0.025). Patients admitted directly to orthoplastic centres had significantly fewer operations (1.78 vs. 3.31) and GP attendances (23.6 vs. 33.52) than those transferred in subsequent to initial management in other units. There is a significant increase in healthcare utilisation after open tibial fracture. Adherence to national standards minimises the impact of this on both patients and health services. PMID:25916805

  15. A simple method for reconstruction of severely damaged primary anterior teeth

    PubMed Central

    Eshghi, Alireza; Esfahan, Raha Kowsari; Khoroushi, Maryam

    2011-01-01

    Restoration of severely decayed primary anterior teeth is often considered as a special challenge by pedodontists. This case report presents a 5-year-old boy with severely damaged maxillary right canine. Subsequent to root canal treatment, a reversed (upside-down) metal post was put into the canal and composite build-up was performed. This new method offers a simple, practical and effective procedure for reconstruction of severely decayed primary anterior teeth, which re-establishes function and esthetics for time the tooth should be present and functional in the child's mouth. PMID:22135694

  16. Post varicella angiopathy.

    PubMed

    Selvakumar, C J; Justin, C; Gnaneswaran, T R; Chandrasekaran, M

    2010-09-01

    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

  17. Post-traumatic spinal deformity.

    PubMed

    Vaccaro, A R; Silber, J S

    2001-12-15

    There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored. PMID:11805617

  18. [Anterior rectal duplication. Value of ultrasonic diagnosis].

    PubMed

    Trguier, C; Montagne, C; Gandon, Y; Langanay, T; Frmond, B; Babut, J M; Carsin, M

    1990-01-01

    A case of neonatal anterior rectal duplication is reported. Abdominal ultrasonography revealed a prerectal cystic mass. The different types of rectal duplications and the main differential diagnosis are described. Mechanical obstruction and neoplastic risk make early surgery necessary. PMID:2181959

  19. Anterior Cervical Discectomy and Fusion with Plating

    MedlinePLUS Videos and Cool Tools

    Anterior Cervical Discectomy and Fusion with Plating Broward Health Medical Center Fort Lauderdale, FL November 17, 2011 I'm Dr. Matthew Moore, head of the Spine Care Center here at North Broward Medical Center. And ...

  20. Nasal provocation and passive anterior rhinomanometry (PAR).

    PubMed

    Clement, P A; van Dishoeck, A; van de Wal, J; Stoop, P; Hoek, T; van Strick, R

    1981-05-01

    A rapid and convenient method of nasal provocation (aerosol provocation combined with passive anterior rhinomanometry) is described. A comparative study between skin tests, bronchial provocations and nasal provocations highlights the usefulness of this method. PMID:7249344

  1. Anterior Cruciate Ligament Reconstruction Learning Module

    MedlinePLUS

    ... only Sections Introduction Your Knee Causes of ACL Injury Symptoms Diagnosis Nonsurgical Treatment Surgical Treatment Your Surgery After Surgery Risks and Complications Conclusion Related Topics Exit This Module Informed Patient - Anterior Cruciate Ligament Reconstruction Help Introduction Welcome ...

  2. Use of anthropometric data from the medial tibial and femoral condyles to design unicondylar knee prostheses in the Chinese population.

    PubMed

    Cheng, Fu Bo; Ji, Xiao Feng; Zheng, Wen Xu; Lai, Ying; Cheng, Kai Liang; Feng, Jia Chun; Li, You Qiong

    2010-03-01

    Anthropometric data on medial tibial condyles and medial femoral condyles of 172 normal knees (94 male knees, 78 female knees) were obtained using three-dimensional computer tomographic measurements. In the medial tibial condyle, we measured the anteroposterior (AP) and widest dimension (WD), and compared the measurements with the similar dimensions of five tibial unicondylar knee prostheses conventionally used in China. In the femur, we used best-fit two-circular arcs to measure the morphology of the sagittal plane of the medial femoral condyle. We found that three of the prostheses showed WD overhang for all ranges of the AP dimension, while two of them showed WD underhang. We also found a progressive decrease in the condylar aspect ratio (WD/AP%) in parallel with an increase in the AP dimension in the medial tibial condyle. However, none of the conventional tibial prosthesis showed a similar change. Furthermore, males had larger values in aspect ratio than females with the same values for AP dimension. There were definite correlations between the radius of the curvature for the posterior part (R1) and distal part (R2) in the sagittal plane of medial femoral condyle. Both of these values were smaller than in the Caucasian population. Both radiuses of curvature for the posterior and distal components showed definite correlations with the AP dimension. The results of this study may provide guidelines for designing unicondylar knee prostheses suitable for the Chinese population. PMID:19629438

  3. Effect of vitamin B12 on functional recovery and histopathologic changes of tibial nerve-crushed rats.

    PubMed

    Tamaddonfard, E; Farshid, A A; Samadi, F; Eghdami, K

    2014-09-01

    Recent studies have suggested a neuroprotective effect for vitamin B12. The present study investigated the effects of vitamin B12, diclofenac and celecoxib in separate and combined treatments on functional recovery of crushed tibial nerve in rats. In ketamine plus xylazin anesthetized rats, right tibial nerve was crushed using a small hemoatatic forceps. Footprints were recorded 1 day before and on days 7, 14 and 21 after induction of nerve injury. Tibial functional index (TFI) was used to evaluate the recovery of tibial nerve function. Histological changes of tibial nerve were investigated by light microscopy. The recovery of TFI values were significantly accelerated with 10 consecutive days treatments with 0.1 and 0.5?mg/kg of vitamin B12, 5?mg/kg of diclofenac and 1 and 5?mg/kg of celecoxib. The severity of Wallerian degeneration was reduced by above-mentioned doses of vitamin B12, diclofenac and celecoxib. Documented effects were observed when 0.1?mg/kg of vitamin B12 was concurrently used with 1?mg/kg of diclofenac and or 0.2?mg/kg of celecoxib. In the present study, vitamin B12, celecoxib and diclofenac (at a high dose) showed neuroprotective effects. Inhibition of cyclooxygenase (COX) 1 and 2 pathways may be involved in neuroprotective effect of vitamin B12. PMID:24470311

  4. In Vivo Kinematics of the Anterior Cruciate Ligament Deficient Knee During Wide-Based Squat Using a 2D/3D Registration Technique.

    PubMed

    Miyaji, Takeshi; Gamada, Kazuyoshi; Kidera, Kenichi; Ikuta, Futoshi; Yoneta, Kei; Shindo, Hiroyuki; Osaki, Makoto; Yonekura, Akihiko

    2012-01-01

    Anterior cruciate ligament (ACL) deficiency increases the risk of early osteoarthritis (OA). Studies of ACL deficient knee kinematics would be important to reveal the disease process and therefore to find mechanisms which would potentially slow OA progression. The purpose of this study was to determine if in vivo kinematics of the anterior cruciate ligament deficient (ACLD) knee during a wide-based squat activity differ from kinematics of the contralateral intact knee. Thirty-three patients with a unilateral ACLD knee consented to participate in this institutional review board approved study with the contralateral intact knee serving as the control. In vivo knee kinematics during the wide-based squat were analyzed using a 2D/3D registration technique utilizing CT-based bone models and lateral fluoroscopy. Comparisons were performed using values between 0 and 100 flexion both in flexion and extension phases of the squat activity. Both the ACLD and intact knees demonstrated increasing tibial internal rotation with knee flexion, and no difference was observed in tibial rotation between the groups. The tibia in the ACLD knee was more anterior than that of the contralateral knees at 0 and 5 flexion in both phases (p < 0.05). Tibiofemoral medial contact points of the ACLD knees were more posterior than that of the contralateral knees at 5, 10 and 15 of knee flexion in the extension phase of the squat activity (p < 0.05). Tibiofemoral lateral contact points of the ACLD knees were more posterior than that of the contralateral knees at 0 flexion in the both phases (p < 0.05). The kinematics of the ACLD and contralateral intact knees were similar during the wide-based squat except at the low flexion angles. Therefore, we conclude the wide-based squat may be recommended for the ACLD knee by avoiding terminal extension. PMID:24150081

  5. Characterization of Biochemical Cartilage Change After Anterior Cruciate Ligament Injury Using T1? Mapping Magnetic Resonance Imaging

    PubMed Central

    Osaki, Kanji; Okazaki, Ken; Takayama, Yukihisa; Matsubara, Hirokazu; Kuwashima, Umito; Murakami, Koji; Doi, Toshio; Matsuo, Yoshio; Honda, Hiroshi; Iwamoto, Yukihide

    2015-01-01

    Background: Patients with anterior cruciate ligament (ACL)injured knees are at an increased risk of posttraumatic osteoarthritis (OA). OA changes secondary to ACL injuries have many variations, and when and where early cartilage degenerative change begins has not yet been established. Purpose: To characterize the location of cartilage degeneration after ACL injury associated with time since injury using T1rho (T1?) mapping. Study Design: Cross-sectional study; Level of evidence, 3. Methods: In this study, 49 knees with ACL injuries and 14 normal knees from uninjured volunteers were imaged with a 3.0-T magnetic resonance scanner. Three regions of interest (ROIs) were defined in the cartilage at the weightbearing area of the femoral condyles (anterior, middle, and posterior zones). Two ROIs were defined in the tibial plateau (anterior and posterior zones). The T1? values within the ROIs were measured. Patients were allocated into 3 groups based on time since injury: <12 weeks (group A; 28 patients), 12 weeks to 2 years (group B; 14 patients), and >2 years to 5 years (group C; 7 patients). Results: Mean T1? values were significantly greater in the anterior and middle ROIs of the medial femoral condyle in group C compared with those in other groups (P < .05). Patients with medial meniscus injury, for whom the time since injury was ?12 weeks, exhibited significantly greater T1? values in the middle areas of the medial femoral condyle versus normal knees and ACL-injured knees without medial meniscus injury. Conclusion: The risk of cartilage degeneration in the area of the femoral condyle that contacts the tibia during small degrees of flexion increased when the time since injury was longer than 2 years. In addition, medial meniscus injury was associated with cartilage degeneration at the medial femoral condyle in the chronic phase. Clinical Relevance: Cartilage degeneration occurs more than 2 years after ACL injury and increases with medial meniscus injury. Early intervention may be desirable for meniscus injury. PMID:26672435

  6. Preemptive carprofen for peri-operative analgesia in dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO): a prospective, randomized, blinded, placebo controlled clinical trial.

    PubMed

    Bufalari, A; Maggio, C; Cerasoli, I; Morath, U; Adami, C

    2012-03-01

    Eighteen client-owned dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO) were included in this blinded clinical study and randomly assigned to one of two treatment groups. Group C (carprofen) received intravenous (IV) carprofen, 4 mg/kg, prior to anesthesia, whereas group P (placebo) received IV saline. General anesthesia was maintained with isoflurane in oxygen and a constant rate infusion (CRI) of sufentanyl IV. Intra-operatively, assessment of nociception was based on changes in physiological parameters and on the analgesics requirement, whereas in the post-operative period evaluation of pain was performed by using a Hellyer and Gaynor pain score and by comparing the doses of rescue buprenorphine required by the two treatment groups. Although no statistically significant differences in intra-operative sufentanyl doses were found between treatment groups, group C had superior cardiovascular stability, and lower post-operative pain scores and rescue buprenorphine doses than group P. Our results indicate that administration of carprofen prior to surgery was effective in improving peri-operative analgesia in dogs undergoing TPLO. PMID:22378051

  7. Anterior Eye Imaging with Optical Coherence Tomography

    NASA Astrophysics Data System (ADS)

    Huang, David; Li, Yan; Tang, Maolong

    The development of corneal and anterior segment optical coherence tomography (OCT) technology has advanced rapidly in recently years. The scan geometry and imaging wavelength are both important choices to make in designing anterior segment OCT systems. Rectangular scan geometry offers the least image distortion and is now used in most anterior OCT systems. The wavelength of OCT light source affects resolution and penetration. An optimal choice of the OCT imaging wavelength (840, 1,050, or 1,310 nm) depends on the application of interest. Newer generation Fourier-domain OCT technology can provide scan speed 100-1000 times faster than the time-domain technology. Various commercial anterior OCT systems are available on the market. A wide spectrum of diagnostic and surgical applications using anterior segment OCT had been investigated, including mapping of corneal and epithelial thicknesses, keratoconus screening, measuring corneal refractive power, corneal surgery planning and evaluation in LASIK, intracorneal ring implantation, assessment of angle closure glaucoma, anterior chamber biometry and intraocular lens implants, intraocular lens power calculation, and eye bank donor cornea screening.

  8. Strength asymmetry and osteoarthritis risk factors in unilateral trans-tibial, amputee gait.

    PubMed

    Lloyd, Chandra H; Stanhope, Steven J; Davis, Irene S; Royer, Todd D

    2010-07-01

    Persons with a unilateral, trans-tibial amputation have an increased risk of developing osteoarthritis (OA) in the knee of their intact limb. Between-side strength discrepancies observed in individuals with an amputation may indicate overuse of the intact limb and increased osteoarthritis risk; however, the relationship between lower extremity strength and gait mechanics has not been addressed in previous literature. It was hypothesized that amputee subjects' strength and gait would be more asymmetrical than controls, and that strength asymmetry would positively correlate with gait variable asymmetry and intact side gait variables associated with osteoarthritis risk. Eight persons with unilateral, trans-tibial amputation and eight able-bodied control subjects participated. Three gait variables related to osteoarthritis risk (knee external adduction moment, knee adduction moment load rate, and vertical ground reaction force load rate) were measured bilaterally, along with three strength measures (hip abductors, knee extensors, and knee flexors). Four of the six variables were more asymmetrical in the amputee group than the control group (p<0.05 and/or effect size greater than 0.70). Knee extension strength asymmetry was significantly related to knee adduction moment load rate asymmetry (rho=0.714), and knee flexion strength asymmetry was moderately related to the vertical ground reaction force on the intact limb (rho=0.643). Results suggest that strength asymmetry in unilateral trans-tibial amputees has a moderate relationship with osteoarthritis risk, and may be a useful way to assess gait ability and the need for rehabilitation in this population. PMID:20678938

  9. Periosteal versus true cross-sectional geometry: a comparison along humeral, femoral, and tibial diaphyses.

    PubMed

    Macintosh, Alison A; Davies, Thomas G; Ryan, Timothy M; Shaw, Colin N; Stock, Jay T

    2013-03-01

    Cross-sectional geometric (CSG) properties of human long bone diaphyses are typically calculated from both periosteal and endosteal contours. Though quantification of both is desirable, periosteal contours alone have provided accurate predictions of CSG properties at the midshaft in previous studies. The relationship between CSG properties calculated from external contours and "true" (endosteal and periosteal) CSG properties, however, has yet to be examined along the whole diaphysis. Cross-sectional computed tomography scans were taken from 21 locations along humeral, femoral, and tibial diaphyses in 20 adults from a late prehistoric central Illinois Valley cemetery. Mechanical properties calculated from images with (a) artificially filled medullary cavities ("solid") and (b) true unaltered cross-sections were compared at each section location using least squares regression. Results indicate that, in this sample, polar second moments of area (J), polar section moduli (Z(p) ), and cross-sectional shape (I(max) /I(min) ) calculated from periosteal contours correspond strongly with those calculated from cross-sections that include the medullary cavity. Correlations are high throughout most of the humeral diaphysis and throughout large portions of femoral and tibial diaphyses (R(2) = 0.855-0.998, all P < 0.001, %SEE ? 8.0, %PE ? 5.0), the major exception being the proximal quarter of the tibial diaphysis for J and Z(p). The main source of error was identified as variation in %CA. Results reveal that CSG properties quantified from periosteal contours provide comparable results to (and are likely to detect the same differences among individuals as) true CSG properties along large portions of long bone diaphyses. PMID:23359138

  10. Hybrid External Fixation for Arbeitsgemeinschaft fr Osteosynthesefragen (AO) 43-C Tibial Plafond Fractures.

    PubMed

    Abd-Almageed, Emad; Marwan, Yousef; Esmaeel, Ali; Mallur, Amarnath; El-Alfy, Barakat

    2015-01-01

    Arbeitsgemeinschaft fr Osteosynthesefragen (AO) type 43-C tibial plafond/pilon fractures represent a challenge for the treating orthopedic surgeon. We assessed the outcomes of using hybrid external fixation for this fracture type. The present prospective cohort study was started in August 2009 and ended by July 2012. Thirty consecutive patients (mean age37.410.7years) with a type C tibial plafond fracture who had presented to our tertiary care orthopedic hospital were included. Motor vehicle accidents and fall from height were the cause of the fracture in 14 (46.7%) and 13 (43.3%) patients, respectively. A type C3 fracture was present in 25 patients (83.3%), and type C1 and C2 fractures were present in 2 (6.7%) and 3 (10.0%) patients, respectively. Nine fractures (30.0%) were open. Hybrid external fixation was used for all fractures. All fractures were united; clinical healing was achieved by a mean of 18.12.2weeks postoperatively and radiologic healing at a mean of 18.91.9weeks. The fixator was removed at a mean of 20.42.0weeks postoperatively. At a mean follow-up point of 13.42.6months, the mean modified Mazur ankle score was 84.610.4. It was not associated with wound classification (p = .256). The most commonly seen complication was ankle osteoarthritis (17 patients; 56.7%); however, it was mild in >50.0% of the affected patients. In conclusion, using hybrid external fixation for type C tibial plafond fractures resulted in good outcomes. However, this should be investigated further in studies with a higher level of evidence. PMID:26215549

  11. Long-term results of high tibial osteotomy for medial osteoarthritis of the knee.

    PubMed

    Pfahler, M; Lutz, C; Anetzberger, H; Maier, M; Hausdorf, J; Pellengahr, C; Refior, H J

    2003-01-01

    We reviewed retrospectively the results in patients who had undergone one hundred and four high tibial lateral osteotomies. The operations were all performed between 1985 and 1993. Each one of fifty men and forty nine women demonstrated a varus deformity of the knee with a coexistent medial osteoarthritis. Results were reviewed in 49 patients (62 knees) with an average follow-up of 10.2 years (range 6-14 years). Of the remaining 42 patients, 8 were lost to follow-up, 10 had died, and 24 were subsequently treated with total knee arthroplasty at an average 4.7 years after having had a high tibial osteotomy. Clinical results were evaluated using the Hospital for Special Surgery Score (HSS) and the Knee Society Score. Radiographs were systematically analysed to evaluate osteoarthritis and leg axis. Forty four (90 per cent) of the forty nine patients stated the results met their expectations and given the same circumstances, they would have the operation once again. In these patients the knee score results were excellent. The same patients had excellent HSS and Knee Society Scores. Five patients (10 per cent) had a poor result and twenty four patients were treated later by total knee arthroplasty because of pain. The following factors set these patients apart from those with more favorable results: previous arthroscopic debridement, obesity, lateral knee osteoarthritis, insufficient valgus correction, and an age of more than 55 years. High tibial valgus osteotomy provides good pain relief and improved function in carefully selected patients. Our results support this conclusion. PMID:14743568

  12. Fast pinless external fixation for open tibial fractures: preliminary report of a prospective study

    PubMed Central

    Huang, Zheyuan; Wang, Bowen; Chen, Fengrong; Huang, Jianming; Jian, Guojian; Gong, Hao; Xu, Tianrui; Chen, Ruisong; Chen, Xiaolin; Ye, Zhiyang; Wang, Jun; Xie, Desheng; Liu, Haoyuan

    2015-01-01

    A major drawback of conventional fixator system is the penetration of fixator pins into the medullary canal. The pins create a direct link between the medullary cavity and outer environment, leading to higher infection rates on conversion to intramedullary nailing. This study was designed to prospectively evaluate the role of new rapid pinless external fixators in primary stabilization of open tibial shaft fractures. In our study, a prospective study of 96 consecutive patients of open tibial shaft fractures treated with new rapid pinless external fixator and reamed intramedullary nail was carried out. The bone healing status, ability to maintain alignment were examined for radiologic outcome, whereas initial management, length of hospital stay, associated morbidity, range of knee and ankle motion, time to partial and full weight-bearing, employment status and perioperative and postoperative complications were used for clinical evaluation. We followed up for over two years for the patients underwent clinical and radiologic after the surgery. The mean hospital stay was 15 days (ranges, 8-68). Bone healing was achieved for all cases except 3 patients who were lost to follow-up study. No patient suffered compartment syndromes. There was no statistically significance in range of motion among the knees of injury and uninjured limbs at final follow-up (P > 0.05). To the last follow-up, there were no cases of deep infection or implant-related fractures. Seventy-one patients who were employed before the injury returned to work after the operation, 16 had changed to less strenuous work. We concluded that better results can be achieved on clinical and radiologic evaluation of primary stabilization with rapid pinless external fixator and early exchange reamed intramedullary nail for suitable patients with open tibial shaft fractures. The incident rate of relative complications is low. The rapid pinless external fixator can be combined favorably with the reamed intramedullary nail and is a valuable addition to the conventional external fixator systems. PMID:26885004

  13. USE OF AUTOLOGOUS BONE GRAFT ASSOCIATED WITH SUPPORT OSTEOSYNTHESIS FOR TIBIAL EDGE BONE LOSSES IN TOTAL KNEE PROSTHESES

    PubMed Central

    Castiglia, Marcello Teixeira; da Silva, Juliano Voltarelli Franco; Quialheiro, Gabriel Silva; Salim, Rodrigo; Júnior, Maurício Kfuri; Paccola, Cleber Antonio Jansen

    2015-01-01

    Objective: To report the initial results from the use of a new technique for fixation of bone grafts in uncontained tibial bone defects in patients undergoing total knee prosthesis implantation. Methods: Six patients with severe varus deformity of the knee who, after cuts and ligament balancing had been performed, still presented bone deficiencies that reached the edge of the tibial cut and compromised the implant stability, underwent a new fixation technique. Results: Five of the patients had good-clinical results, with integration of the graft within 12 weeks. One patient presented clinical complications with wound dehiscence and implant exposure, which evolved to the need for implant removal and knee arthrodesis. Conclusion: Support osteosynthesis as a graft fixation method is a viable option for treating tibial bone deficiencies. The proposed technique certainly needs further studies for its validation.

  14. Surgical treatment of fractures of the tibial tuberosity in 6 adult horses.

    PubMed

    Wright, I M; Montesso, F; Kidd, L J

    1995-03-01

    This paper describes the clinical and radiological features, surgical techniques used and results obtained in 6 horses with fractures of the tibial tuberosity. The horses were presented between 24 h and 8 weeks following injury. In all 6 cases, the fragments were displaced proximocranially and in 2 of these, there was comminution. Four were treated by open reduction and internal fixation using an AO/ASIF narrow dynamic compression plate and in 2 cases the fragments were removed. All horses returned to full athletic function and remained sound in follow-up times of 17-36 months. Implant removal was necessary in 1 case. PMID:7607157

  15. Traumatic anterior shoulder dislocation: a case study of nonoperative management in a mixed martial arts athlete

    PubMed Central

    Sims, Kevin; Spina, Andreo

    2009-01-01

    Objective: To present an evidence-informed approach to the nonoperative management of a first-time, traumatic anterior shoulder dislocation. Clinical Features: A 30-year-old mixed martial arts athlete, with no prior shoulder injuries, presented one day following a first-time, traumatic anterior shoulder dislocation. An eight-week, individualized, intensive, nonoperative rehabilitation program was immediately begun upon presentation. Intervention and Outcome: Management consisted of immobilization of the shoulder in external rotation and a progressive rehabilitation program aimed at restoring range of motion, strength of the dynamic stabilizers, and proprioception of the shoulder. Eight weeks post-dislocation the patient had regained full range of motion and strength compared to the unaffected limb and apprehension and relocation tests for instability were negative. Conclusion: This case illustrates successful management of a first-time, traumatic, anterior shoulder dislocation using immobilization in external rotation combined with an intensive rehabilitation program. PMID:20037691

  16. [Anterior bridges with the IPS-Empress-2 System after alveolar ridge augmentation. A case report].

    PubMed

    Zawta, C; Bernhard, M

    2000-01-01

    The success of a prosthesis is judged according to optimal function, good chewing comfort, adequate phonetics and white and pink esthetics. The aim of a treatment is to approach the perfection of nature. For anterior bridgework, the all-ceramic System IPS Empress 2 offers light transmission and reflection comparable to that of natural teeth, provided that the pink esthetics are optimised in the preprosthetic phase. The provision of an anterior bridge in the IPS Empress 2-system is presented here in the form of a case report. After extraction of the anterior teeth, a ridge augmentation including preparation of the pontic bed was carried out. The type of post and core, preparation and cementation are important parameters for the success of all-ceramic restorations. PMID:10670274

  17. Bone Morphogenetic Protein for the Healing of Tibial Fracture: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Jiang, Chaoyin; Wang, Chunyang; Chen, Hua; Chai, Yimin

    2015-01-01

    Purpose To review the evidence from RCTs on clinical outcomes and benefit of acute tibial fracture and nonunion treated with and without BMPs. Material We searched multiple databases (MEDLINE, EMABSE, BIOSIS and Cochrane central) as well as reference lists of articles and contacted authors. Evaluated outcomes included union rate, revision rate, hardware failure and infection. The weighted and standard mean difference (WMD and SMD) or the relative risk (RR) was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaborations REVMAN 5.0 software. Results Eight RCTs involving 1113 patients were included. For acute tibial fracture, BMP group was associated with a higher rate of union (RR, 1.16; 95% CI, 1.04 to 1.30) and a lower rate of revision (RR, 0.68; 95% CI, 0.54 to 0.85) compared with control group. No significant differences were found in rate of hardware failure and infection. The pooled RR for achieving union for tibial fracture nonunion was 0.98 (95% CI, 0.86 to 1.13). There was no significant difference between the two groups in the rate of revision (RR, 0.48; 95% CI, 0.13 to 1.85) and infection (RR, 0.61; 95% CI, 0.37 to 1.02). Conclusion Study on acute tibial fractures suggests that BMP is more effective that controls, for bone union and for decreasing the rate of surgical revision to achieve union. For the treatment of tibial fracture nonunion, BMP leads to similar results to as autogenous bone grafting. Finally, well-designed RCTs of BMP for tibial fracture treatment are also needed. PMID:26509264

  18. Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

    PubMed Central

    2014-01-01

    Background Currently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing. Methods Anatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes). Statistical analysis was performed by Student's t test. Results Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p?tibial nail meets the requirements of maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures. PMID:24886667

  19. Antibiotic Prophylaxis in Adults With Open Tibial Fractures: What Is the Evidence for Duration of Administration? A Systematic Review.

    PubMed

    Isaac, Sherif M; Woods, Alex; Danial, Irini N; Mourkus, Hany

    2016-01-01

    Open tibial fractures are common injuries after high-energy trauma such as road traffic accidents. Infection is one of the main complications of open fractures. Broad-spectrum antibiotics have been used for prophylaxis and treatment of infection in these fractures. The duration of antibiotic prophylaxis remains controversial, especially for the different types and grades of open fractures. No complete review, to date, has been performed of published studies to demonstrate the wide variety of duration of antibiotic use in practice to prevent infection, especially in open tibial fractures. The purpose of the present study was to review the evidence in the current data regarding the duration of prophylactic antibiotic administration in open tibial fractures and to identify the optimum duration of administration of antibiotics to minimize the risk of infection in these fractures. We reviewed and evaluated all published clinical trials claiming or cited elsewhere as being authoritative regarding the duration of prophylactic antibiotic use in open tibial fracture management. A large number of studies reported antibiotic prophylaxis in open fractures; however, only 8 met the inclusion criteria set out for our review. Only 1 randomized, double-blind, prospective study examined the duration of prophylactic antibiotic administration in open tibial fractures. That study suggested a short course of antibiotics is as effective as a long course in infection prophylaxis. The results of the present review highlight the need for a rigorous randomized, double-blind, multicenter trial to establish an agreed protocol for the optimal length of prophylactic antibiotic administration in open tibial fractures. PMID:26364701

  20. Giant Anterior Cervical Osteophyte Leading to Dysphagia

    PubMed Central

    Hwang, Jin Seop; Chough, Chung Kee

    2013-01-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress. PMID:24757489