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1

Pre, during, and post exercise anterior tibial compartment pressures in long distance runners  

Microsoft Academic Search

The aim of the study was to assess pre, during, and postexercise compartment pressures in the anterior tibial compartment in asymptomatic long distance runners (5000 m) and recreational athletes. Forty-eight participants (n = 48, 24 females and 24 males) underwent the experimental procedures. The participants were assigned into 4 groups of 12 volunteers. Intracompartmen- tal pressures measurements were recorded 1

Panagiotis Baltopoulos; Eugenia Papadakou; Maria Tsironi; Panagiotis Karagounis

2

Pre, during, and post exercise anterior tibial compartment pressures in long distance runners.  

PubMed

The aim of the study was to assess pre, during, and postexercise compartment pressures in the anterior tibial compartment in asymptomatic long distance runners (5000 m) and recreational athletes. Forty-eight participants (n = 48, 24 females and 24 males) underwent the experimental procedures. The participants were assigned into 4 groups of 12 volunteers. Intracompartmental pressures measurements were recorded 1 minute before, at the 1(st) minute after the onset of exercise, and finally 5 minutes after the completion of the exercise on treadmill. The wick catheter technique was the method of choice for measuring intracompartmental pressure values. Post hoc analysis of the groups by measures interaction indicated that all pairwise comparisons among pre-test (1 minute before exercise), during-test (1(st) minute during exercise), and post-test measures (5 minutes after exercise) were statistically significant for male controls (p < .001), male athletes (p < .001), female controls (p < .001) and female athletes (p < .001). The results confirm the correlation between long distance runners and the increased risk of chronic exertional compartment syndrome (CECS) development. Key pointsCompartment syndrome is a condition characterised by increased intracompartmental pressures within inelastic fascia which surrounds muscular compartmentsInitial CECS symptomatology is not clear and increases graduallyAll the study participants presented the lowest intra-compartment pressure values one minute before the beginning of exercise (at rest) with the highest value being recorded at the first minute of exercise.Control population had lower intra-compartment pressure than professional runners.One minute after the beginning of exercise control and athlete men group showed higher intra-compartment pressure than control and athlete women group, indicating a probable sex difference both for athletes and controls.Further studies on predisposing factors of CECS, such as increased intracompartmental pressure values in asymptomatic population is needed to establish the diagnosis in a proper time. PMID:24150140

Baltopoulos, Panagiotis; Papadakou, Eugenia; Tsironi, Maria; Karagounis, Panagiotis; Prionas, George

2008-01-01

3

Fracture of a Polyethylene Tibial Post in a Scorpio Posterior-Stabilized Knee Prosthesis  

PubMed Central

We report the case of a polyethylene tibial post fracture in a 72-year-old woman 14 months after a Scorpio posterior-stabilized (PS) total knee arthroplasty. The polyethylene wear was found around the fracture site of the post, especially over the anterior aspect of the post base. The failure mechanism of the post fracture in the present case was anterior impingement with excessive wear over the base of the anterior aspect of the tibial post, which became a stress-riser of post and cam articulation. This is the first report of a polyethylene tibial post fracture of a Scorpio PS prosthesis. PMID:19885065

Lim, Hong Chul; Hwang, Jin Ho; Kim, Seung Joo; Yoon, Ji Yeol

2009-01-01

4

Preventing Anterior Cruciate Ligament Failure During Impact Compression by Restraining Anterior Tibial Translation or Axial Tibial Rotation  

Microsoft Academic Search

Anterior cruciate ligament injury is highly prevalent in activities that involve large and rapid landing impact loads. We\\u000a hypothesize that restraining anterior tibial translation or axial tibial rotation can prevent the anterior cruciate ligament\\u000a from failing at the range of peak compressive load that can induce ligament failure when both factors are unrestrained. Sixteen\\u000a porcine knee specimens were mounted onto

C. H. Yeow; R. S. Khan; Peter V. S. Lee; James C. H. Goh

5

Pseudoaneurysm of the anterior tibial artery: A rare complication of proximal tibial steinman pin insertion  

PubMed Central

An anterior tibial artery pseudoaneurysm is a rare and unexpected complication of Steinmann pin insertion. We describe the case of an 18-year-old boy, who sustained such an injury to the anterior tibial artery during this procedure. Diagnosis was confirmed on a magnetic resonance (MR) angiogram. Aneurysmal sac excision with lateral repair of the vessel wall was performed. Postoperatively, a good flow was documented on a follow-up MR angiogram. This case highlights a major and unexpected complication of a so-called minor procedure. Too posterior a pin placement in the proximal tibia should be avoided to prevent such injuries. PMID:21430875

Suri, Tarun; Dabas, Vineet; Sural, Sumit; Dhal, Anil

2011-01-01

6

Differentiation of anterior tibial stress fracture from osteoid osteoma.  

PubMed

The authors present a case in which skeletal scintigraphy helped them to differentiate an anterior tibial stress fracture from a possible osteoid osteoma. Important scintigraphic clues to the correct diagnosis included a linear rather than a round to oval configuration to the focus of intense uptake shown by pinhole imaging, absence of focally increased tracer localization on the angiographic and tissue phases, and a symmetrically positioned, less-conspicuous contralateral abnormality. PMID:11139055

Connolly, L P; Connolly, S A; Treves, S T

2001-01-01

7

Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction  

Microsoft Academic Search

The purpose of this prospective study was to define constant anatomic intraarticular and extraarticular landmarks that can be used as definative reference points to reproducibly create a tibial tunnel for anterior cruciate ligament (ACL) reconstruction that (1) results in an impingement-free graft in full extension without an intercondylar roofplasty; (2) positions the tibial tunnel's intraarticular orafice sagittally central in the

Craig D. Morgan; Victor R. Kalman; Daniel M. Grawl

1995-01-01

8

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

Microsoft Academic Search

The purpose of the present study was to retrospectively evaluate the results of anatomically tunneled grafts to the anterior\\u000a tibial artery for distal revascularization in terms of patency and limb salvage rates as well as local morbidity, which can\\u000a lengthen the postoperative hospital stay. Twenty-three patients received 24 bypasses to the anterior tibial artery, with grafts\\u000a tunneled through the interosseous

G. Illuminati; A. Bertagni; V. Martinelli

1998-01-01

9

Parsons' knob (tuberculum intercondylare tertium). A guide to tibial anterior cruciate ligament insertion.  

PubMed

In some human autopsy specimens, a bony prominence located anterior to the tibial eminences represents the confluent insertion of the anterior horn medial meniscus and the medial fibers of the anterior cruciate ligament (ACL). The prominence has been called "Parsons' knob" by anatomists and the "tuberculum intercondylare tertium" by radiologists. This article reviews the anatomy and provides the first magnetic resonance image study and perhaps the first roentgenographic depiction of this landmark in the English-speaking orthopedic literature. This structure, if noted preoperatively, can be helpful in identifying the appropriate site of tibial tunnel placement for ACL reconstructive operations performed under arthroscopic or fluoroscopic guidance. PMID:8519113

Berg, E E

1993-07-01

10

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

PubMed

Stress fracture of the anterior tibial cortex is an extremely challenging fracture to treat, especially in the high-performance female athlete who requires rapid return to competition. Previous reports have not addressed treating these fractures in the world-class athlete with anterior plating. We hypothesize that anterior plating is a biomechanically sound approach to treatment of these fractures, and will lead to an earlier return to full activity than either nonoperative treatment or intramedullary nailing. We present a retrospective series of 4 case reports of 4 world-class female athletes with stress fractures of the anterior tibial cortex treated by anterior plating between 2001 and 2004. Average follow-up was 15 months (range 12 to 48 mo). Anterior tension band plating resulted in fracture healing in all 4 cases and return to full activity at a mean of 10 weeks. All patients returned to preinjury competitive levels. There were no complications of infection, nonunion, or malunion. Anterior tension-band plating of an anterior tibial stress fracture leads to rapid fracture healing and return to competition for high-performance female athletes. This approach should be considered in those athletes who wish to avoid the more prolonged convalescence associated with nonoperative treatment, or the problems, especially of the knee, associated with intramedullary nailing. PMID:16825970

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

2006-07-01

11

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

PubMed Central

Objectives To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae. Methods A total of 47 consecutive patients (51 knees) with arthroscopically proven chondromalacia, who had failed conservative management, underwent a modified Fulkerson tibial tubercle osteotomy. The mean age was 34.4 years (19.6 to 52.2). Pre-operatively, none of the patients exhibited signs of patellar maltracking or instability in association with their anterior knee pain. The minimum follow-up for the study was five years (mean 72.6 months (62 to 118)), with only one patient lost to follow-up. Results A total of 50 knees were reviewed. At final follow-up, the Kujala knee score improved from 39.2 (12 to 63) pre-operatively to 57.7 (16 to 89) post-operatively (p < 0.001). The visual analogue pain score improved from 7.8 (4 to 10) pre-operatively to 5.0 (0 to 10) post-operatively. Overall patient satisfaction with good or excellent results was 72%. Patients with the lowest pre-operative Kujala score benefitted the most. Older patients benefited less than younger ones. The outcome was independent of the grade of chondromalacia. Six patients required screw removal. There were no major complications. Conclusions We conclude that this modification of the Fulkerson procedure is a safe and useful operation to treat anterior knee pain in well aligned patellofemoral joints due to chondromalacia patellae in adults, when conservative measures have failed. PMID:23610687

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

2012-01-01

12

All-Epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: A Surgical Technique Using a Split Tibial Tunnel  

PubMed Central

Many techniques have been described for anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, including extra-articular, complete or partial transphyseal, and physeal-sparing techniques. An all-epiphyseal technique places the tendon and its tunnels and fixation all within the child's epiphysis, leaving the growth plates untouched. We describe an all-epiphyseal quadruple-hamstring ACL reconstruction using a split tibial tunnel. The split tibial tunnels drop the tunnel size down to 4.5 to 5.5 mm from 7 to 8 mm because only half the total graft diameter passes through each of the split tunnels. This increases the safety margin for keeping the tunnel within the tibial epiphysis, in addition to avoiding damage into the growth plate. The bone bridge between the 2 tunnels serves as a solid low-profile fixation post. Femoral graft fixation is achieved with an interference screw, which allows precise tensioning and low-profile fixation entirely within the femoral tunnel. By placing the graft at the native ACL's anatomic attachment points without spanning or violating the growth plates at any step of the procedure, an all-epiphyseal ACL reconstruction with a split tibial tunnel theoretically minimizes the risk of growth disturbance in an ACL-deficient child. PMID:23766968

Lykissas, Marios G.; Nathan, Senthil T.; Wall, Eric J.

2012-01-01

13

Distal tibial fracture post syndesmotic screw removal: an adverse complication  

Microsoft Academic Search

Fractures of the ankle are common injuries. Some ankle fractures have an associated injury to the syndesmosis, necessitating\\u000a fixation with one or more screws. Generally, the overall outcome post ankle fracture is good. However, several complications\\u000a have also been described. The current authors describe a distal tibial fracture following syndesmotic screw removal. A 77-year-old\\u000a woman was admitted with a bimaleollar

Mustafa Citak; Manuel Backhaus; Gert Muhr; Thomas Kälicke

14

Effects of tibial slope changes in the stability of fixed bearing medial unicompartmental arthroplasty in anterior cruciate ligament deficient knees.  

PubMed

Patients with anterior cruciate ligament (ACL) deficiency may have increased failure rates with UKA as a result of abnormal contact stresses and altered knee kinematics. Variations in the slope of the tibial component in UKA may alter tibiofemoral translation, and affect outcomes. This cadaveric study evaluated tibiofemoral translation during the Lachman and pivot shift tests after changing the slope of a fixed bearing unicondylar tibial component. Sectioning the ACL increased tibiofemoral translation in both the Lachman and pivot shift tests (P<0.05). Tibial slope leveling (decreasing the posterior slope) of the polyethylene insert in a UKA decreases anteroposterior tibiofemoral translation in the sagittal plane to a magnitude similar to that of the intact knee. With 8° of tibial slope leveling, anterior tibial translation during the Lachman test decreased by approximately 5mm. However, no variation in slope altered the pivot shift kinematics in the ACL deficient knees. PMID:21839639

Suero, Eduardo M; Citak, Musa; Cross, Michael B; Bosscher, Marianne R F; Ranawat, Anil S; Pearle, Andrew D

2012-08-01

15

Isokinetic Evaluation of Internal\\/External Tibial Rotation Strength after the Use of Hamstring Tendons for Anterior Cruciate Ligament Reconstruction  

Microsoft Academic Search

Background: Evaluation of the knee after an anterior cruciate ligament reconstruction with the use of the semitendinosus and gracilis (hamstring) autografts has primarily focused on flexion and extension strength. The semitendinosus and gracilis muscles contribute to internal tibial rotation, and it has been suggested that harvest of these tendons for the purpose of an anterior cruciate ligament reconstruction contributes to

Tanya Armour; Lorie Forwell; Robert Litchfield; Alexandra Kirkley; Ned Amendola; Peter J. Fowler

2004-01-01

16

Quantitative evaluation of anterior tibial translation during isokinetic motion in knees with anterior cruciate ligament reconstruction using either patellar or hamstring tendon grafts  

Microsoft Academic Search

We studied 79 patients with unilateral injury to the anterior cruciate ligament (ACL). The patients were randomly allocated\\u000a to reconstruction with autologous patellar bone-tendon-bone (BTB) grafts (49 knees) or hamstring tendon (ST) grafts (30 knees).\\u000a We measured anterior tibial translation (ATT) during isokinetic concentric contraction exercise 18–20 months after surgery\\u000a using a computerized electrogoniometer. In both groups the highest ATT during

N. Sato; H. Higuchi; M. Terauchi; M. Kimura; K. Takagishi

2005-01-01

17

Significance of the position of the proximal tip of the tibial nail: An important factor related to anterior knee pain  

PubMed Central

Background: Intramedullary nailing is the treatment of choice for the majority of tibial shaft fractures and anterior knee pain is the most common complication of this surgery; however, its etiology is still unknown. The purpose of this study was to assess the predicting factors related to anterior knee pain following tibial nailing. Materials and Methods: Patients with isolated, unilateral tibial shaft fracture who had undergone tibial nailing were identified retrospectively. Data including age, sex, type of fracture, technique of surgery and location of the nail were collected and finally the association between the above variables and knee pain were analyzed via SPSS software. Results: A total of 95 patients participated in the study. The mean age of the participants was 33.52 ± 1.62, 87 (91.6%) of whom were male and 74 (77.9%) had close fractures respectively. The method of surgery in 60 (63.2%) patients was paratendinous approach and in 35 (36.8%) was transtendinous. Twenty six (27.4%) of the patients had anterior knee pain. There were no significant differences between the two groups of patients with and without knee pain by age, sex, type of fracture and type of surgery (P = 0.952, 0.502, 0.212 and 0.745, respectively). Patients with protrusion of the nail from the anterior cortex had higher risk of developing knee pain after surgery (odds ratio: 2.76, confidence interval: 1.08, 7.08, P = 0.031). Conclusion: The results revealed a higher risk of developing anterior knee pain after tibial nailing in patients with protrusion of the nail from the anterior cortex. PMID:24949290

Tahririan, Mohammad Ali; Ziaei, Ehsan; Osanloo, Reza

2014-01-01

18

Characteristics of anterior tibial translation with active and isokinetic knee extension exercise before and after ACL reconstruction  

Microsoft Academic Search

.  ?The aim of this study was to investigate the biomechanical characteristics of anterior tibial translation (ATT) in anterior\\u000a cruciate ligament (ACL)-deficient or -reconstructed knees with active and isokinetic knee extension exercise. Forty-nine patients\\u000a with unilateral isolated ACL-deficient knees were enrolled. Follow-up examinations were carried out at a mean of 24 months\\u000a postoperatively. An electrogoniometer system was applied to compare the

Hiroshi Higuchi; Masanori Terauchi; Masashi Kimura; Kenji Shirakura; Masayoshi Katayama; Fumiaki Kobayashi; Kenji Takagishi

2002-01-01

19

Hybrid external fixation of distal tibial fractures: new strategy to place pins and wires without penetrating the anterior compartment  

Microsoft Academic Search

IntroductionImpalement of the anterior compartment musculature remains a problem in the hybrid external fixation of distal tibial fractures. The purposes of this study were to develop a tensioned wire configuration which does not violate the anterior compartment and to analyze the biomechanical implications of new wire configuration.Materials and methodsThirty-seven adult volunteers without known pathology around either tibia were recruited. Axial

Jong-Keon Oh; Jeong-Joon Lee; Duk-Young Jung; Bong-Ju Kim; Chang-Wug Oh

2004-01-01

20

Mechanical and electromyographic responses to stretch of the human anterior tibial muscle at different levels of contraction  

Microsoft Academic Search

The EMG response and the mechanical response to 2 degree stretch of the human anterior tibial muscle was studied during contractions ranging from 0% to 80% of maximal voluntary contraction (MVC). The EMG response showed three distinct peaks M1, M2, and M3 with peak latencies of 59 ms, 86 ms, and 120 ms respectively. At low background torques M1 dominated

E. Toft; T. Sinkjaer; S. Andreassen

1989-01-01

21

A new bicortical tibial fixation technique in anterior cruciate ligament reconstruction with quadruple hamstring graft.  

PubMed

We report a prospective series of 101 patients receiving a four-strand semitendinosus-gracilis autograft for anterior cruciate ligament reconstruction using a new bicortical tibial fixation technique with bioabsorbable interference screws. Patients (average age 32 years) were operated on between November 1997 and Mai 1998, and follow-up was at least 12 months postoperatively. The evaluation consisted of history, clinical examination, IKDC score, Cincinnati Knee Score, KT-1000 testing, standardized radiography and magnetic resonance imaging. One hundred patients were available for follow-up. There were two traumatic reruptures 6 and 11 months postoperatively. By IKDC score 87 patients were in groups A and B, 12 in group C, and 2 with a rerupture in group D. Mean Cincinnati Knee Score was 82 (range 46-100), KT-1000 manual maximum at follow-up showed an average difference of 1.7 mm between the sides. Full extension was rapidly achieved in all cases, and flexion averaged 135 degrees . Considering the enlargement caused by the bioabsorbable interference screws, the incidence of tunnel widening was 6.6% on the femoral side and 1.7% on the tibial side. Tunnel widening did not affect the clinical results. Three patients experienced an effusion after more than 6 months postoperatively. There was one infection, which settled without functional impairment after early arthroscopic lavage and intravenous antibiotics. Otherwise no complications occurred. The described technique for anterior cruciate ligament reconstruction combines the advantage of anatomical graft position with sufficient graft fixation. A short intra-articular graft construct with a strong tendon to bone interface was created. Clinically, 87% of patients had a normal or nearly normal IKDC score at follow-up. Magnetic resonance imaging revealed a considerable increase in tunnel area caused by the insertion of the interference screws. On the other hand, the development of a "fibrous interzone" between the graft and the bone tunnel was prevented in most cases. At short-term follow-up the bicortical tibial fixation proved to be efficient even with an aggressive rehabilitation program. PMID:10975262

Buelow, J U; Siebold, R; Ellermann, A

2000-01-01

22

Distally based sural island flap for the reconstruction of a large soft tissue defect in an open tibial fracture with occluded anterior and posterior tibial arteries—a case report  

Microsoft Academic Search

To repair a 10×16 cm soft tissue defects of right lower leg that accompanied with occluded anterior and posterior tibial arteries in a 30-year-old man who sustained comminuted type IIIB Gustilo open tibial and fibular fracture, we present a successful reconstruction by using a large distally based sural island flap perfused by the lowermost perforator of the peroneal artery. This

C. H. Hsieh; C. C. Liang; N.-S. Kueh; H. H. Tsai; S. F. Jeng

2005-01-01

23

Mid-Anterior Tibial Stress Fracture in a Female Elite Athlete  

Microsoft Academic Search

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

Patricia A. M. Netzer

2007-01-01

24

Ultrasound measurement of the size of the anterior tibial muscle group: the effect of exercise and leg dominance  

PubMed Central

Background Knowledge of normal muscle characteristics is crucial in planning rehabilitation programmes for injured athletes. There is a high incidence of ankle and anterior tibial symptoms in football players, however little is known about the effect of limb dominance on the anterior tibial muscle group (ATMG). The purpose of this study was to assess the effect of limb dominance and sports-specific activity on ATMG thickness in Gaelic footballers and non-football playing controls using ultrasound measurements, and to compare results from transverse and longitudinal scans. Methods Bilateral ultrasound scans were taken to assess the ATMG size in 10 Gaelic footballers and 10 sedentary controls (age range 18-25 yrs), using a previously published protocol. Both transverse and longitudinal images were taken. Muscle thickness measurements were carried out blind to group and side of dominance, using the Image-J programme. Results Muscle thickness on the dominant leg was significantly greater than the non-dominant leg in the footballers with a mean difference of 7.3%, while there was no significant dominance effect in the controls (p < 0.05). There was no significant difference between the measurements from transverse or longitudinal scans. Conclusions A significant dominance effect exists in ATMG size in this group of Gaelic footballers, likely attributable to the kicking action involved in the sport. This should be taken into account when rehabilitating footballers with anterior tibial pathology. Ultrasound is a reliable tool to measure ATMG thickness, and measurement may be taken in transverse or longitudinal section. PMID:21914209

2011-01-01

25

[Successful surgical treatment of a multiple ruptured true saphenous vein aneurysm after an anterior femoro-tibial bypass].  

PubMed

Despite the fact, that we have been using the saphena magna as an autolog transplantatum for femoro-popliteal bypass since more than 50 years, the true aneurysma of the saphena graft is rare. Generally the aneurysma formations are detectable years after the primary operation, often in a life or limb threatening form. In our publication we report a successfully operated case of ruptured true saphena aneurysma. The multiplex aneurysma was operated on after a femoro-tibial anterior bypass operation, performed seven years earlier. The patient was normotensiv, without any laboratory sign of hyperlipidaemia. For the reconstruction we used autolog vein, from the upper limb. PMID:11299500

Gyurkovics, E; Kaliszky, P; Jámbor, G; Nagy, Z

2000-06-01

26

Modified Anchor Shaped Post Core Design for Primary Anterior Teeth  

PubMed Central

Restoring severely damaged primary anterior teeth is challenging to pedodontist. Many materials are tried as a post core but each one of them has its own drawbacks. This a case report describing a technique to restore severely damaged primary anterior teeth with a modified anchor shaped post. This technique is not only simple and inexpensive but also produces better retention. PMID:25379294

Rajesh, R.; Baroudi, Kusai; Reddy, K. Bala Kasi; Praveen, B. H.; Kumar, V. Sumanth; Amit, S.

2014-01-01

27

A decreased volume of the medial tibial spine is associated with an increased risk of suffering an anterior cruciate ligament injury for males but not females.  

PubMed

Measurements of tibial plateau subchondral bone and articular cartilage slope have been associated with the risk of suffering anterior cruciate ligament (ACL) injury. Such single-plane measures of the tibial plateau may not sufficiently characterize its complex, three-dimensional geometry and how it relates to knee injury. Further, the tibial spines have not been studied in association with the risk of suffering a non-contact ACL injury. We questioned whether the geometries of the tibial spines are associated with non-contact ACL injury risk, and if this relationship is different for males and females. Bilateral MRI scans were acquired on 88 ACL-injured subjects and 88 control subjects matched for sex, age and sports team. Medial and lateral tibial spine geometries were characterized with measurements of length, width, height, volume and anteroposterior location. Analyses of females revealed no associations between tibial spine geometry and risk of ACL injury. Analyses of males revealed that an increased medial tibial spine volume was associated with a decreased risk of ACL injury (OR?=?0.667 per 100?mm(3) increase). Smaller medial spines could provide less resistance to internal rotation and medial translation of the tibia relative to the femur, subsequently increasing ACL strains and risk of ACL injury. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1451-1457, 2014. PMID:24962098

Sturnick, Daniel R; Argentieri, Erin C; Vacek, Pamela M; DeSarno, Michael J; Gardner-Morse, Mack G; Tourville, Timothy W; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Beynnon, Bruce D

2014-11-01

28

Structural stiffness of the hoffmann simple anterior tibial external fixation frame  

Microsoft Academic Search

Tibial external fixation frames were constructed on aluminum tube simulating tibia bone. A 20-mm gap was left at the fracture\\u000a site in order to measure the structural stiffness of the frame rather than the aluminum tube. The performance of the frames\\u000a were experimentally evaluated and quantified using tests which simulated the loading conditions encountered in normal walking.\\u000a These included axial

J. Vossoughi; Y. Youm; M. Bosse; A. R. Burgess; A. Poka

1989-01-01

29

Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury.  

PubMed

Tibial plateau subchondral bone geometry has been associated with the risk of sustaining a non-contact ACL injury; however, little is known regarding the influence of the meniscus and articular cartilage interface geometry on risk. We hypothesized that geometries of the tibial plateau articular cartilage surface and meniscus were individually associated with the risk of non-contact ACL injury. In addition, we hypothesized that the associations were independent of the underlying subchondral bone geometry. MRI scans were acquired on 88 subjects that suffered non-contact ACL injuries (27 males, 61 females) and 88 matched control subjects that were selected from the injured subject's teammates and were thus matched on sex, sport, level of play, and exposure to risk of injury. Multivariate analysis of the female data revealed that increased posterior-inferior directed slope of the middle articular cartilage region and decreased height of the posterior horn of the meniscus in the lateral compartment were associated with increased risk of sustaining a first time, non-contact ACL injury, independent of each other and of the slope of the tibial plateau subchondral bone. No measures were independently related to risk of non-contact ACL injury among males. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1487-1494, 2014. PMID:25099246

Sturnick, Daniel R; Van Gorder, Robert; Vacek, Pamela M; DeSarno, Michael J; Gardner-Morse, Mack G; Tourville, Timothy W; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J; Beynnon, Bruce D

2014-11-01

30

Navigated reconstruction of a tibial plateau compression fracture post-virtual reconstruction: a case report.  

PubMed

Post-traumatic arthrosis is a common problem following tibial plateau fractures. Computed tomography (CT) with 3D reconstruction is essential in facilitating accurate analysis of the fracture type and depth of compression, but is typically only available pre- or postoperatively. Special reconstruction software tools, based on 3D imaging, have been developed. Limiting factors include a lengthy preoperative planning phase. This study assessed a specific type of navigation software, which is currently in use in maxillofacial surgery, to establish whether it might play a critical role in orthopaedic procedures. We report the case of a 43 year old female who sustained an isolated tibial plateau compression fracture (Schatzker IIIa), and who was successfully treated with open reduction and internal fixation, with the aid of intraoperative 3D imaging and new software navigation tools. This case demonstrates a combined approach using a new software tool based on intraoperative fluoroscopy-3D imaging. PMID:20580886

Citak, Musa; Citak, Mustafa; Suero, Eduardo M; O'Loughlin, Padhraig F; Hüfner, Tobias; Krettek, Christian

2011-06-01

31

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

Microsoft Academic Search

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

Erik Hohmann; Adam Bryant; Peter Reaburn; Kevin Tetsworth

32

The risk of post-operative infection after reamed intramedullary locked nailing of tibial fractures. A review of 730 cases  

Microsoft Academic Search

Summary  730 consecutive acute reamed intramedullary locked nailing of tibial fractures were studied, according to Gustilo’s classification\\u000a of soft tissue lesions for the open fractures. There is a significant increase of post-operative infection rate if the tibial\\u000a fracture is open, and the relative risk increases with the severity of soft tissue lesions. The comparison of these figures\\u000a with those of other

J.-Y. Jenny; G. Jenny; J. Gaudias

1995-01-01

33

In-vivo Anterior Cruciate Ligament Elongation in Response to Axial Tibial Loads  

E-print Network

Background: The knowledge of in vivo anterior cruciate ligament (ACL) deformation is fundamental for understanding ACL injury mechanisms and for improving surgical reconstruction of the injured ACL. This study investigated ...

Gill, Thomas J.

34

Comparison of Bioabsorbable Suture Anchor Fixation on the Tibial Side for Anterior Cruciate Ligament Reconstruction Using Free Soft Tissue Graft: Experimental Laboratory Study on Porcine Bone  

PubMed Central

Purpose The use of graft tissue fixation using bioabsorbable interference screws (BISs) in anterior cruciate ligament (ACL) reconstruction offers various advantages, but limited pullout strength. Therefore, additional tibial fixation is essential for aggressive rehabilitation. We hypothesized that additional graft tissue fixation using bioabsorbable suture anchors (BSA) would provide sufficient pull-out strength. Materials and Methods Twenty four fresh frozen porcine distal femur and patellar tendon preparations were used. All specimens were divided into three groups based on additional fixation methods: A, isolated BIS; B, BIS and BSA; and C, BIS and post cortical screw. Tensile testing was carried out under an axial load. Ultimate failure load and ultimate failure load after cyclic loading were recorded. Results The ultimate failure loads after load to failure testing were 166.8 N in group A, 536.4 N in group B, and 438 N in group C; meanwhile, the ultimate failure loads after load to failure testing with cyclic loading were 140 N in group A, 466.5 N in group B, and 400 N in group C. Stiffness after load to failure testing was 16.5 N/mm in group A, 33.5 N/mm in group B, and 40 N/mm in group C. An additional BSA fixation resulted in a significantly higher ultimate failure load and stiffness than isolated BIS fixation, similar to post screw fixation. Conclusion Additional fixation using a BSA provided sufficient pullout strength for ACL reconstruction. The ultimate failure load of the BSA technique was similar to that of post cortical screws. PMID:24719145

Na, Suk In; Lee, Jong Min; Park, Ju Yong

2014-01-01

35

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 Central

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

Shao, Qi; MacLeod, Toran D.; Manal, Kurt

2010-01-01

36

A modified posteromedial approach combined with extensile anterior for the treatment of complex tibial pilon fractures (AO/OTA 43-C).  

PubMed

The anterior approaches that have been described for open reduction internal fixation of multifragmentary pilon fractures are designed to reconstruct the comminuted and impacted anterior articular surface onto a stable posterior column. Thus, reduction of the posterior column, particularly proper length, is critical. There are differing opinions of how best to surgically approach the posterior pilon fracture. There is also no clear indication as to the timing of both anterior and posterior reconstructions. Our objectives were (1) to develop a more midline posterior approach that might provide better visualization of the posterior aspect of the posterior column and juxtametaphyseal/diaphyseal parts of the tibia, first on the cadaver and then with patients, and (2) to use this as part of a combined posterior and anterior approach during the same anesthesia for complex tibial pilon fractures (AO/OTA 43-C) in a preliminary study of 6 patients. PMID:24857906

Assal, Mathieu; Ray, Adrien; Fasel, Jean H D; Stern, Richard

2014-06-01

37

A multi-scale structural study of the porcine anterior cruciate ligament tibial enthesis.  

PubMed

Like the human anterior cruciate ligament (ACL), the porcine ACL also has a double bundle structure and several biomechanical studies using this model have been carried out to show the differential effect of these two bundles on macro-level knee joint function. It is hypothesised that if the different bundles of the porcine ACL are mechanically distinct in function, then a multi-scale anatomical characterisation of their individual enthesis will also reveal significant differences in structure between the bundles. Twenty-two porcine knee joints were cleared of their musculature to expose the intact ACL following which ligament-bone samples were obtained. The samples were fixed in formalin followed by decalcification with formic acid. Thin sections containing the ligament insertion into the tibia were then obtained by cryosectioning and analysed using differential interference contrast (DIC) optical microscopy and scanning electron microscopy (SEM). At the micro-level, the anteromedial (AM) bundle insertion at the tibia displayed a significant deep-rooted interdigitation into bone, while for the posterolateral (PL) bundle the fibre insertions were less distributed and more focal. Three sub-types of enthesis were identified in the ACL and related to (i) bundle type, (ii) positional aspect within the insertion, and (iii) specific bundle function. At the nano-level the fibrils of the AM bundle were significantly larger than those in the PL bundle. The modes by which the AM and PL fibrils merged with the bone matrix fibrils were significantly different. A biomechanical interpretation of the data suggests that the porcine ACL enthesis is a specialized, functionally graded structural continuum, adapted at the micro-to-nano scales to serve joint function at the macro level. PMID:24697495

Zhao, Lei; Thambyah, Ashvin; Broom, Neil D

2014-06-01

38

Highly crosslinked polyethylene in posterior-stabilized total knee arthroplasty: in vitro performance evaluation of wear, delamination, and tibial post durability.  

PubMed

Recent advances in total knee arthroplasty (TKA) include the development of highly crosslinked polyethylene (HXPE). To assess the suitability of using HXPE in posterior-stabilized TKA, knee simulator wear testing and a novel tibial post durability test were performed on a modern posterior-stabilized implant design with both conventional polyethylene (CPE) and HXPE materials. The laboratory testing reproduced clinically relevant wear and tibial post damage mechanisms. For the designs tested, wear volume was reduced by 67% to 75% for aged HXPE compared with aged CPE. Components of HXPE also demonstrated superior tibial post durability compared with the CPE design, despite the use of unaged material to represent best-case CPE tibial post strength. With appropriate design considerations, HXPE can be successfully incorporated into a posterior-stabilized TKA. PMID:20413249

Stoller, Alex P; Johnson, Todd S; Popoola, Oludele O; Humphrey, Steven M; Blanchard, Cheryl R

2011-04-01

39

Spontaneous patella fracture associated with anterior tibial tubercle pseudarthrosis in a revised knee replacement following knee Arthrodesis  

PubMed Central

Background Conversion of a knee arthrodesis to a Total Knee Arthroplasty is an uncommon procedure. Revision Total Knee Arthroplasty in this setting presents the surgeon with a number of challenges including the management of the extensor mechanism and patella. Case presentation We describe a unique case of a 69 years old Caucasian man who underwent a revision Total Knee Arthroplasty using a tibial tubercle osteotomy after a previous conversion of a knee arthrodesis without patella resurfacing. Unfortunately 9 months following surgery a tibial tubercle pseudarthrosis and spontaneous patella fracture occurred. Both were managed with open reduction and internal fixation. At 30 months follow-up the tibial tubercle osteotomy had completely consolidated while the patella fracture was still evident but with no signs of further displacement. The patient was completely satisfied with the outcome and had a painless range of knee flexion between 0-95°. Conclusions We believe that patients undergoing this type of surgery require careful counseling regarding the risk of complications both during and after surgery despite strong evidence supporting improved functional outcomes. PMID:24195600

2013-01-01

40

Geometric profile of the tibial plateau cartilage surface is associated with the risk of non-contact anterior cruciate ligament injury.  

PubMed

The purpose of this study was to determine if geometry of the articular surfaces of the tibial plateau is associated with non-contact anterior cruciate ligament (ACL) injury. This was a longitudinal cohort study with a nested case-control analysis. Seventy-eight subjects who suffered a non-contact ACL tear and a corresponding number of controls matched by age, sex, and sport underwent 3 T MRI of both knees. Surface geometry of the tibial articular cartilage was characterized with polynomial equations and comparisons were made between knees on the same person and between ACL-injured and control subjects. There was no difference in surface geometry between the knees of the control subjects. In contrast, there were significant differences in the surface geometry between the injured and normal knees of the ACL-injured subjects, suggesting that the ACL injury changed the cartilage surface profile. Therefore, comparisons were made between the uninjured knees of the ACL-injured subjects and the corresponding knees of their matched controls and this revealed significant differences in the surface geometry for the medial (p < 0.006) and lateral (p < 0.001) compartments. ACL-injured subjects tended to demonstrate a posterior-inferior directed orientation of the articular surface relative to the long axis of the tibia, while the control subjects were more likely to show a posterior-superior directed orientation. PMID:24123281

Beynnon, Bruce D; Vacek, Pamela M; Sturnick, Daniel R; Holterman, Leigh Ann; Gardner-Morse, Mack; Tourville, Timothy W; Smith, Helen C; Slauterbeck, James R; Johnson, Robert J; Shultz, Sandra J

2014-01-01

41

Pseudoaneurysm of the Anterior Tibial Artery following Tibio-Talar-Calcaneum Fusion with a Retrograde Nail: A Rare Case and Literature Review  

PubMed Central

This study reports the case of an 87-year-old woman who presented with a nonresolving haematoma 13 weeks following tibiotalar arthrodesis surgery on her right ankle using a retrograde nail. This was revealed by angiography to be a pseudoaneurysm of the anterior tibial artery. The patient subsequently underwent endovascular stenting of the pseudoaneurysm and has had a successful recovery. This case highlights the need for awareness of both the normal arterial supply to the leg and ankle as well as the potential for anatomical variations. Arterial variation may be as high as 6.7% based on published findings from cadaveric studies. As pseudoaneurysm is a rare complication, a high index of suspicion is needed in order to avoid a missed or delayed diagnosis. We urge surgeons to keep in mind the potential for pseudoaneurysm when a patient presents with a nonresolving haematoma and arrange appropriate further investigations as needed. PMID:23984141

Craxford, Simon; Karuppiah, Saravana V.; Milner, Stephen

2013-01-01

42

Bond strength analysis of intracanal posts used in anterior primary teeth: an in vitro study.  

PubMed

The purpose of this in vitro study is to assess the bond strength of three different posts used to restore primary anterior teeth. These posts were made by composite resin, 0.7 mm alpha-shaped orthodontic wire and dentin posts. Thirty roots of extracted primary anterior teeth, with initial physiological resorption, were mounted in a container filled with self cured resin and were endodontically treated Thirty posts were prepared using three different materials: 10 composite resin posts (Z100), 10 alpha-shaped orthodontic wire and 10 dentin posts. A bulk of composite resin (Z100) was made over the posts using a circular Teflon bisected strip. The specimens were stored in 37 degrees C water solution for 24 hours before tensile bond strength tests in 0.5 mm/min speed were performed (Instron model 4442 test machine--Instron Corporation). The results were submitted to the Kruskal-Wallis test and there were no significant statistical differences among the three types of posts assessed (p = 0.8666). The dentin posts technique might be considered an alternative for rehabilitation in pediatric dentistry, because of the possibility of natural resorption. PMID:17091655

Pinheiro, Sérgio Luiz; Bönecker, Marcelo José Strazzeri; Duarte, Danilo Antonio; Imparato, José Carlos Pettorossi; Oda, Margareth

2006-01-01

43

Refracture of a healed tibial shaft fracture after irradiation for post-traumatic squamous-cell carcinoma  

Microsoft Academic Search

A 58-year-old man, who had been operated on 17 years ago for an open Grade III tibial shaft fracture, developed 14 years after the fracture had healed a poorly differentiated squamous cell carcinoma at the site of the old scar. Seventeen years after the original injury, the carcinoma was completely excised and the area irradiated. Fourteen months later a spontaneous

P. Korovessis; M. Repanti; P. Sidiropoulos

1995-01-01

44

Refracture of a healed tibial shaft fracture after irradiation for post-traumatic squamous-cell carcinoma.  

PubMed

A 58-year-old man, who had been operated on 17 years ago for an open Grade III tibial shaft fracture, developed 14 years after the fracture had healed a poorly differentiated squamous cell carcinoma at the site of the old scar. Seventeen years after the original injury, the carcinoma was completely excised and the area irradiated. Fourteen months later a spontaneous fracture of the tibial shaft occurred at the same site. After radical excision of the necrotic bone and affected skin, AO-external osteosynthesis was performed which failed, and 8 months after surgery a septic pseudarthrosis occurred which persisted, though no local recurrence of the carcinoma was clinically or histologically diagnosed. Amputation in the upper third of the tibia was successful without local or systematic recurrence during follow-up. PMID:8550152

Korovessis, P; Repanti, M; Sidiropoulos, P

1995-10-01

45

Post-reduction stress urinary incontinence rates in posterior versus anterior pelvic organ prolapse: a secondary analysis  

PubMed Central

Introduction/hypothesis Stress incontinence with vaginal prolapse reduction is less common in women with posterior-predominant prolapse (rectocele) compared with those with anterior-predominant prolapse (cystocele). Methods This was a secondary analysis of a cohort of prospectively enrolled women with symptomatic pelvic organ prolapse at or beyond the hymen and prolapse-reduced stress urinary incontinence (SUI) testing. Subjects were included if they had anterior- or posterior-predominant prolapse with at least a 1 cm difference in pelvic organ prolapse quantification (POP-Q) points Ba and Bp (N=214). We evaluated the prevalence and risk factors of post-reduction SUI between the two groups. Results Comparing posterior (n=45) and anterior (n=169) prolapse groups, we identified similar rates of post-reduction SUI (posterior: 6/45, 13.3 %; anterior: 18/169, 10.7 %; p= 0.52) and SUI without reduction (posterior: 4.4 %; anterior: 11.2 %; p=0.26). Maximum prolapse size was slightly larger in anterior than in posterior patients (+3.1 vs +2.0 cm beyond the hymen, p=0.001), while a higher proportion of posterior subjects reported a prior hysterectomy (p=0.04). Among posterior subjects, lower maximum urethral closure pressure values (MUCP; p=0.02) were associated with post-reduction SUI. In contrast, among anterior-predominant prolapse, larger prolapse measured at POP-Q point Ba (p=0.003) and maximum POP-Q measurement (p=0.006) were each associated with higher rates of post-reduction SUI and were highly correlated with each other (R=0.90). Conclusions We observed similar rates of post-reduction SUI in women with anterior- and posterior-predominant pelvic organ prolapse. Factors affecting the anterior and posterior prolapse groups differed, suggesting different mechanisms of continence protection. These findings suggest that reduction incontinence testing for operative planning would be as relevant to posterior-predominant prolapses as it is to anterior prolapse. PMID:23306769

DeLancey, John O. L.; Fenner, Dee E.

2014-01-01

46

Complications of Intramedullary Rodding for Chronic Tibial Stress Fractures inFemale Athletes: Three Case Reports  

Microsoft Academic Search

The purpose of this case study is to present complications in three cases of female intercollegiate athletes with intramedullary rodding for chronic tibial stress fracture. Three female college athletes underwent tibial rodding insertion after diagnosed with chronic tibial stress fracture. Postoperatively, the stress fracture healed; however, unusual stress reaction occurred at the distal end of the anterior tibia a few

TOMO YAMADA; LEAMOR KAHANOV

2004-01-01

47

Treatment of post-traumatic myositis ossificans of the anterior thigh with extracorporeal shock wave therapy  

PubMed Central

Objective This case study demonstrates the effectiveness of a novel approach to the treatment of post-traumatic myositis ossificans with extracorporeal shockwave therapy in an elite athlete. Clinical Features A 20 year-old male semi-professional rugby player presented with progressive pain and loss of range of motion after sustaining a severe, right quadriceps contusion nine weeks earlier. The differential diagnosis of myositis ossificans was suspected and confirmed on radiographic examination. Intervention and Outcome A two week treatment protocol was undertaken consisting of three sessions of extracorporeal shockwave therapy and an unsupervised exercise program consisting of active and passive range of motion, gradual strengthening and balance exercises. The patient experienced appreciable improvements in pain and range of motion in two weeks and was able to participate in sport specific activity four weeks after presentation. Summary This case illustrates the successful conservative management of post-traumatic myositis ossificans of the anterior thigh with extracorporeal shockwave therapy and a primarily unsupervised graded exercise program within a condensed treatment time frame of 2 weeks. PMID:22131560

Torrance, David Allen; deGraauw, Christopher

2011-01-01

48

Patellar tendon rupture post reamed intra-medullary tibial nail in a patient with Ehlers-Danlos syndrome. A case report  

Microsoft Academic Search

Patellar tendon rupture is a rare complication of intra-medullary nailing in tibial fractures. We report such a case in a patient with type III Ehlers-Danlos syndrome. We recommend the use of unreamed nails and a parapatellar entry point for tibial nailing in patients with connective tissue disorders.

P. Moroney; T. McCarthy; D. Borton

2004-01-01

49

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

ERIC Educational Resources Information Center

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…

Jonkman, Sietse; Everitt, Barry J.

2009-01-01

50

Medially posted insoles consistently influence foot pronation in runners with and without anterior knee pain.  

PubMed

Anterior knee pain (AKP) is a common injury among runners and effectively treated with posted insoles and foot orthotics. While clinically effective, the underlying biomechanical mechanisms that bring about these improvements remain debatable. Several methodological factors contribute to the inconsistent biomechanical findings, including errors associated with removing and reattaching markers, inferring foot motion from markers placed externally on a shoe, and redefining segmental coordinate systems between conditions. Therefore, the purpose of this study was to evaluate the influence of medially posted insoles on lower extremity kinematics in runners with and without AKP while trying to limit the influence of these methodological factors. Kinematics of 16 asymptomatic and 17 runners with AKP were collected while running with and without insoles. Reflective markers were attached to the surface of the calcaneus and kept in place (as opposed to detached) between conditions, eliminating the error associated with reattaching markers and redefining segmental coordinate systems. Using these methods, no significant interactions between insole and injury and the main effect of injury were detected (p>0.05); therefore, means were pooled across injury. Insoles, on average, reduced peak eversion by 3.6° (95% confidence interval -2.9° to -4.3°), peak eversion velocity by 53.2°/s (95% confidence interval -32.9 to -73.4) and eversion range of motion by 1.33 (95% confidence interval -0.8 to -1.9). However, while insoles systematically reduced eversion variables, they had small influences on the transverse plane kinematics of the tibia or knee, indicating that they may bring about their clinical effect by influencing other variables. PMID:23137595

Rodrigues, Pedro; Chang, Ryan; TenBroek, Trampas; Hamill, Joseph

2013-04-01

51

Proximal Tibial Bone Graft  

MedlinePLUS

... the Smaller Toes AOFAS / FootCareMD / Treatments Proximal Tibial Bone Graft Page Content What is a bone graft? Bone grafts may be needed for various ... the proximal tibia. What is a proximal tibial bone graft? Proximal tibial bone graft (PTBG) is a ...

52

THE EFFECTS OF MODIFIED POSTERIOR TIBIAL SLOPE ON ACL STRAIN AND KNEE KINEMATICS: A HUMAN CADAVERIC STUDY  

PubMed Central

Increases to the posterior tibial slope can lead to an anterior shift in tibial resting position. However, the effect of this shift on anterior cruciate ligament (ACL) strain has not been investigated sufficiently. This study examined the relationship between increased tibial slope and ACL strain, as well as the subsequent kinematics of the tibiofemoral joint. We hypothesized increases in slope would shift the tibia anterior relative to the femur and increase ACL strain. ACL strain measurements and tibiofemoral kinematics were compared for 5 intact and experimental knees subject to anterior opening wedge osteotomy. Combinations of both compressive and AP loading were applied. As slope increased, the resting position of the tibia shifted anteriorly, external tibial rotation increased, and tibial translation remained unchanged. Contrary to our hypothesis, ACL strain decreased. The clinical implication of these findings is that alterations to the posterior tibial slope should not increase strain in the ACL. PMID:18686482

Fening, Stephen D.; Kovacic, Jeffrey; Kambic, Helen; McLean, Scott; Scott, Jacob; Miniaci, Anthony

2008-01-01

53

Retentive strength of different intracanal posts in restorations of anterior primary teeth: an in vitro study  

PubMed Central

Objectives To determine the retentive strength and failure mode of undercut composite post, glass fiber post and polyethylene fiber post luted with flowable composite resin and resin-cement. Materials and Methods Coronal parts of 120 primary canine teeth were sectioned and specimens were treated endodontically. The teeth were randomly divided into 6 groups (n = 20). Prepared root canals received intracanal retainers with a short composite post, undercut composite post, glass fiber post luted with flowable resin or resin-cement, and polyethylene fiber post luted with flowable resin or resin-cement. After crown reconstruction, samples were tested for retentive strength and failure mode. Statistical analysis was done with one-way ANOVA and Tukey tests (p < 0.05). Results There were statistically significant differences between groups (p = 0.001). Mean bond strength in the undercut group was significantly greater than in the short composite post (p = 0.030), and the glass fiber post (p = 0.001) and the polyethylene fiber post group luted with resin-cement (p = 0.008). However, the differences between the undercut group and the groups with flowable composite as the luting agent were not significant (p = 0.068, p = 0.557). Adhesive failure was more frequent in the fiber post groups. Conclusions Although the composite post with undercutting showed the greatest resistance to dislodgement, fiber posts cemented with flowable composite resin provided acceptable results in terms of retentive strength and fracture mode. PMID:24303356

Memarpour, Mahtab; Abbaszadeh, Maryam

2013-01-01

54

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

PubMed

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

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

2013-08-01

55

Aggressive Quadriceps Loading Can Induce Noncontact Anterior Cruciate Ligament Injury  

Microsoft Academic Search

Background: The force responsible for noncontact anterior cruciate ligament (ACL) injuries remains controversial. The patella tendon to tibial shaft angle causes an anterior tibial shear force with quadriceps activation.Hypothesis: An aggressive quadriceps contraction can injure the ACL.Methods: The authors characterized noncontact ACL injury and kinematics with aggressive quadriceps loading. Thirteen freshfrozen knees were potted in a jig held in 20

Gene Demorat; Paul Weinhold; Troy Blackburn; Steven Chudik; William Garrett

2004-01-01

56

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

Microsoft Academic Search

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

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

2011-01-01

57

Biological dentin post for intra radicular rehabilitation of a fractured anterior tooth.  

PubMed

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

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

2014-02-01

58

Chronic exertional compartment syndrome with medial tibial stress syndrome in twins.  

PubMed

Chronic exertional compartment syndrome and medial tibial stress syndrome are uncommon conditions that affect long-distance runners or players involved in team sports that require extensive running. We report 2 cases of bilateral chronic exertional compartment syndrome, with medial tibial stress syndrome in identical twins diagnosed with the use of a Kodiag monitor (B. Braun Medical, Sheffield, United Kingdom) fulfilling the modified diagnostic criteria for chronic exertional compartment syndrome as described by Pedowitz et al, which includes: (1) pre-exercise compartment pressure level >15 mm Hg; (2) 1 minute post-exercise pressure >30 mm Hg; and (3) 5 minutes post-exercise pressure >20 mm Hg in the presence of clinical features. Both patients were treated with bilateral anterior fasciotomies through minimal incision and deep posterior fasciotomies with tibial periosteal stripping performed through longer anteromedial incisions under direct vision followed by intensive physiotherapy resulting in complete symptomatic recovery. The etiology of chronic exertional compartment syndrome is not fully understood, but it is postulated abnormal increases in intramuscular pressure during exercise impair local perfusion, causing ischemic muscle pain. No familial predisposition has been reported to date. However, some authors have found that no significant difference exists in the relative perfusion, in patients, diagnosed with chronic exertional compartment syndrome. Magnetic resonance images of affected compartments have indicated that the pain is not due to ischemia, but rather from a disproportionate oxygen supply versus demand. We believe this is the first report of chronic exertional compartment syndrome with medial tibial stress syndrome in twins, raising the question of whether there is a genetic predisposition to the causation of these conditions. PMID:21667913

Banerjee, Purnajyoti; McLean, Christopher

2011-06-01

59

Effect of Screw Length on Bioabsorbable Interference Screw Fixation in a Tibial Bone Tunnel  

Microsoft Academic Search

Initial tibial fixation strength is the weak link after anterior cruciate ligament reconstruction with a quadrupled hamstring tendon graft fixed with bioabsorbable interference screws. The purpose of this study was to determine the biomechanical differences between 28-mm and tapered 35-mm interference screws for tibial fixation of a soft tissue graft in 16 young cadaveric tibias. Failure mode, displacement before failure,

Jeffrey B. Selby; Darren L. Johnson; Peter Hester; David N. M. Caborn

2001-01-01

60

Posterior Tibial Tendon Dysfunction  

MedlinePLUS

... patients will notice some limitation in activity a er surgery. Anatomy The posterior tibial tendon is one ... the pain to last another 6 months a er treatment starts. Rest Decreasing or even stopping activities ...

61

High tibial osteotomy in knee instability: the rationale of treatment and early results  

Microsoft Academic Search

We treated 14 patients having knee instability and varus alignment with tibial osteotomy with or without ligament reconstruction. Five patients with varus angulated anterior cruciate deficiency (double varus) were treated with single-stage closed-wedge tibial osteotomy and anterior cruciate ligament reconstruction. The remaining nine patients had varying amount of posterior cruciate and postero-lateral corner ligament injuries with varus angulation (triple varus);

Nitin P. Badhe; Ian W. Forster

2002-01-01

62

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

PubMed Central

Background Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk. Methods/Design 80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures. Discussion The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR. Trial registration Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317 PMID:23522373

2013-01-01

63

Post impingement in posterior stabilised total knee arthroplasty.  

PubMed

Posterior stabilised implants are a well-proven treatment for patients requiring primary total knee arthroplasty. Concerns about the posterior stabilised (PS) design have been raised and recent studies suggest that the post-cam articulation can be an additional source of polyethylene wear debris. In this study, the authors report impingement of the tibial post against the patellar component in deep flexion in posterior stabilised total knee arthroplasty. Their data suggest that "post impingement" is associated with a raised joint line, patella infera, too anterior placement of the tibial component and a smaller femoral component size. "Post impingement" may lead to extensor mechanism problems and additional polyethylene wear and therefore may affect the longterm functional results of posterior stabilised total knee arthroplasty. PMID:15055317

Verborgt, Olivier; Victor, Jan

2004-02-01

64

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

PubMed Central

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

Todo, Mitsugu

2014-01-01

65

The effect of malrotation of tibial component of total knee arthroplasty on tibial insert during high flexion using a finite element analysis.  

PubMed

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

Osano, Kei; Nagamine, Ryuji; Todo, Mitsugu; Kawasaki, Makoto

2014-01-01

66

Solitary Tibial Osteolytic Lesion  

PubMed Central

We report an unusual case of solitary osteolytic tibial metastasis from a primary endometrial cancer in a 62-year-old woman. The primary cancer was treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy combined with postoperative external beam radiotherapy, while the tibial metastasis was treated with an above knee amputation. The rarity of the case lies on the fact that metastases distally to the elbow and knee are uncommon and endometrial cancer rarely gives distal bone metastases and particularly solitary to the extremities. PMID:19718252

Pakos, Emilios E.; Gartzonikas, Dimitrios N.; Tsekeris, Pericles G.; Xenakis, Theodore A.

2009-01-01

67

Medial tibial stress syndrome  

Microsoft Academic Search

Lecture 9Medial tibial stress syndrome (MTSS) is an enigmatic condition with confusing terminology, the term often being used interchangeably with shin splints. It is suggested that MTSS and shin splints be used as generic rather than diagnostic terms. On account of variable definitions, the reported incidence rate varies from 4 to 35% in military and athletic populations. Broadly, it represents

Mark E Batt

2011-01-01

68

Tibial fractures in children  

PubMed Central

Background Tibial fracture is the third most common long-bone fracture in children. Traditionally, most tibial fractures in children have been treated non-operatively, but there are no long-term results. Methods 94 children (64 boys) were treated for a tibial fracture in Aurora City Hospital during the period 1980–89 but 20 could not be included in the study. 58 of the remaining 74 patients returned a written questionnaire and 45 attended a follow-up examination at mean 27 (23–32) years after the fracture. Results 89 children had been treated by manipulation under anesthesia and cast-immobilization, 4 by skeletal traction, and 1 with pin fixation. 41 fractures had been re-manipulated. The mean length of hospital stay was 5 (1–26) days. Primary complications were recorded in 5 children. The childrens’ memories of treatment were positive in two-thirds of cases. The mean subjective VAS score (range 0–10) for function appearance was 9. Leg-length discrepancy (5–10 mm) was found clinically in 10 of 45 subjects and rotational deformities exceeding 20° in 4. None of the subjects walked with a limp. None had axial malalignment exceeding 10°. Osteoarthritis of the hip and/or knee was seen in radiographs from 2 subjects. Interpretation The long-term outcome of tibial fractures in children treated non-operatively is generally good. PMID:24786903

Palmu, Sauli A; Auro, Sampo; Lohman, Martina; Paukku, Reijo T; Peltonen, Jari I; Nietosvaara, Yrjana

2014-01-01

69

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

PubMed Central

Background Bone bruises located on the lateral femoral condyle and posterolateral tibia are commonly associated with anterior cruciate ligament (ACL) injuries and may contribute to the high risk for knee osteoarthritis after ACL injury. The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/Hypothesis (1) To analyze tibial and femoral articular cartilage pressure distributions during normal landing and injury simulations, and (2) to evaluate ACL strains for conditions that lead to articular cartilage pressure distributions similar to bone bruise patterns associated with ACL injury. The hypothesis was that combined knee abduction and anterior tibial translation injury simulations would demonstrate peak articular cartilage pressure distributions in the lateral femoral condyle and posterolateral tibia. The corollary hypothesis was that combined knee abduction and anterior tibial translation injury conditions would result in the highest ACL strains. Study Design Descriptive laboratory study. Methods Prospective biomechanical data from athletes who subsequently suffered ACL injuries after testing (n = 9) and uninjured teammates (n = 390) were used as baseline input data for finite element model comparisons. Results Peak articular pressures that occurred on the posterolateral tibia and lateral femoral condyle were demonstrated for injury conditions that had a baseline knee abduction angle of 5°. Combined planar injury conditions of abduction/anterior tibial translation, anterior tibial translation/internal tibial rotation, or anterior tibial translation/external tibial rotation or isolated anterior tibial translation, external tibial rotation, or internal tibial rotation resulted in peak pressures in the posterolateral tibia and lateral femur. The highest ACL strains occurred during the combined abduction/anterior tibial translation condition in the group that had a baseline knee abduction angle of 5°. Conclusion The results of this study support a valgus collapse as the major ACL injury mechanism that results from tibial abduction rotations combined with anterior tibial translation or external or internal tibial rotations. Clinical Relevance Reduction of large multiplanar knee motions that include abduction, anterior translation, and internal/external tibial motions may reduce the risk for ACL injuries and associated bone bruises. In particular, prevention of an abduction knee posture during initial contact of the foot with the ground may help prevent ACL injury. PMID:21487121

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

2012-01-01

70

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

Microsoft Academic Search

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

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

2008-01-01

71

High Tibial Osteotomy  

PubMed Central

High tibial osteotomy (HTO) is a widely performed procedure to treat medial knee arthrosis. In general, published studies on HTO report good long-term results with a correct patient selection and a precise surgical technique. The ideal candidate for an HTO is a middle aged patient (60 to 65 years of age), with isolated medial osteoarthritis, with good range of motion and without ligamentous instability. Some issues that need resolution remain; these include the choice between opening and closing wedge tibial osteotomy, the graft selection in opening wedge osteotomies, the type of fixation, the comparison with unicompartmental knee arthroplasty and whether HTO significantly affects a subsequent total joint replacement. Precise indication, preoperative planning, and operative technique selection are essential to achieve good results. PMID:22708105

Byun, Seong Joon

2012-01-01

72

A case of fracture of posterior margin of lateral tibial plateau by pivot shift mechanism in chronic ACL insufficiency  

Microsoft Academic Search

We present a case of the fracture of the posterior margin of the lateral tibial plateau, probably by pivot shift mechanism\\u000a in a chronic anterior cruciate ligament (ACL) insufficient knee. Multitudes of direct and indirect signs of ACL injury were\\u000a evident on MRI, including anterior translation of the lateral tibial plateau, buckling of the posterior cruciate ligament,\\u000a deep sulcus sign,

Jae Ho Yoo; Bo Kyu Yang; Ho Kwang Ryu

2009-01-01

73

Post-exercise facilitation and depression of M wave and motor evoked potentials in healthy subjects  

Microsoft Academic Search

Objectives: To characterize so-called central fatigue, the effect of various levels of exercise on central and peripheral motor potentials were compared.Methods: Thirteen healthy subjects performed 4 levels of exercise following isometric dorsiflexion of the foot. Post-exercise recordings from the anterior tibial muscle of motor evoked potentials (MEP) evoked by transcranial magnetic stimulation (TMS) and M wave evoked by electrical stimulation

Marianne Lentz; Jørgen Feldbæk Nielsen

2002-01-01

74

Fracture of the anteromedial tibial plateau associated with posterolateral complex injury: case study and literature review.  

PubMed

We report an unusual case of anteromedial tibial plateau compression fracture following hyperextension and forced varus of the knee, resulting in an anterior bone fragment large enough to require osteosynthesis. This uncommon lesion was associated with posterolateral complex injury, diagnosed with magnetic resonance imaging (MRI), while both cruciate ligaments were preserved. After proceeding with tibial plateau osteosynthesis, a peroneal tendon allograft was used for supplementation repair of the lateral collateral ligament and biceps tendon in a single surgical intervention. Tibial plateau fractures are often associated with soft-tissue involvement, mainly of the anterior cruciate ligament and external meniscus. Posterolateral complex injuries also occur with a mechanism of forced varus and hyperextension. These lesions require an accurate diagnosis to avoid future knee instability; moreover, adequate treatment in the acute phase provides a better functional outcome. Physicians should suspect associated posterolateral complex injury when an anteromedial tibial plateau fracture is diagnosed. MRI allows adequate diagnosis and permits surgical treatment in one procedure. PMID:23288728

Conesa, Xavier; Minguell, Joan; Cortina, Josep; Castellet, Enric; Carrera, Lluís; Nardi, Joan; Cáceres, Enric

2013-12-01

75

Radial displacement of the lateral meniscus before and after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Introduction  The purpose of this study was to investigate radial displacement (RD) of the lateral meniscus in patients with anterior cruciate\\u000a ligament (ACL) injury by using magnetic resonance imaging both pre- and post-operatively.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and methods  This study included 59 knees that had undergone ACL reconstruction. The length that extruded from the lateral tibial plateau\\u000a was measured in the coronal plane.\\u000a \\u000a \\u000a \\u000a \\u000a Results  Mean

Atsushi Ichiba; Kaoru Makuya

76

Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study  

Microsoft Academic Search

Patella infera is a known complication of high tibial osteotomy (HTO) that can cause anterior knee pain due to excessive stresses\\u000a associated with abnormal patellofemoral (PF) joint biomechanics. However, the translation of these abnormal biomechanics to\\u000a native cartilage pressure has not been explored. The present study was designed to compare the PF contact pressures of three\\u000a different HTOs in a

Karl Stoffel; Craig Willers; Omar Korshid; Markus Kuster

2007-01-01

77

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

PubMed Central

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 Mann–Whitney 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

Eid, Rita; Homsy, Fodda; Elhusseini, Hasan

2014-01-01

78

Quadriceps protects the anterior cruciate ligament  

Microsoft Academic Search

The aim of this study is to show that the quadriceps is the primary muscular restraint to anterior tibial translation during closed kinetic chain activities such as running, jumping, walking, and standing. It is my hypothesis that the quadriceps vector is directed superiorly during open kinetic chain knee extension and inferiorly during closed kinetic chain knee extension. My methods involve

Marko Bodor

2001-01-01

79

The use of dynamic EMG in predicting the outcome of split posterior tibial tendon transfers in spastic hemiplegia.  

PubMed

The purpose of this study was to assess the outcome of split posterior tibial tendon transfers in patients with spastic cerebral palsy to determine whether the use of preoperative dynamic electromyography was predictive of surgical success. The study is a consecutive case series of 25 children with spastic hemiplegia who underwent unilateral split posterior tibial tendon transfers for varus foot deformities. Three patients were considered failures because of residual varus, which required further surgery. An additional 5 patients had mild residual varus. Preoperative dynamic electromyographic data were evaluated to determine the etiology of postoperative undercorrection. Undercorrection seems to be related to unrecognized anterior tibial muscle overactivity and advanced age at surgery. Overcorrection did not occur. Dropfoot was noted postoperatively in 52% of patients and was related to early cessation of anterior tibial muscle activity in swing. Split posterior tibial tendon transfer is a successful surgery on those patients with increased posterior tibial muscle activity. Undercorrection can be avoided by assessing the activity of the anterior tibial muscle before surgery. These results are expected to assist in surgical decision making for the equinovarus foot in cerebral palsy. PMID:17065945

Scott, Allison C; Scarborough, Nancy

2006-01-01

80

Double-stranded hamstring graft for anterior cruciate ligament reconstruction  

Microsoft Academic Search

Current techniques for anterior cruciate ligament (ACL) reconstruction do not completely reproduce the anatomy and function of the ACL. They address only the anteromedial bundle and do not fully restore ACL function throughout the range of motion. Current grafts control anterior tibial subluxation near extension, but are less efficacious in providing rotatory stability. Recently, several authors have suggested reconstructing not

Guy Bellier; Pascal Christel; Philippe Colombet; Patrick Djian; Jean Pierre Franceschi; Abdou Sbihi

2004-01-01

81

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

Microsoft Academic Search

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

A. A. FARAJ

2002-01-01

82

Double-stranded hamstring graft for anterior cruciate ligament reconstruction.  

PubMed

Current techniques for anterior cruciate ligament (ACL) reconstruction do not completely reproduce the anatomy and function of the ACL. They address only the anteromedial bundle and do not fully restore ACL function throughout the range of motion. Current grafts control anterior tibial subluxation near extension, but are less efficacious in providing rotatory stability. Recently, several authors have suggested reconstructing not just the anteromedial bundle but also the posterolateral bundle. This technical note describes a double-bundle ACL reconstruction using hamstring tendons routed through 2 tibial and 2 femoral independent tunnels. PMID:15483556

Bellier, Guy; Christel, Pascal; Colombet, Philippe; Djian, Patrick; Franceschi, Jean Pierre; Sbihi, Abdou

2004-10-01

83

Grade III open tibial fractures  

Microsoft Academic Search

The purpose of this study was to assess the long-term functional outcome and the quality of life of patients who were treated for a (Gustilo) Grade III open tibial fracture.We included 43 patients with successful limb salvage (group A) and 21 amputees (group B). The groups were similar with regard to age, sex, and Injury Severity Score (ISS). The functional

J. M Hoogendoorn; Chr van der Werken

2001-01-01

84

Distal Tibial Fractures: Intramedullary Nailing  

Microsoft Academic Search

\\u000a Abstract\\u000a   The tibia is an exposed bone with vulnerable soft tissue coverage and is therefore predisposed to local soft tissue problems\\u000a and delayed bone healing. The objective in distal tibial fracture treatment is to achieve stable fixation patterns with a\\u000a minimum of soft-tissue affection. Thus, the risk of soft tissue breakdown and bone healing complications is more likely related\\u000a to

Andreas H. Ruecker; Michael Hoffmann; Martin E. Rupprecht; Johannes M. Rueger

2009-01-01

85

Tibial slope and high tibial osteotomy using the circular external fixator  

Microsoft Academic Search

Alteration of tibial slope is one of the important anatomical changes of the proximal tibia after high tibial osteotomy. Increased\\u000a or decreased tibial slope can effect further total knee prosthesis procedure. In this retrospective study, 18 knees of 17\\u000a patients (17 female, mean age 51 range 43–61, mean BMI is 33.6 ± 4.6 kg\\/m2) who were applied high tibial osteotomy using circular external

Taner Gunes; Cengiz Sen; Mehmet Erdem

2007-01-01

86

Experimental studies of acute anterior cruciate ligament injury and repair  

Microsoft Academic Search

Ten dogs and six rhesus monkeys underwent transection and repair of the anterior cruciate ligament. One-half of the pro cedures involved the femoral end, the other half involved the tibial end of the ligament. Seven of the 10 canine and all of the primate ligaments, that had been transected and repaired, did heal. Functional and clinical instability was demonstrable in

H. Edward Cabaud; William G. Rodkey; John A. Feagin

1979-01-01

87

Reconstruction of the anterior cruciate ligament using a double bundle  

Microsoft Academic Search

Summary: We developed a reconstruction technique for the anterior cruciate ligament using a double bundle that is the combination of bone-tendon-bone (BTB) from the patellar tendon and semitendinosus tendon (ST). BTB is fixed in the tunnels produced on the isometric points on the tibia and femur. ST is fixed on the tibial tunnel through the same route as the BTB,

Kunio Hara; Toshikazu Kubo; Takehiko Suginoshita; Choji Shimizu; Yasusuke Hirasawa

2000-01-01

88

The effects of femoral graft placement on in vivo knee kinematics after anterior cruciate ligament reconstruction  

PubMed Central

Achieving anatomical graft placement remains a concern in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to quantify the effect of femoral graft placement on the ability of ACL reconstruction to restore normal knee kinematics under in vivo loading conditions. Two different groups of patients were studied: one in which the femoral tunnel was placed near the anterior and proximal border of the ACL (anteroproximal group, n=12) and another where the femoral tunnel was placed near the center of the ACL (anatomic group, n =10) MR imaging and biplanar fluoroscopy were used to measure in vivo kinematics in these patients during a quasi-static lunge. Patients with anteroproximal graft placement had up to 3.4mm more anterior tibial translation, 1.1mm more medial tibial translation and 3.7° more internal tibial rotation compared to the contralateral side. Patients with anatomic graft placement had motion that more closely replicated that of the intact knee, with anterior tibial translation within 0.8mm, medial tibial translation within 0.5mm, and internal tibial rotation within 1°. Grafts placed anteroproximally on the femur likely provide insufficient restraint to these motions due to a more vertical orientation. Anatomical femoral placement of the graft is more likely to reproduce normal ACL orientation, resulting in a more stable knee. Therefore, achieving anatomical graft placement on the femur is crucial to restoring normal knee function and may decrease the rates of joint degeneration after ACL reconstruction. PMID:21227425

Abebe, E S; Utturkar, G M; Taylor, D C; Spritzer, C E; Kim, J P; Moorman, C T; Garrett, W E; DeFrate, L E

2011-01-01

89

Computer model to predict subsurface damage in tibial inserts of total knees.  

PubMed

Two designs of total knee replacements were analysed to determine how the geometry of their bearing surface would affect the susceptibility of their ultra high molecular weight polyethylene tibial inserts to delamination. Orientations of the femoral components on the tibial surfaces were calculated with use of rigid body analysis for discrete intervals during the stance phase of gait. For each successive orientation, finite element analysis was used to compress the components together to determine the stresses in the tibial inserts. A damage function analogous to strain energy density was defined to account for the accumulated amplitudes and frequencies of the maximum shear stress cycles and hence to predict fatigue failure. The damage function was applied to each polyethylene element in the tibial insert, and the highest value calculated for each design was its damage score. One knee had a damage score more than three times less than that of the other because of lower stresses and because the contact points moved in the medial-lateral as well as anterior-posterior directions during internal-external rotation. The femoral and tibial components of this knee had large outer frontal radii and close conformity in the frontal plane. We propose that this method, which accounts for the motions and stresses endured during walking, makes different predictions regarding the likelihood of delamination compared with the predictions made by conventional static compression tests performed when the knee is in a neutral position. PMID:9820279

Sathasivam, S; Walker, P S

1998-09-01

90

Management of ipsilateral femoral and tibial fractures  

Microsoft Academic Search

This is a retrospective study of 18 patients who had ipsilateral femoral and tibial fractures. They were treated by the retrograde femoral and antegrade tibial intramedullary nail from a single incision in the knee. The average time for union of femoral shaft fractures was 27.6 (18–40) weeks. One patient required antegrade nailing with a bone graft due to metal failure

Chang-Wug Oh; Jong-Keon Oh; Woo-Kie Min; In-Ho Jeon; Hee-Soo Kyung; Hyung-Soo Ahn; Byung-Chul Park; Poong-Taek Kim

2005-01-01

91

MRI evaluation of anterior knee pain: predicting response to nonoperative treatment  

Microsoft Academic Search

Objective  Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized\\u000a that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates\\u000a with the presence of AKP and with failure of nonoperative management.\\u000a \\u000a \\u000a \\u000a Materials and methods  In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation\\u000a relative to the

Jocelyn R. Wittstein; Seth D. O’Brien; Emily N. Vinson; William E. Garrett

2009-01-01

92

Tibial hyperostosis: a diagnostic approach.  

PubMed

Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss. PMID:24041433

Touraine, Sébastien; Parlier-Cuau, Caroline; Bousson, Valérie; Sverzut, Jean-Michel; Genah, Idan; Petrover, David; Laredo, Jean-Denis

2013-12-01

93

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

Microsoft Academic Search

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

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

2005-01-01

94

Shape optimization of tibial prosthesis components  

NASA Technical Reports Server (NTRS)

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.

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

1993-01-01

95

In vivo kinematics of total knee arthroplasty: flat compared with concave tibial joint surface.  

PubMed

This study evaluated the influence of the geometric configuration of the tibial joint area on the kinematics of the knee. Twenty-two patients with noninflammatory arthritis and minor preoperative deformity were studied. They each received an AMK total knee replacement with retention of the posterior cruciate ligament. Eleven patients without any knee abnormalities were used as controls. The patients were stratified to either the flat (terminology of the manufacturer: standard) or concave (terminology of the manufacturer: constrained) polyethylene insert (n = 11 in each group). Knee kinematics were assessed 1 year after the operation by having the patient ascend a platform corresponding to an extension of the knee from 50 to 70 degrees of flexion. During this motion, two film-exchangers simultaneously exposed six to 13 pairs of serial stereoradiographs. The concave geometric configuration of the tibial insert resulted paradoxically in increased anterior-posterior translations compared with the flat insert but no significant change of rotations and translations in the other directions. Compared with normal knees, the most obvious abnormality was increased anterior-posterior translations (p < 0.004). At 50 degrees of flexion, the implants with the flat tibial polyethylene insert had displaced 2 times and the concave ones had displaced 2.5 times more posteriorly than the normal knees (p < or = 0.001). Less internal tibial rotation was also recorded in the flexed positions for both types of inserts compared with the normal knees (p < 0.02). Four knees in four patients, who reported symptoms of instability and abnormal knee function, showed significantly increased proximal displacement of the center of the tibial plateau in the flexed position. The findings suggest that current prosthetic designs and surgical technique do not restore normal knee kinematics and indicate that design improvements should rely on in vivo kinematic studies. PMID:11192244

Uvehammer, J; Kärrholm, J; Brandsson, S; Herberts, P; Carlsson, L; Karlsson, J; Regnér, L

2000-11-01

96

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

PubMed Central

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

2014-01-01

97

The patella and tibial condyle position after combined and after closing wedge high tibial osteotomy  

Microsoft Academic Search

High tibial osteotomy changes the patella and tibial condyle position, which makes the subsequent total knee replacement technically\\u000a demanding. From 1 January 1993 to 31 December 2000, combined osteotomy [After the first osteotomy made 2 cm distally to the\\u000a joint line, a bone wedge is removed based laterally. Its tip ends at the center of the tibial condyle (half bone wedge).

Miklós Papp; Zoltán Csernátony; Sándor Kazai; Zoltán Károlyi; László Róde

2007-01-01

98

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

PubMed

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

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

2010-10-01

99

Distal realignment (tibial tuberosity transfer).  

PubMed

Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans. PMID:22878656

Feller, Julian Ashley

2012-09-01

100

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

PubMed Central

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.

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

2014-01-01

101

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

PubMed Central

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, 54–64 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-N·m valgus and 5-N·m 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

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

2014-01-01

102

Fetal alcohol syndrome and bilateral tibial exostoses  

Microsoft Academic Search

Maternal exposure to alcohol during pregnancy has been associated with fetal malformations referred to as the fetal alcohol syndrome. This paper describes, for the first time, the presence of bilateral tibial exostoses in a child with FAS.

E. M. Azouz; G. Kavianian; V. M. Der Kaloustian

1993-01-01

103

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

PubMed Central

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

2009-01-01

104

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

PubMed

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

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

2013-12-01

105

Percutaneous plating for unstable tibial fractures  

Microsoft Academic Search

.  ?Twenty-four unstable tibial fractures were stabilized with a narrow limited contact-dynamic compression plate inserted using\\u000a a percutaneous plating technique under fluoroscopic guidance. The major indication for this technique was a tibial fracture\\u000a for which intramedullary nailing would be difficult. There were 16 proximal or distal metaphyseal fractures and 5 segmental\\u000a fractures in adults and 3 mid-shaft fractures in adolescents who

Chang-Wug Oh; Byung-Chul Park; Hee-Soo Kyung; Sung-Jung Kim; Hee-Soo Kim; Seong-Man Lee; Joo-Chul Ihn

2003-01-01

106

Recurrent compartment syndrome after open tibial fracture  

Microsoft Academic Search

Recurrence of compartment syndrome after surgical decompression is rare. We report a case where this occurred after open tibial\\u000a fracture.\\u000a \\u000a A compartment syndrome is a clinical condition in which increased interstitial pressure in a closed osseofascial compartment\\u000a results in microvascular compromise and possible myoneural damage. Compartment syndrome following open tibial fracture has\\u000a been shown to occur with an incidence between

R. U. Ashford; H. S. Plaha; D. H. Thakkar

2000-01-01

107

High-speed non-invasive measurement of tibial rotation during the impact phase of running.  

PubMed

Several injuries to the lower extremity in runners have been linked to excessive rates of internal rotation of the tibia just after ground impact. This study presents an improved method of capturing internal/external tibial rotation, and investigates whether estimates of rates of internal tibial rotation during the first 50 ms of contact during running are influenced by the sampling rate and processing of tibial displacement data. A lightweight plate was moulded to the shape of each subject's right anterior-medial tibia. Nine male subjects ran barefoot (3.35 m.s(-1)) and the landing kinematics of the right leg were recorded at 1000 Hz. The group mean value for the total range of internal rotation of the tibia for the whole stance phase was consistent with the literature (15.4 degrees ), but peak angular velocities (8.3 rad.s(-1)) were substantially higher than previously reported. The cut-off frequency of the low-pass filter influenced the peak angular velocity values obtained with the largest changes occurring between 15 and 40 Hz. Typically, researchers using lower sample rates have to filter around 10 Hz and consequently are likely to underestimate peak angular velocities. These findings have implications for obtaining a sound quantitative foundation for transient tibial motion before furthering our understanding of injury mechanisms. PMID:16338728

Digby, C J; Lake, M J; Lees, A

108

Post  

NSDL National Science Digital Library

What is this thing, this Post? It is a platform for critical response, and a constantly evolving space for sharing research and testing ideas. Post was created by staff members at the Museum of Modern Art in New York to allow people to share texts, images, and videos in the hope that "multiple narratives of art's histories emerge." Along the top section of the homepage, users will find areas like Contents, Themes, Latest, and Participants. Browsing the Themes area. visitors can look over posts on the Fluxus network that existed between New York and Tokyo in the 1960s or the intriguing post examining how archival artworks form a key part of museum culture. Moving on, the Latest area includes a few gems, including mediations on the spatial poems of Shiomi Mieko and a reflection on the term "Latin American Conceptualism." As another consideration, passers-by are also encouraged to leave their own thoughts on each of these intriguing contemplations of what "modern" art means.

109

Two-incision anterior cruciate ligament reconstruction.  

PubMed

Two-incision or rear-entry anterior cruciate ligament (ACL) reconstruction has value from a historical perspective as the original method for arthroscopically assisted reconstructions. As endoscopic approaches became popular it became less commonly utilized. It remains an important technique and has become even more relevant as the discussion of tunnel placement has evolved. It allows independent placement from the tibial tunnel and can be easier to accomplish than anteromedial tunnel drilling. It has also gained favor as a technique to ease performing revision reconstructions following previous endoscopic reconstructions. This review discusses the historical and clinical issues involved with two-incision ACL reconstruction. PMID:24992342

Wright, Rick W

2014-10-01

110

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

PubMed

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

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

2013-01-01

111

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

ERIC Educational Resources Information Center

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

Couture, Christopher J.; Karlson, Kristine A.

2002-01-01

112

Surgical Treatment of Patients with Open Tibial Fractures  

Microsoft Academic Search

Open tibial fractures are true surgical emergencies because of the risk of extensive infection to bone and devitalized soft tissue. The most serious consequence of open tibial fractures is osteomyelitisf-which usually can be prevented by prompt surgical intervention within six to eight hours after injuries occur. Open tibial fractures often are the result of trauma from motor vehicle collisions, farm

Chris Brown; Shirley Henderson; Shirley Moore

1996-01-01

113

Insufficiency fractures of the tibial plateau  

SciTech Connect

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

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

1983-06-01

114

Semimembranosus tendon avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament tear and capsular rupture.  

PubMed

Semimembranosus tendon avulsion fractures are an uncommon occurrence and are often associated with anterior cruciate ligament (ACL) and medial meniscus tears. We present the imaging features of an unusual case of semimembranosus avulsion fracture of the posteromedial tibial plateau associated with posterior cruciate ligament (PCL) tear, medial meniscus tear, and capsular rupture in a 26-year-old man with a football injury. PMID:24026070

Khoshnoodi, Pooria; Tehranzadeh, Arash D; Dunn, James M; Tehranzadeh, Jamshid

2014-02-01

115

Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities  

Microsoft Academic Search

The functional anatomy of the anterior cruciate ligament was studied in 18 freshly amputated specimens. The cruciates were observed in the extremes of flexion and extension, and in midposition in simulated weight-bearing and nonweight-bearing conditions. Five femoral shafts were split longitudinally so that the femoral and tibial attachments of the ligament could be inspected. The findings indicated that (1) the

Lyle A. Norwood; Mervyn J. Cross

1979-01-01

116

The unreamed intramedullary tibial nail in tibial shaft fractures of soccer players: a prospective study  

Microsoft Academic Search

Lower leg fractures are common and complex injuries in soccer players. Twenty-five mainly recreational soccer players who sustained a tibial shaft fracture were treated with the AO-UTN (Unreamed Tibial Nail). This prospective series included 25 males with a mean age of 28.1 years. These patients were prospectively followed for a mean period of 4.7 years. Clinical and radiographic data was

Florian Fankhauser; Franz J. Seibert; Christian Boldin; Bernd Schatz; Bradley Lamm

2004-01-01

117

Open wedge tibial osteotomies influence on axial rotation and tibial slope  

Microsoft Academic Search

Inaccurate coronal plane and inadvertent sagittal plane realignment is a common problem after high tibial osteotomies (HTO).\\u000a While the effects of an HTO on the coronal have been studied extensively, the influence on axial rotation has not been described\\u000a in detail. The current study examines the effect of HTO on tibial rotation in the axial plane as determined by computed

D. Kendoff; D. Lo; P. Goleski; B. Warkentine; P. F. O’ Loughlin; A. D. Pearle

2008-01-01

118

Modification of tibial slope after medial opening wedge high tibial osteotomy: clinical study and mathematical modelling  

Microsoft Academic Search

A prospective non-randomized non-comparative study involved 30 patients who underwent a medial opening wedge high tibial osteotomy\\u000a for medial knee osteoarthritis using a specific surgical procedure. The tibial slope was calculated pre-operatively and at\\u000a a mean follow-up of 14 months. A mathematical model of the surgical procedure was developed in order to plan the height of\\u000a the medial opening wedge and

Elhadi Sariali; Y. Catonne

2009-01-01

119

Union of Medial Opening-Wedge High Tibial Osteotomy Using a Corticocancellous Proximal Tibial Wedge Allograft  

Microsoft Academic Search

Background: Medial opening-wedge high tibial osteotomy has been gaining popularity in recent years, and autogenous iliac crest bone is the gold standard graft; however, the surgical time, risk, and morbidity associated with its harvest are significant. The question of a satisfactory bone-graft substitute has yet to be clearly answered.Hypothesis: A corticocancellous proximal tibial wedge allograft is a satisfactory graft choice

Gerald N. Yacobucci; Matthew R. Cocking

2008-01-01

120

The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy  

Microsoft Academic Search

We investigated whether there is a correlation between coronal plane correction magnitude and tibial slope in patients treated\\u000a with medial open wedge high tibial osteotomy (OWHTO) and also measured changes in patellar height. Thirty-four knees treated\\u000a with for varus deformities were retrospectively reviewed and the follow-up period of the patients was averaged 24.1 months.\\u000a Preoperative and postoperative measurements of the Hospital

Metin Ozalay; Gurkan Ozkoc; Esra Circi; Sercan Akp?nar; Murat A. Hersekli; Mustafa Uysal; Necip Cesur

2008-01-01

121

Radiographic evaluation of native anterior cruciate ligament attachments and graft placement for reconstruction. A cadaveric study.  

PubMed

We examined seven cadaveric knees to determine the radiographic location of the native anterior cruciate ligament insertion sites as well as the location of tunnels used in anterior cruciate ligament reconstruction. Posteroanterior and lateral views at several flexion angles were taken with radiopaque markers around the insertions of the native anterior cruciate ligament and subsequent reconstruction tunnels. The femoral insertion was best seen on the 60 degrees notch view. On the lateral view, the femoral tunnel was easily seen as it crossed the roof of the intercondylar notch; however, because of the angle of the tunnel, the actual entrance into the knee may be well distal and anterior to this location. The tibial insertion and tunnel were easily seen at any flexion angle. The center of the insertion was 40% of the tibial diameter from the anterior margin. The lateral view in extension allowed determination of the tibial tunnel's location in relation to the intercondylar notch roof, but by itself did not allow accurate determination of the femoral tunnel's position. Notch and extension lateral radiographs together provided sufficient information for evaluation of anterior cruciate ligament graft position in a convenient, cost-effective format. Neither view by itself provides enough information to evaluate the position of the graft. PMID:8638757

Lintner, D M; Dewitt, S E; Moseley, J B

1996-01-01

122

Partial release of the superficial medial collateral ligament for open-wedge high tibial osteotomy  

Microsoft Academic Search

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

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

2006-01-01

123

Aneurysm of the tibial-saphenous fistula in hemodialysis patient: the results of surgical treatment.  

PubMed

Arteriovenous fistulas are widely used for hemodialysis patients with end-stage renal failure. Due to the lack of suitable veins because of the arteriovenous fistulas previously opened in the upper extremity, alternative access routes are being tested. Few complications of long-term alternative arteriovenous fistulas have been reported in the literature. We report the results of surgical repairs of aneurysms that occurred on anterior tibial-saphenous arteriovenous fistulas (along the vein) in patients with end-stage renal disease after 5 years on hemodialysis. PMID:22140315

Günday, Murat

2011-01-01

124

Cigarette smoking and open tibial fractures  

Microsoft Academic Search

Complication rates were compared in 140 smoking and 133 non-smoking patients with open tibial fractures. Both the groups were evenly matched demographically and in terms of primary fracture treatment. Flap failure complicated 7 (20%) patients in the smoking group and 4 (14%) in the non-smoking group. The mean time to union was 32 weeks for smokers and 28 weeks for

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

2001-01-01

125

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

PubMed

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

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

2013-03-01

126

Lateral versus medial tibial plateau: morphometric analysis and adaptability with current tibial component design.  

PubMed

The purpose of this study was to analyze the in vivo dimensions of each tibial plateau for planning of unicompartmental knee arthroplasty (UKA), and to compare the morphometric data to the dimensions of nine current designs of UKA tibial components. Thirty-seven knees (31 females and 6 males) operated on with UKA were studied. All patients were examined postoperatively using computed tomography (CT). There were 18 lateral and 19 medial UKAs. On the CT scan, each operated tibial plateau was measured in the transverse plane at the resection level, just below the full polyethylene tibial component. We measured the length of the anteroposterior (AP) cut as well as the maximal mediolateral dimension of the resected plateau (perpendicular to the AP cut). We compared the measurements with nine current UKA systems: Accuris (Smith and Nephew), Advance (Wright Medical), HLS Uni Evolution (Tornier), Miller-Galante and "ZUK" (Zimmer), Oxford and Oxford alpha (Biomet), Preservation (DePuy) and Unix (Stryker). There was good correlation between patient height and mediolateral dimension (r=0.6), and between patient height and area of total tibial plateau (r=0.7). The anteroposterior dimension was greater for the medial plateau (mean 50.8 mm, SD 3.3) than for the lateral plateau (mean 47.2 mm, SD 3.3). This difference was statistically significant (P=0.0016). Some UKA implants are designed with an asymmetric femoral component, but none have an asymmetric tibial component. The present study suggests, however, that the shape of the medial tibial plateau differs from that of the lateral plateau. This difference can lead to mediolateral overhang for medial UKA, if the surgeon aims for optimal anteroposterior coverage. PMID:18779949

Servien, E; Saffarini, M; Lustig, S; Chomel, S; Neyret, Ph

2008-12-01

127

Clinically Relevant Injury Patterns After an Anterior Cruciate Ligament Injury Provide Insight Into Injury Mechanisms  

PubMed Central

Background The functional disability and high costs of treating anterior cruciate ligament (ACL) injuries have generated a great deal of interest in understanding the mechanism of noncontact ACL injuries. Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures. Purpose The objectives of this study were (1) to quantify ACL strain under a range of physiologically relevant loading conditions and (2) to evaluate soft tissue and bony injury patterns associated with applied loading conditions thought to be responsible for many noncontact ACL injuries. Study Design Controlled laboratory study. Methods Seventeen cadaveric legs (age, 45 ± 7 years; 9 female and 8 male) were tested utilizing a custom-designed drop stand to simulate landing. Specimens were randomly assigned between 2 loading groups that evaluated ACL strain under either knee abduction or internal tibial rotation moments. In each group, combinations of anterior tibial shear force, and knee abduction and internal tibial rotation moments under axial impact loading were applied sequentially until failure. Specimens were tested at 25° of flexion under simulated 1200-N quadriceps and 800-N hamstring loads. A differential variable reluctance transducer was used to calculate ACL strain across the anteromedial bundle. A general linear model was used to compare peak ACL strain at failure. Correlations between simulated knee injury patterns and loading conditions were evaluated by the ?2 test for independence. Results Anterior cruciate ligament failure was generated in 15 of 17 specimens (88%). A clinically relevant distribution of failure patterns was observed including medial collateral ligament tears and damage to the menisci, cartilage, and subchondral bone. Only abduction significantly contributed to calculated peak ACL strain at failure (P = .002). While ACL disruption patterns were independent of the loading mechanism, tibial plateau injury patterns (locations) were significantly (P = .002) dependent on the applied loading conditions. Damage to the articular cartilage along with depression of the midlateral tibial plateau was primarily associated with knee abduction moments, while cartilage damage with depression of the posterolateral tibial plateau was primarily associated with internal tibial rotation moments. Conclusion The current findings demonstrate the relationship between the location of the tibial plateau injury and ACL injury mechanisms. The resultant injury locations were similar to the clinically observed bone bruises across the tibial plateau during a noncontact ACL injury. These findings indicate that abduction combined with other modes of loading (multiplanar loading) may act to produce ACL injuries. Clinical Relevance A better understanding of ACL injury mechanisms and associated risk factors may improve current preventive, surgical, and rehabilitation strategies and limit the risk of ACL and secondary injuries, which may in turn minimize the future development of posttraumatic osteoarthritis of the knee. PMID:23144366

Levine, Jason W.; Kiapour, Ata M.; Quatman, Carmen E.; Wordeman, Samuel C.; Goel, Vijay K.; Hewett, Timothy E.; Demetropoulos, Constantine K.

2014-01-01

128

Biomechanical Solutions in Tibial Malleolus Fracture  

NASA Astrophysics Data System (ADS)

This paper presents a biomechanical analysis of three solutions with implants in fracture fixation of tibial malleolus, on the mechanical strength testing. Samples were tested in mechanical traction, the forces revealed the minimum threshold from which start the phenomenon of bone destruction and maximum forces that destroyed the fractured fragments achieved by fixation elements. Experimental tests showed the best technical solution of the three, namely that consists of two Kirschner pins, cortical screws and wire tightening.

Oprisan, C.; Budescu, E.; Cotoros, V.

129

Type III open tibial fractures in children  

Microsoft Academic Search

The management of open tibial fractures in children differs from that in adult patients. We present a retrospective study\\u000a of Type III open fractures of the tibia in children treated in our facility.\\u000a \\u000a A total of 16 Type III open fractures of the tibia were retrospectively studied. Of the 16 fractures, 11 were Type IIIA fractures,\\u000a three Type IIIB, and

M. Fujita; K. Yokoyama; T. Tsukamoto; S. Aoki; T. Noumi; N. Fukushima; M. Itoman

2001-01-01

130

Syndrome in Open Tibial Fractures*t  

Microsoft Academic Search

A retrospective review of the cases of 180 patients who had 198 acute open fractures of the tibial shaft and were admitted to a multiple-trauma re- ferral center over a three-year period revealed an mci- dence of accompanying compartment syndrome of 9.1 per cent (eighteen fractures in sixteen patients). Each of the eighteen compartment syndromes was documented by measurements of

SAMUEL S. BLICK; ROBERT J. BRUMBACK; ATTILA POKA; ANDREW R. BURGESS; NABIL A. EBRAHEIM

131

The management of open tibial fractures  

Microsoft Academic Search

Open tibial fractures are challenging injuries to deal with. To receive the best outcome they require the services of both\\u000a an experienced orthopaedic trauma surgeon and plastic surgeon with an interest in lower limb trauma. The A&E management should\\u000a follow ATLS protocols followed by administration of prophylactic antibiotics. The surgical management includes adequate débridement,\\u000a lavage, skeletal stabilisation and ultimately soft

Peter Hull

2008-01-01

132

Complications of closing wedge high tibial osteotomy  

Microsoft Academic Search

Closing wedge high tibial osteotomy is a common, effective and well-established procedure to treat unicompartment osteoarthrosis\\u000a of the knee. It is, however, not without its complications. This article will discuss some of these complications and present\\u000a an overview of the current literature. It will examine current thoughts on aetiology, techniques to try to avoid, and methods\\u000a of treatment of these

James A. W. Tunggal; Gordon A. Higgins; James P. Waddell

2010-01-01

133

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

SciTech Connect

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

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

2009-03-15

134

Arthrosis of the knee in chronic anterior laxity.  

PubMed

Arthrosis following rupture of the anterior cruciate ligament has been analysed in two series. The first series was derived from a review of 150 cases of reconstruction of the anterior cruciate ligament with a follow-up of 3 years or more. Arthrosis was seen to have developed in 13.3%. The second series was concerned with 64 cases of unilateral arthrosis treated by upper tibial valgus osteotomy in whom there had been a previous rupture of the anterior cruciate ligament. The 'tolerance interval'--that is the time between the original ligamentous injury and the time of osteotomy--for the development of arthrosis was very variable, ranging in the natural-history cases from 10 to 50 years, with a mean of 35 years. It is important to recognise the radiological signs of the onset of arthrosis. These are osteophytosis of the intercondylar notch, osteophyte formation at the posterior part of the medial tibial plateau, and, in particular, narrowing of the medial joint line with posterior subluxation of the medial femoral condyle, well seen in lateral radiographs whilst standing on one lower limb. Early arthroses, appearing after 10 years, may occur as a 'natural arthrosis', but it develops much more frequently after surgical treatment that had failed to correct anterior laxity and particularly when it had been performed on knees that were already pre-arthrotic. The main factor in arthrosis is anterior laxity measured radiologically by an 'active Lachman' radiograph. Removal of the medial meniscus which in itself, is liable to produce arthrosis, is even more harmful in anterior cruciate laxity since it doubles the degree of anterior subluxation of the tibia seen on unilateral weight-bearing. The development of varus deformity, which characterises progressive arthrosis, has its origin in wear of the posterior part of the medial tibial plateau caused by anterior cruciate laxity. Other factors play an important part such as associated lateral laxity, constitutional genu varum and weakness of the hamstring muscles, which oppose the subluxating action of the quadriceps. PMID:24461232

Dejour, H; Walch, G; Deschamps, G; Chambat, P

2014-02-01

135

Surgical technique, using skin, for repair of simultaneously ruptured anterior cruciate and medial collateral ligaments of the canine femorotibial articulation  

E-print Network

for the repair of sinultaneously ruptured anterior cruciate and nedial collateral liganents of the canine stifle (fssoro- tibial) joint. Much attention has bean given to the lesions of the stifle joint in the large dcssestic anhaals, However, the lesions... involve the Iiganents, with osteo- arthritis developing later as a result of abnornal notion within the joint. 13 15 7 Nilsson, Paatsana, and Gibbens describe nethods for repairing ruptures of the nedial collateral and anterior cruciate liganents...

Chastain, Jamie Neal

2012-06-07

136

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

PubMed Central

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.

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

2014-01-01

137

Change in tibial rotation of barefoot versus shod running  

Microsoft Academic Search

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

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

2009-01-01

138

Poststimulation inhibition of the micturition reflex induced by tibial nerve stimulation in rats  

PubMed Central

Abstract The purpose of this study was to determine the effect of tibial nerve stimulation (TNS) on the micturition reflex. Experiments were conducted in 24 rats under urethane anesthesia. A catheter was inserted into the bladder via the bladder dome for saline infusion. A cuff electrode was placed around right tibial nerve for stimulation. TNS (5 Hz, 0.2 msec pulse width) at 2–4 times the threshold (T) intensity for inducing a toe movement was applied either during slow (0.08 mL/min) infusion of the bladder or for 30 min with an empty bladder. TNS had no effect on the micturition reflex when it was applied during slow bladder infusion. However, the 30?min TNS applied with an empty bladder induced poststimulation inhibition and significantly (P < 0.05) increased the bladder capacity to about 140% of prestimulation level in a 50?min period following the termination of stimulation. The bladder compliance was also significantly (P < 0.05) increased after the 30?min TNS. These results suggest that different mechanisms might exist in acute? and post?TNS inhibition of micturition reflex. The animal model developed in this study will be very useful for further investigations of the neurotransmitter mechanisms underlying tibial neuromodulation of bladder function. PMID:24744884

Matsuta, Yosuke; Roppolo, James R.; de Groat, William C.; Tai, Changfeng

2014-01-01

139

The treatment of open tibial fractures and of tibial non-union with a novel external fixator  

Microsoft Academic Search

We report the results of external fixation in 29 patients treated for tibial fractures and tibial non-union using a novel multi axial external fixator (MAXX) followed prospectively until bony union. The results of treatment were classified according to the Association for the Study and Application of the Method of Ilizarov (ASAMI). Overall, 13 patients had excellent bone results; 13 had

C. T Ong; D. S. K Choon; N. P Cabrera; N Maffulli

2002-01-01

140

Sagittal realignment osteotomy for increased posterior tibial slope after opening-wedge high tibial osteotomy: a case report  

Microsoft Academic Search

A 40 year old welder who underwent opening-wedge high tibial osteotomy for correction of alignment in a varus knee developed persistent pain with loss of knee extension. The posterior tibial slope increased from 9 degrees to 20 degrees after the osteotomy and caused the anteromedial knee pain and limited extension. The patient then underwent a revision osteotomy using a closing

Yuka Kimura; Yasuyuki Ishibashi; Eiichi Tsuda; Akira Fukuda; Harehiko Tsukada

2009-01-01

141

Simultaneous arthroscopic implantation of autologous chondrocytes and high tibial osteotomy for tibial chondral defects in the varus knee  

Microsoft Academic Search

There is no consensus on the ideal management of patients with chondral defects of the medial tibial plateau and varus malalignment of the knee. We performed a cohort study to evaluate the outcome of patients affected by these conditions, who underwent arthroscopic implantation of autologous chondrocytes and a medial opening wedge high tibial osteotomy. Eight patients (four men and four

Francesco Franceschi; Umile Giuseppe Longo; Laura Ruzzini; Andrea Marinozzi; Nicola Maffulli; Vincenzo Denaro

2008-01-01

142

Discoid medial meniscus completely coalesced with the anterior cruciate ligament.  

PubMed

Discoid meniscus is an abnormality of the knee in which the meniscus is discoid rather than semilunar in shape. Medial discoid menisci are rare, and no specific associated symptoms suggest this condition. Several medial meniscus anomalies, including discoid variants, have been reported in the literature. This article describes a rare case of medial discoid meniscus completely coalesced with the anterior cruciate ligament (ACL). A 22-year-old man presented with intermittent right knee pain of 6 months' duration. Physical examination revealed mild wasting of the quadriceps with medial joint line tenderness but no effusion. Radiographically, hypoplasia of the lateral tibial spine, increased medial joint space, and increased concavity of the medial tibial condyle were noted in both knees. Arthroscopic examination revealed a complete discoid medial meniscus that was contiguous with the ACL. On probing, a horizontal tear in the medial meniscus was noted. A meniscectomy was performed, and deep longitudinal furrows with exposed subchondral bone were noted underlying the posteromedial tibial condyle. At the patient's 6-month follow-up visit, he had no knee symptoms and had returned to his daily activities, which included jogging. Discoid medial meniscus is a rare anomaly, and this case represents only the second reported in the literature of discoid medial meniscus completely coalesced with ACL. This case supports the theory that the ACL and menisci can be differentiated from 1 mesenchyme. PMID:24200455

Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Chaudhary, Deepak

2013-11-01

143

Anterior cruciate ligament reconstruction using autologous hamstring single-bundle Rigidfix technique compared with single-bundle Transfix technique  

PubMed Central

Background: Initial fixation strength is critical for the early post-operative rehabilitation of patients with anterior cruciate ligament (ACL) reconstructions. However, even the best femoral fixation devices remain controversial. We compared the results of 2 of the femoral fixation techniques,Rigidfix and Transfix. Materials and Methods: A total of 30 patients with unilateral ACL deficiency were randomly assigned to 1 of 2 groups. In Group A an anatomic single-bundle ACL reconstruction was performed using Rigidfix technique(Mitek, Norwood,MA), Group B were treated by a single bundle using Transfix technique(Arthrex, Naples, FL, USA). For tibial fixation, a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. The patients were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman's and the pivot-shift tests. They also completed the International Knee Documentation Committee (IKDC) score. Results: At a mean of 14 months (12–17) followup there were no significant differences concerning time between injury and range of movement between the 2 groups. However, the Rigidfix group showed significantly better results for the subjective assessment of knee function (P = 0.002). The Lachman, anterior drawer, and pivot-shift tests also showed no significant difference between the 2 groups. The IKDC scale showed no significant difference among the groups (P < 0.001).There was no difference regarding duration of operation and cost of the operation between the 2 groups.On clinical evaluation there was no significant difference between the 2 groups. However, regardless of the technique, all knees were improved by ACL reconstruction compared with their preoperative status. Conclusion: Both techniques can be used for reconstruction of ACL. Other factors, such as psychic profile of the patients should be considered for surgery planning. PMID:23210091

Hamid, Mousavi; Majid, Mohammadi

2012-01-01

144

Patellar Height and Posterior Tibial Slope After Open and Closed-Wedge High Tibial OsteotomyA Radiological Study on 100 Patients  

Microsoft Academic Search

Background: Valgus high tibial osteotomy (HTO) may be associated with changes in the patellar height and posterior tibial slope.Hypothesis: Patellar height increases and posterior tibial slope decreases after closed-wedge HTO, whereas patellar height decreases and tibial slope increases after open-wedge osteotomy.Study Design: Cohort study; Level of evidence, 3.Methods: Lateral radiographs of 100 knees were assessed for patellar height (PH) (Insall-Salvati

Hosam El-Azab; Parpakorn Glabgly; Jochen Paul; Andreas B. Imhoff; Stefan Hinterwimmer

2010-01-01

145

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

NASA Astrophysics Data System (ADS)

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

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

2008-09-01

146

Multilevel versus isolated endovascular tibial interventions for critical limb ischemia  

PubMed Central

Objective Endovascular interventions for critical limb ischemia (CLI) continue to have variable reported results. The purpose of this study is to determine the effect of disease level and distribution on the outcomes of tibial interventions. Methods A retrospective analysis of all tibial interventions done for CLI between 2006 and 2009 was performed. Outcomes of isolated tibial (group I) and multilevel interventions (group II) (femoropopliteal and tibial) were compared. Results Endovascular interventions were utilized to treat 136 limbs in 123 patients for CLI: 54 isolated tibial (85% tissue loss), and 82 multilevel (80% tissue loss). Mean age and baseline comorbidities were comparable. The mean ankle-brachial index (ABI) was significantly lower prior to intervention in group II (0.53 vs 0.74; P < .001) but was similar postintervention (0.86 vs 0.88; P = NS). Wound healing or improvement was achieved in 69% in group I and in 87% in group II (P = .05). Mean overall follow-up was 12.6 ± 5.3 months. Time to healing was significantly longer in group I: 11.5 ± 8.8 months vs 7.7 ± 6.6 months (P = .03). Limb salvage was achieved in 81% of group I and 95% of group II (P = .05). The rate of reintervention was similar (13% vs 18%, P = NS), so was the rate of late surgical conversion (0% vs 6%; P = NS). Limb loss resulted from lack of conduit or initial target vessel for bypass and high-risk systemic comorbidities. Overall mortality rates were similar among both groups. An isolated tibial intervention was a predictor of limb loss at 1 year on multivariate analysis and resulted in a lower rate of limb salvage at 1 year compared with multilevel interventions. Additionally, despite comparable primary patency rates, there was improved secondary patency with multilevel interventions compared with the isolated tibial interventions. Predictors of limb loss in patients treated with isolated tibial intervention included multiple synchronous tibial revascularization (P = .005) and advanced coronary artery disease requiring revascularization (P = .005). Conclusions Adequate rates of limb salvage can be achieved in patients undergoing multilevel interventions for CLI, and improved patency is seen with multilevel compared to isolated tibial interventions. Patients with isolated tibial disease appear to have a higher incidence of limb loss secondary to poor initial pedal runoff, more extensive distal disease, and severe comorbidities precluding surgical bypass. Other therapeutic strategies should be considered in these patients, including primary amputation or pedal bypass when applicable. PMID:21803523

Fernandez, Nathan; McEnaney, Ryan; Marone, Luke K.; Rhee, Robert Y.; Leers, Steven; Makaroun, Michel; Chaer, Rabih A.

2014-01-01

147

Anterior bony ankle impingement  

Microsoft Academic Search

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

Brian G. Donley; Manuel Leyes

2001-01-01

148

Open Wedge High Tibial OsteotomyA Roentgenographic Comparison of a Horizontal and an Oblique Osteotomy on Patellar Height and Sagittal Tibial Slope  

Microsoft Academic Search

Background: In patients with unicompartmental medial knee arthritis, medial opening wedge high tibial osteotomy is used to shift the mechanical weightbearing line laterally to reduce pain and improve function. There have been concerns that opening wedge high tibial osteotomy is associated with a reduction of patellar height and increase in the sagittal posterior tibial slope, both of which can adversely

Wadih Y. Matar; Rya Boscariol; Geoffrey F. Dervin

2009-01-01

149

Pulsed lavage improves fixation strength of cemented tibial components.  

PubMed

Pulsatile lavage is purported to improve radiographic survival in cemented total knee arthroplasty (TKA). Similarly, a potential improvement of fixation strength of the tibial tray has been assumed based on the increased cement penetration. In this study, the influence of pulsed lavage on fixation strength of the tibial component and bone cement penetration was evaluated in six pairs of cadaveric specimens. Following surgical preparation, the tibial surface was irrigated using pulsatile lavage on one side of a pair, while on the other side syringe lavage was applied. All tibial components were implanted using the same cementing technique. Cement penetration and bone mineral density was assessed based on computed tomography data. Fixation strength of the tibial trays was determined by a pull-out test with a material testing machine. Median pull-out forces and cement penetration were significantly (p?=?0.031) improved in the pulsed lavage group as compared to the syringe lavage group. Enhanced fixation strength is suggested as being a key to improved survival of the implant. Consequently, pulsatile lavage should be considered as a mandatory preparation step when cementing tibial components in TKA. PMID:20953784

Schlegel, Ulf J; Siewe, Jan; Delank, Karl S; Eysel, Peer; Püschel, Klaus; Morlock, Michael M; de Uhlenbrock, Anne Gebert

2011-08-01

150

Biomechanical analysis for stress fractures of the anterior middle third of the tibia in athletes: nonlinear analysis using a three-dimensional finite element method  

Microsoft Academic Search

We evaluated stresses in the anterior middle third of the tibia that have been reported to predict a poor prognosis for tibial stress fractures compared to other predominant sites (posteromedial regions of the distal third and proximal third). The effect of two different loads (bending-compression load and torsional load) on three sites was investigated using a three-dimensional finite element method.

Norio Sonoda; Etsuo Chosa; Koji Totoribe; Naoya Tajima

2003-01-01

151

Evaluation of the bone healing process in an experimental tibial bone defect model in ovariectomized rats.  

PubMed

The aim of this study was to evaluate the influence of postmenopausal bone loss (induced by ovariectomy) in the process of bone healing in a tibial bone defect model in rats by means of histological evaluation of bone defects and the analysis of the expression of genes and proteins involved in bone consolidation. Twenty female Wistar rats (12 weeks old, weighing ±250 g) were randomly divided into two groups: control group (CG) and ovariectomized group (OG). Rats of OG were submitted to ovariectomy and after 8 weeks post-surgery, all animals were submitted to the tibial bone defect model. The main histological finding analysis revealed that ovariectomized animals showed a higher amount of granulation tissue and immature newly formed bone compared to CG. Furthermore, quantitative histological analysis showed that OG presented a significant decrease in the amount of newly formed bone (p = 0.0351). RT-PCR analysis showed no difference in Runx2, ALP, RANK, RANKL and Osterix gene expression 14-day post-surgery. Interestingly, immunohistochemical evaluation showed that Runx2 was down expressed (p = 0.0001) and RANKL was up expressed (p = 0.0022) in the OG. In conclusion, these data highlight that bone loss induced by ovariectomy causes an impairment in the capacity of bone to heal mainly probably because of alterations in the imbalance of osteoblasts and osteoclasts activities. PMID:24532218

Kido, Hueliton Wilian; Bossini, Paulo Sérgio; Tim, Carla Roberta; Parizotto, Nivaldo Antônio; da Cunha, Anderson Ferreira; Malavazi, Iran; Renno, Ana Claudia Muniz

2014-10-01

152

Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment.  

PubMed

Fractures of the tibial eminence and of the diaphyseal tibia are common pediatric orthopaedic injuries. Although most tibial fractures can be treated nonsurgically, those that require surgical intervention may encounter specific complications. Surgical treatment of fractures of the tibial eminence may be complicated by failed fixation, knee joint stiffness, and arthrofibrosis of the knee, a complication rarely seen in children but occurring most frequently after tibial eminence injuries. Complications of healing after tibial fractures in pediatric patients are uncommon, although some tibial shaft fractures exhibit delayed union or nonunion, infection, and soft-tissue complications. PMID:25344598

Herman, Martin J; Martinek, Melissa A; Abzug, Joshua M

2014-11-01

153

Anterior glenohumeral joint dislocations.  

PubMed

The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthroidal joint. Anterior dislocation is by far the most common direction and can lead to instability of the glenohumeral joint, which ranges from subtle increased laxity to recurrent dislocation. Overtime, understanding of anterior shoulder dislocations and the resulting instability has improved. Likewise, significant advances in arthroscopic equipment have allowed use of the arthroscope to address anatomically the various lesions that cause instability. This article reviews the anatomy, pathophysiology, clinical evaluation, and treatment of anterior shoulder instability. PMID:18803980

Dodson, Christopher C; Cordasco, Frank A

2008-10-01

154

Avian tibial dyschondroplasia. III. Electron probe analysis  

SciTech Connect

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.

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

1985-05-01

155

Outcome at 12 to 22 years of 1502 tibial shaft fractures.  

PubMed

Fractures of the tibial shaft are common injuries, but there are no long-term outcome data in the era of increased surgical management. The aim of this prospective study was to assess the clinical and functional outcome of this injury at 12 to 22 years. Secondary aims were to determine the short- and long-term mortality, and if there were any predictors of clinical or functional outcome or mortality. From a prospective trauma database of 1502 tibial shaft fractures in 1474 consecutive adult patients, we identified a cohort of 1431 tibial diaphyseal fractures in 1403 patients, who fitted our inclusion criteria. There were 1024 men, and mean age at injury was 40.6 years. Fractures were classified according to the AO system, and open fractures graded after Gustilo and Anderson. Requirement of fasciotomy, time to fracture union, complications, incidence of knee and ankle pain at long-term follow-up, changes in employment and the patients' social deprivation status were recorded. Function was assessed at 12 to 22 years post-injury using the Short Musculoskeletal Function Assessment and short form-12 questionnaires. Long-term functional outcome data was available for 568 of the surviving patients, 389 were deceased and 346 were lost to follow-up. Most fractures (90.7%, n = 1363) united without further intervention. Fasciotomies were performed in 11.5% of patients; this did not correlate with poorer functional outcome in the long term. Social deprivation was associated with a higher incidence of injury but had no impact on long-term function. The one-year mortality in those over 75 years of age was 29 (42%). At long-term follow-up, pain and function scores were good. However, 147 (26%) reported ongoing knee pain, 62 (10%) reported ankle pain and 97 (17%) reported both. Such joint pain correlated with poorer functional outcome. Cite this article: Bone Joint J 2014;96-B:1370-7. PMID:25274924

Connelly, C L; Bucknall, V; Jenkins, P J; Court-Brown, C M; McQueen, M M; Biant, L C

2014-10-01

156

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

Code of Federal Regulations, 2012 CFR

...Drugs 8 2012-04-01 2012-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. ...ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590 Knee joint tibial (hemi-knee) metallic...

2012-04-01

157

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

Code of Federal Regulations, 2011 CFR

...Drugs 8 2011-04-01 2011-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. ...ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590 Knee joint tibial (hemi-knee) metallic...

2011-04-01

158

Total Knee Arthroplasty With 4.4 mm of Tibial Polyethylene  

Microsoft Academic Search

Three hundred eighty-seven one-piece, 8-mm tibial components were implanted in 313 patients. All tibial prostheses were manufactured with 4.4 mm of polyethylene. From this group, 116 patients underwent simultaneous bilateral total knee arthroplasty with an 8-mm tibial component on one side and a tibial component with at least 6.4 mm of polyethylene on the other side. Follow-up averaged 11.8 years.

John B. Meding; Jennifer T. Wing; Merrill A. Ritter

2010-01-01

159

Anterior cruciate ligament surgery in the rabbit  

PubMed Central

Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery. PMID:23957941

2013-01-01

160

Reduced ultrasound velocity in tibial bone of young ballet dancers.  

PubMed

Young ballet dancers are at risk both for osteopenia, due to low body weight, inadequate nutrition and gonadal dysfunction, as well as for lower limbs stress fractures. However, a direct relationship between stress fractures and bone mass in dancers could not be demonstrated, raising the possibility that qualitative aspects of bone, such as elasticity, may be adversely affected in the dancers. To test this hypothesis, speed of sound, a physical parameter that reflects both quantitative and qualitative properties of bone, was determined at the tibial bone of 27 dance students and 27 non-dance students. The results were compared to bone mineral density at the tibia and the lumbar spine, measured by dual-energy x-ray absorptiometry. All three bone measurements were lower in the dance group, but the difference was statistically significant only for the tibial speed of sound. The role of tibial speed of sound measurement in assessing bone status in athletes warrants further exploration. PMID:9231848

Foldes, A J; Danziger, A; Constantini, N; Popovtzer, M M

1997-05-01

161

The significance of segmental fibular fractures in the management of associated tibial fractures  

Microsoft Academic Search

One hundred seventy-six patients with 179 tibial shaft fractures (between March 2003 and August 2007) with a minimum of 4 months follow up were retrospectively reviewed by the author. Twenty-nine of these fractures were found to have segmental fibular fractures. These 29 fractures were analysed and compared with the total of 179 tibial fractures. Segmental tibial fractures with and without

P. R. Ramasamy

2009-01-01

162

Bilateral Tibial Tubercle Sleeve Fractures in a Skeletally Immature Patient  

PubMed Central

Tibial tubercle sleeve fracture is a rare injury. In concept, it is similar to the patellar sleeve fracture in a skeletally immature patient. We describe a unique case of simultaneous bilateral tibial tubercle sleeve fractures in a 12-year-old boy. Radiographs and MRI confirmed the injury. The patient underwent open surgical repair of bilateral sleeve fractures with suture anchor fixation. At the final followup, 3 years after his initial injury, the patient demonstrated full knee function bilaterally without radiographic evidence of growth disturbances. PMID:23691395

Desai, Rasesh R.; Parikh, Shital N.

2013-01-01

163

Ultrasound in the diagnosis of posterior tibial tendon pathology.  

PubMed

We retrospectively evaluated the effectiveness of ultrasonography as a diagnostic tool for investigating pathology in the posterior tibial tendon by comparing the preoperative ultrasonograms for 17 patients with their recorded surgical findings. In all cases, the surgical findings confirmed the ultrasonographic diagnoses: 3 inflammations, 4 partial tears, and 10 ruptures. Interestingly, two ruptures had been undiagnosed by magnetic resonance imaging. Ultrasonography, which seems to be a reliable means of visualizing the extent of pathology of the symptomatic posterior tibial tendon, may be a valuable tool in surgical planning. PMID:8886783

Miller, S D; Van Holsbeeck, M; Boruta, P M; Wu, K K; Katcherian, D A

1996-09-01

164

Principles of tibial fracture management with circular external fixation.  

PubMed

There is a growing mass of literature to suggest that circular external fixation for high-energy tibial fractures has advantages over traditional internal fixation, with potential improved rates of union, decreased incidence of posttraumatic osteomyelitis, and decreased soft tissue problems. To further advance our understanding of the role of circular external fixation in the management of these tibial fractures, randomized controlled trials should be implemented. In addition to complication rates and radiographic outcomes, validated functional outcome tools and cost analysis of this method should be compared with open reduction with internal fixation. PMID:24684913

Lowenberg, David W; Githens, Michael; Boone, Christopher

2014-04-01

165

3T magnetic resonance neurography of tibial nerve pathologies.  

PubMed

Diagnosis of tibial neuropathy has been traditionally based on clinical examination and electrodiagnostic studies; however, cross-sectional imaging modalities have been used to increase the diagnostic accuracy and provide anatomic mapping of the abnormalities. In this context, magnetic resonance neurography (MRN) offers high-resolution imaging of the tibial nerve (TN), its branches and the adjacent soft tissues, and provides an objective assessment of the neuromuscular anatomy, abnormality, and the surrounding pathology. This review describes the pathologies affecting the TN and illustrates their respective 3 Tesla (T) MRN appearances with relevant case examples. PMID:22243916

Chalian, Majid; Soldatos, Theodoros; Faridian-Aragh, Neda; Williams, Eric H; Rosson, Gedge D; Eng, John; Carrino, John A; Chhabra, Avneesh

2013-04-01

166

Acute tibial tubercle avulsion fractures in the sporting adolescent  

Microsoft Academic Search

Introduction  The authors report 7 cases of acute tibial tubercle avulsion fractures. The fracture occurred in 6 out of the 7, after an\\u000a abrupt tension of the patellar tendon in male sporting adolescents (age 13–17 years). Two patients presented symptoms of homolateral\\u000a Osgood-Schlatter’s disease before the lesion.\\u000a \\u000a \\u000a \\u000a Method  According to Ogden’s classification, the tibial tubercle avulsion fracture was not displaced in 3 cases

Makram Zrig; Hedi Annabi; Taoufik Ammari; Mohsen Trabelsi; Mondher Mbarek; Habib Ben Hassine

2008-01-01

167

Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies.  

PubMed

The purpose of our study was that to systematically review the fixation techniques for the ACL reconstruction and associated clinical outcomes at the early follow-up. Systematic search on three electronic databases (Cochrane register, Medline and Embase) of fixation devices used for primary ACL reconstruction with doubled semitendinosus and gracilis and bone-patellar tendon-bone autografts in randomized clinical trials of level I and II of evidence published from January 2001 to December 2011. Therapeutic studies collected were with a minimum 12-month follow-up, and the clinical outcomes were evaluated by at least one of International Knee Documentation Committee, Lysholm and Tegner functional scales and at least one of the following knee stability tests: arthrometric AP tibial translation, Lachman test and pivot-shift test. Nineteen articles met the inclusion criteria. At the femoral side cross-pin, metallic interference screw, bioabsorbable interference screw, and suspensory device were used in 32.3, 27.3, 24.8, 15.5 % of patients, respectively. At the tibial side fixation was achieved with metallic interference screw, bioabsorbable interference screw, screw and plastic sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and 1.7 % of patients, respectively. Side-to-side anterior-posterior tibial translation was 1.9 ± 0.9, 1.5 ± 0.9, 1.5 ± 0.8, 2.2 ± 0.4 mm for metallic interference screw, bioabsorbable screw, cross-pin and suspensory device, respectively. At least two-third of all the patients achieved good-to-excellent clinical outcomes. Rate of failure was 6.1, 3.3, 1.7 and 1.2 % for bioabsorbable interference screw, metallic interference screw, cross-pin and suspensory device, respectively. Clinical outcomes are good to excellent in almost two-third of the patients but several pitfalls that affect the current fixation techniques as graft tensioning such as graft-tunnel motion are still unaddressed. PMID:25269758

Speziali, Andrea; Delcogliano, Marco; Tei, Matteo; Placella, Giacomo; Bartoli, Matteo; Menghi, Amerigo; Cerulli, Giuliano

2014-12-01

168

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

NASA Technical Reports Server (NTRS)

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.

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

2001-01-01

169

Double-bundle anterior cruciate ligament reconstruction in a skeletally immature adolescent athlete.  

PubMed

We present a technique for double-bundle anterior cruciate ligament (ACL) reconstruction in a 14-year-old female athlete. The patient presented with anterolateral knee rotatory instability following a traumatic injury suffered while practicing judo. The clinical examination revealed positive Lachman and pivot shift tests with no accompanying meniscal pathology. Roentgenograms revealed open physes, and magnetic resonance imaging scans confirmed an isolated midsubstance ACL tear without cartilaginous injury. The decision was made to anatomically reconstruct the ACL because the athlete wished to continue competitive judo. Autologous hamstring tendons were harvested for double-bundle ACL repair. Following arthroscopic retrograde femoral and antegrade tibial tunnel placement, the ligaments were secured using interference screws within the femoral and tibial epiphysis. Postoperative Lachman and pivot shift tests were negative. PMID:19245996

Salzmann, Gian M; Spang, Jeffrey T; Imhoff, Andreas B

2009-03-01

170

Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee*  

PubMed Central

Objective: To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat varus knee in young and active patients. Methods: Between June 2001 to July 2008, 18 patients with monocompartmental degeneration of the knee combined with a varus malalignment of the leg had the modified biplanar opening high tibial osteotomy and the osteotomy was fixed with the locking plates (Locking Compression Plate System). The mean varus deformity before operation was 11.5° (5°~19°) and no degenerative changes were found in other departments. Stability of the knee was normal in 15 patients, but ruptures in anterior cruciate ligaments or lateral collateral ligament were presented in the remaining 3 patients. Preoperative symptom was mainly limited in the pain of medial compartment. The preoperative and follow-up data for the range of motion and Lysholm score were determined. Subjective satisfactory examination was also applied to the patients for the operation they selected. Results: All of the patients were followed up with an average of 32.5 months (12~82 months). There was no ununion or delayed union in this group during the follow-up period. No complications like broken plate, nerve injury, or blood vessel injury occurred. The postoperative average corrected degree was 9.5° (5.5°~18°). No degenerations developed in the three departments of the knee. The Lysholm scores before and after surgery were 42.5 and 77.5, respectively (P<0.01). The overall fineness rate was 83.3%. The subjective satisfactory survey demonstrated that about 83.3% patients showed satisfactory on the operation. There was no obvious difference in the range of motion before and after operation, but significant changes were found in the Lysholm score and varus degree from preoperative to follow-up. Conclusion: Proximal opening high tibial osteotomy performed in conjunction with the special rigid locking plate yielded good results for symptomatic genu varum. This new classic technique can be effectively applied to the medial compartment degeneration of the knee in active young patients. PMID:19735102

Zhang, Hai-ning; Zhang, Jie; Lv, Cheng-yu; Leng, Ping; Wang, Ying-zhen; Wang, Xiang-da; Wang, Chang-yao

2009-01-01

171

Treatment of type IIIA open fractures of tibial shaft with Ilizarov external fixator versus unreamed tibial nailing  

Microsoft Academic Search

Introduction  The aim of this study was to compare the radiographic results and clinical outcome of unreamed tibial nailing (UTN) and Ilizarov\\u000a external fixation (IEF) for the treatment of type IIIA open fractures of the tibia.\\u000a \\u000a \\u000a \\u000a Materials and Methods  Sixty-one patients with open type IIIA tibial shaft fractures were treated with an IEF (n = 32) or UTN (n = 29). Both groups were compared for

Muharrem Inan; Mehmet Halici; Irfan Ayan; Mehmet Tuncel; Sinan Karaoglu

2007-01-01

172

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

PubMed Central

INTRODUCTION Anterior cruciate ligament ruptures are frequent, especially in sports. Surgical reconstruction with autologous grafts is widely employed in the international literature. Controversies remain with respect to technique variations as continuous research for improvement takes place. One of these variations is the anatomical double bundle technique, which is performed instead of the conventional single bundle technique. More recently, there has been a tendency towards positioning the two bundles through double bone tunnels in the femur and tibia (anatomical reconstruction). OBJECTIVES To compare, through biomechanical tests, the practice of anatomical double bundle anterior cruciate ligament reconstruction with a patellar graft to conventional single bundle reconstruction with the same amount of patellar graft in a paired experimental cadaver study. METHODS Nine pairs of male cadaver knees ranging in age from 44 to 63 years were randomized into two groups: group A (single bundle) and group B (anatomical reconstruction). Each knee was biomechanically tested under three conditions: intact anterior cruciate ligament, reconstructed anterior cruciate ligament, and injured anterior cruciate ligament. Maximum anterior dislocation, rigidity, and passive internal tibia rotation were recorded with knees submitted to a 100 N horizontal anterior dislocation force applied to the tibia with the knees at 30, 60 and 90 degrees of flexion. RESULTS There were no differences between the two techniques for any of the measurements by ANOVA tests. CONCLUSION The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation. PMID:18297210

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

2008-01-01

173

Comparison of unreamed nailing and external fixation of tibial diastases––mechanical conditions during healing and biological outcome  

Microsoft Academic Search

Locked intramedullary nailing and external fixation are alternatives for the stabilization of tibial shaft fractures. The goal of this study was to determine to what extent the mechanical conditions at the fracture site influence the healing process after unreamed tibial nailing compared to external fixation. A standardized tibial diastasis was stabilized with either a locked unreamed tibial nail or a

P. Klein; M. Opitz; H. Schell; W. R. Taylor; M. O. Heller; J.-P. Kassi; F. Kandziora; G. N. Duda

2004-01-01

174

Anterior spinal artery syndrome  

Microsoft Academic Search

Three patients with symptoms due to the anterior spinal artery syndrome were treated by direct perfusion of dexamethasone sodium phosphate and urokinase into the artery of Adamkiewicz. Their symptoms were paraparesis with dissociated sensory loss and sphincter dysfunction, and there was no evidence of the possible cause. In the early phase of the disease, three consecutive injections were carried out

H. Baba; K. Tomita; T. Kawagishi; S. Imura

1993-01-01

175

Bone tunnel enlargement on anterior cruciate ligament reconstruction  

PubMed Central

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

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

2014-01-01

176

A Surgical Planning and Guidance System for High Tibial Osteotomies  

Microsoft Academic Search

Objective The objective was to develop a three-dimensional pre- surgical planner and an intraoperative guidance system for high tibial osteotomy. The parameters that describe the placement and orientation of the osteotomy resection planes were to be transmitted to an accompanying guidance system that allowed the surgeon to reproducibly perform the planned procedure. Materials and Methods The planning system and guidance

C. Y. Tso; Randy E. Ellis; J. Rudan; M. M. Harrison

1998-01-01

177

Total knee arthroplasty after high tibial osteotomy. A systematic review  

Microsoft Academic Search

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

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

2009-01-01

178

Compression plating of tibial fractures following primary external fixation  

Microsoft Academic Search

During the time period from May 1990 to December 1992, a total of 75 tibia fractures were treated in the Department of Traumatology at the University of Bonn. Thirtyeight patients with 40 tibial fractures were managed according to a regimen including primary stabilization, usually using external fixation, soft tissue reconstruction and delayed open reduction and internal fixation using an AO

C. H. Siebert; K.-P. Lehrbaß-Sökeland; F. Rinke; M. Hansis

1997-01-01

179

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

PubMed

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

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

2014-07-01

180

Osteomyelitis due to Mycobacterium fortuitum after Open Tibial fracture  

Microsoft Academic Search

We describe a case of osteomyelitis due to Mycobacterium fortuitum after open tibial fracture. Extensive wound debridement, removal of the intramedullary nail and antibiotic therapy consisting of ofloxacin, roxythromycin and trimethoprim\\/sulfamethoxazole cured the infection. Moreover, the literature describing infections by atypical mycobacteria is reviewed, and common clinical characteristics as well as treatment options are displayed. Immunocompromised individuals are particularly threatened

Hans-Dieter Carl; Peter Schaller; Torsten Freiheit

2001-01-01

181

Treatment of Open Tibial Fractures: Converting or Continuing External Fixation?  

Microsoft Academic Search

Background: The treatment of open tibial fractures is still an orthopaedic challenge and full of complications . In many cases the use of external fixator that has been known as a non- union machine is obligatory with a high incidence of pin track infection and other complications. The aim of this study was to compare the use of external fixation

S. Tabatabai; E. Hosseini

2008-01-01

182

Emergency management of type IIIB open tibial fractures  

Microsoft Academic Search

We present our therapeutic strategy for the treatment of type IIIB open tibial fractures. It involves emergency internal stabilisation of the bone by locked intra-medullary nailing when appropriate and skin cover using either a pedicled or free muscle flap. Where there is bone loss, a cancellous iliac graft is performed at the same time. Eighteen cases of type IIIB open

Y. Tropet; P. Garbuio; L. Obert; P. E. Ridoux

1999-01-01

183

EXTERNAL FIXATION AND SECONDARY INTRAMEDULLARY NAILING OF OPEN TIBIAL FRACTURES  

Microsoft Academic Search

We performed a prospective, randomised trial in 39 patients with open tibial fractures treated initially by external fixation to compare cast immobilisation (group A) and intramedullary nailing (group B) as a sequential protocol planned from the onset of treatment. The results showed that group B achieved faster union (p < 0.05) than group A with less malunion or shortening and

PEDRO ANTICH-ADROVER; DAVID MARTI-GARIN; JUAN MURIAS-ALVAREZ; CARLOS PUENTE-ALONSO

184

Treatment results of bicondylar tibial fractures using hybrid external fixator.  

PubMed

Tibial condyle fractures affect knee stability and motion. Treatment of bicondylar type of tibial plateau fracture is a challenging problem. This study aimed at evaluating the application of hybrid external fixators with minimum deformation in these patients and the resulted outcomes. In this descriptive analytical study, 28 patients with bicondylar tibial plateau fractures treated by HEF device were evaluated. The surgeon used a semicircular and one circular wire instead of the one or two loop of conventional HEF device for a better range of motion of the knee joint. Treatment outcomes including quality of walking, union condition, knee range of motion, complications and the final outcome according to the knee score (rusmussen) were checked. Twenty-eight male patients, with the mean age of 40.54 +/- 13.83 years were enrolled in the study. Complications occurred in 8 (28.6%) patients; 7 cases with superficial infection and 1 patient with deep vein thrombosis. All complications were managed medically with no significant consequences left. All the patients were able to walk with no aid except in one case. In 96.4% and 89.3% of the cases, the clinical and radiological outcomes were good to excellent, respectively according to the knee score. In 85.7% of the patients, the knee range of motion was in normal limits. Application of hybrid external fixator using one and half ring instead of one or two fixator rings in treating bicondylar tibial fractures was associated with desired clinical and radiological results. PMID:24498816

Sales, Jafar Ganjpour; Soleymaopour, Jafar; Ansari, Maroof; Afaghi, Farhad; Goldust, Mohamad

2013-05-15

185

CARTILAGE RESORPTION IN THE TIBIAL EPIPHYSEAL PLATE OF GROWING RATS  

Microsoft Academic Search

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

ROBERT K. SCHENK; DAVID SPIRO; JOSEPH WIENER

1967-01-01

186

Schwannoma of the posterior tibial nerve case study.  

PubMed

Background : Schwannomas are rare, slow-growing, benign tumors consisting of Schwann cells. They may cause pressure along a bony structure, resulting in increased pain and discomfort. Less than 1% of schwannomas become malignant, and localization in the foot is uncommon (2%-3% of reported cases). Methods : We present a case of a schwannoma of a branch of the posterior tibial nerve sheath. The goal is to assist in recognition, diagnosis, and treatment of schwannoma in the foot and ankle. This is a case of a 51-year-old male soccer player with a soft-tissue mass along the medial ankle at the tarsal tunnel area with an insidious onset (2 years). Physical examination revealed a 3.0 × 2.5-cm mass; magnetic resonance imaging confirmed location, size, and depth. Results : Surgical resection of the soft-tissue mass was performed under general anesthesia. The mass was found to be superior to the flexor retinaculum and attached by a small nerve branch of the posterior tibial nerve that traveled through the flexor retinaculum. A tissue specimen was sent to the pathology laboratory, and a schwannoma was confirmed histologically. Conclusions : Schwannomas can occur after trauma, especially if the posterior tibial nerve or its branches are affected intrinsically or extrinsically, leading to discomfort, pain, and numbness along the tarsal tunnel. Also, unique to this case, a schwannoma may occur along the small branches of the posterior tibial nerve and present anatomically superior to the flexor retinaculum. PMID:25275747

Judd, Tanya; Jones, Taunna; Thornberry, Lauren

2014-09-01

187

Total knee arthroplasty following medial opening wedge tibial osteotomy  

Microsoft Academic Search

Medial opening wedge high tibial osteotomy is a popular treatment option for medial compartment osteoarthritis of the knee. One of the proposed advantages is easier conversion to a total knee replacement compared to lateral closing wedge osteotomies, although there are few studies to support this. We reviewed the technical considerations in 36 knees in which conversion of a medial opening

Sani Erak; Douglas Naudie; Steven J. MacDonald; Richard W. McCalden; Cecil H. Rorabeck; Robert B. Bourne

2011-01-01

188

Tibial inlay for posterior cruciate ligament reconstruction: a systematic review.  

PubMed

Although no consensus has been reached regarding the management of PCL deficiency, in vitro and in vivo studies have investigated whether the tibial inlay technique restores the anatomical site of insertion of the PCL, prevents elongation, stretching, graft failure, and improves long-term PCL stability. A systematic search using PubMed, Ovid, the Cochrane Reviews, and Google Scholar databases using 'posterior cruciate ligament tear', 'Tibial inlay technique' and 'posterior cruciate ligament reconstruction' as keywords identified 71 publications, of which 10 were relevant to the topic, and included a total of 255 patients. The tibial inlay technique restores the anatomic insertion site of the PCL, eliminates the killer turn effect, and places the graft at lower potential risk for abrasion and subsequent rupture. It has the disadvantages of increased operating time and risk to the posterior neurovascular structures. There was no evidence of an association between outcome results and Coleman methodology score, but the Coleman methodology scores correlated positively with the level-of-evidence rating. The methodological quality of the studies included has not improved over the years. Given the few reported published findings, we cannot ascertain whether this procedure may provide a consistent alternative to commonly used PCL surgical strategies. The lack of published randomized clinical trials and few reported findings did not allow to ascertain whether the tibial inlay for posterior cruciate ligament reconstruction may provide a consistent alternative to commonly used PCL surgical strategies and to demonstrate procedure efficacy. PMID:20226678

Papalia, Rocco; Osti, Leonardo; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

2010-08-01

189

Factors Associated with the Outcome of Open Tibial Fractures  

PubMed Central

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

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

190

Congenital giant male anterior urethral diverticulum with calculi.  

PubMed

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

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

2014-01-01

191

Treating anterior open bite  

Microsoft Academic Search

Data sourceThe Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS (Latin American & Caribbean Health Sciences Literature) , Brazilian Bibliography of Odontology and SciELO. Ten Chinese journals were searched by hand and the bibliographies of papers were retrieved.Study selectionRandomised controlled trials (RCT) or quasi-RCT of orthodontic or orthopaedic treatments or both to correct anterior open bite in children were

Yijin Ren

2007-01-01

192

Anterior interosseous nerve syndrome  

PubMed Central

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

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

2014-01-01

193

The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes  

PubMed Central

Objective To determine the relationship between lower extremity alignment and MTSS amongst non-professional athletes Design In a prospective Study, sixty six subjects were evaluated. Bilateral navicular drop test, Q angle, Achilles angle, tibial angle, intermalleolar and intercondylar distance were measured. In addition, runner's height, body mass, history of previous running injury, running experience was recorded. Runners were followed for 17 weeks to determine occurrence of MTSS. Results The overall injury rate for MTSS was 19.7%. The MTSS injury rate in girls (22%) was not significantly different from the rate in boys (14.3%). Most MTSS injuries were induced after 60 hours of exercise, which did not differ between boys and girls. There was a significant difference in right and left navicular drop (ND) in athletes with MTSS. MTSS had no significant correlation with other variables including Quadriceps, Tibia and Achilles angles, intercondylar and intermaleolar lengths and lower extremity lengths. Limitation All measurements performed in this study were uniplanar and static. The small sample size deemed our main limitation. The accurate assessment of participants with previous history of anterior leg pain for MTSS was another limitation. Conclusion Although a significant relationship between navicular drop and MTSS was found in this study; there was not any significant relationship between lower extremity alignment and MTSS in our sample study. PMID:19519909

Raissi, Golam Reza D; Cherati, Afsaneh D Safar; Mansoori, Kourosh D; Razi, Mohammad D

2009-01-01

194

Evaluating anterior knee pain.  

PubMed

Musculoskeletal complaints account for about 20% to 30% of all primary care office visits; of these visits, discomfort in the knee, shoulder, and back are the most prevalent musculoskeletal symptoms. Having pain or dysfunction in the front part of the knee is a common presentation and reason for a patient to see a health care provider. There are a number of pathophysiological etiologies to anterior knee pain. This article describes some of the common and less common causes, and includes sections on diagnosis and treatment for each condition as well as key points. PMID:24994047

Hong, Engene; Kraft, Michael C

2014-07-01

195

Combined medial meniscal transplantation and high tibial osteotomy  

Microsoft Academic Search

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

Davide Edoardo Bonasia; Annunziato Amendola

2010-01-01

196

Isokinetic Resistance Training Increases Tibial Bending Stiffness in Young Women  

Microsoft Academic Search

Bone mineral content (BMC) and bone mineral density (BMD) are common but imperfect surrogate measures of bone strength. The\\u000a mechanical response tissue analyzer is a device that measures long bone bending stiffness (EI), which strongly predicts bone breaking strength. We hypothesized that isokinetic resistance training of the knee flexor\\u000a and extensor muscles would increase tibial EI, BMC, and BMD in

Larry E. Miller; Sharon M. Nickols-Richardson; David F. Wootten; Warren K. Ramp; Charles R. Steele; John R. Cotton; James P. Carneal; William G. Herbert

2009-01-01

197

Treatment of segmental tibial fractures with supercutaneous plating.  

PubMed

Segmental tibial fractures usually follow a high-energy trauma and are often associated with many complications. The purpose of this report is to describe the authors' results in the treatment of segmental tibial fractures with supercutaneous locking plates used as external fixators. Between January 2009 and March 2012, a total of 20 patients underwent external plating (supercutaneous plating) of the segmental tibial fractures using a less-invasive stabilization system locking plate (Synthes, Paoli, Pennsylvania). Six fractures were closed and 14 were open (6 grade IIIa, 2 grade IIIb, 4 grade II, and 2 grade I, according to the Gustilo classification). When imaging studies confirmed bone union, the plates and screws were removed in the outpatient clinic. Average time of follow-up was 23 months (range, 12-47 months). All fractures achieved union. Median time to union was 19 weeks (range, 12-40 weeks) for the proximal fractures and 22 weeks (range, 12-42 weeks) for the distal fractures. Functional results were excellent in 17 patients and good in 3. Delayed union of the fracture occurred in 2 patients. All patients' radiographs showed normal alignment. No rotational deformities and leg shortening were seen. No incidences of deep infection or implant failures occurred. Minor screw tract infection occurred in 2 patients. A new 1-stage protocol using supercutaneous plating as a definitive fixator for segmental tibial fractures is less invasive, has a lower cost, and has a shorter hospitalization time. Surgeons can achieve good reduction, soft tissue reconstruction, stable fixation, and high union rates using supercutaneous plating. The current patients obtained excellent knee and ankle joint motion and good functional outcomes and had a comfortable clinical course. PMID:25102507

He, Xianfeng; Zhang, Jingwei; Li, Ming; Yu, Yihui; Zhu, Limei

2014-08-01

198

Segmental tibial fractures: an assessment of procedures in 27 cases  

Microsoft Academic Search

Twenty-seven patients (two women) with segmental tibial fractures (19 open) were treated in our institution with a mean age of 38.9 years (range 22–67 years) and a mean Injury Severity Score of 11.5 (9–34). Sixteen fractures were stabilised initially with an interlocking nail, seven with an external fixator, one with a hybrid external fixator, two cases were plated and one

P. V Giannoudis; A. F Hinsche; A Cohen; D. A Macdonald; S. J Matthews; R. M Smith

2003-01-01

199

Unreamed intramedullary locking nailing for open tibial fractures  

Microsoft Academic Search

Summary. We reviewed the results of the treatment of 24 cases of open tibial fractures using unreamed intramedullary locking nailing.\\u000a The fractures were classified, following the Gustilo system as grade I-7, grade II-7 and grade III-10. The average time to\\u000a achieve bony union was 22 weeks with a 26% incidence of pseudoarthrosis. There were no cases of deep infection. Five

A. García-López; F. Marco; L. López-Durán

1998-01-01

200

Open tibial fractures treated with Hoffmann external fixation  

Microsoft Academic Search

Thirty-two open fractures of the tibial shaft were treated with external fixation between 1973 and 1981. Early amputation was necessary in one patient. In the remainder, including 14 with extensive soft-tissue lesions, wound healing was obtained within 18 weeks, and the median time until full weight bearing without pain was 32 weeks (range 8–60 weeks). Two deep infections healed during

A. Nesbakken; A. Alho; A. J. Bjersand; D. K. Jensen; L. Stangeland; A. Walløe

1988-01-01

201

Amputation versus reconstruction in IIIB and IIIC open tibial fractures  

Microsoft Academic Search

Summary  \\u000a In IIIB and IIIC type open tibial fractures (according to Gustilo) the primary decision that has to be made regarding therapy\\u000a is wether or not the limb can be salvaged. To standardize the criteria for amputation different salvage scores have been established\\u000a in recent years. In this study the Hannover Fracture Scale (HFS), the Predictive Salvage Index (PSI), the

A. Seekamp; G. Regel; S. Ruffert; M. Ziegler; H. Tscherne

1998-01-01

202

Type III-B open tibial fractures in Mozambique  

Microsoft Academic Search

Summary. We have studied prospectively 50 cases of open tibial fractures Type-III B. Treatment was based on the principles of debridement,\\u000a wound irrigation, fracture stabilisation (generally by external fixation) and ‘early bone coverage’ without skin sutures.\\u000a The cases were divided into two groups: Group 1: Eight fractures with segmental bone defects treated by bone transport using\\u000a the Ilizarov technique or

J. Carballedo; M. Schmauch; J. Langa; R. C. Miralles

1996-01-01

203

Distraction osteogenesis with conventional external fixator for tibial bone loss  

Microsoft Academic Search

Between 1991 and 2002, we treated 21 patients with tibial bone loss using a conventional external fixator. Nine patients had an infected open fracture and 12 patients an infected nonunion. After corticotomy, the bone was distracted at the rate of 1 mm (1 mm\\/step) on alternate days or every 48 h. The mean follow-up period was 18.7 (6–108) months after fixator removal. The

Chanchit Sangkaew

2004-01-01

204

Multiple Tibial Insufficiency Fractures in the Same Tibia  

PubMed Central

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

Defoort, Saartje; Mertens, Peter

2011-01-01

205

High tibial osteotomy in young adults with constitutional tibia vara  

Microsoft Academic Search

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

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

2011-01-01

206

Open wedge tibial osteotomy by hemicallotasis for medial compartiment osteoarthritis  

Microsoft Academic Search

Early clinical results were evaluated for 22 adult patients who had undergone an open wedge tibial osteotomy by hemicallotasis\\u000a (HCO) due to medial compartment osteoarthritis.The mean age at the time of the index operation was 56 (range 33–66) years.\\u000a The mean duration of follow up was 16 (range 9–23) months. The median hip-knee-ankle angle (HKA) was 169 (range 162–186) deg

H.-M. Klinger; F. Lorenz; T. Härer

2001-01-01

207

Results of high tibial osteotomy: review of the literature  

Microsoft Academic Search

The aim of this review is to evaluate long-term follow-up and survival analysis studies regarding high tibial osteotomies\\u000a (HTO) for the treatment of medial knee arthritis. Despite the good number of studies available, comparison and pooling of\\u000a the results are challenging because of the different evaluation systems and techniques used. However, in general, published\\u000a studies on HTO report good long-term

Annunziato Amendola; Davide Edoardo Bonasia

2010-01-01

208

Chondral Resurfacing and High Tibial Osteotomy in the Varus Knee  

Microsoft Academic Search

Background: Treatment of patients with degenerative knees and varus malalignment presents a difficult clinical problem.Hypothesis: Combining a medial opening wedge high tibial osteotomy with the microfracture chondral resurfacing procedure is a viable treatment option.Study Design: Retrospective review of prospectively collected data.Methods: A group of 38 consecutive patients (mean age, 51.3 years; range, 34 to 72 years; 29 men and 10

William I. Sterett; J. Richard Steadman

2004-01-01

209

The impact of tibial torsion measurements on gait analysis kinematics  

PubMed Central

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

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

2014-01-01

210

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

Microsoft Academic Search

Tibial rotation is an important aspect of knee function and can be altered after total knee arthroplasty (TKA). These alterations\\u000a include decreased internal rotation with knee flexion as compared to the normal state and paradoxical external rotation with\\u000a flexion. Mobile bearing total knee prostheses may allow greater unconstrained tibial rotation. I compared tibial rotation\\u000a after fixed bearing or mobile bearing

James B. Stiehl

2009-01-01

211

Changing the treatment to reduce complication rate in open tibial fractures  

Microsoft Academic Search

Complications of open tibial fractures have been found to be very frequent after application of monotherapies (external fixator,\\u000a plate, intramedullary nailing). The use of combined therapy has improved our results. We treated 658 patients for open tibial\\u000a fractures over a course of 15 years. Plating was the method of treatment in the initial phase, and then external fixators\\u000a and unreamed tibial

István Kádas; Zoltán Magyari; Zsolt Vendégh; Balázs Gloviczki

2009-01-01

212

Open tibial fractures in children under 13 years of age—10 years experience  

Microsoft Academic Search

Objective: To evaluate the results of treatment in children with open tibial fractures.Design: Retrospective review.Subjects: Eighty three children under 13 years of age treated for an open tibial fracture between 1989 and 1999.Main outcome measures: Patient demographics, mechanism of injury, fracture classification, treatment method, clinical outcome and complications.Results: Eighty one percent of children had an open tibial fracture as their

B. G Jones; R. D. D Duncan

2003-01-01

213

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

Microsoft Academic Search

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

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

2011-01-01

214

Midterm Follow-up of Opening-Wedge High Tibial Osteotomy  

Microsoft Academic Search

Background: High tibial osteotomy is a valuable option for patients with varus gonarthrosis. To avoid difficulties with closing-wedge osteotomies, medial opening-wedge high tibial osteotomies have been advocated.Hypothesis: Opening-wedge high tibial osteotomy is a good option in highly active patients with varus gonarthrosis who would like to delay or prevent progression to total knee arthroplasty without activity restrictions.Study Design: Case series;

Patrick J. DeMeo; Eric M. Johnson; Peter P. Chiang; Angela M. Flamm; Mark C. Miller

2010-01-01

215

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

PubMed Central

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

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

2014-01-01

216

Unreamed nailing of tibial fractures — a prospective study of the routine use of the unreamed tibial nail  

Microsoft Academic Search

We prospectively studied 44 patients treated with the AO Unreamed Tibial Nail (UTN) at two orthopaedic trauma units. There\\u000a were 15 open fractures: eight type I, four type II, one type IIIA, and two IIIB (Gustilo). The mean follow-up time was 13\\u000a months (range 6–24 months). There were 14 type A, 26 type B and four type C fractures (AO

P. Harrington; I. Sharif; H. Smyth; G. C. Fenelon; D. Mulcahy; M. Pegum

1996-01-01

217

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

PubMed Central

This prospective study evaluated the effect of tibial tuberosity advancement (TTA) on lameness, thigh circumference, range of motion (ROM), and radiographic osteoarthritis (OA) scores at 6 wk, 6 mo, and 1 y after surgery in 24 client-owned dogs with cranial cruciate ligament (CrCL) deficiency. Complications associated with TTA were also assessed. A significant improvement in lameness score and thigh circumference was observed in CrCL deficient limbs that received TTA, but no significant overall change in range of motion occurred in the affected limbs over the course of the study. Post-operative complications were identified in 33.3% of the dogs. This study demonstrates that TTA results in significant clinical improvement in patients up to 1 y after surgery. However, 21% of the dogs had post-operative recurrent lameness. PMID:23997261

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

2013-01-01

218

Bioengineered anterior cruciate ligament  

NASA Technical Reports Server (NTRS)

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.

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

2001-01-01

219

Minimizing Alteration of Posterior Tibial Slope During Opening Wedge High Tibial Osteotomy: a Protocol with Experimental Validation in Paired Cadaveric Knees  

PubMed Central

Introduction The High Tibial Osteotomy (HTO) is a reliable procedure in addressing uni- compartmental arthritis with associated coronal deformities. With osteotomy of the proximal tibia, there is a risk of altering the tibial slope in the sagittal plane. Surgical techniques continue to evolve with trends towards procedure reproducibility and simplification. We evaluated a modification of the Arthrex iBalance technique in 18 paired cadaveric knees with the goals of maintaining sagittal slope, increasing procedure efficiency, and decreasing use of intraoperative fluoroscopy. Methods Nine paired cadaveric knees (18 legs) underwent iBalance medial opening wedge high tibial osteotomies. In each pair, the right knee underwent an HTO using the modified technique, while all left knees underwent the traditional technique. Independent observers evaluated postoperative factors including tibial slope, placement of hinge pin, and implant placement. Specimens were then dissected to evaluate for any gross muscle, nerve or vessel injury. Results Changes to posterior tibial slope were similar using each technique. The change in slope in traditional iBalance technique was -0.3° ±2.3° and change in tibial slope using the modified iBalance technique was -0.4° ±2.3° (p=0.29). Furthermore, we detected no differences in posterior tibial slope between preoperative and postoperative specimens (p=0.74 traditional, p=0.75 modified). No differences in implant placement were detected between traditional and modified techniques. (p=0.85). No intraoperative iatrogenic complications (i.e. lateral cortex fracture, blood vessel or nerve injury) were observed in either group after gross dissection. Discussion & Conclusions Alterations in posterior tibial slope are associated with HTOs. Both traditional and modified iBalance techniques appear reliable in coronal plane corrections without changing posterior tibial slope. The present modification of the Arthrex iBalance technique may increase the efficiency of the operation and decrease radiation exposure to patients without compromising implant placement or global knee alignment. PMID:25328454

Westermann, Robert W; DeBerardino, Thomas; Amendola, Annunziato

2014-01-01

220

[Anterior sacral meningomyelocele].  

PubMed

Anterior sacral meningomyelocele is the rarest and least known form of congenital myelocele. It is not manifested externally, it is usually not attended with changes in the neurologic status, and may be regarded as a presacral dermoid cyst. The authors observed 5 members of one family with similar clinical and X-ray signs of such herniations, in 2 they were verified. The presence of cystic structures in the cavity of the small pelvis in conjunction with a congenital defect in the bodies of the sacral vertebrae is an indication for conducting pneumomyelography so as to make a more precise diagnosis. A study of the hereditary and family history is a necessary trend in the examination of such patients because the disease may be of a familial character. PMID:919974

Solopaev, A A; Myl'nikov, P I; Gerber, Iu M; Riazantsev, P N

1977-01-01

221

Tibia Rotational Technique to Drill Femoral Bone Tunnel in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction  

PubMed Central

In anatomic anterior cruciate ligament (ACL) reconstruction, several pitfalls in creating the femoral bone tunnels at the correct position are of great concern. Our new method, the tibia rotational (TR) technique, may contribute to resolving these. The purpose of this study is to describe further details about the TR technique in anatomic double-bundle ACL reconstruction. Both anteromedial and posterolateral femoral bone tunnels were drilled through a posterolateral tibial bone tunnel using tibial rotation without deep knee flexion. When it is difficult to reach the mark with the rigid guide pin, the narrow curved TR technique guide and the flexible drill system allow drilling femoral bone tunnels in the correct position. The TR technique offers the technical ease required for widespread acceptance while prioritizing the fundamental goals of an anatomic double-bundle ACL reconstruction.

Mitani, Genya; Takagaki, Tomonori; Hamahashi, Kosuke; Kaneshiro, Nagatoshi; Serigano, Kenji; Maeda, Takashi; Nakamura, Yutaka; Mochida, Joji

2014-01-01

222

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

PubMed Central

AIM: To determine if rabbit models can be used to quantify the mechanical behaviour involved in tibial stress fracture (TSF) development. METHODS: Fresh rabbit tibiae were loaded under compression using a specifically-designed test apparatus. Weights were incrementally added up to a load of 30 kg and the mechanical behaviour of the tibia was analysed using tests for buckling, bone strain and hysteresis. Structural mechanics equations were subsequently employed to verify that the results were within the range of values predicted by theory. A finite element (FE) model was developed using cross-sectional computer tomography (CT) images scanned from one of the rabbit bones, and a static load of 6 kg (1.5 times the rabbit's body weight) was applied to represent running. The model was validated using the experimental strain gauge data, then geometric and elemental convergence tests were performed in order to find the minimum number of cross-sectional scans and elements respectively required for convergence. The analysis was then performed using both the model and the experimental results to investigate the mechanical behaviour of the rabbit tibia under compressive load and to examine crack initiation. RESULTS: The experimental tests showed that under a compressive load of up to 12 kg, the rabbit tibia demonstrates linear behaviour with little hysteresis. Up to 30 kg, the bone does not fail by elastic buckling; however, there are low levels of tensile stress which predominately occur at and adjacent to the anterior border of the tibial midshaft: this suggests that fatigue failure occurs in these regions, since bone under cyclic loading initially fails in tension. The FE model predictions were consistent with both mechanics theory and the strain gauge results. The model was highly sensitive to small changes in the position of the applied load due to the high slenderness ratio of the rabbit’s tibia. The modelling technique used in the current study could have applications in the development of human FE models of bone, where, unlike rabbit tibia, the model would be relatively insensitive to very small changes in load position. However, the rabbit model itself is less beneficial as a tool to understand the mechanical behaviour of TSFs in humans due to the small size of the rabbit bone and the limitations of human-scale CT scanning equipment. CONCLUSION: The current modelling technique could be used to develop human FE models. However, the rabbit model itself has significant limitations in understanding human TSF mechanics. PMID:24147262

Franklyn, Melanie; Field, Bruce

2013-01-01

223

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

PubMed Central

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

2013-01-01

224

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

PubMed

A radiographic model was developed to investigate the influence of three surgical variables on the change in attachment point distance (CAPD) of a hypothetical graft using the unitunnel technique of anterior cruciate ligament (ACL) reconstruction. Using three different femoral target points, we tested the hypothesis that varying the angle of knee flexion between 70 degrees and 110 degrees and varying the tibial starting point over a 4-cm range do not result in a significant variation in CAPD. We also tested the hypothesis that the CAPD from 0 degrees to 135 degrees is greater than the CAPD from 0 degrees to 90 degrees. There was a statistically significant correlation (r = 0.8465, P < 0.0001) between radiographically estimated and isometer-measured values of CAPD. The tibial starting point and the femoral target point were found to affect the CAPD significantly (P < 0.005). A more proximal tibial starting point was associated with a lower CAPD. Both the center of the anatomic femoral attachment of the ACL, and a point 1 mm medial to the junction of the roof and lateral wall of the femoral intercondylar notch and 6 mm anterior to its posterior margin, were associated with lower CAPD values than a target point 5 mm superior and posterior to the center of the femoral ACL attachment. The angle of knee flexion did not significantly affect the CAPD. The CAPD [0 degrees-135 degrees] was significantly greater than the CAPD [0 degree-90 degrees] for all combinations of variables (P < 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8536017

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

1993-01-01

225

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

PubMed Central

Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint. When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15° and 90° of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly—as was expected on the basis of the increased anterior tibial translation—as well as laterally on the surface of the tibial plateau. The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom. PMID:19182035

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

2009-01-01

226

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

SciTech Connect

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.

Hagspiel, Klaus D., E-mail: kdh2n@virginia.edu [University of Virginia, Department of Radiology (United States); Bonatti, Hugo [Vanderbilt University, Department of Surgery (United States); Sabri, Saher [University of Virginia, Department of Radiology (United States); Arslan, Bulent [Moffitt Cancer Center (United States); Harthun, Nancy L. [Johns Hopkins University, Division of Vascular Surgery, Department of Surgery (United States)

2011-04-15

227

Reverse TPLO for asymmetrical -premature closure of the proximal tibial physis in a dog.  

PubMed

A 4 · 5-month-old, 13 · 8 kg, female neutered mixed breed dog was presented for evaluation of acute non-weight bearing right pelvic limb lameness. Radiographs revealed a tibial tuberosity avulsion fracture for which open reduction/internal fixation was performed. Asymmetrical premature closure of the cranial aspect of the proximal tibial physis ensued with a tibial plateau angle of -12°. Abnormal stifle biomechanics resulted in lameness and caudal cruciate ligament fraying. Tibial plateau -levelling osteotomy was performed in standard fashion with the exception that the proximal tibial -fragment was rotated cranioproximally to increase the tibial plateau angle from -12° to +5° (reverse tibial -plateau levelling osteotomy). Normal healing and resolution of lameness followed and the dog remained -clinically healthy 2 years postoperatively. This case report demonstrates that any change in proximal tibial anatomy, whether traumatic, iatrogenic or with therapeutic intent, can cause altered stifle biomechanics and should not be underestimated. Surgical management through corrective -osteotomy can be used to restore adequate function. PMID:24962124

Demianiuk, R M; Guiot, L P

2014-11-01

228

Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo–Anderson classification  

Microsoft Academic Search

The aim of the present study was to comparatively analyse certain outcome measures of open tibial fractures, stratified per grade of open injury and method of treatment. For this purpose, a systematic review of the English literature from 1990 until 2010 was undertaken, comprising 32 eligible articles reporting on 3060 open tibial fractures. Outcome measures included rates of union progress

Costas Papakostidis; Nikolaos K. Kanakaris; Juan Pretel; Omar Faour; Daniel Juan Morell; Peter V. Giannoudis

2011-01-01

229

Staged external and internal less-invasive stabilisation system plating for open proximal tibial fractures  

Microsoft Academic Search

High-energy proximal tibial fractures are complex injuries that may lead to significant complications. Staged treatment of these injuries using a spanning external fixator across the knee joint in the acute setting decreases the incidence of complications. This article is a prospective evaluation of outcomes using a two-stage procedure for treatment of 15 patients who sustained open proximal tibial fractures between

Ching-Hou Ma; Chin-Hsien Wu; Shang-Won Yu; Cheng-Yo Yen; Yuan-Kun Tu

2010-01-01

230

Contact Mechanics of the Medial Tibial Plateau After Implantation of a Medial  

E-print Network

Contact Mechanics of the Medial Tibial Plateau After Implantation of a Medial Meniscal Allograft meniscal allograft restores the normal contact mechanics of the medial tibial plateau at the time as an autograft, and the knee with an allograft. Measure- ments were made using pressure-sensitive film in 10

Hull, Maury

231

Accuracy of frontal and sagittal plane correction in open-wedge high tibial osteotomy  

Microsoft Academic Search

Purpose: This study was performed to determine the accuracy of correction in the frontal plane and to evaluate whether a frontal plane correction influences the sagittal slope of the proximal tibial surface in open-wedge high tibial osteotomy. Type of Study: Retrospective review. Methods: In this study, 30 patients (32 knees) with a mean age of 38 years (range, 20 to

Christoph B Marti; Emanuel Gautier; Stefan W Wachtl; Roland P Jakob

2004-01-01

232

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

Microsoft Academic Search

The patellar tendon length changes and patella infera occurs in medial open wedge osteotomies. We hypothesized that patellar tendon length in the sagittal plane would not change in a proximal medial tibial biplanar retrotubercle open wedge osteotomy. Proximal medial tibial biplanar retrotubercle open wedge osteotomies were conducted on 23 knees of 22 patients; the mean patient age was 59±7years (range,

Irfan Esenkaya; Koray Unay

233

[Arthroscopic reconstruction of the anterior cruciate ligament using double anteromedial and posterolateral bundles].  

PubMed

We propose a method for repairing the anterior cruciate ligament which takes advantage of the multifascular nature of the ligament to achieve better physiological anteroposterior and rotational stability compared with conventional methods. Arthroscopic reconstruction of the anteromedial and posterolateral bundles of the ligament closely reproduces normal anatomy. We have used this technique in 92 patients with anterior cruciate ligament laxity and present here the mid-term results. The hamstring tendons (gracilis and semitendinosus) are harvested carefully to obtain good quality grafts. Arthroscopic preparation of the notch allows careful cleaning of the axial aspect of the lateral condyle; it is crucial to well visualize the region over the top and delimit the 9 h-12 h zone for the right knee or the 12-15 h zone for the left knee. The femoral end of the anteromedial tunnel lies close to the floor of the intercondylar notch, 5 to 10 mm in front of the posterior border of the lateral condyle, at 13 h for the left knee and 11 h for the right knee. The femoral end of the posterolateral tunnel lies more anteriorly, at 14 h for the left knee and 10 h for the right knee. The tibial end of the posterolateral tunnel faces the anterolateral spike of the tibia. The tibial end of the anteromedial tunnel lies in front of the apex of the two tibial spikes half way between the anteromedial spike and the anterolateral spike, 8 mm in front of the protrusion of the posteriolateral pin. The posterolateral graft is run through the femoral and tibial tunnels first. A cortical fixation is used for the femoral end. The femoral end of the anteromedial graft is then fixed in the same way. The tibial fixation begins with the posterolateral graft with the knee close to full extension. The anteromedial graft is fixed with the knee in 90 degrees flexion. Thirty patients were reviewed at least six months after the procedure. Mean age was 28.2 years. Mean overall IKDC score was 86% (36% A and 50% B). Gain in laxity was significant: 6.53 preoperatively and 2.1 postoperatively. Most of the patients (86.6%) were able to resume their former occupation 2 months after the procedure. The different components of the anterior cruciate ligament and their respective functions have been the object of several studies. The anteromedial bundle maintains joint stability during extension and anteroposterior stability during flexion. The posterolateral bundle contributes to the action of the anteromedial bundle with an additional effect due to its position: rotational stability during flexion. In light of the multifascicular nature of the anterior cruciate ligament and the residual rotational laxity observed after conventional repair, our proposed method provides a more anatomic reconstruction which achieves better correction of anteroposterior and rotational stability. This technique should be validated with comparative trials against currently employed methods. PMID:12457115

Franceschi, J P; Sbihi, A; Champsaur, P

2002-11-01

234

Percutaneous plating of distal tibial fractures in children and adolescents.  

PubMed

Fractures of the tibia and fibula are among the most common injuries involving the lower extremities in children and adolescents. Although most can be treated nonoperatively, with satisfactory long-term results, some fractures require surgical stabilization. The increasing experience in adults with minimally invasive plate osteosynthesis for the treatment of complex fractures of the lower extremity has supported the treatment of selected distal tibia fractures in older children and adolescents. This article details the surgical technique for plating of the distal tibia using the percutaneous approach and assesses the results and complications in a pediatric series. We retrospectively reviewed 11 consecutive patients with open physes who had undergone percutaneous plating of a distal tibial fracture between January 2008 and January 2012. All patients were monitored clinically and radiographically until fracture union. Complications related to treatment, such as malunion, delayed union, nonunion, infection, and the need for subsequent surgical treatment, were recorded. Eleven patients (11 tibial fractures) were treated with minimally invasive plate osteosynthesis. The average follow-up period was 22 months (range, 12-48 months). Fractures healed with an average time to union of 9.4 weeks (range, 8-16 weeks). There were no cases of delayed union or nonunion. No clinically evident neurovascular complications were observed. One patient had a superficial infection, treated successfully by oral antibiotics. There were no cases of rotational deformity or leg-length discrepancy at the final follow-up. Because of its biologic advantages and stable fixation that allows early mobilization, percutaneous plating seems a reasonable treatment option for selected distal tibial fractures in children and adolescents. Level of evidence: Level IV therapeutic study - Case series. PMID:24500423

Masquijo, Julio J

2014-05-01

235

Anterior ankle arthrodesis  

PubMed Central

Ankle arthrodesis is a common procedure that resolves many conditions of the foot and ankle; however, complications following this procedure are often reported and vary depending on the fixation technique. Various techniques have been described in the attempt to achieve ankle arthrodesis and there is much debate as to the efficiency of each one. This study aims to evaluate the efficiency of anterior plating in ankle arthrodesis using customised and Synthes TomoFix plates. We present the outcomes of 28 ankle arthrodeses between 2005 and 2012, specifically examining rate of union, patient-reported outcomes scores, and complications. All 28 patients achieved radiographic union at an average of 36 wk; the majority of patients (92.86%) at or before 16 wk, the exceptions being two patients with Charcot joints who were noted to have bony union at a three year review. Patient-reported outcomes scores significantly increased (P < 0.05). Complications included two delayed unions as previously mentioned, infection, and extended postoperative pain. With multiple points for fixation and coaxial screw entry points, the contoured customised plate offers added compression and provides a rigid fixation for arthrodesis stabilization. PMID:24649408

Slater, Gordon L; Sayres, Stephanie C; O’Malley, Martin J

2014-01-01

236

Deep anterior lamellar Keratoplasty  

PubMed Central

Keratoconus is a disease causing increased steepening of the cornea resulted in irregular astigmatism. Treatment options are Glasses, Hard contact lenses, Cross linking, Intracorneal Segments insertion, Refractive surgery (Gilda et al., 2008), or Keratoplasty. Lamellar Keratoplasty (LKP) can be a better choice to manage cases of moderate and some cases of severe Keratoconus without deep scarring and severe thinning, also in cases of corneal scarring not involving the deeper layers of the cornea. LKP is a corneal graft technique consisting of transplantation of partial-thickness donor tissue, devoid of endothelium, Descemet membrane (DM), and rear stroma into a recipient healthy stromal bed after dissection of pathologic anterior stroma. However, deep lamellar Keratoplasty (DLKP) is a surgical method that completely removes pathologic corneal stroma tissue down to the DM, followed by transplantation of donor cornea without endothelium over the host bed. DLKP has a number of advantages over penetrating Keratoplasty (PKP). Because it does not violate the intraocular structures of the eye, it diminishes or eliminates the chance of postoperative glaucoma, cataract formation, retinal detachment, cystoids macular edema, expulsive choroidal hemorrhage and epithelial ingrowths. Furthermore, this procedure avoids the replacement of host endothelium with donor endothelium and thus precludes endothelial graft rejection, with comparable visual outcomes and low rate of chronic endothelial cell loss compared to PKP. PMID:23960861

Al-Kharashi, Soliman A.; Al-Obailan, Majed M.; Almohaimeed, Mansour; Al-Torbak, Abdullah A.

2009-01-01

237

Midterm results of total knee arthroplasty after high tibial osteotomy  

Microsoft Academic Search

Background  The outcome of total knee arthroplasty (TKA) after high tibial osteotomy (HTO) is still controversial. In order to determine\\u000a if osteotomy has any effect on this outcome we performed a medium-term review of a cohort of patients with knee osteoarthritis.\\u000a \\u000a \\u000a \\u000a Materials and methods  Thirty-two patients (38 knees), who were treated with a HTO before the TKA during the last 8 years, were

Konstantinos J. Kazakos; Christos Chatzipapas; Dionysios Verettas; Vasilios Galanis; Konstantinos C. Xarchas; Ioannis Psillakis

2008-01-01

238

CIR sand casting system for trans-tibial socket.  

PubMed

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

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

2003-08-01

239

Tibial stress fractures in an active duty population: long-term outcomes.  

PubMed

Tibial stress fractures are a common overuse injury among military recruits. The purpose of this study was to determine what, if any, long-term effects that tibial stress fractures have on military personnel with respect to physical activity level, completion of military training, recurrence of symptoms, and active duty service. Twenty-six military recruits included in a previous tibial stress fracture study were contacted 10 years after initial injury and asked a series of questions related to any long-term consequences of their tibial stress fracture. Of the 13 patients available for contact, no patients reported any necessary limited duty while on active duty, and no patient reported being separated or discharged from the military as a result of stress fracture. Tibial stress fractures in military recruits are most often an isolated injury and do not affect ability to complete military training or reflect a long-term need for decreased physical activity. PMID:23449055

Kilcoyne, Kelly G; Dickens, Jonathan F; Rue, John-Paul

2013-01-01

240

Anterior Knee Pain (Chondromalacia Patellae).  

ERIC Educational Resources Information Center

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)

Garrick, James G.

1989-01-01

241

Imaging of anterior mediastinal tumours  

PubMed Central

Abstract Anterior mediastinal tumours include primary and secondary tumours. Patients may be asymptomatic or present with symptoms related to local tumour invasion or systemic symptoms due to release of hormones/cytokines or antibodies. The most common symptoms at presentation include chest pain, dyspnoea, cough, fever and chills. Despite rapid developments in imaging techniques, accurate staging of anterior mediastinal tumours remains a diagnostic quandary. Multimodality imaging plays an important role in determining surgical resectability and/or impact on subsequent management. This article briefly discusses the epidemiology and incidence of anterior mediastinal tumours and describes the role of imaging in tumour characterization and staging in detail. We focus on the more commonly encountered anterior mediastinal tumours. PMID:23131900

Ching Ong, Ching

2012-01-01

242

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

PubMed

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

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

2007-01-01

243

Early active extension after anterior cruciate ligament reconstruction does not result in increased laxity of the knee  

Microsoft Academic Search

If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior–posterior knee laxity (A–P

Jonas Isberg; Eva Faxén; Sveinbjörn Brandsson; Bengt I. Eriksson; Johan Kärrholm; Jon Karlsson

2006-01-01

244

Malrotated tibial component increases medial collateral ligament tension in total knee arthroplasty.  

PubMed

Malrotation of the tibial component can lead to complications after total knee arthroplasty (TKA). Despite reports of internal rotation being associated with more severe pain or stiffness than external rotation, the biomechanical reasons remain largely unknown. We used a computer simulation model and evaluated traction forces in the lateral collateral ligament (LCL) and medial collateral ligament (MCL) with a malrotated tibial component during squatting. We also examined tibiofemoral and patellofemoral contact forces and stresses under similar conditions. A dynamic musculoskeletal knee model was simulated in three different constrained tibial geometries with a prototype component. The testing conditions were changed between 15° external and 15° internal rotation of the tibial component. With internal rotation of the tibial component, the MCL force increased progressively; the LCL force also increased, but only up to less than half of the MCL force values. A higher degree of constraint of the tibial component was associated with greater femoral rotational movement and higher MCL forces. The tibiofemoral and patellofemoral contact forces were not influenced by malrotation of the tibial component, but the contact stresses increased because of decreased contact area. This altered loading condition could cause patient complaints and polyethylene problems after TKA. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1658-1666, 2014. PMID:25171755

Kuriyama, Shinichi; Ishikawa, Masahiro; Furu, Moritoshi; Ito, Hiromu; Matsuda, Shuichi

2014-12-01

245

A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy  

PubMed Central

Background Tibial osteotomy is a treatment for younger and/or physically active patients suffering from uni-compartmental knee osteoarthritis. The open wedge osteotomy by the hemicallotasis technique includes the use of external fixation. The use of external fixation has several advantages, as early mobilization and the opportunity for optimal correction. However, the hemicallotasis technique has also been described as a cumbersome procedure for the patient. The aim of this study was to prospectively evaluate patient-relevant outcomes during the first 2 post-operative years. Especially the treatment period, during which external fixation was used, was closely monitored. Methods In an uncontrolled study, fifty-eight consecutive patients, 30 men and 28 women (mean age 54 years) were operated on by the hemicallotasis technique were evaluated with the patient-relevant outcome measure Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively, during the treatment with external fixation, one week after removal of the external fixation, at 6 months, and at one and two years postoperatively. Results At the 2-year postoperative follow-up, all subscales of the KOOS were improved (p < 0.001), mostly in pain (41–80 on a 0–100 worst to best scale) and knee-related quality of life (21–61 on a 0–100 worst to best scale), compared to the preoperative status. Significant improvements in pain and other symptoms, function of daily life and quality of life were seen already during the treatment period (mean 98 ± 18 days) with the external fixation. More demanding functions such as kneeling, squatting, jumping and running, were improved first after extraction of the external fixation device and the pins. Conclusion Tibial osteotomy by the hemicallotasis technique yields large improvement in self-rated pain, function and quality of life, which persists over two years. Surprisingly, large improvements occurred already during the immediate post-operative period when the external fixation was still used. PMID:15811186

W-Dahl, Annette; Toksvig-Larsen, Soren; Roos, Ewa M

2005-01-01

246

Treatment of distal tibial fractures with the Ilizarov external fixator - a prospective observational study in 39 consecutive patients  

PubMed Central

Background The management of displaced distal tibial fractures is still controversial. The different internal fixation techniques are often burdened by relatively high complication rates. Minimally invasive techniques with ring fixators have been introduced as an alternative allowing immediate reduction and stabilization, avoiding a staged protocol. The aim of this prospective study was to analyze the clinical and radiographic outcome the Ilizarov technique in patients with distal metaphyseal tibial fractures, with or without intra-articular involvement. Methods Thirty-nine consecutive patients with isolated fractures treated with the Ilizarov technique were followed prospectively for one year. Depending on the type of fracture, 4 or 5 rings were used, in some cases with additional foot extension. Unrestricted weight-bearing was allowed in all cases. Pre- and post-operatively conventional radiographs, post-operative pain assessment and complications were evaluated. The function was evaluated clinically and with self-appraisal protocols: EQ-5D, NHP and FAOS. Results No patient developed compartment syndrome or deep venous thrombosis. Pin infections were frequent, but they were mostly superficial and were treated with antibiotics and/or the removal of isolated pins. Two patients required debridement. One of them had a deep infection and developed a residual deformity which was corrected and healed after re-operation. Another patient had a severe residual deformity. The fixator was removed after a median period of 16 weeks (range 11–30). The radiological results were poor in 5 patients but the overall self-appraisal showed satisfactory results in 36 patients. Conclusions The Ilizarov method allowed early definitive treatment with a low complication rate and a good clinical outcome. PMID:23327492

2013-01-01

247

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

PubMed

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

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

2011-12-01

248

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

Microsoft Academic Search

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

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

249

Biomechanical analysis of the anterior cervical fusion.  

PubMed

This paper presents a biomechanical analysis of the cervical C5-C6 functional spine unit before and after the anterior cervical discectomy and fusion. The aim of this work is to study the influence of the medical procedure and its instrumentation on range of motion and stress distribution. First, a three-dimensional finite element model of the lower cervical spine is obtained from computed tomography images using a pipeline of image processing, geometric modelling and mesh generation software. Then, a finite element study of parameters' influence on motion and a stress analysis at physiological and different post-operative scenarios were made for the basic movements of the cervical spine. It was confirmed that the results were very sensitive to intervertebral disc properties. The insertion of an anterior cervical plate influenced the stress distribution at the vertebral level as well as in the bone graft. Additionally, stress values in the graft decreased when it is used together with a cage. PMID:21806410

Fernandes, P C; Fernandes, P R; Folgado, J O; Levy Melancia, J

2012-01-01

250

[Results of treatment of tibial spine fracture in children].  

PubMed

In this work there are presented the results of the treatment of 10 patients with avulsion fracture of tibial spine. In this group were 9 boys and 1 girl. The age range was from 9 to 14, and the median age was 11.5. In 6 cases the diagnosed injuries were of I and II degree according to the classification of Meyers and McKeever. These were treated conservatively. In 4 cases the results were very good, in other two there occurred the extension deficiency lower than 5 degrees. 4 patients with the III degree injury underwent operation which constituted in the fracture reposition and stabilization with wire suture. In all cases the clinical results were very good. PMID:15307380

Rokicki, Rafa?; Ga?dzik, Tadeusz Szymon

2004-01-01

251

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

NASA Technical Reports Server (NTRS)

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.

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

1996-01-01

252

Diffuse anterior retinoblastoma: A review?  

PubMed Central

Diffuse anterior retinoblastoma is a rare variant of diffuse infiltrating retinoblastoma which occurs in up to 1–2% of cases of retinoblastoma. In diffuse anterior retinoblastoma there is a small focus of tumor in the peripheral retina from which free tumor cells enter the aqueous humor and implant on the ciliary body, iris, lens and trabecular meshwork. Patients most commonly present with pseudouveitis, pseudohypopyon and increased intraocular pressure. The differential diagnosis is broad and all of the reported cases relied upon aspirates from the aqueous humor in order to make the diagnosis prior to proceeding with treatment. Treatment involves enucleation and, depending upon the extent of the tumor, may require systemic chemotherapy or external beam radiation. This review summarizes the 7 previously reported cases of diffuse anterior retinoblastoma, discusses pathologic features, and addresses the challenges of early diagnosis and future directions. PMID:24227977

Jijelava, Kristen P.; Grossniklaus, Hans E.

2013-01-01

253

Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation  

PubMed Central

Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1 year, the anteroposterior side to side translation difference (KT-1000 manual maximum) showed mean improvement from 5.1 mm ± 1.5 preoperatively to 1.6 mm ± 1.2 (P < 0.001) postoperatively. The Lysholm score too showed statistically significant (P < 0.001) improvement from 52.4 ± 15.2 (range: 32-76) preoperatively to a postoperative score of 89.1 ± 3.2 (range 67-100). According to the IKDC score 90% patients had normal results (Category A and B). The AM femoral tunnel initial posterior blow out was seen in 4 patients and confluence in the intraarticular part of the femoral tunnels was seen in 6 patients intraoperatively. The quadriceps strength on isokinetic testing had an average deficit of 10.3% while the hamstrings had a 5.2% deficit at the end of 1 year as compared with the normal side. Conclusion: Our study revealed that the DBACL reconstruction using crosspin fixation for AM bundle and aperture fixation for PL bundle on the femoral side resulted in significant improvement in KT 1000, Lysholm and IKDC scores. PMID:24600062

Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

2014-01-01

254

3D Analysis of the Alignment of the Lower Extremity in High Tibial Osteotomy  

Microsoft Academic Search

The alignment of the lower extremities after high tibial osteotomy (HTO) varies widely on the radiographs. It is difficult\\u000a to assess the rotation change on the radiographs. We developed computer software to calculate the alignment of the lower extremities\\u000a and to simulate HTO. The purpose of this study is to compare and evaluate the variance in the femoro-tibial angle (FTA)

Hideo Kawakami; Nobuhiko Sugano; Takashi Nagaoka; Keisuke Hagio; Kazuo Yonenobu; Hideki Yoshikawa; Takahiro Ochi; Asaki Hattori; Naoki Suzuki

2002-01-01

255

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

Microsoft Academic Search

Ehlers-Danlos syndrome type IV is a life-threatening genetic connective tissue disorder. We report a 24-year-old woman with\\u000a EDS-IV who presented with metachronous bilateral aneurysms\\/pseudoaneurysms of the posterior tibial arteries 15 months apart.\\u000a Both were treated successfully with transarterial coil embolization from a distal posterior tibial approach.

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

2011-01-01

256

Management of distal tibial intra-articular fractures with circular external fixation  

Microsoft Academic Search

The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular\\u000a surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by\\u000a transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis:\\u000a theoretical and clinical aspects of the regeneration and growth

G. Lovisetti; M. A. Agus; F. Pace; D. Capitani; F. Sala

2009-01-01

257

External fixation as a primary and definitive treatment for tibial diaphyseal fractures  

Microsoft Academic Search

The aim of this study was to evaluate the effectiveness of unilateral external fixator as primary and definitive treatment\\u000a for open tibial fractures, fractures with severe soft tissues injuries, threatened compartment syndrome, and in multiply injured\\u000a patients. Two hundred and twenty-three tibial shaft fractures (212 patients) were treated. In open fractures, union was achieved\\u000a in 25 weeks, while in closed in

Michail Beltsios; Olga Savvidou; John Kovanis; Panagiotis Alexandropoulos; Panagiotis Papagelopoulos

2009-01-01

258

Synchronisation of tibial rotational alignment with femoral component in total knee arthroplasty  

Microsoft Academic Search

The rotational axis of the tibial component in total knee arthroplasty described by Insall is generally accepted, but rotational\\u000a mismatch between the femoral and the tibial components can occur because the alignment of each component is determined separately.\\u000a We developed a connecting instrument to synchronise the axis of the tibia to the axis of the femur. We compared the rotational

Dong-Hoon Lee; Jai-Gon Seo; Young-Wan Moon

2008-01-01

259

Case Reports: Tantalum Debris Dispersion During Revision of a Tibial Component for TKA  

Microsoft Academic Search

Porous tantalum nonmodular tibial components for TKA were introduced in 1999. We revised three well-fixed tantalum tibial\\u000a trays. For removal, we used osteotomes and revision oscillating saw blades. Removal of the components was laborious and resulted\\u000a in generation of abundant tantalum debris that seeded the periarticular soft tissues despite meticulous protection with gauze.\\u000a The retained metallic debris that is visible

Jose Miguel Sanchez Marquez; Nicolas Del Sel; Alejandro Leali; Alejandro González Della Valle

2009-01-01

260

The new “dual osteotomy”: combined open wedge and tibial tuberosity anteriorisation osteotomies  

Microsoft Academic Search

The high frequency with which medial compartment osteoarthritis is associated with patellofemoral osteoarthritis makes the\\u000a addition of tibial tuberosity anteriorisation to high tibial osteotomy an appealing solution, despite the discouraging previously\\u000a reported long-term results when tubercle anteriorisation was combined with a Coventry closed wedge technique. We conducted\\u000a a prospective study of a new osteotomy combination: “the dual osteotomy”. An open

Wael Samir Abdel Megied; Mahmoud A. Mahran; Mootaz F. Thakeb; Amr A. K. H. Abouelela; Yasser Elbatrawy

2010-01-01

261

Tibial shaft malunion treated with reamed intramedullary nailing: a revised technique  

Microsoft Academic Search

Thirty-seven consecutive adult tibial shaft malunions which had not undergone surgical treatment were prospectively treated\\u000a with reamed intramedullary nailing. Indications for this treatment modality included a malunion of a tibial shaft which had\\u000a only been conservatively treated, lesion level fitting for traditional or locked reamed intramedullary nail fixation, less\\u000a than 2 cm shortening, and without evidence of deep infection at

C. C. Wu; W. J. Chen; C. H. Shih

2000-01-01

262

The Effects of Medialization and Anteromedialization of the Tibial Tubercle on Patellofemoral Mechanics and Kinematics  

Microsoft Academic Search

Background: Medialization and anteromedialization of the tibial tubercle are used to correct patellar subluxation in adults.Purpose: To compare the effects of the 2 osteotomies on patellofemoral joint contact pressures and kinematics.Study Design: Controlled laboratory study.Methods: Tibial tubercle osteotomies were performed on 10 cadaveric human knees. The knees were tested between 0° and 90° of flexion while dynamic patellofemoral joint contact

Arun J. Ramappa; Maria Apreleva; Fraser R. Harrold; Peter G. Fitzgibbons; David R. Wilson; Thomas J. Gill

2006-01-01

263

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

PubMed

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

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

2011-03-01

264

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

PubMed Central

Background: No consistent relationship between the severity of symptoms of knee osteoarthritis (OA) and radiographic change has been demonstrated. Objectives: To determine the relationship between symptoms of knee OA and tibial cartilage volume, whether pain predicts loss of cartilage in knee OA, and whether change in cartilage volume over time relates to change in symptoms over the same period. Method: 132 subjects with symptomatic, early (mild to moderate) knee OA were studied. At baseline and 2 years later, participants had MRI scans of their knee and completed questionnaires quantifying symptoms of knee OA (knee-specific WOMAC: pain, stiffness, function) and general physical and mental health (SF-36). Tibial cartilage volume was determined from the MRI images. Results: Complete data were available for 117 (89%) subjects. A weak association was found between tibial cartilage volume and symptoms at baseline. The severity of the symptoms of knee OA at baseline did not predict subsequent tibial cartilage loss. However, weak associations were seen between worsening of symptoms of OA and increased cartilage loss: pain (rs = 0.28, p = 0.002), stiffness (rs = 0.17, p = 0.07), and deterioration in function (rs = 0.21, p = 0.02). Conclusion: Tibial cartilage volume is weakly associated with symptoms in knee OA. There is a weak association between loss of tibial cartilage and worsening of symptoms. This suggests that although cartilage is not a major determinant of symptoms in knee OA, it does relate to symptoms. PMID:14962960

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

2004-01-01

265

What is the optimal alignment of the tibial and femoral components in knee arthroplasty?  

PubMed Central

Background Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral components and their role in outcome and implant survival. Methods We performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence of positioning on survival and functional outcome was considered. Results Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure rates, maltracking, and knee pain. Interpretation Based on currently available evidence, surgeons should aim for optimal alignment of tibial and femoral components when performing TKA. PMID:25036719

Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G; Husted, Henrik; Troelsen, Anders

2014-01-01

266

Increase in posterior tibial slope would result in correction loss in frontal plane after medial open-wedge high tibial osteotomy  

Microsoft Academic Search

Purpose  The purpose of this study was to clarify the causes of the increase in the posterior tibial slope during open-wedge high tibial\\u000a osteotomy (HTO) and to investigate whether its changes influenced the correction angle in frontal plane.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We retrospectively reviewed 20 patients (26 knees) treated with open-wedge HTO. They were divided into the following two groups.\\u000a Group A consisted of

Shigeki Asada; Masao Akagi; Shigeshi Mori; Tetsunao Matsushita; Kazuki Hashimoto; Chiaki Hamanishi

267

Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks.  

PubMed

The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6 months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees. PMID:24837218

Takeda, Kentaro; Hasegawa, Takayuki; Kiriyama, Yoshimori; Matsumoto, Hideo; Otani, Toshiro; Toyama, Yoshiaki; Nagura, Takeo

2014-07-18

268

Endoscopic ACL reconstruction using stryker biosteon cross-pin femoral fixation and interlock cross-pin tibial fixation.  

PubMed

Hamstring tendon autografts have, over the past decade, increasingly become the graft of choice for anterior cruciate ligament (ACL) reconstructions. Studies have shown that multiply stranded hamstring grafts have superior biomechanical characteristics when compared to patellar tendon autografts. Harvests of hamstring tendons have been shown to cause less donor-site morbidity than the harvest of patellar bone-tendon-bone grafts. Historically, however, fixation methods for hamstring grafts have limited their successful use. Fixation for both the tibia and femur distant from the intra-articular portions of the graft decreased the stiffness of the construct. The fixation also contributed to tunnel widening and ganglion formation. New methods have been developed to maximize the mechanical strengths of hamstring grafts and optimize biological factors in healing of the graft to the bone tunnels. Femoral cross-pin fixation provides secure fixation close to the knee joint, while also allowing for placement of the graft in the native ACL footprint at the far posterior aspect of the intercondylar notch. Tibial interference screw fixation allows fixation close to the joint as well. Addition of the interlock pin through the interference screw increases pullout strength significantly. Recent advances in material science have led to the development of bioabsorbable implants that afford high initial fixation strengths while limiting subsequent complications from permanent hardware. PMID:15455332

Berg, Troy L; Paulos, Lonnie E

2004-01-01

269

The Anterior and Midcingulate Cortices  

E-print Network

Pleasant versus unpleasant olfactory stimuli 194 The reward value of food 195 The reward value of water 195 cingulate activity that codes the reward value for food and water. 4 Present links between cognitiveCHAPTER 8 The Anterior and Midcingulate Cortices and Reward Edmund T. Rolls Chapter contents Goals

Rolls, Edmund T.

270

Tuberculum intercondylare tibiae tertium as a predictive factor for anterior cruciate ligament injury.  

PubMed

The aim of this study was to assess the presence of tuberculum intercondylare tibiae tertium, also known as Parsons' knob, and to determine its prominence. Knee radiographs of 171 patients operated on for anterior cruciate ligament injury were examined. The control group included 120 sex- and age-matched patients who underwent orthopaedic examination for knee pain, in whom anterior cruciate ligament injury was ruled out. Knee radiographs revealed the presence of tuberculum intercondylare tibiae tertium in 55 (32.2%) and 16 (13.3%) patients from the study and control groups, respectively. The between-group difference was statistically significant. The authors developed their own method of tuberculum intercondylare tibiae tertium measurement using proportional coefficients based on the length of the tibial plateau to compare the values of the tuberculum intercondylare tibiae tertium. The results showed tuberculum intercondylare tibiae tertium to be not only more common but also more pronounced, especially in height, in the patients with anterior cruciate ligament lesions. PMID:11734481

Pe?ina, M; Bajok, I; Pe?ina, H I

2001-01-01

271

Malrotation in total knee arthroplasty: Effect on tibial cortex strain captured by laser-based strain acquisition  

Microsoft Academic Search

Background. Malrotation of the tibial and femoral components has been recognized to be a clinical complication affecting the per- formance and durability of total knee arthroplasty. This study used a novel strain acquisition technique to determine the effect of tibio-femoral component malrotation on tibial torque and strain distribution of the proximal tibial cortex with a cemented fixed-bearing posterior-stabilized knee. Methods.

Oliver Kessler; Elvis Lacatusu; Mark B. Sommers; Eckard Mayr; Michael Bottlang

2006-01-01

272

Effects of growth hormone in patients with tibial fracture: a randomised, double-blind, placebo-controlled clinical trial  

Microsoft Academic Search

Objective: Investigate whether intervention with GH after tibial fracture enhances fracture healing. Design: Randomised, double-blind, placebo-controlled study in 406 patients (93 women, 313 men, age: 18-64 years) with tibial fracture. Methods: Patients were stratified by tibial fracture (open or closed) and allocated to placebo or GH treatment (15, 30 or 60 mg\\/kg daily, until clinically assessed healing or until 16

Michael Raschke; Michael Højby Rasmussen; Shunmugam Govender; David Segal; Mette Suntum; J. S. Christiansen

2007-01-01

273

Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature  

Microsoft Academic Search

Avulsion fractures of the tibial tubercle are uncommon. Bilateral tibial tubercle avulsion fractures are extremely rare. In\\u000a this article, we describe Watson-Jones type III simultaneous bilateral tibial tubercle avulsion fractures in a 17-year-old\\u000a boy who fell on the ground while taking off in high jump in sport. An open anatomic reduction and internal fixation was performed.\\u000a We report here on

Georgios Georgiou; Alexandra Dimitrakopoulou; Angeliki Siapkara; Konstantinos Kazakos; Stefanos Provelengios; Elefterios Dounis

2007-01-01

274

The Coronal Plane High Tibial Osteotomy. Part 1: A Clinical and Radiographic Analysis of Intermediate Term Outcomes  

Microsoft Academic Search

The coronal plane high tibial osteotomy is a novel technique that is used to treat tibiofemoral malalignment. The authors\\u000a hypothesize that the coronal plane high tibial osteotomy is (1) efficacious in treating both varus and valgus tibiofemoral\\u000a malalignment; (2) does not alter the slope of the proximal tibia; and (3) does not alter the relationship between the patella\\u000a and tibial

Keith M. Baumgarten; Stephen Fealy; Stephen Lyman; Thomas L. Wickiewicz

2007-01-01

275

Les ruptures du tendon du muscle tibial antérieur  

Microsoft Academic Search

In sports medicine, tears of the tibialis anterior are exceptional. We describe our experience with one case. Two types of injury can be observed: true tears involving the main body of the muscle under the pulley or the more distal portion at the insertion and fissurations. These injuries usually occur in a context of longstanding tenosynovitis or tendinopathy and are

M. Raguet

2008-01-01

276

Anatomic Anterior Cruciate Ligament Reconstruction With a Flexible Reamer System and 70? Arthroscope  

PubMed Central

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

Rasmussen, Jeffrey F.; Lavery, Kyle P.; Dhawan, Aman

2013-01-01

277

Fatigue strength of common tibial intramedullary nail distal locking screws  

PubMed Central

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 8–10 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

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

2009-01-01

278

Spinal manipulation and anterior headweighting for the correction of forward head posture and cervical hypolordosis: A pilot study  

Microsoft Academic Search

ObjectiveTo evaluate the effectiveness of Pettibon spinal manipulation and anterior headweighting for correct cervical hypolordosis and forward head posture, quantified by measurements taken from pre and post intervention lateral cervical radiographs.

Mark W Morningstar; Megan N. Strauchman

2003-01-01

279

Mini-open anterior spine surgery for anterior lumbar diseases  

Microsoft Academic Search

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

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

2008-01-01

280

Tibial Compression is Anabolic in the Adult Mouse Skeleton Despite Reduced Responsiveness With Aging  

PubMed Central

The ability of the skeleton to adapt to mechanical stimuli diminishes with age in diaphyseal cortical bone, making bone formation difficult for adults. However, the effect of aging on adaptation in cancellous bone, tissue which is preferentially lost with age, is not well characterized. To develop a model for early post-menopausal women and determine the effect of aging on cancellous bone adaptation in the adult mouse skeleton, in vivo tibial compression was applied to adult (26 wk old) osteopenic female mice using loading parameters, peak applied load and peak diaphyseal strain magnitude, that were previously found to be osteogenic in young, growing (10 wk old) mice. A Load-Matched group received the same peak applied loads (corresponding to +2100 ?? at the medial diaphysis of the tibia) and a Strain-Matched group received the same peak diaphyseal strains (+1200 ??, requiring half the load) as the young mice. The effects of mechanical loading on bone mass and architecture in adult mice were assessed using micro-computed tomography and in vivo structural stiffness measures. Adaptation occurred only in the Load-Matched group in both the metaphyseal and diaphyseal compartments. Cancellous bone mass increased 54% through trabecular thickening, and cortical area increased 41% through medullary contraction and periosteal expansion. Adult mice were able to respond to an anabolic stimulus and recover bone mass to levels seen in growing mice; however, the adaptive response was reduced relative to that in 10 wk old female mice for the same applied load. Using this osteogenic loading protocol, other factors affecting pathological bone loss can be addressed using an adult osteopenic mouse model. PMID:21642027

Lynch, Maureen E.; Main, Russell P.; Xu, Qian; Schmicker, Thomas L.; Schaffler, Mitchell B.; Wright, Timothy M.; van der Meulen, Marjolein C. H.

2011-01-01

281

Posterior tibial nerve stimulation for fecal incontinence: Where are we?  

PubMed Central

Neurostimulation remains the mainstay of treatment for patients with faecal incontinence who fails to respond to available conservative measures. Sacral nerve stimulation (SNS) is the main form of neurostimulation that is in use today. Posterior tibial nerve stimulation (PTNS) - both the percutaneous and the transcutaneous routes - remains a relatively new entry in neurostimulation. Though in its infancy, PTNS holds promise to be an effective, patient friendly, safe and cheap treatment. However, presently PTNS only appears to have a minor role with SNS having the limelight in treating patients with faecal incontinence. This seems to have arisen as the strong, uniform and evidence based data on SNS remains to have been unchallenged yet by the weak, disjointed and unsupported evidence for both percutaneous and transcutaneous PTNS. The use of PTNS is slowly gaining acceptance. However, several questions remain unanswered in the delivery of PTNS. These have raised dilemmas which as long as they remain unsolved can considerably weaken the argument that PTNS could offer a viable alternative to SNS. This paper reviews available information on PTNS and focuses on these dilemmas in the light of existing evidence. PMID:24409042

George, Anil Thomas; Maitra, Rudra Krishna; Maxwell-Armstrong, Charles

2013-01-01

282

Electrodiagnostic Examination of the Tibial Nerve in Clinically Normal Ferrets  

PubMed Central

Tibial nerves of 10 normal domestic ferrets (Mustela putorius furo) were evaluated by means of electrodiagnostic tests: motor nerve conduction studies (MNCSs), supramaximal repetitive nerve stimulation (SRNS), F waves, and cord dorsum potentials (CDPs). Values of conduction velocity, proximal and distal compound muscular action potentials, and amplitudes of MNCS were, respectively, 63.25 ± 7.56?m/sec, 10.79 ± 2.75?mV, and 13.02 ± 3.41?mV. Mean decrements in amplitude and area of compound muscular action potentials of wave 9 with low frequency SRNS were 0.3 ± 3.83% and 0.1 ± 3.51%. The minimum latency of the F waves and the F ratio were, respectively, 8.49 ± 0.65?ms and 1.92 ± 0.17. Onset latency of CDP was 1.99 ± 0.03?ms. These tests may help in diagnosing neuromuscular disorders and in better characterizing the hindlimb paresis reported in many ferrets with systemic illnesses. PMID:20706690

Bianchi, Ezio; Callegari, Daniela; Ravera, Manuela; Dondi, Maurizio

2010-01-01

283

Case Reports: Pediatric PCL Insufficiency from Tibial Insertion Osteochondral Avulsions  

PubMed Central

Posterior cruciate ligament (PCL) insertion-site osteochondral avulsions in children, particularly from the tibia, are not commonly seen by orthopaedic surgeons. Because of the rarity of these injuries, careful attention to the specific physical examination and imaging findings seen with these injuries is necessary so that the proper diagnosis can be made. Osteochondral avulsions of the PCL can be missed on plain radiographs in skeletally immature patients, and therefore magnetic resonance imaging is necessary for proper diagnosis. With this knowledge, clinicians can formulate treatment plans which can return their patients to activities while avoiding potential morbidity resulting from missed diagnoses or improper treatment. We report two rare cases of PCL insufficiency stemming from tibial insertion osteochondral avulsions. Both patients underwent subsequent open reduction and internal fixation of the avulsion using two different fixation methods (bioabsorbable anchors versus cannulated screw and washer) and have returned to full sporting activities. Electronic supplementary material The online version of this article (doi:10.1007/s11999-008-0373-6) contains supplementary material, which is available to authorized users. PMID:18648903

Pandya, Nirav K.; Janik, Luke; Chan, Gilbert

2008-01-01

284

Early migration of tibial components is associated with late revision  

PubMed Central

Purpose We performed two parallel systematic reviews and meta-analyses to determine the association between early migration of tibial components and late aseptic revision. Methods One review comprised early migration data from radiostereometric analysis (RSA) studies, while the other focused on revision rates for aseptic loosening from long-term survival studies. Thresholds for acceptable and unacceptable migration were determined according to that of several national joint registries: < 5% revision at 10 years. Results Following an elaborate literature search, 50 studies (involving 847 total knee prostheses (TKPs)) were included in the RSA review and 56 studies (20,599 TKPs) were included in the survival review. The results showed that for every mm increase in migration there was an 8% increase in revision rate, which remained after correction for age, sex, diagnosis, hospital type, continent, and study quality. Consequently, migration up to 0.5 mm was considered acceptable during the first postoperative year, while migration of 1.6 mm or more was unacceptable. TKPs with migration of between 0.5 and 1.6 mm were considered to be at risk of having revision rates higher than 5% at 10 years. Interpretation There was a clinically relevant association between early migration of TKPs and late revision for loosening. The proposed migration thresholds can be implemented in a phased, evidence-based introduction of new types of knee prostheses, since they allow early detection of high-risk TKPs while exposing only a small number of patients. PMID:23140091

2012-01-01

285

Correction of esthetic and biomechanical outcomes after maxillary anterior single dental implant fracture: a case report.  

PubMed

Rehabilitation of the single anterior tooth in the esthetic region after a dental implant fracture requires management of contributing biomechanical and/or biological etiologic factors. The multidisciplinary treatment of a fractured maxillary anterior single dental implant with a staged, combined surgical and prosthetic approach is discussed. Alleviation of several, but not all, risk factors eliminated the need for replacement of gingiva with pink porcelain and maintained a stable post implant host complex. PMID:24571543

Beier, Ulrike Stephanie; Strobl, Heinrich; Dhima, Matilda

2014-02-01

286

Revision open anterior approaches for spine procedures  

Microsoft Academic Search

Background contextAnterior exposure has become an increasingly popular procedure for the general and vascular surgeon due to the increased use of anterior lumbar interbody fusion and artificial disc replacement for the treatment of many spinal problems.

Andrew A. Gumbs; Scott Hanan; James J. Yue; Rahul V. Shah; Bauer Sumpio

2007-01-01

287

Pediatric anterior cruciate ligament reconstruction  

Microsoft Academic Search

An increasing number of anterior cruciate ligament (ACL) injuries are seen in children now than in the past due to increased\\u000a sports participation. The natural history of ACL deficient knees in active individuals, particularly in children is poor.\\u000a Surgical management of ACL deficiency in children is complex due to the potential risk of injury to the physis and growth\\u000a disturbance.

Mark O. McConkey; Davide Edoardo Bonasia; Annunziato Amendola

2011-01-01

288

Die Arteria falcea anterior des Erwachsenen  

Microsoft Academic Search

The anterior falcate artery (arteria falcea anterior) represents the continuation of the anterior ethmoidal artery. In the adult, it has been described previously only in its rostral portion, which supplies the falx cerebri. In the present study, however, it is shown that there exists a continuation which runs in the parietal dura of the superior sagittal sinus and which unites

F. Müller

1978-01-01

289

Secondary anterior crocodile shagreen of Vogt  

Microsoft Academic Search

The clincopathological features and pathogenesis of secondary mosaic degeneration of the cornea (anterior crocodile shagreen of Vogt) are described. The structural basis for the normal anterior corneal mosaic pattern seems to lie in the particular arrangement of many prominent collagen lamellae of the anterior stroma that thake an oblique course to gain insertion into Bowman's layer. Since, at normal intraocular

R C Tripathi; A J Bron

1975-01-01

290

ANTERIOR KNEE PAIN RELATIONSHIP WITH Q ANGLE  

Microsoft Academic Search

Anterior knee pain one of the most friquent patient group for physician who deal with musculesceletal system. Presence of many reason of anterior knee pain ,leads many diffuculties in evaluation of this pain. Purpose of this study is to evaluate increase in Q angle whom is comman and contribution to anterior knee pain.50 patients with pain and 50 pain free

Atakan ÖZKAN; Devlet Hastanesi

291

Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity  

PubMed Central

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

Kim, Sung-Jae; Kumar, Praveen

2010-01-01

292

Surface damage analysis of retrieved highly crosslinked polyethylene tibial components after short-term implantation.  

PubMed

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

Willie, B M; Foot, L J; Prall, M W; Bloebaum, R D

2008-04-01

293

Economic Evaluation of Reamed versus Unreamed Intramedullary Nailing in Patients with Closed and Open Tibial Fractures: Results from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)  

Microsoft Academic Search

IntroductionRecently, results from the large, randomized study to prospectively evaluate reamed intramedullary nails in patients with tibial fractures (SPRINT) trial suggested a benefit for reamed intramedullary nail insertion in patients with closed tibial shaft fractures largely based on cost-neutral autodynamizations and a potential advantage for unreamed intramedullary nailing in open fractures. We performed an economic evaluation to compare resource use

Matthias Briel; Sheila Sprague; Diane Heels-Ansdell; Gordon Guyatt; Mohit Bhandari; Gordon Blackhouse; David Sanders; Emil Schemitsch; Marc Swiontkowski; Paul Tornetta; Stephen D. Walter; Ron Goeree

2011-01-01

294

Endovascular exclusion coupled with operative anterior leg compartment decompression in a case of postthromboembolectomy tibialis anterior false aneurysm.  

PubMed

The aim of this study was to present a case of iatrogenic thromboembolectomy-related tibialis anterior false aneurysm (FA) treated with endovascular FA exclusion and anterior leg compartment (ALC) operative decompression and to assess the current management options in posttraumatic leg vessel FAs. A 68-year-old man had a painful pulsating mass in the superior ALC 2 months after a thromboembolectomy was performed during popliteal aneurysm repair. He had been discharged under oral anticoagulation and had ALC manual massages for mild post-revascularization leg edema. Angio-CT showed tibialis anterior injury successfully treated with a covered stent graft, while a residual ALC hematoma was surgically evacuated. Endovascular treatment of tibialis anterior FAs using a covered stent graft is an excellent therapeutic option. After an endovascular procedure, caution must be taken to identify the need for early operative ALC decompression. Current leg vessel FA management should consider both the specific anatomic characteristics of the FA and the possibility of development of delayed compartment syndrome. PMID:23706180

De Santis, Francesco; Mani, Gabriele; Martini, Guido; Zipponi, Daniel

2013-10-01

295

Operative Treatment of Tibial Fractures in Children: Are Elastic Stable Intramedullary Nails an Improvement Over External Fixation?  

Microsoft Academic Search

Background: Operative treatment of tibial fractures in children requires implants that do not violate open physes while maintaining tibial length and alignment. Both elastic stable intramedullary nails and external fixation can be utilized. We retrospectively reviewed our experience with these two techniques to determine if one is superior to the other. Methods: We retrospectively reviewed the operative records and trauma

ERIK N. KUBIAK; KENNETH A. EGOL; DAVID SCHER; BRADLEY WASSERMAN; DAVID FELDMAN; KENNETH J. KOVAL

296

Comparison of a New Braid Fixation System to an Interlocking Intramedullary Nail for Tibial Osteotomy Repair in an Ovine Model  

E-print Network

alignment, tibial shaft fractures can be treated by external fixation with a cast, intramedullary (IM) nail) and polymethylmethacrylate bone cement with an interlocking intramedullary (IM) nail fixation in an ovine model. Study DesignComparison of a New Braid Fixation System to an Interlocking Intramedullary Nail for Tibial

Scharer, John E.

297

Delayed and non-union following opening wedge high tibial osteotomy: surgeons’ results from 182 completed cases  

Microsoft Academic Search

Opening wedge high tibial osteotomy (OWHTO) is a recently described procedure for medial compartment arthritis of the knee in the active, younger population. Despite having a number of advantages over the traditional closing wedge high tibial osteotomy (CWHTO) a potential complication of OWHTO is a high rate of delayed- and non-union. This study reports the occurrence of delayed- and non-union

Stuart J. Warden; Hayden G. Morris; Kay M. Crossley; Peter D. Brukner; Kim L. Bennell

2005-01-01

298

Cannulated screw and hexapodal fixator reconstruction for compound upper tibial fractures  

PubMed Central

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

Uzun, Metin; Bilen, Fikri Erkal; Eralp, Levent

2014-01-01

299

Fibular shaft allograft support of posterior joint depression in tibial plateau fractures.  

PubMed

Posterior depression of the lateral articular surface of the tibial plateau can be difficult to elevate and support with morselized bone graft and internal fixation. Progressive collapse after open reduction and internal fixation has been described and can lead to failure in treatment. A standard anterolateral approach to the tibia may not allow direct reduction and stabilization of posterolateral joint depression given the anatomic barriers of the fibular collateral ligament and the proximal tibiofibular articulation. Posterolateral approaches to the tibial plateau have been described and may allow direct reduction of the articular depression. These approaches, however, require dissection close to the common peroneal nerve, and some approaches also require a proximal fibular osteotomy. The use of an intraosseous fibular shaft allograft as an adjunct to open reduction and internal fixation in select cases of depressed posterolateral tibial plateau fractures allows both reduction of the joint and stabilization of the articular segment through a single approach familiar to many orthopaedic surgeons. PMID:24121981

Sassoon, Adam A; Torchia, Michael E; Cross, William W; Cass, Joseph R; Sems, S Andrew

2014-07-01

300

Fracture of Two Moderately Cross-Linked Polyethylene Tibial Inserts in a TKR Patient  

PubMed Central

Highly cross-linked polyethylene has become the gold standard in total hip replacement for its wear resistance. Moderately crosslinked polyethylene is now available for total knee replacement (TKR), although concerns about reduced mechanical strength have prevented widespread adoption. The purpose of this report is to describe an unusual case where a patient underwent cruciate retaining TKR using a moderately crosslinked polyethylene tibial insert that went on to fracture twice in the same location across the primary and first revision surgery. The first tibial insert was 10?mm thick and was implanted for 16 months. The second tibial insert was 15?mm thick and was implanted for 11 months. Both fractured along the posterior aspect of the medial articular surface. The lack of a specific event leading to these fractures and the fact that they occurred twice in the same location in the same patient suggest that caution is still necessary regarding the introduction of crosslinked polyethylene for TKR surgery. PMID:24511401

Teeter, Matthew G.; McAuley, James P.; Naudie, Douglas D.

2014-01-01

301

Anterior Segmental Distraction Osteogenesis in the Hypoplastic Cleft Maxilla  

PubMed Central

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

Rao (Janardhan), Sruthi; Kotrashetti, S. M.; Lingaraj, J. B.; Pinto, P. X.; Keluskar, K. M.; Jain, Siddharth; Sone, Piyush; Rao, Santhosh

2013-01-01

302

Simultaneous bilateral tibial tubercle avulsion fracture in an adolescent: a case report and review of the literature.  

PubMed

Avulsion fractures of the tibial tubercle are uncommon. Bilateral tibial tubercle avulsion fractures are extremely rare. In this article, we describe Watson-Jones type III simultaneous bilateral tibial tubercle avulsion fractures in a 17-year-old boy who fell on the ground while taking off in high jump in sport. An open anatomic reduction and internal fixation was performed. We report here on the successful surgical treatment of a simultaneous bilateral fracture of the tibial tuberosity in an adolescent. These types of fractures involve a growth plate, extend through the articular surface and appear to do well with open reduction and secure internal fixation despite their bilateral nature, with recovery and functional outcome comparable to results from unilateral tibial tubercle avulsion fractures. PMID:16917786

Georgiou, Georgios; Dimitrakopoulou, Alexandra; Siapkara, Angeliki; Kazakos, Konstantinos; Provelengios, Stefanos; Dounis, Elefterios

2007-02-01

303

How the fixation method stiffness and initial tension affect anterior load-displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft.  

PubMed

There were two objectives to this study. The first was to investigate the relationship of graft fixation stiffness and graft initial tension on the anterior load-displacement behavior of knees reconstructed with a double-loop hamstrings tendon graft. The second was to determine the corresponding graft tensions at 225 N of anterior force applied to the knee. To satisfy these objectives, the anterior-load displacement curves were measured for seven cadaveric knees with the ACL intact at flexion angles ranging from 0 degrees to 90 degrees. The ACL was reconstructed in the same knees using a double-loop hamstrings graft. A/P load-displacement curves of the knee and graft tension were measured as the fixation method stiffness and the initial tension applied at full extension were varied (25-326 N/mm and 25-300 N). The 0 N posterior limit (unloaded position of tibia) and the anterior laxity (difference between the 0 N posterior limit and 225 N anterior limit) were computed to characterize the A/P load-displacement of the intact and reconstructed knees. The key results were that the 0 N posterior limit of the tibia was insensitive to changes in stiffness (p>0.6503) but that increasing initial tension caused increasing posterior subluxation of the tibia with respect to the femur (p=0.0001). The tibia was subluxed posteriorly by 5-6 mm on average at high levels of initial tension. Both initial tension and stiffness significantly affected the anterior laxity (p=0.0001 for both factors). Anterior laxity was restored closely to normal (i.e. <1 mm difference) by relatively high initial tension of 200 N in combination with low stiffness of 25 N/mm and by low initial tension of 25 N in combination with higher stiffness ranging between 94 and 326 N/mm. When anterior laxity is restored to normal using a high initial tension-low stiffness combination however, the tibia undergoes a large posterior subluxation with respect to the femur in the unloaded state (approximately 5 mm) and a relatively high graft tension of 275 N is developed at 225 N of anterior force. Both the tibial subluxation and graft tension are reduced substantially with low initial tension-higher stiffness combinations because the amount of initial tension required to restore anterior laxity to normal is reduced by about 200 N. PMID:15099643

Eagar, Paul; Hull, M L; Howell, S M

2004-05-01

304

Predictors of dimercaptosuccinic acid chelatable lead and tibial lead in former organolead manufacturing workers  

PubMed Central

OBJECTIVES: To identify predictors of tibial and dimercaptosuccinic acid (DMSA) chelatable lead in 543 organolead manufacturing workers with past exposure to organic and inorganic lead. METHODS: In this cross sectional study, tibial lead (by 109Cd K-shell x ray fluorescence), DMSA chelatable lead (4 hour urinary lead excretion after oral administration of 10 mg/kg), and several exposure measures were obtained on study participants, mean (SD) age 57.6 (7.6) years. RESULTS: Tibial lead concentrations ranged from -1.6 to 52.0 micrograms lead/g bone mineral, with a mean (SD) of 14.4 (9.3) micrograms/g. DMSA chelatable lead ranged from 1.2 to 136 micrograms, with a mean (SD) of 19.3 (17.2) micrograms. In a multiple linear regression model of tibial lead, age (p < 0.01), duration of exposure (p < 0.01), current (p < 0.01) and past (p = 0.05) cigarette smoking, and diabetes (p = 0.01) were all independent positive predictors, whereas height (p = 0.03), and exercise inducing sweating (p = 0.04) were both negative predictors. The final regression model accounted for 31% of the variance in tibial lead concentrations; 27% was explained by age and duration of exposure alone. DMSA chelatable lead was directly associated with tibial lead (p = 0.01), cumulative exposure to inorganic lead (y.microgram/m3, p = 0.01), current smoking (p < 0.01), and weight (p < 0.01), and negatively associated with diabetes (p = 0.02). The final model accounted for 11% of the variance in chelatable lead. When blood lead was added to this model of DMSA chelatable lead, tibial lead, cumulative exposure to inorganic lead, and diabetes were no longer significant; blood lead accounted for the largest proportion of variance (p < 0.001); and the total model r2 increased to 19%. CONCLUSIONS: The low proportions of variance explained in models of both tibial and chelatable lead suggest that other factors are involved in the deposition of lead in bone and soft tissue. In epidemiological studies of the health effects of lead, evaluation of associations with both these measures may allow inferences to be made about whether health effects are likely to be recent, and thus potentially reversible, or chronic, and thus possibly irreversible. The data also provide direct evidence that in men the total amount of lead in the body that is bioavailable declines with age.   PMID:10341742

Schwartz, B. S.; Stewart, W. F.; Todd, A. C.; Links, J. M.

1999-01-01

305

Posterior tibial artery aneurysm: a case report with review of literature  

PubMed Central

Background Aneurysms infra-patellar region are uncommon. Of them, true aneurysms are very rare and that of posterior tibial artery are extremely rare. The more common, pseudoaneurysms are commonly associated with trauma whereas the true ones are linked with either inflammatory or mycotic origins. Case Presentation We reported another case of true aneurysm of posterior tibial artery without any evident aetiology. This was repaired with resection of aneurysm followed by interposition vein graft. Conclusion Through this report, we discussed the rarity, review of literature and management of this unusual condition. PMID:24934412

2014-01-01

306

Unilateral tibial agenesia with preaxial polysyndactyly and renal disorder in two patients: a new syndrome?  

PubMed

Left tibial agenesis, polysyndactyly with talipes equinovarus deformity and Grade IV vesicoureteral reflux of the right kidney are described in a 40-day-old male and an unrelated 1-month-old male, is also reported with right tibial agenesis, polysyndactyly with talipes equinovarus deformity and right kidney agenesis and left Grade V vesicoureteral reflux. No other pathology was recorded. Follow up at 1 year and 3 years, respectively, revealed normal motor and mental development. As this combination has been unpublished before, we believe that this a new syndrome. PMID:11152146

Tüysüz, B; Beker, B D; Centel, T; Ungür, S; Iter, O

2001-01-01

307

Operative Treatment and Soft Tissue Management of Open Distal Tibial Fractures – Pitfalls and Results  

Microsoft Academic Search

\\u000a Abstract\\u000a   Open tibial fractures usually result from high-energy trauma. Severe soft-tissue injuries are often combined with open fractures\\u000a of the distal tibia. A consecutive series of 42 patients with open extraarticular distal tibial fractures (Gustilo I–IIIc)\\u000a operated on between July 2006 and February 2009 were included in the study reported here. We performed open reduction and\\u000a internal fixation for the

Maximilian Faschingbauer; Jan Meiners; Arndt Peter Schulz; Klaus-Dieter Rudolf; Benjamin Kienast

2009-01-01

308

Bony and soft tissue landmarks of the ACL tibial insertion site: an anatomical study  

Microsoft Academic Search

Purpose  To identify and describe reliable landmarks for tibial tunnel placement in anatomical ACL reconstruction.\\u000a \\u000a \\u000a \\u000a Methods  Eight non-paired cadaveric knees were used. After dissection, the tibial plateaus, menisci and ACL insertions were grossly\\u000a observed to identify anatomical landmarks and relate them to the ACL insertion site. The specimens were scanned with a laser\\u000a scanner, and 3-Dimensional images were obtained. Measurements of the

Mario Ferretti; Daniel Doca; Sheila M. Ingham; Moises Cohen; Freddie H. Fu

309

Modified biplanar open-wedge high tibial osteotomy with rigid locking plate to treat varus knee  

Microsoft Academic Search

Objective  To introduce and characterize the modified biplanar opening high tibial osteotomy with rigid fixation to treat varus knee\\u000a in young and active patients.\\u000a \\u000a \\u000a \\u000a Methods  Between June 2001 to July 2008, 18 patients with monocompartmental degeneration of the knee combined with a varus malalignment\\u000a of the leg had the modified biplanar opening high tibial osteotomy and the osteotomy was fixed with the

Hai-ning Zhang; Jie Zhang; Cheng-yu Lv; Ping Leng; Ying-zhen Wang; Xiang-da Wang; Chang-yao Wang

2009-01-01

310

ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy  

Microsoft Academic Search

High tibial osteotomy (HTO) is an accepted surgical technique for the treatment of medial compartmental arthrosis of the knee\\u000a in younger patients. Compared to total knee arthroplasty, HTO may be a good choice in patients who wish to continue with heavy\\u000a labor and\\/or impact sports. Based on the rehabilitation protocol after HTO, impact sports, such as running, jumping rope,\\u000a and

Kwang Am Jung; Su Chan Lee; Seung Hyun Hwang; Moon Bok Song

2009-01-01

311

Effect of opening-wedge high tibial osteotomy on the three-dimensional kinematics of the knee.  

PubMed

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

d'Entremont, A G; McCormack, R G; Horlick, S G D; Stone, T B; Manzary, M M; Wilson, D R

2014-09-01

312

[Minitracheotomy in treating upper airway obstruction after anterior cervical fusion].  

PubMed

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

Arimune, Mutsuaki; Sanjou, Hiroyasu; Yamada, Tokuhiro; Yabe, Mitsuhide; Miyake, Hitoshi

2004-10-01

313

Anterior cruciate: methods of physical examination.  

PubMed

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. PMID:21286055

Grant, J; Kirby, R L

1982-02-01

314

Nasal endoscopic and anterior craniotomy resection for esthesioneuroblastoma: how we did it.  

PubMed

The objective of this study was to report and present an approach to combine functional and esthetic technique of endoscopic nasal tumor resection with anterior cranial fossa extension resection in a case of Esthesioneuroblastoma (ENB), a rare slow growing malignant neoplasm of the olfactory mucosa. For this purpose, the mass was excised by nasal endoscopic approach with microdebrider and anterior craniotomy with bi-coronal incision. The cribriform plate defect was reconstructed with temporalis fascia and nasal defect with fascia and rotated middle turbinate. Radiotherapy was given. At 4 years follow up no evidence of tumor locally or systemic metastasis were seen. In conclusion endoscopic excision complimented with anterior craniotomy for the anterior cranial fossa extension of resectable ENB with post-op radiotherapy is an effective treatment modality satisfying both oncosurgical as well as esthetic requirements. PMID:24533412

Sham, Somani; Chetana, Naik

2014-01-01

315

Neuroanatomy of the complex tibial organ of Stenopelmatus (Orthoptera: Ensifera: Stenopelmatidae).  

PubMed

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

Strauss, Johannes; Lakes-Harlan, Reinhard

2008-11-01

316

Bilateral distal tibial stress fractures in a healthy field-hockey goalkeeper.  

PubMed

Stress fractures occurring within the lower limbs are relatively common in athletes and military personnel. The specific bones affected are often predictable when the patient's activities are considered. We present an unusual case of bilateral distal tibial stress fractures sustained while playing as a goalkeeper in field hockey, in an otherwise healthy 46-year-old woman. PMID:25188931

O'Neill, Barry James; Ryan, Katie; Burke, Neil G; Moroney, Paul John

2014-01-01

317

External Pin Fixation with Early Flap Coverage for Open Tibial Fractures with Soft Tissue Loss  

Microsoft Academic Search

Meaningful data on the management of open tibial fractures cannot be obtained unless one categorizes the injury according to fracture type, degree of soft tissue loss and the velocity of the injury. Treatment by converting the type III injury to a type II injury with well vascularized soft tissue is presented. Eighteen patient with 20 type III and type III(a)

ANOWARUL ISLAM; SHAH MOHAMMAD AMANULLAH

2010-01-01

318

The injured foot: cutaneous coverage with a distally based posterior tibial cross leg flap  

Microsoft Academic Search

Treatment of extensive soft tissue defects of the foot has long been a challenging problem for the reconstructive surgeon. We report a series of 5 injured feet with major soft tissue loss and significant bony injury, treated with distally based cross leg flaps based on the posterior tibial artery, with satisfactory cosmetic and functional results. The survival of the flap

F. Giraldo; M. D. Garci´a; J. de Grado; C. GonzA´lez; J. A. Rus

1996-01-01

319

Delayed presentation is no barrier to satisfactory outcome in the management of open tibial fractures  

Microsoft Academic Search

The management of open tibial fractures is a challenge to all orthopaedic trauma surgeons. The major goals are fracture union, uncomplicated soft tissue healing and return to pre-injury level of function. The geographical isolation and vastness of the Northern Territory of Australia complicates the management of these injuries by adding a significant delay to treatment. Forty-five patients sustained 48 open

Robert U Ashford; Janak A Mehta; Robin Cripps

2004-01-01

320

Open tibial fractures: faster union after unreamed nailing than external fixation  

Microsoft Academic Search

Unreamed intramedullary nailing is an alternative to external fixation in the treatment of open tibial fractures. We compared a prospective series of thirty-one patients managed with a solid nail with static interlocking without intramedullary reaming, with a retrospective series of thirty-one patients managed by external fixation. The protocol for soft tissue treatment was the same throughout the study period. Most

Karl Akke Alberts; Georg Loohagen; Hildur Einarsdottir

1999-01-01

321

Intraoperative control of axes, rotation and length in femoral and tibial fractures technical note  

Microsoft Academic Search

In an effort to limit the amount of soft tissue dissection at the fracture site, indirect reduction and minimally invasive fixation techniques have been developed to treat femoral and tibial fractures. These techniques, which do not rely upon anatomical reduction of the fracture fragments are technically difficult. Correct limb length, axial alignment in the frontal and sagittal plane, and rotation

Ch. Krettek; T. Miclau; P. Schandelmaier; H. Tscherne

1998-01-01

322

Age changes in the tibial and plantar nerves of the rat.  

PubMed Central

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

Sharma, A K; Bajada, S; Thomas, P K

1980-01-01

323

Author's personal copy The effect of excessive tibial torsion on the capacity of muscles  

E-print Network

about the long axis of the tibia, is common in patients with cerebral palsy who walk with a crouch gait: Crouch gait; Tibial torsion; Cerebral palsy; Dynamics; Induced acceleration 1. Introduction Many children with cerebral palsy walk with excessive flexion of their hips and knees, a movement pattern known as crouch gait

Delp, Scott

324

The influence of mediolateral deformity, tibial torsion, and foot position on femorotibial load  

Microsoft Academic Search

The influence of mediolateral deformity, tibial torsion, and different centers of foot support was studied with a three-dimensional computer model that incorporates the significant muscles of the lower extremities needed for quasi-static walking. This theoretical method avoids the variability in gait pattern from the pain and discomfort associated with deformity in patients. The study illustrates the possible importance of the

U. Lindgren; A. Seireg

1989-01-01

325

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

...one or more planes. It has no linkage across-the-joint. This prosthesis is made of alloys, such as cobalt-chromium-molybdenum, and is intended to resurface one tibial condyle. The generic type of device is limited to those prostheses intended...

2014-04-01

326

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

Code of Federal Regulations, 2013 CFR

...one or more planes. It has no linkage across-the-joint. This prosthesis is made of alloys, such as cobalt-chromium-molybdenum, and is intended to resurface one tibial condyle. The generic type of device is limited to those prostheses intended...

2013-04-01

327

Isolated femoropopliteal bypass graft for limb salvage after failed tibial reconstruction: A viable alternative to amputation  

Microsoft Academic Search

Purpose: Femoropopliteal bypass grafting procedures performed to isolated popliteal arteries after failure of a previous tibial reconstruction were studied. The results were compared with those of a study of primary isolated femoropopliteal bypass grafts (IFPBs). Methods: IFPBs were only constructed if the uninvolved or patent popliteal segment measured at least 7 cm in length and had at least one major

Russell H. Samson; D. P. Showalter; J. P. Yunis

1999-01-01

328

Surgical treatment of depression fractures of the lateral tibial plateau using porous titanium granules  

PubMed Central

The clinical and radiological results were excellent in this pilot study of four cases of depression fracture of the lateral tibial plateau, where, in addition to internal fixation with screws or a buttress plate, porous titanium granules were used to support the elevated articular surface. PMID:19242873

Mjoberg, Bengt

2009-01-01

329

Chondral Resurfacing and High Tibial Osteotomy in the Varus KneeSurvivorship Analysis  

Microsoft Academic Search

Background: Active patients with arthritic malalignment of the knee are difficult to manage. Arthroplasty, unicompartmental or total knee replacement, may not be appropriate in patients who desire to remain highly active. High tibial osteotomy has been recommended for the treatment of varus osteoarthritis to decrease pressure on the damaged medial compartment.Purpose: To determine the length of time patients with varus

William I. Sterett; J. Richard Steadman; Michael J. Huang; Lauren M. Matheny; Karen K. Briggs

2010-01-01

330

Open wedge tibial osteotomy with acrylic bone cement as bone substitute  

Microsoft Academic Search

We studied the results of 245 valgus producing high tibial osteotomies performed with the use of an opening wedge technique and rigid internal fixation followed by early passive and active motion of the knee. Previous studies have used iliac bone grafts or hemicollastasis held by an external fixator for opening the osteotomy. In our series the opening was obtained by

P Hernigou; W Ma

2001-01-01

331

Evaluation of patellar height and measurement methods after valgus high tibial osteotomy  

Microsoft Academic Search

Several controversies exist regarding the surgical difficulties and the results of total knee arthroplasty performed after failed valgus high tibial osteotomy (HTO), and the main subject is the change in patellar height that results as patella baja or infera. The purpose of this retrospective study was to evaluate patellar height after valgus HTO and the measurement methods that were actually

Hayrettin Kesmezacar; Rifat Erginer; Tahir Ogut; Aksel Seyahi; Muharrem Babacan; Yuksel Tenekecioglu

2005-01-01

332

Mechanism of bone incorporation of ?-TCP bone substitute in open wedge tibial osteotomy in patients  

Microsoft Academic Search

A histological study was performed of bone biopsies from 16 patients (17 biopsies) treated with open wedge high tibial osteotomies for medial knee osteoarthritis. The open wedge osteotomies were filled with a wedge of osteoconductive beta tricalcium phosphate (?-TCP) ceramic bone replacement. At the time of removal of the fixation material, core biopsies of the area where the ?-TCP was

Robert D. A. Gaasbeek; Hanneke G. Toonen; Ronald J. van Heerwaarden; Pieter Buma

2005-01-01

333

High tibial osteotomy with Puddu plate for the treatment of varus gonarthrosis  

Microsoft Academic Search

In this study, the results of open-wedge osteotomy with Puddu plate for the treatment of varus gonarthrosis have been evaluated prospectively. This study assessed 65 knees of 60 patients with varus gonarthrosis who underwent high tibial osteotomies. Our study population consisted of 13 male and 47 female patients with a mean age of 54 (range 39–76) years. For the clinical

Mehmet Asik; Cengiz Sen; Bulent Kilic; S. Bora Goksan; Feyyaz Ciftci; Omer F. Taser

2006-01-01

334

Opening Wedge High Tibial Osteotomy for Symptomatic Hyperextension-Varus Thrust  

Microsoft Academic Search

Background: The purpose of this study was to assess the functional outcome of opening wedge high tibial osteotomy (HTO) in a young, active group of patients with instability rather than osteoarthritis.Methods: The results of 17 opening wedge HTOs in 16 patients with a symptomatic hyperextension-varus thrust were evaluated. Functional results were evaluated according to the activity scoring system of Tegner

Douglas D. R. Naudie; Annunziato Amendola; Peter J. Fowler

2004-01-01

335

Articular Cartilage Contact Pressure after Tibial Tuberosity TransferA Cadaveric Study  

Microsoft Academic Search

Medial transfer of the tibial tuberosity has been commonly used for treatment of recurrent dislocation of the patella and patellofemoral malalignment. In this study, six fresh human cadaveric knees were used. Static intrajoint loads were recorded using Fuji Prescale pressure-sensitive film for contact pressure and contact area determination in a closed kinetic chain knee testing protocol. Peak pressures, average contact

Ryosuke Kuroda; Helen Kambic; Antonio Valdevit; Jack T. Andrish

2001-01-01

336

The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes  

Microsoft Academic Search

OBJECTIVE: To determine the relationship between lower extremity alignment and MTSS amongst non-professional athletes DESIGN: In a prospective Study, sixty six subjects were evaluated. Bilateral navicular drop test, Q angle, Achilles angle, tibial angle, intermalleolar and intercondylar distance were measured. In addition, runner's height, body mass, history of previous running injury, running experience was recorded. Runners were followed for 17

Golam Reza D Raissi; Afsaneh D Safar Cherati; Kourosh D Mansoori; Mohammad D Razi

2009-01-01

337

A simple modified arthroscopic procedure for fixation of displaced tibial eminence fractures  

Microsoft Academic Search

Avulsion fractures of the tibial eminence have been well described in children and adults with an increased in incidence resulting from road traffic and athletic accidents. According to the literature, only surgical treatment is advocated because of the high incidence of the nonunion and instability following conservative treatment. Open reduction can cause some morbidity and, therefore, arthroscopic techniques have been

Leonardo Osti; Franco Merlo; Stephen H. Liu; Luigi Bocchi

2000-01-01

338

Neuroanatomy of the complex tibial organ in the splay-footed cricket Comicus calcaris Irish 1986 (Orthoptera: Ensifera: Schizodactylidae).  

PubMed

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 34±4 neurons, the highest number in an atympanate Ensiferan. Additionally, an accessory chordotonal organ with 15±5 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

Strauss, Johannes; Lakes-Harlan, Reinhard

2010-11-15

339

Changes in microarchitectural characteristics at the tibial epiphysis induced by collagen-induced rheumatoid arthritis over time  

PubMed Central

Background Little is known about the time course of changes in the microarchitecture of the tibial epiphysis with rheumatoid arthritis (RA), although such information would be valuable in predicting risk of fracture. Therefore, we used in vivo microcomputed tomography (?-CT) to assess patterns of microarchitectural alterations in the tibial epiphysis using collagen-induced RA in an animal model. Methods Bovine type II collagen was injected intradermally into the tails of rats for induction of RA. The tibial joints were scanned by in vivo ?-CT at 0, 4, and 8 weeks following injection. Microarchitectural parameters were measured to evaluate alteration patterns of bone microarchitecture at the tibial epiphysis. Results The microarchitectural alterations in an RA group were significantly different from those in a control group from 0 to 4 weeks and from 4 to 8 weeks following injection (P < 0.05). The distribution of trabecular bone thickness and trabecular bone separation from 0 weeks to 8 weeks differed significantly (P < 0.05). Conclusion These results indicate that the patterns of microarchitectural alterations at the tibial epiphysis are strongly affected by collagen-induced progression of RA and entail a severe risk of fracture at the tibial epiphysis. This study represents a valuable first approach to tracking periodic and continuous changes in the microarchitectural characteristics of the tibial epiphysis with collagen-induced RA. PMID:23049249

Lee, Joo Hyung; Chun, Keyoung Jin; Kim, Han Sung; Kim, Sang Ho; Lee, Kwon-Yong; Kim, Dae Jun; Lim, Dohyung

2012-01-01

340

Development and Validation of an Instrument to Predict Functional Recovery in Tibial Fracture Patients: The Somatic Pre-Occupation and Coping (SPOC) Questionnaire  

PubMed Central

Objective To explore the role of patients’ beliefs in their likelihood of recovery from severe physical trauma. Methods We developed and validated an instrument designed to capture the impact of patients’ beliefs on functional recovery from injury; the Somatic Pre-occupation and Coping (SPOC) questionnaire. At 6-weeks post-surgical fixation, we administered the SPOC questionnaire to 359 consecutive patients with operatively managed tibial shaft fractures. We constructed multivariable regression models to explore the association between SPOC scores and functional outcome at 1-year, as measured by return to work and short form-36 (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Results In our adjusted multivariable regression models that included pre-injury SF-36 scores, SPOC scores at 6-weeks post-surgery accounted for 18% of the variation in SF-36 PCS scores and 18% of SF-36 MCS scores at 1-year. In both models, 6-week SPOC scores were a far more powerful predictor of functional recovery than age, gender, fracture type, smoking status, or the presence of multi-trauma. Our adjusted analysis found that for each 14 point increment in SPOC score at 6-weeks (14 chosen on the basis of half a standard deviation of the mean SPOC score) the odds of returning to work at 1-year decreased by 40% (odds ratio = 0.60; 95% CI = 0.50 to 0.73). Conclusion The SPOC questionnaire is a valid measurement of illness beliefs in tibial fracture patients and is highly predictive of their long-term functional recovery. Future research should explore if these results extend to other trauma populations and if modification of unhelpful illness beliefs is feasible and would result in improved functional outcomes. PMID:22011635

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

341

The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction  

Microsoft Academic Search

Functional stability of the knee is dependent on an intact ligamentous system and the timely and efficient contraction of supporting musculature. The aim of this study was to assess the relationship between muscle strength and functional stability in 31 patients pre- and post-operatively, following a unilateral anterior cruciate ligament rupture. All subjects underwent reconstructive surgery using semitendonosis and gracilis tendons.

S. L. Keays; J. E. Bullock-Saxton; P. Newcombe; A. C. Keays

2003-01-01

342

Mild toxic anterior segment syndrome mimicking delayed onset toxic anterior segment syndrome after cataract surgery  

PubMed Central

Toxic anterior segment syndrome (TASS) is an acute sterile postoperative anterior segment inflammation that may occur after anterior segment surgery. I report herein a case that developed mild TASS in one eye after bilateral uneventful cataract surgery, which was masked during early postoperative period under steroid eye drop and mimicking delayed onset TASS after switching to weaker steroid eye drop. PMID:25230969

Lee, Su-Na

2014-01-01

343

Correlates of knee anterior laxity in sportswomen.  

PubMed

The purpose of this study was to evaluate whether any of the following factors are related to knee anterior laxity in healthy sportswomen: anthropometric characteristics, lower limb alignment characteristics, hormone-related factors and sport history. Six hundred and sixteen sportswomen were tested in the pre-season. The data have been analysed using linear regression for possible association of knee anterior laxity with other variables. Univariate linear regression indicated a positive association of knee anterior laxity with knee extension and navicular drop and a negative association with body height. Multivariate linear regression analysis showed statistically significant associations between knee anterior laxity and the combination of passive knee extension and the chosen sport (R(2)=0.089; p<0.05). The combination of passive knee extension and sport type was found to be related to the amount of knee anterior laxity, although the association was weak with this combination of factors able to explain only about 9% of the variability in laxity. Knowing which factors influence the amount of knee anterior laxity will help us to better interpret the results of knee anterior laxity testing and help us to understand the possible role of knee anterior laxity as a risk factor for knee injury. PMID:19423353

Vauhnik, Renata; Morrissey, Matthew C; Rutherford, Olga M; Turk, Zmago; Pilih, Iztok A; Perme, Maja Pohar

2009-12-01

344

Anterior pericardial tracheoplasty for congenital tracheal stenosis.  

PubMed

Congenital tracheal stenosis may be a life-threatening anomaly not relieved by airway intubation. Over the past 7 years, anterior pericardial tracheoplasty has been used at our institution for treatment of congenital long-segment tracheal stenosis in infants with impeding airway obstruction. Case histories of eight patients undergoing nine anterior pericardial tracheoplasties have been reviewed to assess this technique. Of these patients, six have required preoperative tracheal intubation before repair to maintain ventilation. The surgical technique of anterior pericardial tracheoplasty includes a median sternotomy approach with partial normothermic cardiopulmonary bypass. An anterior tracheotomy through all hypoplastic rings allows enlargement with autologous pericardium to 1.5 times the predicted normal diameter. After insertion, the pericardium and hypoplastic tracheal cartilages are suspended to surrounding mediastinal structures, which prevents airway collapse. Seven of eight infants have survived without tracheoplasty dehiscence or wound infections. Five were ultimately extubated and are currently free of symptoms from 6 months to 5 years after anterior pericardial tracheoplasty. The other two survivors had residual stenosis as a result of complications of prior tracheostomy. One of these patients has undergone a successful second anterior pericardial tracheoplasty and is currently extubated and well. The other is palliated at 6 months with a tracheostomy awaiting a second anterior pericardial tracheoplasty. Our review of anterior pericardial tracheoplasty has demonstrated the safety, utility, and at least medium-term benefit of this procedure in infants of any age and weight. PMID:1943189

Heimansohn, D A; Kesler, K A; Turrentine, M W; Mahomed, Y; Means, L; Matt, B; Weisberger, E; Brown, J W

1991-11-01

345

Acute hemiconcern: a right anterior parietotemporal syndrome  

Microsoft Academic Search

Three patients developed a striking visual and motor behaviour in the acute phase of a stroke involving the territory of the right anterior parietal artery (postcentral gyrus, parts or upper and middle temporal gyri, anterior part of inferior parietal gyrus, and supramarginal gyrus). The patients concentrated on the left side of their bodies, looking at it for long periods and

J Bogousslavsky; E Kumral; F Regli; G Assal; J Ghika

1995-01-01

346

Experiments on anterior regeneration in Eurythoe complanata (\\  

Microsoft Academic Search

In the polychaete Eurythoe complanata (Amphinomidae) regeneration of the nervous system has been monitored after amputation of anterior segments and after amputation plus extirpation of one to a few anterior ganglia of the ventral nerve cord. The serotonergic subunit of the nervous system was visualized with an antibody directed against the bioamine 5-HT. Cell proliferation could be demonstrated by incorporation

Monika C. M. Müller; Andreas Berenzen; Wilfried Westheide

2003-01-01

347

Microsurgical anatomy of the anterior choroidal artery  

Microsoft Academic Search

Summary In this study, the authors present the results of 50 dissections of the anterior choroidal a. in man. Fifty cerebral hemispheres were prepared with the classic techniques of preservation and vascular injection. An ectopic origin was observed in 4% of cases. The intracisternal segment of the anterior choroidal a. forms a neurovascular bundle with the optic tract and basal

X Morandi; G Brassier; P Darnault; Ph Mercier; JM Scarabin; JM Duval

1996-01-01

348

Physeal-sparing technique for femoral tunnel drilling in pediatric anterior cruciate ligament reconstruction using a posteromedial portal.  

PubMed

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

Lemos, Stephen E; Keating, Patrick M; Scott, Timothy P; Siwiec, Ryan M

2013-11-01

349

Physeal-Sparing Technique for Femoral Tunnel Drilling in Pediatric Anterior Cruciate Ligament Reconstruction Using a Posteromedial Portal  

PubMed Central

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

Lemos, Stephen E.; Keating, Patrick M.; Scott, Timothy P.; Siwiec, Ryan M.

2013-01-01

350

Eighteen months of anterior chamber inflammation.  

PubMed

A 60-year-old Chinese patient was seen multiple times in the ophthalmology outpatient department due to persistent anterior-chamber inflammation and raised intraocular pressure. The patient was being treated with topical corticosteroids and oral acyclovir. Signs of corneal endotheliitis were observed in subsequent follow-ups. A clinical diagnosis could be made on slit-lamp examination, but aetiology could not be specified. An anterior-chamber diagnostic tap performed 18 months after the initial presentation revealed cytomegalovirus (CMV). Prompt response was noted with oral valganciclovir treatment. Our case highlights the importance of performing anterior-chamber tap in cases with persistent anterior-chamber inflammation. There was a long interval between the presentation and diagnosis mainly due to the absence of any concurrent ocular signs. An anterior-chamber tap was delayed until the ocular signs were suggestive of CMV endotheliitis. Timely diagnosis in such cases can improve the outcome as well as the prognosis. PMID:23997088

Jhanji, Vishal; Kwok, Rachel; Young, Alvin L

2013-01-01

351

Anterior Segment Imaging in Combat Ocular Trauma  

PubMed Central

Purpose. To evaluate the use of ocular imaging to enhance management and diagnosis of war-related anterior segment ocular injuries. Methods. This study was a prospective observational case series from an ongoing IRB-approved combat ocular trauma tracking study. Subjects with anterior segment ocular injury were imaged, when possible, using anterior segment optical coherence tomography (AS-OCT), confocal microscopy (CM), and slit lamp biomicroscopy. Results. Images captured from participants with combat ocular trauma on different systems provided comprehensive and alternate views of anterior segment injury to investigators. Conclusion. In combat-related trauma of the anterior segment, adjunct image acquisition enhances slit lamp examination and enables real time In vivo observation of the cornea facilitating injury characterization, progression, and management. PMID:24191191

Ryan, Denise S.; Sia, Rose K.; Colyer, Marcus; Stutzman, Richard D.; Wroblewski, Keith J.; Mines, Michael J.; Bower, Kraig S.

2013-01-01

352

MDCT and MRI for the diagnosis of complex fractures of the tibial plateau: A case control study  

PubMed Central

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

XU, YUNQIN; LI, QIANG; SU, PEIHUA; SHEN, TUGANG; ZHU, YAZHONG

2014-01-01

353

Tibial changes in experimental disuse osteoporosis in the monkey  

NASA Technical Reports Server (NTRS)

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.

Young, D. R.; Niklowitz, W. J.; Steele, C. R.

1983-01-01

354

The laterally extended medial hemisoleus flap for reconstruction of a tibial wound in the distal third of the leg  

Microsoft Academic Search

A soleus flap as a local reconstructive option for soft-tissue coverage of a tibial wound in the distal third of the leg has\\u000a never been well recognized. In a 2-year period, seven patients underwent reconstruction of a less extensive tibial wound (4?×?3\\u000a to 10?×?4 cm) in the distal third of the leg after orthopedic trauma with the laterally extended medial hemisoleus

Lee L. Q. Pu

2007-01-01

355

Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials  

Microsoft Academic Search

The choice between reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures is an\\u000a ongoing controversy. We carried out a comprehensive search strategy. Six eligible randomised controlled trials were included.\\u000a Three reviewers independently assessed methodological quality and extracted outcome data. Analyses were performed using Review\\u000a Manager 5.0. The results showed lower risks of tibial fracture

Deting Xue; Qiang Zheng; Hang Li; Shengjun Qian; Bo Zhang; Zhijun Pan

2010-01-01

356

Surgical treatment of complex tibial plateau fractures by closed reduction and external fixation. A review of 32 consecutive cases operated  

Microsoft Academic Search

Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce\\u000a the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical\\u000a technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two\\u000a complex tibial plateau

C. Faldini; M. Manca; S. Pagkrati; D. Leonetti; M. Nanni; G. Grandi; M. Romagnoli; M. Himmelmann

2005-01-01

357

Surface Damage in Machined Ram-Extruded and Net-Shape Molded Retrieved Polyethylene Tibial Inserts of Total Knee Replacements  

Microsoft Academic Search

Background: Polyethylene wear has emerged as a major determining factor in the long-term clinical perfor- mance of total knee replacements. This study addresses the in vivo wear performance of two types of poly- ethylene tibial inserts used in similar total knee arthroplasty designs. Methods: A surface damage assessment of retrieved specimens was performed for twenty-six net-shape molded tibial inserts manufactured

AIVARS BERZINS; JOSHUA J. JACOBS; RICHARD BERGER; CHRIS ED; RAGHUNATHAN NATARAJAN; THOMAS ANDRIACCHI; JORGE O. GALANTE

358

Early complications of medial opening wedge high tibial osteotomy using autologous tricortical iliac bone graft and T-plate fixation  

Microsoft Academic Search

Despite several advantages of medial opening wedge high tibial osteotomy, this procedure has been noted to have a high rate of complications especially with the use of a spacer plate for fixation. We retrospectively evaluated the early complications of 138 medial opening wedge high tibial osteotomies done using autologous tricortical iliac bone graft and T-plate fixation(AO locking compression T-plate, Ti\\/3H

Dong Ju Chae; Gautam M. Shetty; Kook Hyun Wang; Antonio Santa Cruz Montalban Jr; Jong In Kim; Kyung Wook Nha

2011-01-01

359

Treatment of Schatzker Type V and VI Tibial Plateau Fractures Using a Midline Longitudinal Incision and Dual Plating  

PubMed Central

Purpose The purpose of this study was to evaluate the results of the treatment of Schatzker type V and VI tibial plateau fractures using a midline longitudinal incision and dual-plate fixation. Materials and Methods Ten patients with Schatzker type V and VI tibial plateau fractures treated with a midline longitudinal incision and dual plating were analyzed. The patients were followed for a minimum of one year. Clinical outcomes were evaluated using range of motion, visual analogue scale (VAS) and Knee Society Score. Radiological outcomes were evaluated using the bony union time, medial proximal tibial angle (MPTA) and posterior proximal tibial angle (PPTA). Results The mean VAS score was 2.2 points, and the mean Knee Society function score was 85 points at the final follow-up. The mean flexion contracture was 2.5° and the mean further flexion was 125°. It took an average of 4 months until bony union occurred. The mean MPTA and PPTA were 90.5° and 4.4°, respectively. There was one case of delayed wound healing, but no other complications were observed. Conclusions The treatment of Schatzker type V and VI tibial plateau fractures with a midline longitudinal incision and dual-plate fixation resulted in satisfactory clinical and radiological outcomes. This can be an option when treating Schatzker type V and VI tibial plateau fractures. PMID:23741703

Cho, Kye-Youl; Oh, Hyun-Sup; Yoo, Jae-Ho; Kim, Duk-Hyun; Cho, Young-Joo

2013-01-01

360

Variants of cerebral arteries - anterior circulation  

PubMed Central

Summary Advances in imaging techniques allow for in vivo identification of abnormalities and normal variants of cerebral arteries. These arterial variations can be asymptomatic and uncomplicated although, some of them increase the risk of aneurysm formation, acute intracranial hemorrhage, play a vital role in neurosurgical planning or can be misidentified as serious pathology and medical errors. The goal of this publication is to discuss arterial anomalies of anterior cerebral circulation, their prevalence and demonstrate radiological images of some of those variants. In this article we will discuss variants of internal carotid artery, anterior cerebral artery, anterior communicating artery, middle cerebral artery, persistent stapedial artery and fenestration. PMID:24115959

Makowicz, Grzegorz; Poniatowska, Renata; Lusawa, Malgorzata

2013-01-01

361

Cervical squamous cell carcinoma with isolated tibial metastasis: A case report and review of the literature  

PubMed Central

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

YUAN, FANG; ZHANG, CHUNMEI; CUI, ZHUMEI; LI, XIANG; LI, XIA; LIN, WEI; YANG, XINGSHENG

2014-01-01

362

Ipsilateral distal femoral and proximal tibial epiphyseal growth plate injury: a case report  

PubMed Central

Introduction Both the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Even though they are uncommon, they have a high incidence rate of complications. Case presentation We present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. The patient was a 10-year-old boy, treated by open reduction and internal fixation. Conclusion Although distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care. Anatomic reduction is important, especially to minimize the risk of growth arrest and the development of degenerative arthritis. However, there is a high incidence of growth arrest and neurovascular injury with these type of fractures. PMID:23724954

2013-01-01

363

Autograft Transfer from the Ipsilateral Femoral Condyle in Depressed Tibial Plateau Fractures  

PubMed Central

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.

Sferopoulos, N.K

2014-01-01

364

Metal sensitivity in patients treated for tibial fractures with plates of stainless steel.  

PubMed

In three patients a local dermatitis developed 3-3 1/2 months after tibial osteosynthesis with plates and screws of stainless steel 316 L (AO). Two of the patients had a positive patch test for chromium (and cobalt) and one for nickel. Infection was not indicated and it is suggested that the dermatitis was caused by a metallic sensitivity. The skin affection disappeared after removal of the metal. PMID:920115

Cramers, M; Lucht, U

1977-01-01

365

The role of plating in the operative treatment of severe open tibial fractures: a systematic review  

Microsoft Academic Search

Open fractures of the tibial diaphysis are the result of high-energy trauma. They are usually associated with extensive soft\\u000a tissue loss and represent serious clinical problems. Surgical treatment of these injuries has been associated with substantial\\u000a complications such as osteomyelitis, delayed bone healing, poor functional outcome, soft-tissue failure, or even amputations.\\u000a More recently a staged treatment, with initial application of

Peter V. Giannoudis; Costas Papakostidis; George Kouvidis; Nikolaos K. Kanakaris

2009-01-01

366

Treatment of III B open tibial fractures with early osteosynthesis and local muscle flaps  

Microsoft Academic Search

Summary  \\u000a From 1986 to 1994 18 patients with 19 IIIB open tibial fractures were treated following similar therapeutic management. This\\u000a included early and radical primary debridement, early and whereever possible immediate internal fixation of the bone and coverage\\u000a with a local muscle flap (hemisoleus or gastrocnemius). At the time of follow-up all fractures had consolidated clinically\\u000a as well as radiographically.

S. Eggli; E. Schöll; R. Hertel

1998-01-01

367

Failure of particulate bioglass to prevent experimental staphylococcal infection of open tibial fractures  

Microsoft Academic Search

range from 355 to 500 mm, consisting of 45 wt% SiO2\\/24.5 wt% Na2O\\/24.5 wt% CaO\\/6 wt% P2O5) in vivo by examining its effi- cacy in reducing the rate of infection by Staphylococcus aureus after the fixation of open tibial fractures in rabbits. An in vivo test was carried out with male rabbits split into two groups infected with S. aureus

Zong-Ping Xie; Chang-Qing Zhang; Cheng-Qing Yi; Jian-Jun Qiu; Jian-Qiang Wang; Juan Zhou

2010-01-01

368

Adjustments in gait symmetry with walking speed in trans-femoral and trans-tibial amputees  

Microsoft Academic Search

The effect of increased walking speed on temporal and loading asymmetry was investigated in highly active trans-femoral and trans-tibial amputees. With increasing walking speed, temporal gait variables reduced in duration, particularly on the prosthetic limb, while vertical ground reaction force (vGRF) increased in magnitude, particularly on the intact limb. Thus, temporal asymmetry reduced and loading asymmetry increased with walking speed.

Lee Nolan; Andrzej Wit; Krzysztof Dudziñski; Adrian Lees; Mark Lake; Micha? Wychowañski

2003-01-01

369

Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator  

Microsoft Academic Search

The aim of this study was to evaluate the efficacy of tibial lengthening using a reamed type intramedullary nail and an Ilizarov\\u000a external fixator for the treatment of leg length discrepancy or short stature. This retrospective study was performed on 18\\u000a tibiae (13 patients) in which attempts were made to reduce complications. We used an Ilizarov external fixator and a

Hayoung Kim; Sang Ki Lee; Kap Jung Kim; Jae Hoon Ahn; Won Sik Choy; Yong In Kim; Jea Yun Koo

2009-01-01

370

Precision of tibial cartilage morphometry with a coronal water-excitation MR sequence  

Microsoft Academic Search

.   The aim of this study was to analyze the precision of tibial cartilage morphometry, by using a fast, coronal water-excitation\\u000a sequence with high spatial resolution, to compare the reproducibility of 3D thickness vs volume estimates, and to test the\\u000a technique in patients with severe osteoarthritis. The tibiae of 8 healthy volunteers and 3 patients selected for total knee\\u000a arthroplasty

A. Hyhlik-Dürr; S. Faber; R. Burgkart; T. Stammberger; K.-P. Maag; K.-H. Englmeier; M. Reiser; F. Eckstein

2000-01-01

371

Anisotropic properties of human tibial cortical bone as measured by nanoindentation  

Microsoft Academic Search

The purpose of this study was to investigate the effects of elastic anisotropy on nanoindentation measurements in human tibial cortical bone. Nanoindentation was conducted in 12 different directions in three principal planes for both osteonic and interstitial lamellae. The experimental indentation modulus was found to vary with indentation direction and showed obvious anisotropy (one-way analysis of variance test, P<0.0001). Because

Z. Fan; J. G. Swadener; J. Y. Rho; M. E. Roy; G. M. Pharr

2002-01-01

372

Adult tibial eminence fracture fixation: arthroscopic procedure using K-wire folded fixation  

Microsoft Academic Search

The purpose of this article is to describe a new and simple technique for arthroscopic fixation of tibial intercondylar eminence\\u000a avulsion fractures using folded surgical pin. This technique allows reduction and fixation of the bone fragment without using\\u000a special equipment. After standard arthroscopic procedure to explore the knee and to remove fracture debris and blood clot,\\u000a the bone block is

Nicolas Bonin; Laurent Jeunet; Laurent Obert; David Dejour

2007-01-01

373

Evidence of Increased Cholecalciferol Requirement in Chicks with Tibial Dyschondroplasia1  

Microsoft Academic Search

A series of experiments was conducted to test the hypothesis that vitamin D utilization may not be as efficient in chicks with tibial dyschondroplasia (TD). The basal diet contained 1.0% Ca and 0.45% available P with no supplemental cholecalciferol (D3). Chicks from low TD (LTD) and high TD (HTD) selected lines were fed diets supplemented with various levels of vitamin

TIANSHUN XU; ROLAND M. LEACH; BRUCE HOLLIS; JOSEPH H. SOARES

374

Bone allograft provides bone healing in the medial opening high tibial osteotomy  

Microsoft Academic Search

Various materials are used to fill osteotomy defects created in the medial opening wedge high tibial osteotomy (MOWHTO). Our\\u000a hypothesis was that a bone allograft would provide the osteotomy site bone healing within the expected time. We performed\\u000a the MOWHTO using a cancellous bone allograft in 310 knees in 284 patients between 2000 and 2005. Internal fixation was achieved\\u000a with

Veljko Santic; Anton Tudor; Branko Sestan; Dalen Legovic; Luka Sirola; Ivan Rakovac

2010-01-01

375

Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study  

Microsoft Academic Search

Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active\\u000a patient. The various implants used in HTO differ with regard to its design, the fixation stability and osteotomy technique.\\u000a It is assumed that the combination of a plate fixator with a biplanar, v-shaped osteotomy supports bone healing. So far, there\\u000a are no

Dietrich Pape; Olaf Lorbach; Christian Schmitz; Lüder C. Busch; Nicolien Van Giffen; Romain Seil; Dieter M. Kohn

2010-01-01

376

Flexion gap configuration in total knee arthroplasty following high tibial osteotomy  

Microsoft Academic Search

Previous reports have described the potentially compromising effect of a high tibial osteotomy (HTO) on the results of a subsequent total knee arthroplasty (TKA). Although the reasons are not clear, some authors reported problems in soft-tissue balancing. In a prospective study, 22 patients with an average interval of 5.8 years after closed-wedge HTO were operated for TKA. All operations were

H. Bäthis; L. Perlick; M. Tingart; C. Lüring; C. Perlick; J. Grifka

2004-01-01

377

Calcium phosphate cement enhances primary stability of open-wedge high-tibial osteotomies  

Microsoft Academic Search

We investigated if injectable calcium phosphate cement improves primary stability in open-wedge high-tibial osteotomy. A 10 mm\\u000a open-wedge osteotomy was performed on eight pairs of preserved cadaver tibiae and seven pairs of composite (Sawbone) left\\u000a tibiae. Osteosynthesis was performed with the Dynafix plate system. The gap resulting from surgery either was filled with\\u000a 15 g injectable calcium phosphate cement in half the

Thomas Lind-Hansen; Poul Torben Nielsen; Juozas Petruskevicius; Benny Endelt; Karl Brian Nielsen; Ivan Hvid; Martin Lind

2009-01-01

378

Opening wedge tibial osteotomy for large varus deformity with Ceraver TM resorbable beta tricalcium phosphate wedges  

Microsoft Academic Search

The results in 53 knees that had been treated by proximal tibial opening-wedge osteotomy for large varus deformity and osteoarthritis\\u000a of the medial compartment were evaluated after a mean length of follow-up of ten years (range, 8–12 years). We used a porous\\u000a beta-tricalcium phosphate (?-TCP) wedge because it is resorbable and osteoinductive. All osteotomies were completely consolidated\\u000a and complete osseointegration of

Philippe Hernigou; Xavier Roussignol; Charles Henri Flouzat-Lachaniette; Paolo Filippini; Isaac Guissou; Alexandre Poignard

2010-01-01

379

Opening wedge high tibial osteotomy affects both the lateral patellar tilt and patellar height  

Microsoft Academic Search

In the current study, we evaluated changes in the patellofemoral joint indices in 49 knees from 39 patients (11 men and 28\\u000a women with a median age of 64 years; range 53–79) who had undergone an opening wedge high tibial osteotomy (OWHTO). Osteoarthritis\\u000a had been diagnosed in 39 knees and osteonecrosis in the other 10 knees in this patient cohort. Radiographs

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

2010-01-01

380

Simultaneous bilateral opening-wedge high tibial osteotomy with early full weight-bearing exercise  

Microsoft Academic Search

Simultaneous bilateral opening-wedge high tibial osteotomies (OWHTOs), using the TomoFix fixation device and artificial bone\\u000a wedges (?-TCP) were performed on 20 knees of 10 patients with an average age of 67 years (range 53–75) at the time of the\\u000a operation. We established an early weight-bearing exercise program during which patients were permitted partial weight-bearing\\u000a exercise 1 week after osteotomy, with all patients

Ryohei Takeuchi; Masato Aratake; Haruhiko Bito; Izumi Saito; Ken Kumagai; Hiroyuki Ishikawa; Yasushi Akamatsu; Yohei Sasaki; Tomoyuki Saito

2008-01-01

381

The influence of open and closed high tibial osteotomy on dynamic patellar tracking: a biomechanical study  

Microsoft Academic Search

High tibial osteotomy (HTO) can cause alterations in patellar height, depending on the surgical technique, the amount of correction\\u000a and the postoperative management. Alterations in patella location after HTO may lead to postoperative complications. However,\\u000a information on changes in dynamic patellar kinematics following HTO is very limited. We conducted a biomechanical study, to\\u000a analyze the effect of open (OWO) and

Robert Gaasbeek; R. T. C. Welsing; Marco Barink; Nico Verdonschot; Albert van Kampen

2007-01-01

382

The high tibial osteotomy, open versus closed wedge, a comparison of methods in 108 patients  

Microsoft Academic Search

Introduction: One hundred and eight patients with varus gonarthrosis were treated with high tibial osteotomy (HTO) in 2001. Fifty one patients received an open wedge osteotomy by using the ‘Puddu’ plate and 57 patients received a Coventry-type closing wedge osteotomy. For both groups the follow-up examination period was 22.5 months (253–1009 days). Material and Methods: To evaluate the study, radiological and subjective

S. Hoell; J. Suttmoeller; V. Stoll; S. Fuchs; G. Gosheger

2005-01-01

383

Diagnosing the systemic associations of anterior uveitis.  

PubMed

Up to one-half of patients with anterior uveitis suffer from related systemic diseases. The common associations are the seronegative arthropathies and, in children, juvenile chronic arthritis. Anterior uveitis may also occur in the context of sarcoidosis or Behçet's disease. Syphilis and tuberculosis remain a significant problem for specific populations and may be the cause of anterior uveitis in these groups. By thorough clinical history and the correct selection and interpretation of simple investigations, it is generally possible for the ophthalmologist to make or exclude a systemic diagnosis, predict the ocular prognosis and direct selected patients to the appropriate physician. Diseases that threaten the patient's wellbeing must certainly be recognized. In the present review we present a method for identifying the systemic associations of anterior uveitis. PMID:9843260

Smith, J R; Coster, D J

1998-11-01

384

Anterior regeneration in the hemichordate Ptychodera flava  

PubMed Central

Ptychodera flava is a hemichordate whose anterior structures regenerate reproducibly from posterior trunk pieces when amputated. We characterized the cellular processes of anterior regeneration with respect to programmed cell death and cell proliferation, following wound healing. We found scattered proliferating cells at day two of regeneration using a PCNA antibody. On day four, most proliferating cells were associated with the nerve tract under the epidermis, and on day six, a small proboscis derived from proliferated cells was regenerated, and a mouth had broken though the epidermis. TUNEL detected elevated levels of apoptosis in the endoderm that began furthest away from the region of wound healing, then moved anteriorly over eight days. Posterior to anterior apoptosis is likely to remove digestive endoderm for later differentiation of pharyngeal endoderm. We hypothesize that P. flava regeneration is nerve dependent and that remodeling in the gut endoderm plays an important role in regeneration. PMID:18924231

Rychel, Amanda L.; Swalla, Billie J.

2008-01-01

385

Vascular injury during anterior lumbar surgery  

Microsoft Academic Search

Background contextWith the number of anterior lumbar procedures expected to increase significantly over the next few years, it is important for spine surgeons to have a good understanding about the incidence of vascular complications during these operations.

Salvador A Brau; Rick B Delamarter; Michael L Schiffman; Lytton A Williams; Robert G Watkins

2004-01-01

386

38 CFR 3.379 - Anterior poliomyelitis.  

Code of Federal Regulations, 2010 CFR

If the first manifestations of acute anterior poliomyelitis present themselves in a veteran within 35 days of termination of active military service, it is probable that the infection occurred during...

2010-07-01

387

Isolated dislocation of the posterior tibial tendon in an amateur snowboarder: a case report.  

PubMed

Isolated dislocation of the posterior tibial tendon is an uncommon pathologic entity that typically occurs in the setting of acute trauma. The diagnosis remains challenging and is often delayed second to the rarity of the injury and symptoms similar to that of medial ankle sprains and other routinely diagnosed injuries about the ankle. The factors that predispose this tendon to dislocation include a hypoplastic retromalleolar groove, flexor retinaculum insufficiency, chronic repetitive trauma, and a structural abnormality from a previous medial malleolar fracture, or a combination thereof. Dislocation has also been cited as a complication of multiple local steroid injections and tarsal tunnel release. The mechanism of injury appears to involve forced dorsiflexion and eversion of the ankle when the posterior tibial tendon is contracted. Most cases do not respond well to conservative treatment and will require surgery to restore function and eliminate symptoms. We report a case of posterior tibial tendon dislocation related to a snowboarding injury and offer our technique for surgical correction. PMID:24361009

Gambardella, Gabriel V; Donegan, Ryan; Caminear, David S

2014-01-01

388

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty  

PubMed Central

Purpose To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. Materials and Methods We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. Results The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. Conclusions Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA. PMID:23508525

Baek, Seung-Wook; Kim, Chul-Woong

2013-01-01

389

Curvature scaling in the medial tibial condyle of large bodied hominoids.  

PubMed

The shape of joint articular surfaces can provide important information about the locomotor habits of animals. Understanding sources of shape variation in these surfaces is critical to correctly inferring the link between form and function. This study tests the hypothesis that increases in body size within a species result in flatter joint contours of the joint articular surface. Joint flattening is expected to regulate the magnitude and direction of transarticular stresses passing through the joint. Three-dimensional laser scans of polyvinylsiloxane molds of the medial tibial condyle of gorillas (n = 40), common chimpanzees (n = 40), and modern humans (n = 40) were evaluated for differences in articular surface topography, with all measures of joint curvature examined in relation to femoral head superoinferior diameter (as a surrogate for body size). Analyses did not detect an allometric shape change in the curvature of the medial tibial condyle with increasing body size within any of the three taxa examined here. Medial tibial condyle curvature appears to be largely independent of body size as estimated by femoral head diameter. These results do not provide direct support for the hypothesis that joints become flatter in response to increased transarticular loading. PMID:20235323

Sylvester, Adam D; Organ, Jason M

2010-04-01

390

Selective Activation of the Human Tibial and Common Peroneal Nerves with a Flat Interface Nerve Electrode  

PubMed Central

Problem Addressed 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. Methodology During intraoperative trials involving three subjects, an 8-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. Results, Significance, and Potential Impact 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. Estimated joint moments suggests 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. PMID:23918148

Schiefer, M A; Freeberg, M; Pinault, G J C; Anderson, J; Hoyen, H; Tyler, D J; Triolo, R J

2013-01-01

391

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

PubMed

Many aspects of the proposed relationship between material properties and clinical performance of UHMWPE components remain unclear. In this study, we explored the hypothesis that the clinical performance of tibial inserts is directly related to its large-deformation mechanical behavior measured near the articulating surface. Retrieval analysis was performed on three conventional UHMWPE and three Hylamer-M tibial components of the same design and manufacturer. Samples of material were then obtained from the worn regions of each implant and subjected to mechanical characterization using the small punch test. Statistically significant relationships were observed between the metrics of the small punch test and the total damage score and the burnishing damage score of the implants. We also examined the near-surface morphology of the retrievals using transmission electron microscopy. TEM analysis revealed lamellar alignment at and below the wear surfaces of the conventional UHMWPE retrievals up to a maximum depth of approximately 8 microm, consistent with large-deformation crystalline plasticity. The depth of the plasticity-induced damage layer varied not only between the retrievals, but also between the conventional UHMWPE and Hylamer-M components. Thus, the results of this study support the hypothesis that the clinical performance of UHMWPE tibial inserts is related to the large-deformation mechanical behavior measured near the articulating surface. PMID:10646945

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

2000-02-01

392

Complications associated with tibial plateau leveling osteotomy: A retrospective of 1519 procedures  

PubMed Central

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

Coletti, Thomas J.; Anderson, Mark; Gorse, Mary Jean; Madsen, Richard

2014-01-01

393

Treatment of tibial plateau fractures with high strength injectable calcium sulphate  

PubMed Central

The aim of this article is to discuss the clinical efficacy of high strength injectable calcium sulphate (MIIGX3) in the treatment of tibial plateau fractures. Thirty-one patients with tibial plateau fractures treated with MIIGX3 were included. Postoperative radiographic study was used to evaluate congruity of the articular surface, bone regrowth, and the absorption process of MIIGX3. Rasmussen’s score system was adapted for the postoperative knee function recovery assessment. Twenty-eight of 31 patients were followed-up successfully with an average follow-up length of 14.6 months. Complete fracture healing was found in all patients. Complications included wound exudation and articular subsidence. Postoperative knee function was good according to Rasmussen’s score system. Six months after surgery, radiographs demonstrated equivalent bone density in the previous area of MIIGX3 as that of surrounding cancellous bone. The use of MIIGX3 in the treatment of tibial plateau fractures provides adequate intraoperative stability and improves the safety of early knee motion. PMID:18704416

Han, Kaiwei; Ma, Hui; Zhang, Chuncai; Su, Jiachan; Zhao, Jie; Li, Jingfeng; Bai, Yushu; Tang, Hao

2008-01-01

394

Autonomous Mathematical Reconstruction of Polyethylene Tibial Inserts to Measure Low Wear Volumes  

PubMed Central

Wear of the polyethylene tibial component is a major factor in the success of total knee replacements. However, sampling resolution and the challenges of estimating original surfaces with relatively complex articulating geometries have limited the accuracy of volumetric measurements of wear on surgically retrieved inserts. A mathematical model analyzed volume error due to sampling resolution and found that 100x100?m point spacing reduced error below 1 mm3. Small volumes of material were progressively removed from the topside of three unworn tibial inserts, after which each component was weighed and digitized with a laser coordinate measuring machine. Six inserts worn in knee simulator tests and nine surgically retrieved inserts visually scored for damage were also digitized. For these tests, the original surface of an insert was mathematically reconstructed from unworn regions of the same component, and volume loss and its spatial distribution were calculated. Volume loss estimated by autonomous reconstruction correlated strongly to mass removed manually (R2=0.954, slope = 1.02±0.04 mm3/mm3), mass lost during simulator testing (R2=0.935, slope = 1.01±0.07 mm3/mm3) and visual damage scores separated by size (R2large=0.9824, R2small=0.9728). These results suggest that an autonomous mathematical reconstruction can be used to effectively measure volume loss in retrieved tibial inserts. PMID:22915471

Knowlton, Christopher B.; Wimmer, Markus A.

2013-01-01

395

The Outcome of Bone Substitute Wedges in Medial Opening High Tibial Osteotomy  

PubMed Central

Background: Opening wedge high tibial osteotomy often requires bone grafting to improve the union rate and avoid instability at the osteotomy site. Autograft and allograft have both been associated with complications and the use of bone substitute wedges has been advocated to improve the outcome. This study investigated the clinical, radiological and histological outcomes of using biphasic calcium phosphate ceramic (Triosite) wedges in opening wedge high tibial osteotomy and determined whether the presence of the graft would compromise the satisfactory conversion to a total knee replacement. Methods: A consecutive cohort underwent radiological review to determine whether the osteotomy healed and the correction was maintained. Biopsies were performed on those undergoing second procedures. All patients converted to total knee arthroplasty were assessed separately as to any surgical complications attributed to the Triosite wedge. Results: There were 36 osteotomies in 33 patients with a minimum of 4 years follow up. All osteotomies healed. There was an average 90 (5-14) of correction, which was maintained. Histological assessment of 17 cases confirmed adequate bone replacement of the Triosite although some areas of tricalcium phosphate remained visible. Conversion to a total knee arthroplasty occurred in 11 cases with no complications. Conclusion: Biphasic calcium phosphate ceramic wedges (Triosite) can be reliably used in opening wedge high tibial osteotomy with a low incidence of complications and satisfactory conversion to total knee arthroplasty. PMID:24082978

Hooper, N.M.; Schouten, R.; Hooper, G.J.

2013-01-01

396

Patellofemoral pain in female ballet dancers: correlation with iliotibial band tightness and tibial external rotation.  

PubMed

Review of the literature reveals that ballet dancers have a high incidence of idiopathic patellofemoral pain. Twenty-four female ballet dancers were subjects in a study of the relationship between: 1) iliotibial band (ITB) tightness and patellofemoral pain, and 2) ITB tightness and degrees of tibial external rotation used in the dance demi-plie. Dancers were initially assessed by questionnaire to determine if any had knee pain. Twelve subjects met the study criteria for patellofemoral pain, and 12 dancers without knee pain served as controls for the study, Iliotibial band tightness was measured (Ober test), and degrees of tibial external rotation used during knee flexion (demi-plie) in standing were measured in both legs of all 24 subjects (48 legs). Chi-square analysis of the collected data revealed that there was an association between ITB tightness and patellofemoral pain in the dancers. Data analysis using the Wilcoxon Rank Sum test revealed that the degree of tibial external rotation used by dancers with iliotibial band tightness was significantly greater than those without ITB tightness. This study confirms the assumption that ITB tightness in dancers may be a contributing factor to patellofemoral pain. Follow-up study is indicated to determine if the preservation or restoration of functional ITB length is effective in the prevention and/or treatment of patellofemoral pain in ballet dancers. PMID:7550298

Winslow, J; Yoder, E

1995-07-01

397

Section Modulus Is the Optimum Geometric Predictor for Stress Fractures and Medial Tibial Stress Syndrome in Both Male and Female Athletes  

Microsoft Academic Search

Background: Various tibial dimensions and geometric parameters have been linked to stress fractures in athletes and military recruits, but many mechanical parameters have still not been investigated.Hypotheses: Sedentary people, athletes with medial tibial stress syndrome, and athletes with stress fractures have smaller tibial geometric dimensions and parameters than do uninjured athletes.Study Design: Cohort study; Level of evidence, 3.Methods: Using a

Melanie Franklyn; Barry Oakes; Bruce Field; Peter Wells; David Morgan

2008-01-01

398

Ultrasound of the male anterior urethra.  

PubMed

Ascending and descending techniques are used to demonstrate the male anterior urethra. The authors developed an ultrasound approach with the patient compressing his own urethra manually during voiding to achieve distension of the urethra with urine. The subsequent sonourethrography is more accurate than conventional fluoroscopic contrast studies in defining urethral filling defects and is as accurate for the demonstration of strictures. The technique has replaced contrast urethrography at the authors' institutions for the routine evaluation of the anterior urethra. PMID:12970608

Berman, Laurence H; Bearcroft, Philip W P; Spector, Sol

2002-06-01

399

Dentulous Appliance for Upper Anterior Edentulous Span  

PubMed Central

This article discusses about a fixed dentulous appliance that was constructed to replace the primary upper anterior edentulous span in a four year old girl. It constituted a design, whereby the maxillary primary second molars were used to support the appliance through bands and a wire that contained an acrylic flange bearing trimmed acrylic teeth, anteriorly. The appliance was functionally and aesthetically compliant. PMID:24551736

Chalakkal, Paul; Devi, Ramisetty Sabitha; Srinivas, G. Vijay; Venkataramana, Pammi

2013-01-01

400

Trading Post  

NSDL National Science Digital Library

In the wake of COP-4, Resources for the Future (RFF) (described in the August 28, 1998 Scout Report) has posted Webpages on climate change negotiations. One of these, Trading Post, is "a resource for the analysis and reporting of research and writings on 'flexibility mechanisms' -- the Clean Development Mechanism, emissions trading, and Joint Implementation (or activities implemented jointly) -- authorized by the Kyoto Protocol."

401

Lacrimal sac compression by an anterior ethmoidal mucocele presenting as a late complication of dacryocystorhinostomy  

PubMed Central

This was an unusual case of lacrimal sac compression by an anterior ethmoidal mucocele presenting as a late complication of a dacryocystorhinostomy (DCR) that was jointly managed by ophthalmic and ENT surgeons via an endoscopic approach. A 22-year-old lady presented with a 12-month history of a painless lump in her left medial canthus area and a 6-month history of left intermittent epiphora. She had a DCR when she was 15 years old with initial symptom control until recent recurrence. There were no nasal or other eye symptoms. The rest of the eye and nasendoscopic examinations were unremarkable. An MRI scan suggested a dacryocystocele; however, a further CT scan revealed a 1.6 cm cystic lesion consistent with an anterior ethmoidal mucocele compressing the lacrimal sac. An endoscopic left anterior ethmoidectomy with marsupialisation of the mucocele was performed in combination with an endoscopic DCR. She made good post-operative recovery. PMID:24964413

Olaleye, Oladejo; Salleh, Shizalia; David, Don; Bickerton, Richard

2013-01-01

402

Cervical Cord Decompression Using Extended Anterior Cervical Foraminotomy Technique  

PubMed Central

Objective At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. Methods Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. Results In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was 9.77 mm2 (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. Conclusions Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed. PMID:25328648

Kim, Sung-Duk; Lee, Cheol-Young; Kim, Hyun-Woo; Jung, Chul-Ku; Kim, Jong Hyun

2014-01-01

403

Giant anterior cervical osteophyte leading to Dysphagia.  

PubMed

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

Hwang, Jin Seop; Chough, Chung Kee; Joo, Won Il

2013-09-01

404

Anterior clinoid mucocele coexisting with sphenoid sinus mucocele  

Microsoft Academic Search

An anterior clinoid mucocele, known to be extremely rare, can lead to visual complications due to its proximity to the optic nerve. We report a patient who developed visual disturbance due to an anterior clinoid mucocele. Interestingly, the anterior clinoid mucocele coexisted with a sphenoid sinus mucocele. When an anterior clinoid mucocele coexists with a sphenoid sinus mucocele, more deliberate

Soon Ho Kwon; Si Hong Kim; Joo-Heon Yoon

2009-01-01

405

A technique to salvage endodontically compromised maxillary anterior tooth.  

PubMed

A complication of endodontic treatment is over-preparation of the tooth structure in an attempt to access calcified pulp chambers and root canals. This could result in thin root walls that might compromise the long-term prognosis of the tooth. There are various treatment options when such a complication occurs, among them, extraction of the compromised tooth and its replacement with a dental implant. This clinical report describes a nonsurgical, multidisciplinary treatment alternative where a maxillary anterior tooth with a thinned root wall was successfully saved by repairing the damaged root to its original thickness using a composite resin material and subsequently restoring with a cast post and core and a crown. PMID:24654367

Comut, Alper; Foran, Denise; Cunningham, Ralph P

2014-01-01

406

Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor  

NASA Astrophysics Data System (ADS)

Diagnosis method of anterior cruciate ligament (ACL) using body-mounted sensor is discussed. A wide variety of diagnosis method such as Pivot Shift Test (PST), Lachman Test and monitoring of jump motion (JT) are applied to examine the injured ACL. These methods, however, depend on the ability and the experience of examiner. The proposed method numerically provides three dimensional translation and rotation of the knee by using a newly developed 3D sensor. The 3D sensor is composed of three accelerometers and three gyroscopes. Measured acceleration of the knee during the examination is converted to the fixed system of coordinate according the acceleration of gravity and 3D rotation of the sensor, and is numerically integrated to derive 3D trajectory and rotation angle around the tibia. The experimental results of JT suggest that unsymmetrical movement of rotation angle of the tibia and sudden movement of estimated 3D trajectory show instability of knee joint. From the results of PST analysis, it is observed that the tibial angular velocity around the flexed position changes 41.6 [deg/s] at the injured side and 21.7 [deg/s] at the intact side. This result suggests the reposition of injured knee from subluxation.

Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

2007-12-01

407

Current practice variations in the management of anterior cruciate ligament injuries in Croatia  

PubMed Central

AIM: To investigate current preferences and opinions on the diagnosis, treatment and rehabilitation of patients with anterior cruciate ligament (ACL) injury in Croatia. METHODS: The survey was conducted using a questionnaire which was sent by e-mail to all 189 members of the Croatian Orthopaedic and Traumatology Association. Only respondents who had performed at least one ACL reconstruction during 2011 were asked to fill out the questionnaire. RESULTS: Thirty nine surgeons responded to the survey. Nearly all participants (95%) used semitendinosus/gracilis tendon autograft for reconstruction and only 5% used bone-patellar tendon-bone autograft. No other graft type had been used. The accessory anteromedial portal was preferred over the transtibial approach (67% vs 33%). Suspensory fixation was the most common graft fixation method (62%) for the femoral side, followed by the cross-pin (33%) and bioabsorbable interference screw (5%). Almost all respondents (97%) used a bioabsorbable interference screw for tibial side graft fixation. CONCLUSION: The results show that ACL reconstruction surgery in Croatia is in step with the recommendations from latest world literature. PMID:24147268

Mahnik, Alan; Mahnik, Silvija; Dimnjakovic, Damjan; Curic, Stjepan; Smoljanovic, Tomislav; Bojanic, Ivan

2013-01-01

408

Picture Post  

NSDL National Science Digital Library

The Picture Post Network involves individuals, schools, organizations and communities in a systematic monitoring project of their local environment, especially vegetation health. Digital photographs - taken from the same location and positioned in the same direction and orientation - allow individuals, schools, organizations, communities and scientists to monitor a variety of environmental parameters, including plant health, growth, and phenology; erosion and deposition; water levels; and cloud and canopy cover. Participants study change over time in their local area, view NASA satellite imagery on the same days as the pictures, and contribute towards improving their own communities. The website provides instructions for participating, including planning and installing a picture post, monitoring projects, and taking and uploading pictures, and a repository of images. Picture Posts may be added by anyone interested in monitoring a particular location. Currently, Picture Posts sites are active at science centers, schoolyards and gardens, local parks, and nature reserves.

409

Effect of vitamin B12 on functional recovery and histopathologic changes of tibial nerve-crushed rats.  

PubMed

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

Tamaddonfard, E; Farshid, A A; Samadi, F; Eghdami, K

2014-09-01

410

Prenatal diagnosis of anterior sacral meningocele.  

PubMed

Anterior sacral meningocele is an extremely rare condition and there has been only one previous report of a prenatal diagnosis. We report the case of a 36-year-old primigravida who was referred following detection of a huge fetal pelvic cyst on routine ultrasound examination at 19 + 4 weeks' gestation. Neither fetal ultrasound nor magnetic resonance imaging (MRI) at 20 + 5 weeks' gestation could detect communication between the cyst and the spinal cord. Because extension of the pear-shaped cyst through the pelvic diaphragm down to the perineum was reminiscent of dilated vagina and uterine cervix, a tentative diagnosis of hydrometrocolpos secondary to imperforate hymen was considered. On follow-up MRI at 33 + 5 weeks' gestation, a narrow stalk connecting the pelvic cyst and the spinal canal through the anterior sacral foramen was clearly delineated, allowing us to reach the prenatal diagnosis of anterior sacral meningocele. PMID:20882559

Sumi, A; Sato, Y; Kakui, K; Tatsumi, K; Fujiwara, H; Konishi, I

2011-04-01

411

Sexual dimorphism of anterior sacral curvature.  

PubMed

This study assesses the predictive value of anterior sacral curvature for sex estimation from skeletonized remains. Sacra from a sample of 125 American adults of known age and sex were examined. Nine measurements describing anterior sacral curvature were used in the analysis. Statistical treatment of the data included univariate statistics and discriminant function analysis for sex classification. A bootstrap validation method was employed to assess the classification error rates. Sacral curvature was significantly greater in men than in women at the level of the S2-S3 and S3-S4 articulations (p<0.05). Correct classification estimates for the discriminant function range from 66-72%. Although sexually dimorphic, metric observations of sacral curvature are not as reliable at predicting sex as other skeletal elements. Anterior sacral curvature should only be used for sex estimation in the absence of other, more reliable, indicators. PMID:20487142

Plochocki, Jeffrey H

2011-01-01

412

Relationship between human femorotibial joint configuration and the morphometry of the anterior cruciate ligament  

Microsoft Academic Search

Introduction  Individual variations in the anatomy of the knee joint have been suggested to affect the ability to functionally compensate\\u000a for ACL insufficiency or to put an individual at an increased risk of ACL injury. These variations include the posterior tibial\\u000a slope, the concavity of the medial tibial plateau, the convexity of the lateral tibial plateau, and the configuration of the

Jens Dargel; Rüdiger Schmidt-Wiethoff; Janna Feiser; Jürgen Koebke; Klaus Schlüter-Brust; Peer Eysel; Joern W.-P. Michael

2011-01-01

413

Arthroscopically assisted quadriceps double-bundle tibial inlay posterior cruciate ligament reconstruction: an analysis of techniques and a safe operative approach to the popliteal fossa  

Microsoft Academic Search

The arthroscopically assisted posterior cruciate ligament tibial inlay technique, frequently used in athletic individuals and in revision cases, requires a thorough and comprehensive understanding of posterior knee anatomy. Importantly, variations in the posterior vascular anatomy may be encountered. A safe and methodical posteromedial approach in a layered fashion to achieve proper and safe tibial inlay graft placement and fixation is

Frank R Noyes; Michael J Medvecky; Manoj Bhargava

2003-01-01

414

Postoperative Analgesia with Controlled-Release Oxycodone for Outpatient Anterior Cruciate Ligament Surgery  

Microsoft Academic Search

Reconstruction of the anterior cruciate ligament (ACL) of the knee is associated with a considerable degree of post- operative pain. Although immediate-release oral opioids are usually effective in relieving moderate to severe pain, they must be given every 4-6 h. A controlled-release (CR) formulation of oxycodone maintains therapeutic opioid concentrations for a more prolonged period, thus provid- ing sustained pain

Scott S. Reuben; Neil Roy Connelly; Holly Maciolek

1999-01-01

415

Efficacy of 3-Dimensional plates over Champys miniplates in mandibular anterior fractures  

PubMed Central

Background: Mandibular fractures are treated surgically by either rigid or semi-rigid fixation, two techniques that reflect almost opposite concept of craniomaxillofacial osteosynthesis. The shortcomings of these fixations led to the development of 3 dimensional (3D) miniplates. This study was designed with the aim of evaluating the efficiency of 3D miniplate over Champys miniplate in anterior mandibular fractures. Materials & Methods: This study was done in 40 patients with anterior mandibular fractures. Group I consisting of 20 patients in whom 3D plates were used for fixation while in Group II consisting of other 20 patients, 4 holes straight plates were used. The efficacy of 3D miniplate over Champy’s miniplate was evaluated in terms of operating time, average pain, post operative infection, occlusion, wound dehiscence, post operative mobility and neurological deficit. Results: The mean operation time for Group II was more compared to Group I (statistically significant).There was significantly greater pain on day of surgery and at 2nd week for Group II patients but there was no significant difference between the two groups at 4th week. The post operative infection, occlusal disturbance, wound dehiscence, post operative mobility at facture site, neurological deficit was statistically insignificant (chi square test). Conclusion: The results of this study suggest that fixation of anterior mandibular fractures with 3D plates provides three dimensional stability and carries low morbidity and infection rates. The only probable limitation of these 3D plates may be excessive implant material, but they seem to be easy alternative to champys miniplate. How to cite the article: Barde DH, Mudhol A, Ali FM, Madan RS, Kar S, Ustaad F. Efficacy of 3-Dimensional plates over Champys miniplates in mandibular anterior fractures. J Int Oral Health 2014;6(1):20-6. PMID:24653598

Barde, Dhananjay H; Mudhol, Anupama; Ali, Fareedi Mukram; Madan, R S; Kar, Sanjay; Ustaad, Farheen

2014-01-01

416

Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.  

PubMed

The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery. PMID:25078592

Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

2014-01-01

417

Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates  

PubMed Central

Background: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach. Materials and Methods: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup. Results: Forty patients (33 men and 7 women) who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years). All patients had a satisfactory articular reduction defined as ?2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP) and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection. Conclusions: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and allows early knee mobilization. Careful soft tissue handling and employing minimal invasive techniques minimizes soft tissue complications. PMID:23682182

Prasad, G Thiruvengita; Kumar, T Suresh; Kumar, R Krishna; Murthy, Ganapathy K; Sundaram, Nandkumar

2013-01-01

418

A minimally invasive modified reverse sural adipofascial flap for treating posttraumatic distal tibial and calcaneal osteomyelitis.  

PubMed

Our aim was to report a modified reverse sural adipofascial flap for treating posttraumatic distal tibial or calcaneal osteomyelitis. We retrospectively reviewed the records of 15 patients with posttraumatic distal tibial or calcaneal osteomyelitis treated with modified reverse sural adipofascial flaps between 2005 and 2010. The flap was raised through 2 short incisions in the posterior aspect of the lower leg. The raw surface of the flap was covered with a full-thickness skin graft. Donor sites were closed primarily. Lower Extremity Functional Scale (LEFS) scores and 2-point discrimination (TPD) were recorded preoperatively and postoperatively. There were 12 males and 3 females, with an average age of 39 years (range = 18-55 years). Twelve lesions were in the distal tibia and 3 in the calcaneus. The flap ranged in size from 11 × 5 cm to 16 × 7 cm. All flaps survived, and skin grafts healed without complications. Recipient sites had an anatomic contour, and all patients were able to ambulate without the assistance of special shoes or orthoses. No infections recurred, and no ulcers of the grafted skin occurred with the regular wearing of shoes. The follow-up duration was 18.7 ± 6.8 months (range = 12-36 months). The mean LEFS score increased from 22.4 ± 8.3 preoperatively to 53.0 ± 11.2 postoperatively (P = .001). TPD markedly recovered at 24 months postoperatively. The modified reverse sural adipofascial flap provides good outcomes in treating distal tibial and calcaneal osteomyelitis with minimal donor site morbidity. PMID:24275754

Yang, Chenglin; Geng, Shuo; Fu, Chunjiang; Sun, Jiabing; Bi, Zhenggang

2013-12-01

419

Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst  

PubMed Central

Baker cyst is an enlargement of the gastrocnemius-semimembranosus bursa. Neuropathy can occur due to either direct compression from the cyst itself or indirectly after cyst rupture. We report a unique case of a 49-year-old man with left sole pain and paresthesia who was diagnosed with posterior tibial neuropathy at the lower calf area, which was found to be caused by a ruptured Baker cyst. The patient's symptoms resembled those of lumbosacral radiculopathy and tarsal tunnel syndrome. Posterior tibial neuropathy from direct pressure of ruptured Baker cyst at the calf level has not been previously reported. Ruptured Baker cyst with resultant compression of the posterior tibial nerve at the lower leg should be included in the differential diagnosis of patients who complain of calf and sole pain. Electrodiagnostic examination and imaging studies such as ultrasonography or magnetic resonance imaging should be considered in the differential diagnosis of isolated paresthesia of the lower leg. PMID:24020041

Moon, Seock Ho; Im, Sun; Park, Geun-Young; Moon, Su-Jin; Park, Hye-Jeong; Choi, Hyun-Sook

2013-01-01

420

The influence of posterior-inferior tibial slope in ACL injury  

Microsoft Academic Search

Purpose  To explore the effect of different posterior-inferior tibial slope (PITS) angles on ACL injury at non-contact sports, knee\\u000a laxity and the need for ACL reconstruction.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  One hundred patients with an acute, arthroscopically verified total ACL rupture were followed prospectively with the intention\\u000a of treating the injury without reconstruction. Knee laxity was assessed with the Lachman and pivot shift tests with

Ioannis Kostogiannis; Per Swärd; Paul Neuman; Thomas Fridén; Harald Roos

2011-01-01

421

Comparison of delayed and primary wound closure in the treatment of open tibial fractures  

Microsoft Academic Search

Introduction  Primary wound closure in the management of open tibial fractures has generally been discouraged. Several prior studies suggest\\u000a that infections are not caused by the initial contamination, but are instead the result of organisms acquired in the hospital.\\u000a Primary wound closure after adequate wound care and fracture stabilisation could therefore be considered a reasonable option.\\u000a \\u000a \\u000a \\u000a Materials and methods  We analysed 95

E. Hohmann; K. Tetsworth; M. J. Radziejowski; T. F. Wiesniewski

2007-01-01

422

Knee braces can decrease tibial rotation during pivoting that occurs in high demanding activities  

Microsoft Academic Search

Purpose  The purpose of this study was to investigate whether knee braces could effectively decrease tibial rotation during high demanding\\u000a activities.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Using an in vivo three-dimensional kinematic analysis, 21 physically active, healthy, male subjects were evaluated. Each subject\\u000a performed two tasks that were used extensively in the literature because they combine increased rotational and translational\\u000a loads on the knee, (1) descending

Dimitrios Giotis; Vasilios Tsiaras; Stavros Ristanis; Franceska Zampeli; Grigoris Mitsionis; Nicholas Stergiou; Anastasios D. Georgoulis

2011-01-01

423

Tritiated thymidine uptake in chondrocytes of chickens afflicted with tibial dyschondroplasia  

SciTech Connect

/sup 3/H-Thymidine was localized in sections of growth-plate cartilage and associated tibial dyschondroplastic lesion by autoradiography. One hour after /sup 3/H-thymidine was injected, radioactivity was found in the proliferating zone; after 48 hr it was also in the hypertrophic zone, and by 96 hr it was present in cells that were 4 to 5 mm into the lesion. This indicates that the lesion develops from the growth plate itself. The life span of the cells in the growth plate appears to be about 48 hr.

Gay, C.V.; Leach, R.M.

1985-10-01

424

Distal tibial osteochondroma causing fibular deformity and deep peroneal nerve entrapment neuropathy: a case report.  

PubMed

Osteochondromas are the most common benign bone tumors, comprising 9% of all bone tumors and 35% of benign bone tumors. They are frequently diagnosed incidentally. Osteochondromas are mostly asymptomatic, but may cause mechanical findings depending on the location and size of the tumor. Rarely, they may originate from the interosseous surface of the tibia and affect the fibula. We report here a case of a rare osteochondroma originating from the distal tibial metaphysis and causing deep peroneal nerve entrapment syndrome with clinical and radiological findings. To our knowledge, this is the first case in the literature. PMID:25230273

Genç, Berhan; Solak, Aynur; Kalayc?o?lu, Sena; ?ahin, Neslin

2014-01-01

425

Reliability of computer-assisted surgery as an intraoperative ruler in navigated high tibial osteotomy  

Microsoft Academic Search

Background  Computer-assisted surgery (CAS) can act as an intraoperative ruler in high tibial osteotomy (HTO) to visualize continuously\\u000a the leg during surgery.\\u000a \\u000a \\u000a \\u000a \\u000a Questions  The aim of the study is to evaluate the accuracy of CAS with respect to preoperative planning and postoperative deviation\\u000a from the planned leg axis in HTO. In addition, the influence of surgeon experience as well as operation time

Florian Gebhard; Christian Krettek; Tobias Hüfner; Paul A. Grützner; Ulrich Stöckle; Andreas B. Imhoff; Stephan Lorenz; Jan Ljungqvist; Peter Keppler

2011-01-01

426

Gait analysis of walking before and after medial opening wedge high tibial osteotomy  

Microsoft Academic Search

Introduction  Medial opening wedge high tibial osteotomy (HTO) is used to treat medial compartment osteoarthritis (OA) of the knee. HTO\\u000a shifts the weight-bearing line from the medial compartment into the lateral compartment. The aim of this study was to investigate\\u000a the functional biomechanical consequences of this alteration in alignment.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Eleven male patients with medial compartment osteoarthritis underwent three-dimensional gait analysis during

Martin Lind; Jodie McClelland; Joanne E. Wittwer; Timothy S. Whitehead; Julian A. Feller; Kate E. Webster

427

Remodeling potentials of biphasic calcium phosphate granules in open wedge high tibial osteotomy  

Microsoft Academic Search

Introduction  Biphasic calcium phosphate (BCP) has proved to be an effective bone substitute, but it’s effectiveness and remodeling potential\\u000a in open wedge high tibial osteotomy (OWHTO) has not been analyzed yet. This study sought to evaluate the bone healing and\\u000a remodeling potentials of BCP granules using a radiographic rating system in biplanar OWHTO.\\u000a \\u000a \\u000a \\u000a Materials and methods  Fifteen patients (15 knees) underwent biplanar

Metin Ozalay; Orcun Sahin; Sercan Akpinar; Gurkan Ozkoc; Murat Cinar; Necip Cesur

2009-01-01

428

Early results of a novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn  

PubMed Central

Background The aim of this study was to describe the results of a 1-year patient follow-up after anterior vaginal wall darn, a novel technique for the repair of anterior vaginal wall prolapse. Methods Fifty-five patients with anterior vaginal wall prolapse underwent anterior vaginal wall darn. The anterior vaginal wall was detached using sharp and blunt dissection via an incision beginning 1 cm proximal to the external meatus and extending to the vaginal apex. The space between the tissues that attach the lateral vaginal walls to the arcus tendineus fasciae pelvis was then darned. Cough Stress Test, Pelvic Organ Prolapse Quantification, seven-item Incontinence Impact Questionnaire, and six-item Urogenital Distress Inventory scores were performed 1-year postoperatively to evaluate recovery. Results One-year postoperatively, all patients were satisfied with the results of the procedure. No patient had vaginal mucosal erosion or any other complication. Conclusions One-year postoperative findings for patients in this series indicate that patients with stage II–III anterior vaginal wall prolapse were successfully treated with the anterior vaginal wall darn technique. PMID:24973955

2014-01-01

429

In vivo tibial stiffness is maintained by whole bone morphology and cross-sectional geometry in growing female mice  

PubMed Central

Whole bone morphology, cortical geometry, and tissue material properties modulate skeletal stresses and strains that in turn influence skeletal physiology and remodeling. Understanding how bone stiffness, the relationship between applied load and tissue strain, is regulated by developmental changes in bone structure and tissue material properties is important in implementing biophysical strategies for promoting healthy bone growth and preventing bone loss. The goal of this study was to relate developmental patterns of in vivo whole bone stiffness to whole bone morphology, cross-sectional geometry, and tissue properties using a mouse axial loading model. We measured in vivo tibial stiffness in three age groups (6wks, 10wks, 16wks old) of female C57Bl/6 mice during cyclic tibial compression. Tibial stiffness was then related to cortical geometry, longitudinal bone curvature, and tissue mineral density using microcomputed tomography (microCT). Tibial stiffness and the stresses induced by axial compression were generally maintained from 6 to 16wks of age. Growth-related increases in cortical cross-sectional geometry and longitudinal bone curvature had counteracting effects on induced bone stresses and, therefore, maintained tibial stiffness similarly with growth. Tissue mineral density increased slightly from 6 to 16wks of age, and although the effects of this increase on tibial stiffness were not directly measured, its role in the modulation of whole bone stiffness was likely minor over the age range examined. Thus, whole bone morphology, as characterized by longitudinal curvature, along with cortical geometry, plays an important role in modulating bone stiffness during development and should be considered when evaluating and designing in vivo loading studies and biophysical skeletal therapies. PMID:20673665

Main, Russell P.; Lynch, Maureen E.; van der Meulen, Marjolein C.H.

2010-01-01

430

Making heads from tails: Development of a reversed anterior–posterior axis during budding in an acoel  

Microsoft Academic Search

The anterior–posterior axis is a key feature of the bilaterian body plan. Although axis specification during embryogenesis has been studied extensively, virtually nothing is known about how this axis can be established post-embryonically, as occurs in budding animals. We investigated bud formation in the acoel Convolutriloba retrogemma, which reproduces by a remarkable process involving the formation of animals with linked

James M. Sikes; Alexandra E. Bely

2010-01-01

431

Strain Inhomogeneity in the Anterior Cruciate Ligament  

E-print Network

be needed to predict injury ofthe anterior cruciate ligament (ACL), Richmond, CA 94804 this work tested the application ofa number of loads important to injury etiology of the ACL. To provide the data for testing, moments, quadriceps, and hamstrings forces. Various combinations of these loads Davis, CA 95616 were also

Hull, Maury

432

Retrograde Amnesia Following Anterior Thalamic Infarction  

Microsoft Academic Search

Background : Retrograde amnesia (RA) refers to the failure to recall events that occurred before a brain injury. RA is known to be associated with brain lesions involving the hippocampus, entorhinal cortex and the frontal lobe. Anterior thalamic lesion often causes anterograde amnesia but rarely causes RA. The aim of the present study is in two parts . First, we

Jee-Young Oh; Jay C. Kwon; Juhee Chin; Jae-Hong Lee; Kyoung-Gyu Choi; Kee-Duk Park; Yong Jeong; Duk L. Na

2002-01-01

433

Chlamydia in Anterior Ischemic Optic Neuropathy  

Microsoft Academic Search

There is an increasing body of evidence linking the common respiratory human pathogen Chlamydia pneumoniae with atherosclerosis and other vascular disorders. Our research was designed to investigate the association of this organism with anterior ischemic optic neuropathy (AION), representing an acute ischemic disorder of the optic nerve head. Sera were examined of 14 consecutive patients with AION and of 14

Pia V. Vécsei; Karl Kircher; Andreas Reitner; Gelas Khanakha; Gerold Stanek

2002-01-01

434

The Role of the Very Long Posterior Tibial Artery Flap following Severe Lower Limb Trauma: Case Series and Literature Review  

PubMed Central

Summary: With advancing techniques, knowledge, and training, the decision to salvage a lower limb following severe trauma is becoming ever more popular and successful. However, in cases where amputation is inevitable due to extensive injury or infection, we encourage the use of the very long posterior tibial artery (VLPTA) flap when the sole of the foot and posterior tibial neurovasculature are intact. We report 3 patients who underwent below-knee amputation and reconstruction using the VLPTA flap. A literature review was also performed to identify the outcomes and any complications associated with VLPTA flap. PMID:25289233

Sayed, Leela; Williams, Stephen; Offer, Graham J.

2013-01-01

435

Management of extensive tibial osteolysis with the Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation.  

PubMed

Although total ankle replacement has endured improvement in implant design since its conception, failure requiring revision remains a known endpoint. We describe a technique for management of extensive tibial osteolysis for failed Agility™ total ankle replacement systems using geometric metal-reinforced polymethylmethacrylate cement augmentation. This technique provides immediate component stability and is a cost-effective alternate to impaction bone grafting. With this technique, the complications we have experienced have been limited to minor delayed incisional healing, and all patients have resumed meaningful weightbearing activities with stable integration of the tibial component. PMID:24370485

Prissel, Mark A; Roukis, Thomas S

2014-01-01

436

Clinical and functional outcomes after operative management of Salter-Harris III and IV fractures of the proximal tibial epiphysis.  

PubMed

Pediatric proximal tibial epiphysis fractures are uncommon and have subsequently received little attention in terms of treatment and outcomes. We studied the clinical and functional outcomes of 13 patients with Salter-Harris III and IV fractures of the proximal tibial epiphysis after operative fixation. Associated meniscus, ligamentous, or neurovascular injury was present in 100% of this cohort. Provisional external fixation and locked plating spanning the open physis were used in the majority of cases. The mean clinical follow-up was 15.69 months, where all fractures progressed to union. Good functional outcomes with a low complication rate are possible after operative fixation of these infrequent injuries. PMID:24977943

Hill, Brian W; Rizkala, Amir R; Li, Mengnai

2014-09-01

437

Measurement of anterior chamber diameter and biometry of anterior segment by Scheimpflug slitlamp photography  

SciTech Connect

Twenty-eight fresh donor eyes (Georgia Lions Eye Bank) ranging in age from four months to 87 years were used for an in vitro study to determine the feasibility of obtaining accurate anterior chamber diameter measurements with our Scheimpflug ultraviolet-visible slitlamp densitography apparatus. The in vivo study was performed on 16 hybrid monkeys (of varying age). These data were within 0.1 mm of measurements obtained with a modified paracentesis needle specially designed to obtain such measurements. The results of the foregoing study demonstrate that the Scheimpflug slitlamp photographic analyses can provide an accurate measurement of the anterior chamber diameter without entering the globe surgically. This will enable the surgeon to determine the diameter and order an anterior chamber IOL of a specified size prior to surgery. The authors have devised an automated program to analyze the negatives and provide direct anterior chamber diameter measurements.

Lerman, S.; Hockwin, O.

1985-03-01

438

Antipronation taping and temporary orthoses. Effects on tibial rotation position after exercise.  

PubMed

Abnormal lower-limb biomechanics--in particular, abnormal pronation of the subtalar joint with concomitant increased internal rotation of the tibia--is one of the major causes of overuse injuries of the lower limb. A randomized, controlled, within-subjects research design (N = 14) was used to investigate the effect of a temporary felt orthosis and an antipronation taping technique to control the transverse tibial rotation position immediately after application and after each of two 10-minute periods of exercise. The results showed that the taping technique was superior to both the orthosis and no intervention in controlling tibial rotation position immediately after application and after 10 minutes of exercise. After 20 minutes of exercise, neither the tape nor the orthosis was significantly superior to the control; however, the trends suggested that some residual control was maintained. Future studies are needed to determine the amount of foot pronation control required to relieve symptoms in a symptomatic population in order to determine the clinical effectiveness of these treatment methods. PMID:10095333

Hadley, A; Griffiths, S; Griffiths, L; Vicenzino, B

1999-03-01

439

Crosslink density, oxidation and chain scission in retrieved, highly cross-linked UHMWPE tibial bearings.  

PubMed

Irradiated, thermally stabilized, highly cross-linked UHMWPE bearings have demonstrated superior wear performance and improved in vitro oxidation resistance compared with terminally gamma-sterilized bearings, yet retrieval analysis reveals unanticipated in vivo oxidation in these materials despite fewer or no measurable free radicals. There has been little evidence to date that the oxidation mechanism in thermally stabilized materials is the same as that in conventional materials, and so it is unknown whether oxidation in these materials is leading to chain scission and a degradation of mechanical properties, molecular weight, and crosslink density. The aim of this study was to determine whether measured in vivo oxidation in retrieved, highly cross-linked tibial bearings corresponds with a decreasing crosslink density. Analysis of three tibial bearing materials revealed that crosslink density decreased following in vivo duration, and that the change in crosslink density was strongly correlated with oxidation. The results suggest that oxidation in highly cross-linked materials is causing chain scissions that may, in time, impact the material properties. If in vivo oxidation continues over longer durations, there is potential for a clinically significant degradation of mechanical properties. PMID:24589360

Reinitz, Steven D; Currier, Barbara H; Levine, Rayna A; Van Citters, Douglas W

2014-05-01

440

Knee-simulator testing of conventional and cross-linked polyethylene tibial inserts.  

PubMed

We compared the resistance to delamination and to adhesive/abrasive wear of conventional and highly cross-linked polyethylene tibial inserts of a cruciate-retaining total knee design using a knee simulator. Both groups were tested after aggressive, accelerated aging, and 1 set of conventional inserts was studied without aging. Aging oxidized the conventional, but not the highly cross-linked, inserts. The simulated normal gait testing lasted for 5 and 10 million cycles for the conventional and highly cross-linked inserts, respectively. Aged conventional inserts showed delaminations, whereas none were observed in the unaged conventional and aged cross-linked inserts. Wear rates measured by the gravimetric method were 9 +/- 2 mm3, 10 +/- 4 mm3, and 1 +/- 0 mm3 per million cycles; by the metrologic method, they were 8 +/- 1 mm3, 9 +/- 2 mm3, and 3 +/- 0 mm3 for the unaged conventional, aged conventional, and aged highly crosslinked inserts, respectively. In the test model used, oxidation led to delamination, whereas increased cross-link density resulted in reduced adhesive/abrasive wear of tibial inserts. PMID:15483806

Muratoglu, Orhun K; Bragdon, Charles R; Jasty, Murali; O'Connor, Daniel O; Von Knoch, Rebecca S; Harris, William H

2004-10-01

441

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

Microsoft Academic Search

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

David N. M. Caborn; Jeffrey B. Selby

2002-01-01

442

Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption  

Microsoft Academic Search

Instrumented anterior\\/posterior laxity measurements were performed on 138 patients evaluated within 2 weeks of injury with their first traumatic knee hemar throsis. All patients were tested with the MEDmetric Arthrometer model KT-1000 in a knee injury clinic. Seventy-five of the patients had knee arthroscopy. Thirty-three had arthrometer laxity tests under anes thesia. Eighty-seven percent of patients arthroscoped had anterior cruciate

Dale M. Daniel; Mary Lou Stone; Raymond Sachs; Lawrence Malcom

1985-01-01

443

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

Microsoft Academic Search

We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and

T. M. van Raaij; J. de Waal Malefijt

2006-01-01

444

Acute flaccid paralysis with anterior myelitis - california, june 2012-june 2014.  

PubMed

In August 2012, the California Department of Public Health (CDPH) was contacted by a San Francisco Bay area clinician who requested poliovirus testing for an unvaccinated man aged 29 years with acute flaccid paralysis (AFP) associated with anterior myelitis (i.e., evidence of inflammation of the spinal cord involving the grey matter including anterior horn cell bodies) and no history of international travel during the month before symptom onset. Within 2 weeks, CDPH had received reports of two additional cases of AFP with anterior myelitis of unknown etiology. Testing at CDPH's Viral and Rickettsial Disease Laboratory for stool, nasopharyngeal swab, and cerebrospinal fluid (CSF) did not detect the presence of an enterovirus (EV), the genus of the family Picornaviridae that includes poliovirus. Additional laboratory testing for infectious diseases conducted at the CDPH Viral and Rickettsial Disease Laboratory did not identify a causative agent to explain the observed clinical syndrome reported among the patients. To identify other cases of AFP with anterior myelitis and elucidate possible common etiologies, CDPH posted alerts in official communications for California local health departments during December 2012, July 2013, and February 2014. Reports of cases of neurologic illness received by CDPH were investigated throughout this period, and clinicians were encouraged to submit clinical samples for testing. A total of 23 cases of AFP with anterior myelitis of unknown etiology were identified. Epidemiologic and laboratory investigation did not identify poliovirus infection as a possible cause for the observed cases. No common etiology was identified to explain the reported cases, although EV-D68 was identified in upper respiratory tract specimens of two patients. EV infection, including poliovirus infection, should be considered in the differential diagnosis in cases of AFP with anterior myelitis and testing performed per CDC guidelines. PMID:25299608

Ayscue, Patrick; Haren, Keith Van; Sheriff, Heather; Waubant, Emmanuelle; Waldron, Paul; Yagi, Shigeo; Yen, Cynthia; Clayton, Anna; Padilla, Tasha; Pan, Chao; Reichel, John; Harriman, Kathleen; Watt, James; Sejvar, James; Nix, William Allan; Feikin, Daniel; Glaser, Carol; Ek, Moturi

2014-10-10

445

Doppler ultrasound and tibial tuberosity maturation status predicts pain in adolescent male athletes with Osgood-Schlatter's disease: a case series with comparison group and clinical interpretation  

PubMed Central

Background The pathogenesis of the Osgood-Schlatter's disease (OSD) is still debated. The fragmentation of the ossification centre has been questioned as a definitive sign of OSD and has been seen as a normal development of the anterior tibial tubercle (ATT). Objectives It is unknown if such changes are present in the presumed pathological tendon insertion seen in OSD, nor the relation of Doppler-positive changes to pain on clinical examination. Methods A prospective analysis was carried out on 20 consecutive symptomatic male athletes (13.9?years±1.3) and a comparison group of asymptomatic subjects. All underwent a comparative clinical assessment and ultrasound with colour Doppler scan on both knees. Subjective pain was recorded with a visual analogue scale (VAS) during provocative manoeuvres: palpation, resisted contraction and single leg squat. Results Positive Doppler US (within the distal end of the patellar tendon) was associated with higher pain on palpation (47±24.5 vs 18±11.4, p<0.01) and resisted static contraction (59±20.2 vs 27±12.5, p<0.001) compared with Doppler-negative subjects. No Doppler activity was found in the comparison group. VAS for palpation and resisted contraction of the athletes graded as stage 2 (51.1±22.0 and 60.0±21.2) were significantly higher than stage 3 (17.8±12.0 and 18.9±16.9) and stage 4 (15.0±7.1 and 25.0±7.1; p<0.01). Conclusions More painful OSD is associated with the presence of neo-vessels. This may be linked with a particular stage of ATT maturation and applied compressive forces. A Doppler ultrasound scan adds practical information to develop the care plan of the patient. PMID:22952406

Sailly, Matthieu; Whiteley, Rod; Johnson, Amanda

2013-01-01

446

Management of post-operative Nocardia endophthalmitis.  

PubMed

Post-operative Nocardia endophthalmitis has an aggressive course and poor visual prognosis. It often masquerades as severe post-operative uveitis or toxic anterior segment syndrome due to the absence of vitreous involvement resulting in a delay in diagnosis. The poor prognosis in Nocardia endophthalmitis is due to severe intra-ocular inflammation which may lead to phthisis. Therefore, treatment with corticosteroids after appropriate antibiotics have been initiated may improve the outcome. This is an interventional case report highlighting the typical features of Nocardia endophthalmitis, which when diagnosed early and managed medically with antibiotics and steroids, resulted in an excellent visual outcome in our patient. PMID:22885210

Pradhan, Z S; Jacob, P; Korah, S

2012-01-01

447

Cemented cruciate-retaining total knee arthroplasty in osteoarthritis: a comparison of pegged and stemmed tibial designs.  

PubMed

We compared the clinical, functional, and radiographic outcomes between pegged (37 knees in 37 patients) and stemmed (33 knees in 31 patients) tibial designs in patients undergoing primary cemented total knee arthroplasty (TKA) for osteoarthritis (OA). Outcomes were evaluated using the knee society score (KSS-Clinical and Function scores) and knee injury and osteoarthritis outcome score (KOOS-pain, symptoms, stiffness, and function scores) at 6, 12, and 24 months postoperatively. Pre- and postoperative radiographs were evaluated for alignment and tibial coverage. All the outcome scores showed statistically significant improvement compared with the respective preoperative ones in both the groups at all points in time (p???0.039). None of the outcome scores were significantly different between the two groups at any point in time (p???0.06). Postoperative knee range of motion was also similar between the two groups at all points in time (p???0.641). Mean percentage tibial coverage was significantly greater in the pegged group as compared with the stemmed one (95.5% vs. 93.4%, p?=?0.036). Incidence of complications (p?=?0.617) and rates of revision (p?=?1.000) were similar between the two groups. In conclusion, comparison of clinical and functional outcomes between the pegged and the stemmed tibial designs in TKA for primary OA did not reveal any significant difference at 2 years. PMID:24420980

Shah, Siddharth Mahesh; Dutton, Andrew Quoc; Liang, Shen; Ng, Geoffrey; Dasde, Shamal

2014-10-01

448

The Quantitative Detection of Posttraumatic Osteoarthrosis after Fractures of the Tibial Plateau Using MRI-based Chondrovolumetry  

Microsoft Academic Search

Despite developing better treatment for fractures of the tibial head, particularly intraarticular ones, late degenerative arthritis still presents a very serious problem. Difficulties in the diagnosis of early secondary degenerative changes derive from the fact that plain radiographs are limited to the detection of late manifestations and indirect signs of osteoarthritis because articular cartilage is not visible radiographically. To examine