Sample records for anterior tibial post

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

    Microsoft Academic Search

    Panagiotis Baltopoulos; Eugenia Papadakou; Maria Tsironi; Panagiotis Karagounis

    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

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

    PubMed Central

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

    2008-01-01

    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 1st 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 (1st 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

  3. Anterior tibial compartment pressure during race walking

    Microsoft Academic Search

    Lennart Sanzen; Artur Forsberg; Nils Westlin

    1986-01-01

    In 14 race walkers the intramuscular pressure in the anterior tibial muscle was measured with a wick cath eter. At rest the pressure was 10 to 15 mmHg and increased by a factor of 10 during full speed walking. Those walkers who experienced pain in the anterior tibial muscle also had a higher than average pressure. Fasciotomy decreased the intramuscular

  4. Exercise-induced bilateral anterior tibial compartment syndrome without pain

    Microsoft Academic Search

    G. Ciacci; A. Federico; F. Giannini; M. Mondelli; F. Reale; A. Rossi

    1986-01-01

    We report the case of a 41 year old man who complained of a severe bilateral deficit of the anterior tibial compartment two hours after prolonged exercise. On admission there was no spontaneous or evoked pain, no objective sensory deficit but total loss of dorsiflexion of feet and toes. Electrophysiological investigation showed no voluntary or evoked electrical activity in tibial

  5. Dynamic analysis of anterior tibial translation during isokinetic quadriceps femoris muscle concentric contraction exercise

    Microsoft Academic Search

    S Kizuki; K Shirakura; M Kimura; N Fukasawa; E Udagawa

    1995-01-01

    Using a knee motion analyser, we have studied anterior tibial translation under a range of loading conditions in normal and anterior cruciate ligament (ACL) deficient knees. Anterior displacement in excess of that observed in passive knee flexion was noted in a static Lachman test. Anterior tibial displacement in normal knees increased steadily as the knee was extended from 60° flexion

  6. Anterior cruciate ligament reconstructionThe effect of tibial tunnel placement on range of motion

    Microsoft Academic Search

    Victor M. Romano; Ben K. Graf; James S. Keene; Richard H. Lange

    1993-01-01

    In 111 patients who had anterior cruciate ligament reconstructions, postoperative radiographic measure ments of anterior to posterior and medial to lateral location of the tibial tunnels were correlated with the final range of motion achieved. In the 25 patients with extension deficits of 10° or more, placement of the tibial tunnel was more anterior (average, anterior 23% of the tibia)

  7. Rotational alignment of the tibial component in total knee arthroplasty: the anterior tibial cortex is a reliable landmark

    PubMed Central

    BALDINI, ANDREA; INDELLI, PIER FRANCESCO; DE LUCA, LAPO; MARIANI, PIERPAOLO CERULLI; MARCUCCI, MASSIMILIANO

    2013-01-01

    Purpose to compare the anterior tibial surface curvature, the Akagi’s line and the medial third of the tibial tubercle in order to assess which is the most reliable landmark for correct tibial component rotational positioning in total knee arthroplasty. Methods three independent investigators reviewed 124 knee MRI scans. The most suitable tibial baseplate tracing for the Nexgen Total Knee System (Zimmer, Warsaw, USA) was superimposed on the scan matching the anterior tibial cortex with the anterior aspect of the baseplate. The rotation of the tibial baseplate tracing was calculated with respect to the transepicondylar axis (TEA), the medial third of the tibial tubercle line, Akagi’s line and the femoral posterior condylar axis (PCA). Customized software was created and used for analysis of the MRI datasets. The reliability of each measurement was then calculated by using the intraclass correlation coefficient for interobserver agreement. Results observer agreement on the position of the Akagi’s line was within 3° in 64% of the cases and within 5° in 85% of the cases. Agreement on the position of the medial third of the tibial tubercle was within 3° in 29% of the cases and within 5° in 70% of the cases. Agreement on the localization of the anterior tibial surface curvature was within 3° in 89% of the cases and within 5° in 99% of the cases. Component alignment along the anterior cortex guaranteed full matching ± 3° with the epicondylar axis in 75% of the knees. Conclusions the anterior tibial surface curvature was found to be a more reliable and more easily identifiable landmark for correct tibial component alignment than either Akagi’s line or the medial third of the tibialtubercle. Level of evidence level III, retrospective cohort study. PMID:25606527

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

    Microsoft Academic Search

    C. Mabit; C. Pécout

    1994-01-01

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

  9. Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament

    Microsoft Academic Search

    Stephen M. Howell

    1998-01-01

    Reconstruction of a torn anterior cruciate ligament (ACL) cannot be successful without a properly placed tibial tunnel. Preventable complications such as anterior knee pain, effusions, extension loss, and recurrent instability can occur when the tibial tunnel is improperly placed and the roof and notchplasty are insufficient. This article reviews the principles for anatomic placement of the tibial tunnel so that

  10. Free vascularised epiphyseal transfer designed on the reverse anterior tibial artery.

    PubMed

    Sawaizumi, M; Maruyama, Y; Okajima, K; Motegi, M

    1991-01-01

    This report describes a case of radial club hand which was reconstructed by a proximal growth plate of the fibula supplied by the reverse anterior tibial artery. A brief discussion on epiphyseal transfer of the fibula is included. PMID:1993241

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

    Microsoft Academic Search

    G. Illuminati; A. Bertagni; V. Martinelli

    1998-01-01

    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

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

    PubMed

    Wong, Jessica J; Muir, Brad

    2013-06-01

    Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up. PMID:23754857

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

    PubMed Central

    Wong, Jessica J.; Muir, Brad

    2013-01-01

    Peri-articular fractures after anterior cruciate ligament (ACL) reconstructive surgery are rare. To our knowledge, this case documents the first insufficiency fracture of the tibial plateau after ACL reconstruction, which presented three weeks after the procedure. A 25-year-old female recreational soccer player suffered an insufficiency fracture of the tibial plateau, extending 1.5 mm into the anterior wall of tibial tunnel and medial compartment under the anterior horn of medial meniscus, which presented as a diagnostic challenge. Clinically, the fracture mimicked a low-grade infection of the surgical site, while radiographically, the fracture resembled an avulsion fracture, later confirmed as a tibial tunnel fracture with computed tomography. With the ACL graft integrity not in jeopardy, four weeks of non-weightbearing and a delayed post-operative rehabilitation program was effective in allowing the fracture to heal. Good functional outcome was achieved after conservative management, with minimal loss of terminal knee extension and minimal pain at 22-month follow-up. PMID:23754857

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

    PubMed Central

    Rosene, John M.; Fogarty, Tracey D.

    1999-01-01

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

  15. Atypical presentation of popliteal artery entrapment syndrome: involvement of the anterior tibial artery.

    PubMed

    Bou, Steven; Day, Carly

    2014-11-01

    Popliteal artery entrapment syndrome (PAES) is a rare condition that should be suspected in a young patient with exertional lower extremity pain. We report the case of an 18-year-old female volleyball player with bilateral exertional lower extremity pain who had been previously diagnosed with tendinitis and periostitis. Diagnostic studies showed entrapment of the left popliteal artery and the left anterior tibial artery. To our knowledge, there has only been 1 previous report of anterior tibial artery involvement in PAES. PMID:24880061

  16. Arthroscopic 4-Point Suture Fixation of Anterior Cruciate Ligament Tibial Avulsion Fractures

    PubMed Central

    Boutsiadis, Achilleas; Karataglis, Dimitrios; Agathangelidis, Filon; Ditsios, Konstantinos; Papadopoulos, Pericles

    2014-01-01

    Tibial eminence avulsion fractures are rare injuries occurring mainly in adolescents and young adults. When necessary, regardless of patient age, anatomic reduction and stable internal fixation are mandatory for fracture healing and accurate restoration of normal knee biomechanics. Various arthroscopically assisted fixation methods with sutures, anchors, wires, or screws have been described but can be technically demanding, thus elongating operative times. The purpose of this article is to present a technical variation of arthroscopic suture fixation of anterior cruciate ligament avulsion fractures. Using thoracic drain needles over 2.4-mm anterior cruciate ligament tibial guidewires, we recommend the safe and easy creation of four 2.9-mm tibial tunnels at different angles and at specific points. This technique uses thoracic drain needles as suture passage cannulas and offers 4-point fixation stability, avoiding potential complications of bony bridge fracture and tunnel connection. PMID:25685674

  17. Relationship between static anterior laxity using the KT-1000 and dynamic tibial rotation during motion in patients with anatomical anterior cruciate ligament reconstruction.

    PubMed

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

    2013-01-01

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

  18. The "N + 7 rule" for tibial tunnel placement in endoscopic anterior cruciate ligament reconstruction.

    PubMed

    Miller, M D; Hinkin, D T

    1996-02-01

    Tibial tunnel placement during endoscopic anterior cruciate ligament (ACL) reconstruction has received increased emphasis in the recent literature. Appropriate tunnel length is a critical technical consideration. A tunnel that is too short results in graft extrusion, necessitating supplemental fixation techniques. A tunnel that is too long may make distal fixation and femoral tunnel placement difficult. A simple rule is proposed that allows for correct tunnel length and allows placement of the bone plug consistently within the tibial tunnel, allowing interference screw fixation. PMID:8838744

  19. Effect of Trunk Position on Anterior Tibial Displacement Measured by the KT-1000 in Uninjured Subjects

    PubMed Central

    Webright, William G.; Perrin, David H.; Gansneder, Bruce M.

    1998-01-01

    Objective: Clinicians may obtain false-negative Lachman tests for tibial displacement when the trunk position of the athlete varies as the anterior cruciate ligament injury is assessed on the field, on the sideline, and in the clinic. We examined the influence of supine, semireclined, and sitting trunk positions on arthrometric laxity measurements of the knee. Design and Setting: Subjects in the 3 trunk-thigh test positions (15 °, 45 °, and 90 ° of hip flexion) were passively supported and tested in a counterbalanced order. The right knee was maintained at 29.0 ° ± 3.1 ° of flexion. A 133-N (30-1b) anterior force was applied to the right knee using a modified KT-1000 knee arthrometer equipped with a strain gauge that allowed for digital display of the displacement force. Subjects: Ten males and 5 females without present knee injury or history of knee ligament repair to the right lower extremity. Measurements: Three tibial displacement (mm) trials at each trunk position were averaged and used for analysis. Results: A 1-factor (trunk-thigh position) repeated-measures analysis of variance revealed no significant difference in anterior tibial displacement values among the 3 trunk-thigh positions (P > .05). Group means for displacement were 7.9 ± 2.3 mm (supine), 8.1 ± 2.5 mm (semireclined), and 8.3 ± 2.6 mm (sitting). Conclusions: These findings suggest that alterations in trunk position are not a problem in the instrumented assessment of anterior tibial displacement in an uninjured population. Further research should determine the relevance of these findings, as well as “end-feel” (ie, stiffness) in subjects with injury to the anterior cruciate ligament. Further research should also determine if these findings can be applied when comparing passive versus active (eg, propped on elbows or hands) trunk support in subjects with anterior cruciate ligament-injured knees. ImagesFigure 1.Figure 2.Figure 3. PMID:16558516

  20. Anterior tibial compartment syndrome following rupture of a popliteal cyst

    Microsoft Academic Search

    Toshio Ushiyama; Taku Kawasaki; Yoshitaka Matsusue

    2003-01-01

    A ruptured popliteal cyst usually results in calf pain and swelling. We report the case of a patient with rheumatoid arthritis\\u000a who developed anterior compartment syndrome of the leg following rupture of a popliteal cyst. Since acute compartment syndrome\\u000a requires prompt treatment, clinicians should be aware of this rare complication.

  1. A Comparison of the Fixation Strengths Provided by Different Intraosseous Tendon Lengths during Anterior Cruciate Ligament Reconstruction: A Biomechanical Study in a Porcine Tibial Model

    PubMed Central

    Yang, Dong-Lyul; Cheon, Sang-Ho; Oh, Chang-Wug

    2014-01-01

    Background The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. Methods Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 × 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. Results No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). Conclusions In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction. PMID:24900898

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

    PubMed

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

    1998-08-01

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

  3. Tibial bone bridge and bone block fixation in double-bundle anterior cruciate ligament reconstruction without hardware: a technical note.

    PubMed

    Siebold, R; Thierjung, H; Cafaltzis, K; Hoeschele, E; Tao, J; Ellert, T

    2008-04-01

    Current techniques for tibial graft fixation in four tunnels double bundle (DB) anterior cruciate ligament (ACL) reconstruction are by means of two interference screws or by extracortical fixation with a variety of different implants. We introduce a new alternative tibial graft fixation technique for four tunnels DB ACL reconstruction without hardware. About 3.5 to 5.5 cm bone cylinder with a diameter of 7 mm is harvested from the anteromedial (and posterolateral) tibial bone tunnel (s) with a core reamer. The anteromedial (AM) and posterolateral (PL) hamstring tendon grafts (or alternatively tendon allografts) are looped over an extracortical femoral fixation device and cut in length according to the total femorotibial bone tunnel length. The distal 3 cm of each, the AM- and PL bundle graft are armed with two strong No. 2 nonresorbable sutures and the four suture ends of each graft are tied to each other over the 2 cm wide cortical bone bridge between the tibial AM and PL bone tunnel. In addition the AM- and/or PL bone block which was harvested at the beginning of the procedure is re-impacted into the two tibial bone tunnels. A dorsal splint is used for the first two postoperative weeks and physiotherapy is started the second postoperative day. The technique is applicable for four tunnels DB ACL reconstruction in patients with good tibial bone quality. The strong fixation technique preserves important tibial bone stock and avoids the use of tibial hardware which knows disadvantages. It does increase tendon to bone contact and tendon-to-bone healing and does reduce implant costs to those of a single bundle (SB) ACL reconstruction. Revision surgery may be facilitated significantly but the technique should not be used when bony defects are present. In case of insufficient bone bridge fixation or bone blocks hardware fixation can be applied as usual. PMID:18066528

  4. The Role of Fibers in the Femoral Attachment of the Anterior Cruciate Ligament in Resisting Tibial Displacement

    PubMed Central

    Kawaguchi, Yasuyuki; Kondo, Eiji; Takeda, Ryo; Akita, Keiichi; Yasuda, Kazunori; Amis, Andrew A.

    2015-01-01

    Purpose The purpose was to clarify the load-bearing functions of the fibers of the femoral anterior cruciate ligament (ACL) attachment in resisting tibial anterior drawer and rotation. Methods A sequential cutting study was performed on 8 fresh-frozen human knees. The femoral attachment of the ACL was divided into a central area that had dense fibers inserting directly into the femur and anterior and posterior fan-like extension areas. The ACL fibers were cut sequentially from the bone: the posterior fan-like area in 2 stages, the central dense area in 4 stages, and then the anterior fan-like area in 2 stages. Each knee was mounted in a robotic joint testing system that applied tibial anteroposterior 6-mm translations and 10° or 15° of internal rotation at 0° to 90° of flexion. The reduction of restraining force or moment was measured after each cut. Results The central area resisted 82% to 90% of the anterior drawer force; the anterior fan-like area, 2% to 3%; and the posterior fan-like area, 11% to 15%. Among the 4 central areas, most load was carried close to the roof of the intercondylar notch: the anteromedial bundle resisted 66% to 84% of the force and the posterolateral bundle resisted 16% to 9% from 0° to 90° of flexion. There was no clear pattern for tibial internal rotation, with the load shared among the posterodistal and central areas near extension and mostly the central areas in flexion. Conclusions Under the experimental conditions described, 66% to 84% of the resistance to tibial anterior drawer arose from the ACL fibers at the central-proximal area of the femoral attachment, corresponding to the anteromedial bundle; the fan-like extension fibers contributed very little. This work did not support moving a single-bundle ACL graft to the side wall of the notch or attempting to cover the whole attachment area if the intention was to mimic how the natural ACL resists tibial displacements. Clinical Relevance There is ongoing debate about how best to reconstruct the ACL to restore normal knee function, including where is the best place for ACL graft tunnels. This study found that the most important area on the femur, in terms of resisting displacement of the tibia, was in the central-anterior part of the femoral ACL attachment, near the roof of the intercondylar notch. The testing protocol did not lead to data that would support using a large ACL graft tunnel that attempts to cover the whole natural femoral attachment area. PMID:25530509

  5. The Interrelationships Among Sex Hormone Concentrations, Motoneuron Excitability, and Anterior Tibial Displacement in Women and Men

    PubMed Central

    Hoffman, Mark; Harter, Rod A; Hayes, Bradley T; Wojtys, Edward M; Murtaugh, Paul

    2008-01-01

    Context: Sex hormone fluctuations have been implicated as a contributing factor to the high rates of noncontact injury to the anterior cruciate ligament in females. Objective: To determine the strength of the relationships among variables of sex hormone concentrations, motoneuron excitability, and anterior tibial displacement (ATD) in women and men and to determine if these relationships differ between the sexes. Design: Cohort study. Setting: Sports medicine laboratory. Patients or Other Participants: Twenty-eight regularly menstruating women (age ?=? 22.4 ± 3.4 years) and 15 men (age ?=? 22.3 ± 3.7 years) participated in the study. Intervention(s): Fluctuations in sex hormones were determined for the participants. Female participants were tested every other day of their menstrual cycles, whereas male participants were tested every fourth day during the 28-day period. Main Outcome Measure(s): We measured Hoffmann reflexes (maximum Hoffmann reflex [Hmax] to maximum M-wave [Mmax] ratio in the soleus), ATD under a 134-N load, and saliva concentrations of estrogen and progesterone. The independent variable was sex. Pearson product moment correlation coefficients were calculated for each participant by pairing measurements made on the same day. Two-tailed independent-samples t tests were used to determine the difference between the male and female correlations for each variable. Results: Over the course of the study, the relationships between Hmax?Mmax and estrogen, Hmax?Mmax and progesterone, ATD and estrogen, and ATD and progesterone were not different between the sexes. However, the relationship between ATD and progesterone was different between the sexes (P ?=? .036). Conclusions: The observed correlations did not support our hypothesis that the relationships between sex hormone levels and reflex activity or between sex hormone levels and ATD would be different for women compared with men. If sex hormone concentrations significantly contribute to anterior cruciate ligament ruptures because of changes in laxity or in motoneuron excitability, their mechanism of action is likely multifactorial and complex. PMID:18668169

  6. Venous drainage of the radial forearm and anterior tibial reverse flow flaps: anatomical and radiographic perfusion studies.

    PubMed

    Nakajima, H; Imanishi, N; Aiso, S; Fujino, T

    1997-09-01

    The anatomy of the venous system in the pedicles of the radial forearm and anterior tibial reverse flow flaps was investigated in fresh cadavers (n = 6) and their drainage pathways were observed in a radiographic perfusion study of the veins of 2 radial forearm and 2 anterior tibial pedicles. The venous system was found to consist mainly of three types of veins: venae comitantes, communicating veins between the venae comitantes, and vasa vasorum. Valves were identified in all three types of vein. In the venous system, including the vasa vasorum, there was no route of reverse flow that did not pass directly through valves. Valve incompetence was demonstrated in the radiographic perfusion study. However, valve incompetence did not occur in all valves and a difference in valve resistance against reverse flow pressure existed. Veins with relatively weak valve resistance became the drainage pathway. A possible cause of the difference in valve resistance was differences in the anatomy of the valve sinuses. PMID:9326141

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

    PubMed

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

    2011-06-01

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

  8. [Anterior laxity and internal arthritis of the knee. Results of the reconstruction of the anterior cruciate ligament associated with tibial osteotomy].

    PubMed

    Lerat, J L; Moyen, B; Garin, C; Mandrino, A; Besse, J L; Brunet-Guedj, E

    1993-01-01

    Fifty-one knees were reviewed out of 53 which had been operated on (between 1981 and 1991) for instability due to a long-standing rupture of the anterior cruciate ligament (A.C.L.), associated with medial arthritis related to a varus deformity. They had undergone a reconstruction of the cruciate ligament using the patellar tendon (5 cases had received an artificial ligament) and a high tibial osteotomy. In 80 per cent of cases this was an opening osteotomy with interposition of a heterologous bone graft, and in 39 cases it was a closing osteotomy. The average age was 37 +/- 6 years. The oldest patient was 58 years old. 80 per cent of cases were men and 88 per cent of the patients practised sport on a regular basis at the time of the accident. The average delay before surgery was 9.5 years. Almost all the patients has already undergone a medial meniscectomy and there were deep cartilaginous lesions and the bone was exposed in 50 per cent of cases. 28 knees were reexamined after a follow-up of over 4 years. Based on the ARPEGE score the results on pain and stability were good. Return to sport has been possible for 43 per cent of patients. Pivot shift, which was constant before surgery (grade 2 or 3), disappeared in 20 cases and was estimated at grade 1 in 8 cases (of which 6 had suffered a rupture of the graft). For the 20 cases in which the reconstruction of the A.C.L. had held, the average anterior radiological subluxation was 4.3 +/- 3.2 mm (from 2 to 14 mm) and the average gain after surgery was 6.7 +/- 3.7 mm (from 2.5 to 18 mm). The femoro-tibial angle went from an average of 6 degrees of varus to 3 degrees of valgus. The opening osteotomy was more precise for correction in the frontal plane. A large valgus (over 3 degrees) was not desirable and a hypercorrection was occasionally difficult to accept by relatively young patients who are likely to take up sport again. The osteotomy often involuntarily modified the normal posterior tibial plateau slope (especially closing osteotomy). A backwards increase of the tibial plateau slope is a factor which increases the anterior subluxation of the femur on the tibia. This is confirmed before and after surgery. It seems preferable to decrease the tibial slope during the osteotomy in order to protect the A.C.L. reconstruction.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8066285

  9. Modified Anchor Shaped Post Core Design for Primary Anterior Teeth

    PubMed Central

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

    2014-01-01

    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

  10. 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

    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

    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. PMID:24962098

  11. Medial Opening Wedge Tibial Osteotomy and the Sagittal PlaneThe Effect of Increasing Tibial Slope on Tibiofemoral Contact Pressure

    Microsoft Academic Search

    Craig M. Rodner; Douglas J. Adams; Vilmaris Diaz-Doran; Janet P. Tate; Stephen A. Santangelo; Augustus D. Mazzocca; Robert A. Arciero

    2006-01-01

    Background:Altering the tibial slope in an anterior cruciate ligament–deficient knee has been shown to affect anterior-posterior tibial translation. The effects on articular contact pressure of altering tibial slope during a high tibial osteotomy are unknown.Hypotheses:Performing an opening wedge osteotomy anterior to the midaxial line will increase tibial slope. Increasing tibial slope with a high tibial osteotomy in an anterior cruciate

  12. Strain-Blood Pressure Index for Evaluation of Early Changes in Elasticity of Anterior Tibial Artery in Patients with Type 2 Diabetes Mellitus

    PubMed Central

    Zou, Chunpeng; Jiao, Yan; Zheng, Chao; Zhao, Yaping; Li, Xingwang

    2014-01-01

    Background The aim of this study was to investigate the feasibility and value of strain-blood pressure index (SBPI) to assess early changes in elasticity of anterior tibial artery in patients with type 2 diabetes mellitus (T2DM). Material/Methods Eighty-one randomly selected in-patients with T2DM were divided into 2 groups – a vascular complication negative group (n=42) and a vascular complication positive group (n=39). Forty healthy volunteers were enrolled in a control group. Ultrasonographic scans using Xstrain™ technique were conducted for every patient to obtain the maximum circumferential strain (CSmax) of anterior tibial artery; patient blood pressure was also measured for calculating strain-blood pressure index (SBPI=CSmax/[(local pulse pressure)/local diastolic blood pressure] ×100%. Afterwards, SBPIs of various groups were comparatively analyzed. Results Differences in SBPIs among the 3 groups were statistically significant (control group > negative group > positive group, P<0.05). Conclusions SBPI could be used as a new indicator for the evaluation on the anterior tibial arterial elasticity of T2DM patients and it was able to reflect the early elasticity changes in anterior tibial arteries in T2DM patients with atherosclerosis. PMID:25418129

  13. Structural Properties of Six Tibial Fixation Methods for Anterior Cruciate Ligament Soft Tissue Grafts

    Microsoft Academic Search

    Hugh E. Magen; Stephen M. Howell; Maury L. Hull

    1999-01-01

    This study compared the stiffness (K), yield load (YL), and slippage (SL) of six tibial fixation methods. These properties were determined from load-to-failure and cyclic tests of double-looped tendon grafts fixed to both animal and young human tissue. Tandem washers (K 259 N\\/mm, YL 1159 N, SL 0.5 mm) and the Washerloc (K 248 N\\/mm, YL 905 N, SL 2.0

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

    E-print Network

    Gill, Thomas J.

    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 ...

  15. 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

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

    2014-01-01

    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

  16. Structural stiffness of the Hoffmann simple anterior tibial external fixation frame.

    PubMed

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

    1989-01-01

    Tibial external fixation frames were constructed on aluminum tube simulating tibia bone. A 20-mm gap was left at the fracture site in order to measure the structural stiffness of the frame rather than the aluminum tube. The performance of the frames were experimentally evaluated and quantified using tests which simulated the loading conditions encountered in normal walking. These included axial compression, anteroposterior (AP) bending, lateral bending and torsional loading of the frame. The parameters studied were (a) number of fixation pins, (b) number of connecting rods and (c) location of clamps on the pins. Four constants were evaluated from these tests using various structural configurations of the frames; these resulted in four stiffness coefficients in compression, AP bending, lateral bending and torsion. Stiffnesses of various frames with different geometric configurations were compared by comparing their appropriate stiffness coefficients. Such comparison can set forth a quantitative guideline in selecting a suitable frame configuration for the type of injury and condition of fracture pattern. This type of quantitative analysis can also be useful in modifying the frame during the postoperative bone healing process. PMID:2729681

  17. In Vivo Three-Dimensional Imaging Analysis of Femoral and Tibial Tunnel Locations in Single and Double Bundle Anterior Cruciate Ligament Reconstructions

    PubMed Central

    Yang, Jae-Hyuk; Chang, Minho; Kwak, Dai-Soon; Jang, Ki-Mo

    2014-01-01

    Background Anatomic footprint restoration of anterior cruciate ligament (ACL) is recommended during reconstruction surgery. The purpose of this study was to compare and analyze the femoral and tibial tunnel positions of transtibial single bundle (SB) and transportal double bundle (DB) ACL reconstruction using three-dimensional computed tomography (3D-CT). Methods In this study, 26 patients who underwent transtibial SB ACL reconstruction and 27 patients with transportal DB ACL reconstruction using hamstring autograft. 3D-CTs were taken within 1 week after the operation. The obtained digital images were then imported into the commercial package Geomagic Studio v10.0. The femoral tunnel positions were evaluated using the quadrant method. The mean, standard deviation, standard error, minimum, maximum, and 95% confidence interval values were determined for each measurement. Results The femoral tunnel for the SB technique was located 35.07% ± 5.33% in depth and 16.62% ± 4.99% in height. The anteromedial (AM) and posterolateral (PL) tunnel of DB technique was located 30.48% ± 5.02% in depth, 17.12% ± 5.84% in height and 34.76% ± 5.87% in depth, 45.55% ± 6.88% in height, respectively. The tibial tunnel with the SB technique was located 45.43% ± 4.81% from the anterior margin and 47.62% ± 2.51% from the medial tibial articular margin. The AM and PL tunnel of the DB technique was located 33.76% ± 7.83% from the anterior margin, 45.56% ± 2.71% from the medial tibial articular margin and 53.19% ± 3.74% from the anterior margin, 46.00% ± 2.48% from the medial tibial articular margin, respectively. The tibial tunnel position with the transtibial SB technique was located between the AM and PL tunnel positions formed with the transportal DB technique. Conclusions Using the 3D-CT measuring method, the location of the tibia tunnel was between the AM and PL footprints, but the center of the femoral tunnel was at more shallow position from the AM bundle footprint when ACL reconstruction was performed by the transtibial SB technique. PMID:24605187

  18. A case of anterior cruciate ligament tear accompanied by avulsion fractures of tibial tuberosity and Gerdy's tubercle.

    PubMed

    Yoo, Jae Ho; Kim, Kang-Il; Yoon, Kyoung Ho

    2011-12-01

    A 54-year-old man visited our clinic due to a painful swelling of his right knee. He had attempted a forceful kick by his right leg during a Sepak Takraw-like sports activity, only to fail to hit the ball. He felt a popping sense on the knee and collapsed, even without direct trauma. Imaging studies revealed a disruption of the anterior cruciate ligament (ACL), and separate avulsion fractures of the tibial tuberosity and Gerdy's tubercle. The fractures were stabilized by two cancellous screws, respectively. The intra-operative fluoroscopy demonstrated a manifest ACL insufficiency. A simultaneous reconstruction of the ligament was not performed. At 6 months after surgery, he had no difficulty in his activities of daily living. The involved knee joint was believed to have undergone a forceful pivot shift mechanism. Injuries to the ACL can be suspected from indirect signs on the radiologic images by a careful reconstitution of the injury mechanism and the associated lesions. Manifest osseous lesions on the plain radiographs can herald a major ligamentous injury and may be interpreted as an indirect sign of the ACL injury, which helps to establish a relevant management plan. PMID:20724164

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

    PubMed

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

    2014-06-01

    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

  20. Disturbances in the voluntary recruitment order of anterior tibial motor units in spastic paraparesis upon fatigue.

    PubMed

    Grimby, L; Hannerz, J; Rånlund, T

    1974-01-01

    The recruitment order of motor units in the tibialis anterior muscle upon fatigue of tonic voluntary contraction was studied in 20 patients with severe spastic paraparesis. An electromyographic technique for secure identification of single motor units was used. Before fatigue the recruitment order is stable and low-frequency units are recruited before high-frequency units; this recruitment pattern agrees with that in normal voluntary activity. When fatigue appears, however, the recruitment order becomes indefinite and high-frequency units can be recruited before low-frequency units; this recruitment pattern agrees with that in normal phasic voluntary activity. Finally, all voluntary activation power disappears, even in the case of units which have never been active. Contraction ability and original recruitment order are restored upon rest but also upon tonic reflex support of the voluntary drive. Whether the fatigue reaction may be due to insufficient gamma motoneurone innervation and whether it is related to spasticity are discussed. The practical physiotherapeutic implications are reviewed. PMID:4360399

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

    PubMed Central

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

    2013-01-01

    Background Anatomic tunnel positioning is important in anterior cruciate ligament (ACL) reconstructive surgery. Recent studies have suggested the limitations of a traditional transtibial technique to place the ACL graft within the anatomic tunnel position of the ACL on the femur. The purpose of this study is to determine if the 2-incision tibial tunnel-independent technique can place femoral tunnel to native ACL center when compared with the transtibial technique, as the placement with the tibial tunnel-independent technique is unconstrained by tibial tunnel. Methods In sixty-nine patients, single-bundle ACL reconstruction with preservation of remnant bundle using hamstring tendon autograft was performed. Femoral tunnel locations were measured with quadrant methods on the medial to lateral view of the lateral femoral condyle. Tibial tunnel locations were measured in the anatomical coordinates axis on the top view of the proximal tibia. These measurements were compared with reference data on anatomical tunnel position. Results With the quadrant method, the femoral tunnel centers of the transtibial technique and tibial tunnel-independent technique were located. The mean (± standard deviation) was 36.49% ± 7.65% and 24.71% ± 4.90%, respectively, from the over-the-top, along the notch roof (parallel to the Blumensaat line); and at 7.71% ± 7.25% and 27.08% ± 7.05%, from the notch roof (perpendicular to the Blumensaat line). The tibial tunnel centers of the transtibial technique and tibial tunnel-independent technique were located at 39.83% ± 8.20% and 36.32% ± 8.10%, respectively, of the anterior to posterior tibial plateau depth; and at 49.13% ± 4.02% and 47.75% ± 4.04%, of the medial to lateral tibial plateau width. There was no statistical difference between the two techniques in tibial tunnel position. The tibial tunnel-independent technique used in this study placed femoral tunnel closer to the anatomical ACL anteromedial bundle center. In contrast, the transtibial technique placed the femoral tunnel more shallow and higher from the anatomical position, resulting in more vertical grafts. Conclusions After single-bundle ACL reconstruction, three-dimensional computed tomography showed that the tibial tunnel-independent technique allows for the placement of the graft closer to the anatomical femoral tunnel position when compared with the traditional transtibial technique. PMID:23467279

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

    PubMed

    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

    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

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

    NASA Astrophysics Data System (ADS)

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

    2014-04-01

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

  4. Disturbances in the voluntary recruitment order of anterior tibial motor units in spastic paraparesis upon fatigue 1

    PubMed Central

    Grimby, Lennart; Hannerz, Jan; Rånlund, Tyra

    1974-01-01

    The recruitment order of motor units in the tibialis anterior muscle upon fatigue of tonic voluntary contraction was studied in 20 patients with severe spastic paraparesis. An electromyographic technique for secure identification of single motor units was used. Before fatigue the recruitment order is stable and low-frequency units are recruited before high-frequency units; this recruitment pattern agrees with that in normal voluntary activity. When fatigue appears, however, the recruitment order becomes indefinite and high-frequency units can be recruited before low-frequency units; this recruitment pattern agrees with that in normal phasic voluntary activity. Finally, all voluntary activation power disappears, even in the case of units which have never been active. Contraction ability and original recruitment order are restored upon rest but also upon tonic reflex support of the voluntary drive. Whether the fatigue reaction may be due to insufficient gamma motoneurone innervation and whether it is related to spasticity are discussed. The practical physiotherapeutic implications are reviewed. Images PMID:4360399

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

    NASA Astrophysics Data System (ADS)

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

    2006-03-01

    Thermotherapy is generally considered appropriate for post-stroke patients with spasticity, yet its acute antispastic effects have not been comprehensively investigated. F-wave parameters have been used to demonstrate changes in motor neuron excitability in spasticity and pharmacological antispastic therapy. The present study aimed to confirm the efficacy of thermotherapy for spasticity by evaluating alterations in F-wave parameters in ten male post-stroke patients with spastic hemiparesis (mean age: 49.0±15.0 years) and ten healthy male controls (mean age: 48.7±4.4 years). The subjects were immersed in water at 41°C for 10 min. Recordings were made over the abductor hallucis muscle, and antidromic stimulation was performed on the tibial nerve at the ankle. Twenty F-waves were recorded before, immediately after, and 30 min following thermotherapy for each subject. F-wave amplitude and F-wave/M-response ratio were determined. Changes in body temperature and surface-skin temperature were monitored simultaneously. The mean and maximum values of both F-wave parameters were higher on the affected side before thermotherapy. In the post-stroke patients, the mean and maximum values of both parameters were significantly reduced after thermotherapy ( P<0.01). Hence, the antispastic effects of thermotherapy were indicated by decreased F-wave parameters. Body temperature was significantly increased both immediately after and 30 min after thermotherapy in all subjects. This appeared to play an important role in decreased spasticity. Surface-skin temperature increased immediately after thermotherapy in both groups and returned to baseline 30 min later. These findings demonstrate that thermotherapy is an effective nonpharmacological antispastic treatment that might facilitate stroke rehabilitation.

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

    PubMed

    Viera, C L; Ribeiro, C C

    2001-01-01

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

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

    PubMed

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

    2002-01-01

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

  8. Post traumatic immediate GBR: alveolar ridge preservation after a comminuted fracture of the anterior maxilla.

    PubMed

    Kim, Yongsoo; Leem, Dae Ho

    2015-04-01

    Without a proper intervention, a crushed alveolar process fracture can cause significant dimensional changes on affected hard and soft tissue that lead to difficult circumstances for post traumatic bone augmentation and dental implant placement. We present herein the cases of immediate guided bone regeneration (GBR) for the maxillary anterior alveolar process with comminuted fracture. Shortly after the hospital visit, guided bone regeneration was conducted for three patients using only xenograft material and bone fragments from traumatic site, without an additional donor site. Resorbable collagen membrane was used on the bone graft site, and titanium mesh was also used if significant bone loss were expected. Radiographic evaluation 6 months after GBR confirmed that all three cases had sufficiently preserved alveolar bone which is clinically required for implant placement. Dental implant installation was carried out for two patients and no specific findings were noted in follow-up after the placement. In this method, additional operation sites for bone collection are not necessary and the number of surgical steps before implant placement can be reduced. Furthermore, this immediate intervention can effectively minimize the alveolar ridge shrinkage of anterior maxilla after injury. PMID:25351617

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

    Microsoft Academic Search

    TOMO YAMADA; LEAMOR KAHANOV

    2004-01-01

    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

  10. Tibial Fixation of Bone-Patellar Tendon-Bone Grafts in Anterior Cruciate Ligament ReconstructionA Cadaveric Study of Bovine Bone Screw and Biodegradable Interference Screw

    Microsoft Academic Search

    Naiquan Zheng; Chad T. Price; Peter A. Indelicato; Bo Gao

    2008-01-01

    Background: The use of interference screw fixation for bone-patellar tendon-bone grafts in anterior cruciate ligament fixation is well established. No previous study has compared bovine bone screws and biodegradable interference screws or demonstrated their efficacy for requirements associated with early rehabilitation.Hypothesis: There is no difference in tension loss and pull-out strength between bovine bone screws and biodegradable interference screws.Study Design:

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

    PubMed Central

    Torrance, David Allen; deGraauw, Christopher

    2011-01-01

    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

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

    ERIC Educational Resources Information Center

    Jonkman, Sietse; Everitt, Barry J.

    2009-01-01

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

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

    PubMed

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

    2005-04-01

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

  14. The Effect of High Tibial Osteotomy on the Posterior Tibial Slope

    PubMed Central

    DRAGOSLOVEANU, Serban; CRISTEA, Stefan; DRAGOSLOVEANU, Calin

    2014-01-01

    Introduction: High tibial osteotomy remains a useful procedure for delaying total knee arthroplasty for young patients with unicompartimental medial osteoarthritis of the knee. The tibial posterior slope is essential for both ligament function and knee kinematics. Even though many articles were published in the literature, the long term influence of open wedge high tibial osteotomy on the posterior slope of the tibial plateau remains unknown. Objective: We assessed the relationship among the degree of correction, the surgical technique, the postoperative modification of tibial slope, knee flexion and Knee score at the two years. Material and methods: We used for evaluation a calibrated x-rays with correction factor. All the measures were done with Cedara I-View 6.3.2 application. All 47 patients were operated in our hospital between 2008-2011, with the same technique, open wedge high tibial osteotomy with an acrylic cement wedge. All patients postponed weight bearing for 6 weeks. Results: We found that there is no statistical significance (p=0.2) between the preoperative varus and the after surgery tibial slope, but the resulting posterior inclination after surgery influences the tibial posterior slope at 2 years (p<=0.005).The degree of correction has a strong influence over the increase or decrease of tibial posterior slope(p<0.005). An increase in tibial slope increases the knee flexion by 1.45° for every degree of inclination (p<0.05). Functional results are not influenced by small modifications in tibial inclination (p>0.05). Conclusion: From this findings we may conclude that the most important factors that changes the posterior inclination of the tibia surface are the height of the cement wedge and the surgical technique, by placing the acrylic cement wedge more anteriorly. We have found that the vast majority of our high tibial osteotomies are in fact "flexion" osteotomies. At the 2 years control we have found a slight increase in tibial slope angle (average 1.77°) and knee flexion (average 2.56°) with no functional response. This is a case series study with level of evidence IV. PMID:25705274

  15. Bilateral atraumatic tibial tubercle avulsion fractures: Case report and review of the literature.

    PubMed

    Khoriati, Al-Achraf; Guo, Shigong; Thakrar, Raj; Deol, Rupinderbir S; Shah, Khalil Y

    2015-04-01

    An avulsion fracture of the tibial tubercle is an uncommon injury, comprising less than 1% of all physeal injuries. The occurrence of such injuries bilaterally is even rarer. We report a case of bilateral atraumatic tibial tubercle avulsion fractures and its presentation, mechanism of injury, surgical management, post-operative rehabilitation and implications for clinical practice. A 17-year-old healthy male presented to the emergency department with severe pain on the anterior aspect of both knees and was unable to walk, having been brought in by ambulance after hearing a crack whilst jogging. On examination, there was significant swelling of both knees which were held in extension. On both sides there was a prominent deformity on the region of the tibial tubercle with a palpable gap, although no open skin wound. He was unable to actively move either knee joint. No neurovascular deficit was present. Plain radiographs revealed bilateral tibial tubercle avulsion fractures. Gentle manipulation was performed in the emergency department to the fragments in order to remove the tension from the skin. The fragments were reduced and fixed surgically with 4mm cannulated screws in an anterior to posterior direction. Both limbs were placed in temporary casts in 20 degrees of flexion. Postoperatively, the patient was kept non-weight bearing for four weeks then placed into a range of motion brace and movement commenced. Full weight bearing was permitted at the one month stage and he was advised to avoid any sporting activity until the 8 week stage and contact sports until the 10 week stage. Full movement of both joints was regained and the patient returned to full sporting activity in the absence of symptoms. This case emphasises the need for a high degree of vigilance when faced with such a presentation and a low threshold for further investigation and surgical intervention. PMID:25638599

  16. Light transmission of posts and cores used for the anterior esthetic region.

    PubMed

    Michalakis, Konstantinos X; Hirayama, Hiroshi; Sfolkos, John; Sfolkos, Konstantinos

    2004-10-01

    Restoration of endodontically treated teeth is a routine procedure in everyday clinical practice. Placement of posts and cores is often required for replacement of the missing coronal aspect of teeth. Use of traditional post-and-core systems (gold and titanium) in conjunction with all-ceramic restorations results in poor esthetics because of the reflection and lack of light transmission. For a highly esthetic outcome, there is a need to use a material that transmits and refracts light in much the same manner as a natural tooth. The purpose of this study was to clinically evaluate the light transmission of a (1) ceramic post (Celay), (2) polyester post reinforced with zirconium fibers (Snowlight), and (3) zirconia post (Cosmopost), in comparison with a cast-metal post and core covered with opaque porcelain (control). The light transmission of these systems when used in conjunction with IPS Empress all-ceramic crowns was evaluated. PMID:15506027

  17. Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth

    PubMed Central

    Rao, K Nandan; Kandaswamy, Raghavendra; Umashetty, Girish; Rathore, Vishnu Pratap Singh; Hotkar, Chetan; Patil, Basanagouda S

    2014-01-01

    Background: To investigate and compare the post-obturation pain after one-visit and two-visit root canal treatment in non-vital anterior teeth. Materials & Methods: One hundred forty eight patients requiring root canal therapy on permanent anterior non-vital teeth with single root were included in this study. Patients were randomly assigned to either the one-appointment or the twoappointment group. The standardized protocol for all the teeth involved local anesthesia, isolation and access, engine-driven rotary nickel-titanium canal instrumentation with 2.5% NaOCl irrigation and obturation. Teeth in group 1 (n = 74) were obturated during the first appointment by using laterally condensed gutta-percha and resin sealer. Teeth in group 2 (n = 74) were given closed dressing and were obturated during the second appointment, 7 to 14 days later. A modified Visual Analogue Scale was used to measure pain after 6 hours, 24 hours, 48 hours and 7 days after the treatment. Statistical analysis was done to compare groups at each interval by using an independent-samples t test. Results: The incidence and intensity of post-obturation pain in both Group ‘A’ and Group ‘B’ gradually reduced over the study period. When the incidence of pain was compared in the single and two visit group, it was found that the single-visit group experienced slightly less pain than the two-visit group during all study intervals, but the difference found was not statistically significant. Conclusion: There was no difference in postoperative pain between patients treated in only one appointment and patients treated in two appointments. The majority of patients in both groups reported no pain or only minimal pain after 7 days of treatment. How to cite the article: Rao KN, Kandaswamy R, Umashetty G, Rathore VP, Hotkar C, Patil BS. Post-Obturation pain following one-visit and two-visit root canal treatment in necrotic anterior teeth. J Int Oral Health 2014;6(2):28-32. PMID:24876699

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

    PubMed Central

    Yee Han, Dave Lee

    2015-01-01

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

  19. Heart failure following anterior myocardial infarction: an indication for ventricular restoration, a surgical method to reverse post-infarction remodeling.

    PubMed

    Stanley, Alfred W H; Athanasuleas, Constantine L; Buckberg, Gerald D

    2004-10-01

    Anterior myocardial infarction produces abrupt left ventricular (LV) dysynergy and global systolic dysfunction. Rapid intense neurohumoral activation, infarct expansion, and early ventricular chamber dilatation all contribute to restoring a normal stroke volume despite a persistently depressed ejection fraction. Continued neurohumoral activation provokes late remodeling of the remote non-infarcted myocardium, characterized by an abnormal progressively increasing LV volume/mass ratio that leads to further LV remodeling. Heart failure is a progressive disorder of LV remodeling. Heart failure from post-infarction remodeling is unique because of the persistent non-functioning scar that self- perpetuates abnormal loading conditions and neurohumoral activation. Medical therapy attenuates remodeling and improves survival but does not change the size of the scar. Surgical ventricular restoration to exclude the non-functioning infarct from the ventricular cavity decreases ventricular volumes, increases global ejection fraction, attenuates neurohumoral activation and yields an excellent 5-year survival. Combined medical and surgical therapy is recommended in this patient population. PMID:15886971

  20. Proximal Tibial Bone Graft

    MedlinePLUS

    Injections and other Procedures Treatments of the Ankle Treatments of the Big Toe Treatments of the Heel Treatments of the Midfoot Treatments of the Smaller Toes AOFAS / FootCareMD / Treatments Proximal Tibial ...

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

    PubMed Central

    2013-01-01

    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

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

    PubMed Central

    Todo, Mitsugu

    2014-01-01

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

  3. Evaluation of the Single-Incision Arthroscopic Technique for Anterior

    E-print Network

    Hull, Maury

    A Study of Tibial Tunnel Placement, Intraoperative Graft Tension, and Stability Stephen M. Howell,* LTC tensile behavior of the double-looped semitendinosus and gracilis tendon graft can be normal or abnormal compared with the native anterior cruciate ligament, that the placement and angle of the tibial tunnel can

  4. Resting state functional connectivity of the anterior cingulate cortex in veterans with and without post-traumatic stress disorder.

    PubMed

    Kennis, Mitzy; Rademaker, Arthur R; van Rooij, Sanne J H; Kahn, René S; Geuze, Elbert

    2015-01-01

    Post-traumatic stress disorder (PTSD) is an anxiety disorder that is associated with structural and functional alterations in several brain areas, including the anterior cingulate cortex (ACC). Here, we examine resting state functional connectivity of ACC subdivisions in PTSD, using a seed-based approach. Resting state magnetic resonance images were obtained from male veterans with (n?=?31) and without (n?=?25) PTSD, and healthy male civilian controls (n?=?25). Veterans with and without PTSD (combat controls) had reduced functional connectivity compared to healthy controls between the caudal ACC and the precentral gyrus, and between the perigenual ACC and the superior medial gyrus and middle temporal gyrus. Combat controls had increased connectivity between the rostral ACC and precentral/middle frontal gyrus compared to PTSD patients and healthy civilian controls. The resting state functional connectivity differences in the perigenual ACC network reported here indicate that veterans differ from healthy controls, potentially due to military training, deployment, and/or trauma exposure. In addition, specific alterations in the combat controls may potentially be related to resilience. These results underline the importance of distinguishing trauma-exposed (combat) controls from healthy civilian controls when studying PTSD. PMID:25137414

  5. Tibial fractures in children

    PubMed Central

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

    2014-01-01

    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

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

    Microsoft Academic Search

    Marianne Lentz; Jørgen Feldbæk Nielsen

    2002-01-01

    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

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

    PubMed

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

    2013-12-01

    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

  8. Dynamic contact stress patterns on the tibial plateaus during simulated gait: a novel application of normalized cross correlation.

    PubMed

    Wang, Hongsheng; Chen, Tony; Torzilli, Peter; Warren, Russell; Maher, Suzanne

    2014-01-22

    The spatial distribution and pattern of local contact stresses within the knee joint during activities of daily living have not been fully investigated. The objective of this study was to determine if common contact stress patterns exist on the tibial plateaus of human knees during simulated gait. To test this hypothesis, we developed a novel normalized cross-correlation (NCC) algorithm and applied it to the contact stresses on the tibial plateaus of 12 human cadaveric knees subjected to multi-directional loads mimicking gait. The contact stress profiles at different locations on the tibial plateaus were compared, where regions with similar contact stress patterns were identified across specimens. Three consistent regional patterns were found, among them two most prominent contact stress patterns were shared by 9-12 of all the knees and the third pattern was shared by 6-8 knees. The first pattern was located at the posterior aspect of the medial tibial plateau and had a single peak stress that occurred during the early stance phase. The second pattern was located at the central-posterior aspects of the lateral plateau and consisted of two peak stresses coincident with the timing of peak axial force at early and late stance. The third pattern was found on the anterior aspect of cartilage-to-cartilage contact region on the medial plateau consisted of double peak stresses. The differences in the location and profile of the contact stress patterns suggest that the medial and lateral menisci function to carry load at different points in the gait cycle: with the posterior aspect of the medial meniscus consistently distributing load only during the early phase of stance, and the posterior aspect of the lateral meniscus consistently distributing load during both the early and late phases of stance. This novel approach can help identify abnormalities in knee contact mechanics and provide a better understanding of the mechanical pathways leading to post-traumatic osteoarthritis. PMID:24342497

  9. Peroneal nerve damage by bicortical tibial screw in ACL reconstruction

    Microsoft Academic Search

    Antonios Papoutsidakis; Georgios I. Drosos; Ourania I. Koukou; Nikolaos Piskopakis; Dionysios-Alexandros Verettas

    2010-01-01

    Arthroscopically assisted anterior cruciate ligament reconstruction is regarded as a minimally invasive surgery with low morbidity\\u000a but complications still occur. Reports of neurovascular injuries related to graft harvesting, tunnel placement, or graft fixation\\u000a are limited. A rare case of peroneal nerve injury related to hardware used for graft fixation in the tibial in a 28-year-old\\u000a female patient who underwent an

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

    PubMed

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

    2015-01-01

    A 22-year-old man suffered severe sudden onset head and neck pain after being pushed from behind during an assault. Physical examination was normal. Cervical MRI demonstrated an intradural hematoma, anterior to the cord, between C2-4. Subsequent contrast enhanced MR angiography and digital subtraction vertebral angiography confirmed that the cause of the hemorrhage was a fusiform (presumed dissecting) pseudoaneurysm of the artery of the cervical enlargement at its junction with the anterior spinal artery. The aneurysm was managed conservatively. Follow-up angiography demonstrated that the aneurysm had spontaneously thrombosed within 10?days and remained occluded at 2?months. The patient remained occluded at 6 months following the initial injury. Anterior spinal aneurysms represent a management dilemma and options are discussed. PMID:25809436

  11. Comparative Evaluation of the Reinforcing Effect of Different Post Systems in the Restoration of Endodontically Treated Human Anterior Teeth at Two Different Lengths of Post Space Preparation- An in Vitro Study

    PubMed Central

    Jindal, Sahil; Jindal, Ritu; Gupta, Kanika; Mahajan, Sandeep; Garg, Sunidhi

    2013-01-01

    Objectives: Comparative evaluation of the reinforcing effect of different post systems in the restoration of endodontically treated human anterior teeth at two different lengths of post space preparation- an in vitro study Materials and Methods: 135 extracted human incisors were endodontically treated, out of which 120 teeth were decoronated 2mm above the cementoenamel junction and divided into four experimental groups based on the post system to be used: Glass fiber post (GFP) and stainless steel post (SSP), titanium post (TTP), cast metal post (CMP). Each group was divided into two sub-groups according to the length of post space preparation: 5mm and 10mm. All the samples were restored with metal crowns. The fracture resistance was measured by applying loads at an angle of 135º to the long axis of teeth in an instron universal testing machine. Fracture mode was analyzed for all the samples. Results from the four test groups were compared and analysed using one-way ANOVA test and the Post-hoc Bonferroni test to demonstrate differences between pairs of groups. Results: The results revealed that SSP group at 10mm post space length showed the significantly (“P-value< 0.05”) highest fracture resistance (793.7787 N). Decrease in post length resulted in the decrease in fracture resistance in all the groups reduced to values even lesser than the control (437.8733N). Conclusion: The different post systems used in the study were able to reinforce endodontically treated teeth only at 10mm post space length. PMID:23724211

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

    PubMed

    Abbott, Allan; Halvorsen, Marie; Dedering, Asa

    2013-05-01

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

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

    PubMed Central

    Eid, Rita; Homsy, Fodda; Elhusseini, Hasan

    2014-01-01

    When fabricating indirect post and core, internal coronal walls are tapered to remove undercuts and allow a better adaptation. To evaluate the fracture strength of anterior tooth reconstructed with post and core and crowned, with two different taper of internal coronal walls, 6° and 30° to the long axis, two groups of 30 clear plastic analogues simulating endodontically treated maxillary central incisors were prepared. The analogues crowned were subjected to a compressive load with a 1-kN cell at a crosshead speed of 0.05?mm/min at 130° to the long axis until fracture occurred. Data were analyzed by Lillifors and 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

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

    PubMed

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

    2010-10-01

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

  15. Radiographic and Clinical Changes of the Tibial Tuberosity Fol lowing Tibial Plateau Leveling Osteotomy

    E-print Network

    tibial tuberosity fracture. The statistical significance of the other risk factors is less clear are clinically significantRadiographic and Clinical Changes of the Tibial Tuberosity Fol lowing Tibial Plateau Leveling

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

    PubMed Central

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

    2010-01-01

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

  17. Post-operative analgesia following anterior cruciate ligament reconstruction: a controlled study using femoral nerve regional anaesthesia

    Microsoft Academic Search

    N. J. Harris; D. R. Bickerstaff; D. Farquharson; F. J. Appleton

    1997-01-01

    We present a prospective randomised double-blind study assessing the value of femoral nerve block anaesthesia (FNB) in patients undergoing anterior cruciate ligament reconstruction. Patients in the study group received a FNB using a nerve stimulator to deliver 20 ml of 0.5% marcaine together with a patient-controlled analgesia system delivering morphine. Patients in the control group received only a patient-controlled analgesia

  18. Posterior Tibial Tendon Dysfunction (PTTD)

    MedlinePLUS

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

  19. Arthroscopic Absorbable Suture Fixation for Tibial Spine Fractures

    PubMed Central

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

    2013-01-01

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

  20. Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model

    Microsoft Academic Search

    Takanori Iriuchishima; Goro Tajima; Sheila J. M. Ingham; Wei Shen; Takashi Horaguchi; Akiyoshi Saito; Patrick Smolinski; Freddie H. Fu

    2009-01-01

    Anterior cruciate ligament (ACL) graft impingement against the intercondylar roof has been postulated, but not thoroughly\\u000a investigated. The roof impingement pressure changes with different tibial and femoral tunnel positions in ACL reconstruction.\\u000a Anterior tibial translation is also affected by the tunnel positions of ACL reconstruction. The study design included a controlled\\u000a laboratory study. In 15 pig knees, the impingement pressure

  1. Topographic Analysis of the Glenoid and Proximal Medial Tibial Articular Surfaces – A Search for the Ideal Match for Glenoid Resurfacing

    PubMed Central

    Gupta, Anil K.; Forsythe, Bryan; Lee, Andrew S.; Harris, Joshua D.; McCormick, Frank; Abrams, Geoffrey D.; Verma, Nikhil N.; Romeo, Anthony A.; Inoue, Nozomu; Cole, Brian J.

    2014-01-01

    Background Current knowledge of the appropriate site of osteochondral allograft harvest to match glenoid morphology for the purposes of glenoid resurfacing is lacking. This has led to difficulty with adequately restoring the geometry of the glenoid using current available techniques. The purpose of this study was to quantify the articular surface topography of the glenoid and medial tibial plateau via 3-dimensional (3D) modeling to determine if the medial tibial articular surface provides an anatomic topographic match to the articular surface of the glenoid. Hypothesis We hypothesized that the medial tibial plateau will provide a suitable osteochondral harvest site due to its concavity and anatomic similarity to the glenoid. Study Design Descriptive Laboratory Study Materials and Methods Computed tomography (CT) was performed on four cadaveric proximal tibias and four scapulae, allowing for 16 glenoid-tibial comparative combinations. 3D CT models were created and exported into point cloud models. A local coordinate map of the glenoid and medial tibial plateau articular surfaces was created. Two zones of the medial tibial articular surface (anterior and posterior) were quantified. The glenoid articular surface was defined as a best-fit circle of the glenoid articular surface maintaining a two millimeter bony rim. This surface was virtually placed on a point on the tibial articular surface in 3D space. The tibial surface was segmented and its 3D surface orientation was determined with respect to its surface. 3D orientation of the glenoid surface was reoriented so that the direction of the glenoid surface matched that of the tibial surface. The least distances between the point-clouds on the glenoid and tibial surfaces were calculated. The glenoid surface was rotated 360 degrees in one-degree increments and the mean least distance was determined at each rotating angle. Results When the centroid of the glenoid surface was placed on the medial tibial articular surface, it covered approximately two-thirds of the anterior or posterior tibial surfaces. Overall, the mean least distance difference in articular congruity of all 16 glenoid-medial tibial surface combinations was 0.74 mm (standard deviation; ± 0.13 mm). The mean least distance difference of the anterior and posterior two-thirds of the medial tibial articular surface was 0.72 mm (± 0.13 mm) and 0.76 mm (± 0.16 mm), respectively. There was no significant difference between and the anterior and posterior two-thirds of the tibia with regard to topographic match of the glenoid (p=0.187). Conclusion We describe a novel methodology to quantify the topography of the tibial and glenoid articular surfaces. The findings suggest that the medial tibial articular surface provides an appropriate anatomic match to the glenoid articular surface. Both the anterior and posterior two-thirds of the medial tibial articular surface can serve as potential sites for osteochondral graft harvest. This methodology can be applied to future studies evaluating the ideal sites of graft harvest to treat zonal glenoid bone wear and/or loss. Clinical Relevance This study provides evidence of a near anatomic topographic match between the medial tibial plateau and glenoid articular surfaces, which has direct clinical application for future biologic osteochondral glenoid resurfacing. This concept has not been described in the literature to date. PMID:23857887

  2. Tibial Plateau Fracture in a Female Soccer Player: A Case Study

    PubMed Central

    Giulietti, Jeff A.; Denegar, Craig R.; Harner, Christopher D.

    1994-01-01

    In general, tibial plateau fractures are rarely associated with noncontact, twisting, injuries to the knee in athletics. A 23-year-old woman sustained a noncontact valgus injury to her left knee while playing indoor soccer. Evaluation on-site and the following morning revealed no deformity and only mild pain over the anterolateral tibial plateau. All stress tests of the knee were negative. A 2+ effusion was noted the day after injury, causing us to suspect an internal derangement of the left knee. A nondisplaced tibial plateau fracture was confirmed by radiographs. The patient was treated non-operatively with a hinged knee brace and protective weight bearing with axillary crutches. Ten weeks following the injury, radiographs revealed a healed fracture, and the patient was instructed to gradually increase her athletic activity. The mechanism of injury and symptoms suggested injury to the tibial collateral ligament and anterior cruciate ligament. The physical examination findings, however, led us to believe otherwise. It is important to recognize that valgus stresses to the knee can result in damage to structures other than the soft tissues (ie, tibial collateral ligament). This injury resulted in a nondisplaced tibial plateau fracture that healed uneventfully with appropriate nonoperative treatment. ImagesFig 1.Fig 2. PMID:16558256

  3. ORV Arthroscopic Reduction and Internal Fixation of Tibial Eminence Fractures

    PubMed Central

    Myer, Daniel M.; Purnell, Gregory J.; Caldwell, Paul E.; Pearson, Sara E.

    2013-01-01

    Tibial eminence fractures are an uncommon but well-described avulsion of the anterior cruciate ligament. Treatment principles are based on the amount and pattern of fracture displacement. Management has evolved from closed reduction and immobilization to arthroscopic reduction and internal fixation followed by early rehabilitation. Various fixation methods have evolved, ranging from arthroscopic reduction and percutaneous screw fixation to arthroscopic suture repair. We present a technique for arthroscopic reduction and internal fixation using a cannulated drill bit and high-strength suture. This technique facilitates anatomic reduction with uncomplicated tunnel placement and suture passing in an effort to allow strong fixation and early rehabilitation. PMID:24400179

  4. Effects of tibial torsion on distal alignment of extramedullary instrumentation in total knee arthroplasty

    PubMed Central

    2013-01-01

    Background and purpose Whether tibial torsion affects the positioning of extramedullary instrumentation and is a possible factor in malalignment of the tibial component in total knee arthroplasty (TKA) is unknown. We assessed the influence of tibial torsion on distal alignment of extramedullary systems for TKA, using the center of the intermalleolar distance as anatomical reference at the ankle joint. Patients and methods We analyzed CT scans of knee and ankle joints of 50 patients with knee osteoarthritis (mean age 73 years, 52 legs). The tibial mechanical axis was identified and translated anteriorly at the level of the medial one-third (proximal AP axis 1), at the medial border of the tibial tuberosity (proximal AP axis 2), and at the level of the talar dome (distal AP axis). The center of the intermalleolar distance and the width of the medial and lateral malleolus were calculated. The proximal AP axes 1 and 2 were translated at the level of the ankle joint and any difference between their alignment and the distal AP axis was calculated as angular and linear values. Results The center of the ankle joint was located, on average 2 mm medial to that of the intermalleolar distance. The distal AP axis was externally rotated by 18° and 27° compared to the proximal AP axes 1 and 2, respectively. Overall, the center of the ankle joint was shifted laterally by 9–11 mm with respect to the proximal AP tibial axes. Interpretation To avoid a varus tibial cut in TKA, extramedullary alignment systems should be aligned more medially at the ankle joint than previously thought, due to the effect of tibial torsion and—to a lesser extent—to the different malleolar width. PMID:23594222

  5. Micromotion analysis of the fixation of total knee tibial component

    Microsoft Academic Search

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

    1995-01-01

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

  6. Topography of the distal tibial nerve and its branches.

    PubMed

    Lumsden, David B; Schon, Lew C; Easley, Mark E; Duouguih, Wiemi A; Anderson, Claude D; Miller, Stuart D; Ottey, Deron K

    2003-09-01

    The tibial nerve trunk and its branches were dissected in 20 embalmed cadaver legs and the relative topographic anatomy was defined at 3-cm intervals up to 15 cm proximal to the medial malleolar-calcaneal (MMC) axis. Each nerve branch was found in various locations. The calcaneal nerve was found to descend from medial to posteromedial. It was never found anterolaterally and only rarely laterally. The lateral plantar nerve was found to rotate externally from lateral and posterolateral to lateral and posteromedial as it descends. This nerve was not found medially or anteromedially. The first branch of the lateral plantar nerve was indistinguishable from the trunk of the tibial nerve descending medially to between the lateral plantar and calcaneal nerves. The overall pattern of the medial plantar nerve was an internal rotation from anteromedial (proximal) to anterior (distally). It was not found posteriorly. The flexor hallucis longus motor branch was located an average of 17.9 cm (range, 10-24 cm) proximal to the MMC axis. Preliminary application of these data has facilitated surgical dissection and afforded an understanding of how tibial nerve trunk pathology correlates with clinical manifestations. PMID:14524520

  7. Distal Tibial Fractures: Intramedullary Nailing

    Microsoft Academic Search

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

    2009-01-01

    \\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

  8. Surgical treatment of tibial plafond fractures.

    PubMed

    Stapleton, John J; Zgonis, Thomas

    2014-10-01

    Intra-articular fractures of the tibial plafond are typically the result of rotational or axial loading forces, and both mechanisms of injuries can result in an associated fibula fracture. Rotational distal tibial plafond fractures are typically of lower energy and are associated with less articular injury and chondral impaction, whereas axial load injuries of the distal tibial plafond are associated with a higher incidence of intra-articular and soft tissue injury. The goal of this article is to review the mechanisms of injury, fracture patterns, and potential complications associated with the most common presentations of tibial plafond fractures. PMID:25281515

  9. Compartment syndrome with mononeuropathies after anterior cruciate ligament reconstruction.

    PubMed

    J Kindle, Brett; Murthy, Naveen; Stolp, Kathryn

    2015-05-01

    Compartment syndrome rarely follows anterior cruciate ligament reconstruction. However, when it does, it may result in mononeuropathies that are amenable to neurolysis. The authors of this study present an 18-yr-old woman who sustained a right anterior cruciate ligament tear and underwent uneventful anterior cruciate ligament reconstruction using femoral and popliteal nerve blocks. Postoperatively, she developed compartment syndrome requiring emergent fasciotomies. At 11 wks after fasciotomy, results of electrophysiologic tests showed evidence of severe fibular and tibial neuropathies. Magnetic resonance images showed extensive tricompartmental myonecrosis. Fibular and tibial neurolysis as well as decompression were performed, followed by intensive outpatient rehabilitation. At the 6-mo follow-up, she reported resolution of pain as well as significant improvement in sensation, strength, and function. Early recognition and intervention are crucial to prevent serious neurologic damage. Excessive tourniquet pressure and anesthetic nerve blocks may have been responsible. PMID:25802956

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

    Microsoft Academic Search

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

    2005-01-01

    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

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

    PubMed Central

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

    2012-01-01

    Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2?cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity. PMID:23259115

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

    PubMed

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

    2012-01-01

    Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2?cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity. PMID:23259115

  13. Clinical Instability of the Knee and Functional Differences Following Tibial Plateau Fractures Versus Distal Femoral Fractures

    PubMed Central

    Ebrahimzadeh, Mohammad Hosein; Birjandinejad, Ali; Moradi, Ali; Fathi Choghadeh, Maysam; Rezazadeh, Jafar; Omidi-Kashani, Farzad

    2015-01-01

    Background: Fractures of the knee account for about 6% of all trauma admissions. While its management is mostly focused on fracture treatment, it is not the only factor that defines the final outcome. Objectives: This study aimed to study objective and subjective outcomes after proximal tibial versus distal femoral fractures in terms of knee instability and health-related quality of life. Patients and Methods: This retrospective, cross-sectional, cohort study was carried out on 80 patients with either isolated proximal tibial (n = 42) or distal femoral (n = 38) fractures, who underwent open reduction and internal fixation. All the fractures were classified based on the Schatzker and AO classification for tibial plateau and distal femoral fractures, respectively. The patients were followed and examined by an orthopedic knee surgeon for clinical assessment of knee instability. In their last follow-up visit, these patients completed a Lysholm knee score and the short-form (SF) 36 health survey. Results: Among the 42 tibial plateau fractures, 25% were classified as Schatzker type 2. Of the 38 distal femoral fractures, we did not find any type B1 or B3 fractures. The overall prevalence of anterior and posterior instability was 42% and 20%, respectively. Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) injuries were detected clinically in 50% and 28%, respectively. The incidence rates of ligament injuries in tibial plateau fractures were as follows: Anterior Collateral Ligament (ACL) 26%, Posterior Collateral Ligament (PCL) 7%, MCL 24%, and LCL 14%. Medial collateral ligament injury was the most common in the Schatzker type 2 (50% of the injuries). Distal femoral fractures were associated with ACL injury in 16%, PCL in 13%, MCL in 26% and LCL in 14%. However, final knee range of motion (ROM) and function (Lysholm score) were not associated with fracture location. No statistically significant difference was observed between the two groups, except for the valgus stress test at 30°knee flexion, which was more positive in tibial fractures. All eight domains of SF-36 score in the distal femoral and proximal tibial fractures were significantly different from the normal values; however, there were no statistically significant differences between femoral and tibial fracture scores. Conclusions: Although ROM is acceptable in knee joint fractures, instability is common. However, it seems that knee function and quality of life are not associated with the location of the fracture.

  14. Genu Recurvatum after Tibial Tuberosity Fracture

    PubMed Central

    Nathan, Senthil T.; Parikh, Shital N.

    2013-01-01

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

  15. Genu recurvatum after tibial tuberosity fracture.

    PubMed

    Nathan, Senthil T; Parikh, Shital N

    2013-01-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

    2014-01-01

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

  18. Distal tibial physeal bridge: a complication from a tension band plate and screw construct. Report of a case.

    PubMed

    Oda, Jon E; Thacker, Mihir M

    2013-05-01

    We report on a case of a tension band plate and screw construct (Eight Plate) used over the anterior distal tibia in an 9-year-old girl in an attempt to induce recurvatum of the ankle joint to correct a recalcitrant equinus deformity. With growth of the distal tibial physis, the epiphyseal screw was drawn through the physis into the distal tibial metaphysis, resulting in the creation of a transphyseal bony bar. Caution should be exercised when attempting temporary hemiepiphyseodesis using a plate and screw construct in small epiphyses or in an osteopenic bone. PMID:22158054

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

    PubMed Central

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

    2014-01-01

    Background Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft. Purpose To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft. Study Design Controlled laboratory study. Methods Ten human cadaveric knees (age, 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

  20. Osteomyelitis of the tibia following anterior cruciate ligament reconstruction

    PubMed Central

    O’Neill, Barry J.; Molloy, Alan P.; McCarthy, Tom

    2012-01-01

    INTRODUCTION Osteomyelitis following anterior cruciate ligament (ACL) reconstruction is extremely rare. PRESENTATION OF CASE We present a thirty year old man who presented with pain in his proximal tibia six years after ACL reconstruction. Haematological investigations were normal. He was diagnosed with osteomyelitis of his proximal tibia. He was successfully treated with washout and debridement of his tibial tunnel. DISCUSSION This case highlights the need to exclude osteomyelitis as a late complication of ACL reconstruction in patients with proximal tibial pain. We also report on an unusual pathogen as casue of osteomyelitis. CONCLUSION Osteomyelitis in a tibial tunnel can present as a late complication of ACL reconstruction, even in the presence of normal haematological investigations. PMID:23274848

  1. Indirect reduction and composite fixation of extraarticular proximal tibial fractures.

    PubMed

    Bolhofner, B R

    1995-06-01

    Forty-one extraarticular comminuted proximal tibial fractures were treated during a 7-year period. The fractures were proximal tibial metaphyseal injuries or metaphyseal-diaphyseal junction injuries with extension proximally and distally but not involving the knee joint. All fractures were treated surgically with open reduction and internal fixation using an indirect reduction technique with a lateral plate, and a medial substitution external fixator concomitantly. All fractures were seen for followup until they healed (average healing time, 12.1 weeks). The timing of internal fixation was based on the status of the soft tissue (average time to surgery, 8.5 days after injury). A temporary spanning external fixator was used in 17 (41.5%) fractures to allow for further assessment, demarcation, and improvement of the anterior soft tissues. There were 3 (7%) delayed unions, 1 (2%) malunion, and no nonunions. There were 2 (5%) wound infections and 5 (12%) pin track problems. One postsurgical soft tissue problem was encountered. Through this technique, reliable healing and alignment were achieved in this often difficult fracture pattern, particularly for fractures that were difficult or impossible to treat with an intermedullary nail. PMID:7634689

  2. Shape optimization of tibial prosthesis components

    NASA Technical Reports Server (NTRS)

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

    1993-01-01

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

  3. Tibial rotational osteotomy with intramedullary nail fixation

    PubMed Central

    Stevens, Peter M.

    2009-01-01

    There are several theoretic advantages of using intramedullary rod fixation for tibial osteotomy fixation. We performed a retrospective review of patients who were treated with a mid-diaphyseal osteotomy of the tibia fixed with an intramedullary rod for isolated, symptomatic tibial torsion. Forty patients (59 tibias) were included in the study and were followed for a minimum of 12 months or until rod removal (average follow-up 22.6 months). Major complication rate was 8.5%, which is comparable to alternative methods of fixation. We believe that intramedullary rods are a safe alternative for fixation of tibial rotational osteotomy in patients with physeal closure. PMID:19941168

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

    PubMed Central

    2009-01-01

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

  5. In vivo kinematics for subjects with and without an anterior cruciate ligament.

    PubMed

    Komistek, Richard D; Allain, Jerome; Anderson, Dylan T; Dennis, Douglas A; Goutallier, Daniel

    2002-11-01

    The objective of the current study was to compare kinematic patterns of anterior cruciate retaining total knee arthroplasty and posterior stabilized total knee arthroplasty. Fifteen patients received an anterior cruciate retaining total knee arthroplasty and 15 received a posterior stabilized total knee arthroplasty. All total knee arthroplasties were clinically successful (Hospital for Special Surgery score > 90). Each patient was examined during level walking using fluoroscopy. Femorotibial contact paths for the medial and lateral condyles were determined using a computer automated model-fitting technique. Ten of 15 (67%) patients receiving an anterior cruciate retaining total knee arthroplasty and 12 of 15 patients (80%) receiving a posterior stabilized total knee arthroplasty experienced anterior contact at some phase of the gait cycle. Anterior contact in anterior cruciate retaining total knee arthroplasty can be attributed to the presence of the anterior cruciate ligament, resisting the anterior tibial shear forces during gait. The reason for anterior contact observed in posterior stabilized total knee arthroplasty is unclear, possibly related to the sagittal topography (dwell-point position) of the tibial component. Increased axial rotation was seen in anterior cruciate retaining total knee arthroplasty possibly because of the preservation of the four-bar linkage within the knee. Patients receiving an anterior cruciate retaining total knee arthroplasty experienced kinematic patterns more similar to the normal knee. PMID:12439275

  6. Fetal alcohol syndrome and bilateral tibial exostoses

    Microsoft Academic Search

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

    1993-01-01

    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.

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

    PubMed Central

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

    2013-01-01

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

  8. Effects of in vitro wear of machined and molded UHMWPE tibial inserts on TKR kinematics.

    PubMed

    Benson, L C; DesJardins, J D; LaBerge, M

    2001-01-01

    The effect of manufacturing process on the wear and mechanical performance of a total knee replacement (TKR) design was investigated with the use of a force-controlled knee joint simulator. Ultra-high molecular weight polyethylene (UHMWPE) tibial inserts processed by direct compression molding from 1900H resin were compared to UHMWPE tibial inserts machined from a compression-molded sheet of GUR 1050. Both sets of components had the same posterior-cruciate-retaining geometry, and were identically aligned with cobalt-chromium-molybdenum alloy femoral components. Wear tests were conducted at a frequency of 1 Hz for 4 million cycles with the use of a standard walking cycle pattern. Implant kinematics, including anterior-posterior (AP) displacement and internal-external (IE) rotation in response to applied loads were monitored. Gravimetric wear, surface roughness, and surface morphology were used to characterize the wear process of the UHMWPE inserts. Results showed that the molded UHMWPE inserts exhibited less gravimetric wear over time than the machined inserts of the same design. Both the machined and molded components exhibited scratching, pitting, and burnishing over their wear areas. The AP displacement distance per cycle of the molded tibial inserts decreased over the course of testing, resulting in a shorter total testing displacement for this group compared to machined tibial inserts. Although AP displacement distance per cycle for machined tibial inserts did not change significantly over the course of testing, their position relative to the femoral components shifted posteriorly over time, resulting in an elongated wear track. PMID:11505423

  9. Adult tibial shaft fractures – different patterns, various treatments and complications

    PubMed Central

    Madadi, Firooz; Eajazi, Alireza; Madadi, Firoozeh; Besheli, Laleh Daftari; Sadeghian, Reza; Lari, Mehdi Nasri

    2011-01-01

    Summary Background Tibial Fractures constitute a large number of emergency operations in most trauma centers. There are different approaches for tibial fractures. To our knowledge, there is insufficient evidence to consider post-operative complications in relation to both surgical methods and the types of fractures. Our purpose is to report our experience regarding the efficacy and complications associated with diverse surgical methods of different patterns of tibial shaft fractures in adults. Material/Methods We studied 387 adult patients. The patients’ information was registered from the charts and after examination. The methods used were intramedullary interlocking nails, simple intramedullary rods, plating and external fixation. Early and late complications were recorded and by applying the DELPHI method different treatments were compared. Finally, the safest mode of treatment is proposed. Results In the intramedullary interlocking nails method the most noticeable complication was delayed union and the highest rate of complications was seen in open oblique fractures. In the simple intramedullary rods method the most frequent complication was pain, and in the with butterfly fractures the complications were the most. In the plating method the most frequent complication was pain, and most of the complications were seen in open comminuted fractures. Finally, in the external fixation method the most frequent complication was non-union and complications were the highest in the patients with oblique, comminuted and segmented fractures. Conclusions The proposed method to treat transverse, oblique and butterfly fractures is simple intramedullary rods; whereas intramedullary interlocking nails is the better method for comminuted, segmented and spiral fractures. PMID:22037743

  10. Diagnosis of exercise-induced pain in the anterior aspect of the lower leg

    Microsoft Academic Search

    Jorma Styf

    1988-01-01

    Ninety-eight patients with chronic exercise-induced pain in the anterior compartment of the lower leg under went extensive clinical and laboratory investigations to establish the diagnosis. They all were referred because of a putative chronic compartment syndrome (CCS). Intramuscular pressure was recorded bilaterally during exercise in the anterior tibial muscle in all of them. Conduction-velocity recordings of the deep and super

  11. Missed compartment syndrome after replacement of the anterior cruciate ligament following continuous epidural analgesia

    Microsoft Academic Search

    F. Sorrentino; S. Eggli; U. Stricker; F. T. Ballmer; R. Hertel

    1998-01-01

    Summary  \\u000a In this article we report a case of an early postoperative compartment syndrome of the anterior tibial compartment with complete\\u000a sensomotoric palsy of the peroneal nerve after arthroscopic-assisted replacement of the anterior cruciate ligament (ACL) of\\u000a the knee. The tourniquet pressure was 360 mm Hg and operation time was 1.75 h. After the operation the leg was bandaged to

  12. 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.

  13. Anterior Cruciate Ligament Reconstruction and Preservation: The Single-Anteromedial Bundle Biological Augmentation (SAMBBA) Technique.

    PubMed

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

    2014-12-01

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

  14. A convex lateral tibial plateau for knee replacement

    Microsoft Academic Search

    J. V. Baré; H. S. Gill; D. J. Beard; D. W. Murray

    2006-01-01

    Unicompartmental knee replacements have not performed as well in the lateral compartment as in the medial. This may be because the tibial components have flat or slightly concave surfaces which match the medial plateau but not the convex lateral plateau. The aim of this study was to find the optimal radius for a convex lateral tibial component.Twelve normal lateral tibial

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

    ERIC Educational Resources Information Center

    Couture, Christopher J.; Karlson, Kristine A.

    2002-01-01

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

  16. Unexplained proximal tibiofibular joint pain after high tibial osteotomy.

    PubMed

    Testa, Enrique Adrian; Haeni, David L; Behrens, Gerrit; Hirschmann, Michael T

    2014-05-01

    Problems of the proximal tibiofibular joint (pTFj) after high tibial osteotomy (HTO) are rare. With this case report, we strive to highlight the importance of investigating the pTFj in patients with unexplained knee pain after HTO. A 44 year old male patient presented with diffuse pain on his left knee 3 years after medial opening wedge HTO due to medial compartment overloading in a varus knee. Patient described persistent anterior tibial and lateral knee pain. 2 years after HTO, patient underwent implant removal but the knee pain persisted. As the reason for the persistent pain was not identified, further radiological evaluation was done. Single photon emission computerized tomography/computerized tomography (SPECT/CT) revealed that there was no increased uptake within the tibiofemoral joint, indicating a biologically well performed correction of the varus deformity. However, markedly increased tracer uptake was found at the pTFj. On the inherent axial CT scans, it was seen that the proximal screws were too long and placed within the pTFj. Along with this a severe osteoarthritis of the pTFj was identified. The cause of the patient's pain was then confirmed by a CT guided infiltration of local anesthetic. An arthrodesis of the pTFj was performed and at 12 months followup after the arthrodesis the patient was pain free. This case highlights how important it is to evaluate the pTFj in patients with unexplained pain after HTO. SPECT/CT was helpful in identifying the patient's problem in this challenging case. PMID:24932045

  17. Insufficiency fractures of the tibial plateau

    SciTech Connect

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

    1983-06-01

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

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

    PubMed

    Harilainen, Arsi; Linko, Eric; Sandelin, Jerker

    2006-06-01

    Patellar tendon graft has been the most frequently used material in anterior cruciate ligament (ACL) reconstruction, but the hamstring tendons have been increasingly used as well; however, which graft is to be preferred is not adequately supported by existing clinical studies. In this prospective randomized clinical trial, the study hypothesis was that the hamstring tendons are equally good graft material as the patellar tendon in ACL reconstruction. Ninety-nine patients with laxity due to a torn ACL underwent arthroscopically assisted reconstruction with graft randomization according to their birth year to either patellar tendon with metal interference screw fixation or double looped semitendinosus and gracilis tendons with fixation similar to the Endobutton technique using a titanium metal plate suspension proximally and screw-washer postdistally. Excluding preoperative Lysholm knee score, there were no significant differences between the two groups in the preoperative and operative data. A standard rehabilitation regimen was used for all the patients, including immediate postoperative mobilization without a knee brace, protected weight bearing for 2 weeks, and return to full activity at 6-12 months postoperatively. Forty patients in the patellar tendon group and 39 patients in the hamstring tendon group were available for clinical evaluation at median 5 years after surgery (ranges 3 years 11 months-6 years 7 months). The results revealed no statistically significant differences with respect to clinical and instrumented laxity testing, isokinetic muscle torque measurements, International Knee Documentation Committee ratings, Lysholm (knee score), Tegner (activity level) and Kujala patellofemoral knee scores. There was an enlargement of the drill tunnels, statistically more in the hamstring tendon group, but no increase from 2 to 5 years in either group. Narrowing of the joint spaces (IKDC measurement method) from 2 to 5 years postoperatively was seen in both the groups, however, without difference between the two groups. PMID:16552549

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

    Microsoft Academic Search

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

    2006-01-01

    To perform an open-wedge high-tibial osteotomy (HTO), the medial proximal tibia is frequently exposed by partial distal release of the overlying insertion of the medial collateral ligament (MCL). Biomechanically, any release of the MCL can increase knee laxity when valgus stress is applied. Clinically however, post-surgical valgus instability following HTO with partial MCL release is an uncommon complication. It is

  20. Irreducible tibial pilon fracture caused by incarceration of the fibula in the tibial medullary canal.

    PubMed

    Ellanti, Prasad; Hammad, Yassir; Kosutic, Damir; Grieve, Philip P

    2012-01-01

    Fractures can be irreducible for several reasons, including soft tissue or bone fragment interposition. We report an unusual fracture configuration of a comminuted tibial pilon fracture in which the distal fibular shaft fragment was occupying the medullary canal of the proximal tibial shaft fragment and inhibiting reduction and fixation. To the best of our knowledge, this has not been previously reported in a published study. PMID:22153657

  1. Adhesion of flexor hallucis longus at the site of a tibial-shaft fracture - A cause of a checkrein deformity.

    PubMed

    Yuen, C P; Lui, T H

    2015-03-01

    Post-traumatic adhesion of toe flexors at the tibial fracture site resulted in checkrein deformity is rare and only a few case reports or case series were reported in the English literature. Major differential diagnosis includes deep compartment syndrome or adhesion of the muscle due to various causes. We are not able to conclude what is the best treatment option. Open exploration and adhesiolysis at the adhesion site together with tendon lengthening at the distal tibial level is a feasible surgical option with satisfactory result. PMID:25682418

  2. Posterior cruciate ligament tibial inlay reconstruction

    Microsoft Academic Search

    Eugene E. Berg

    1995-01-01

    A patellar bone-tendon-bone tibial inlay reconstruction of the posterior cruciate ligament using a popliteal arthrotomy was designed to minimize graft-tunnel wall abrasion. Arthroscopic techniques are used for femoral graft fixation. In a small series, the procedure decreased the quadriceps active drawer in 70° of flexion by an average of 4 mm and improved patellofemoral symptoms.

  3. ACUTE COMPARTMENT SYNDROME IN TIBIAL DIAPHYSEAL FRACTURES

    Microsoft Academic Search

    M. M. MCQUEEN; J. CHRISTIE; C. M. COURT-BROWN

    1996-01-01

    e reviewed 25 patients with tibial diaphyseal fractures which had been complicated by an acute compartment syndrome. Thirteen had undergone continuous monitoring of the compartment pressure and the other 12 had not. The average delay from injury to fasciotomy in the monitored group was 16 hours and in the non-monitored group 32 hours (p < 0.05). Of the 12 surviving

  4. Clinical Performance of Contemporary Tibial Polyethylene Components

    Microsoft Academic Search

    Roy D. Crowninshield; Markus A. Wimmer; Joshua J. Jacobs; Aaron G. Rosenberg

    2006-01-01

    A postclinical retrieval analysis was performed on 43 polyethylene tibial components of a contemporary total knee arthroplasty system with implantation duration between 12 and 80 months. Components were scored for 8 potential modes of surface wear or damage on the top and back surfaces. Moderate backside wear of 4.1 ?m\\/y was documented by measuring the extent of manufacturer's engraved lettering

  5. Tibial cortical lesions: a multimodality pictorial review.

    PubMed

    Tyler, P A; Mohaghegh, P; Foley, J; Isaac, A; Zavareh, A; Thorning, C; Kirwadi, A; Pressney, I; Amary, F; Rajeswaran, G

    2015-01-01

    Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department. PMID:25445894

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

    PubMed Central

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

    2014-01-01

    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

  7. Temperature rise during reamed tibial nailing.

    PubMed

    Giannoudis, P V; Snowden, S; Matthews, S J; Smye, S W; Smith, R M

    2002-02-01

    The current study determined the temperature rise during reamed tibial intramedullary nailing in vivo. Eighteen adult patients were studied. The tibial medullary canal diameter ranged from 8 to 11 mm and was reamed to at least 1.5 mm above the required nail diameter with AO reamers. Reaming of the medullary cavity ranged from 9 to 12 mm before nail insertion. Intraoperative monitoring of the heat produced during reaming of the medullary cavity was done by inserting two platinum resistance thermometer probes into the cortical bone at the short isthmic segment of the tibial shaft. The probes were connected to a data logger, and temperature readings were taken every 5 seconds during each reaming procedure. The mean tibial temperature before initiation of reaming was 35.6 degrees C (standard deviation, +/- 0.5 degrees), and peak temperatures recorded were from 36.1 degrees C to 51.6 degrees C. A direct correlation was observed between temperature elevation and amount of reaming. With reaming above 10 mm, tibias with a canal diameter of 8 mm showed a statistically higher temperature rise compared with tibias with a canal diameter of 9, 10, or 11 mm. No patients had intraoperative or postoperative complications related to skin or bone thermal necrosis, and bony healing progressed uneventfully. The small amount of reaming required to insert a nail into a normal 9-, 10-, or 11- mm tibial canal does not seem to produce a clinical problem. Reaming smaller canals (8 mm) to a larger size may induce a significant heating effect. PMID:11937890

  8. Instrumented measurement of in vivo anterior-posterior translation in the canine knee to assess anterior cruciate integrity

    PubMed Central

    Lopez, Mandi J.; Hagquist, William; Jeffrey, Susan L.; Gilbertson, Sara; Markel, Mark D.

    2007-01-01

    This study was designed to objectively quantify in vivo anterior-posterior canine knee translation relative to anterior cruciate ligament (ACL) integrity. Tibial translation was determined in one knee of 43 crossbreed hounds from radiographs performed while a set anterior and then posterior force was applied to the tibia using a custom designed device. The total (TTT), anterior (ATT), and posterior (PTT) tibial translation were measured (absolute) and normalized to the width of the tibia (normalized). Absolute and normalized TTT was significantly greater in ruptured ACL knees than in partially disrupted (PD) ACL knees, which were significantly greater than in intact ACL knees. ATT and PTT was significantly greater in ruptured ACL knees than in PD or intact ACL knees, which were not significantly different. The sensitivity and specificity of normalized TTT to distinguish knees with intact from PD ACLs were both 100%. Normalized TTT to distinguish knees with PD from ruptured ACLs had a sensitivity and specificity of 100% and 92%, respectively. Intra- and inter-observer intra-class correlation coefficients were 0.84 or higher for all translations. This precise non-invasive technique to assess canine knee translational stability and ACL integrity permits repetitive, objective measurements for diagnostic use and to assess therapeutic intervention efficacy. PMID:15304264

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

    PubMed

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

    2015-04-01

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

  10. Post-natal molecular adaptations in anteromedial and posterolateral bundles of the ovine anterior cruciate ligament: one structure with two parts or two distinct ligaments?

    PubMed

    Huebner, Kyla D; O'Brien, Etienne J O; Heard, Bryan J; Chung, May; Achari, Yamini; Shrive, Nigel G; Frank, Cyril B

    2012-01-01

    The human anterior cruciate ligament (ACL) is a composite structure of two anatomically distinct bundles: an anteromedial (AM) and posterolateral (PL) bundles. Tendons are often used as autografts for surgical reconstruction of ACL following severe injury. However, despite successful surgical reconstruction, some people experience re-rupture and later development of osteoarthritis. Understanding the structure and molecular makeup of normal ACL is essential for its optimal replacement. Reportedly the two bundles display different tensions throughout joint motion and may be fundamentally different. This study assessed the similarities and differences in ultrastructure and molecular composition of the AM and PL bundles to test the hypothesis that the two bundles of the ACL develop unique characteristics with maturation. ACLs from nine mature and six immature sheep were compared. The bundles were examined for mRNA and protein levels of collagen types I, III, V, and VI, and two proteoglycans. The fibril diameter composition of the two bundles was examined with transmission electron microscopy. Maturation does alter the molecular and structural composition of the two bundles of ACL. Although the PL band appears to mature slower than the AM band, no significant differences were detected between the bundles in the mature animals. We thus reject our hypothesis that the two ACL bundles are distinct. The two anatomically distinct bundles of the sheep ACL can be considered as two parts of one structure at maturity and material that would result in a structure of similar functionality can be used to replace each ACL bundle in the sheep. PMID:22148917

  11. Arthrosis of the knee in chronic anterior laxity.

    PubMed

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

    2014-02-01

    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

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

    PubMed

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

    2008-12-01

    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

  13. The management of tibial torsion in patients with spina bifida.

    PubMed

    Fraser, R K; Menelaus, M B

    1993-05-01

    We reviewed 20 patients with spina bifida who had had surgical management of tibial torsion. Eight had had bilateral procedures and 12 a unilateral procedure, giving a total of 28 limbs for analysis. We performed closed osteoclasis on seven limbs and tibial osteotomy on 21. In the closed osteoclasis group six limbs (85%) had a good result after an average follow-up of nine years (2 to 22). All limbs developed postoperative anteromedial bowing of the tibia which later remodelled. In the tibial osteotomy group 19 (90%) had a good result. The average follow-up was nine years (2 to 28). Complications occurred in seven limbs (33%). We recommend closed osteoclasis of the tibia for the young patient with spina bifida in whom walking is impeded by excessive internal tibial torsion, and supramalleolar tibial osteotomy in the older patient with excessive external tibial torsion and a planovalgus foot. PMID:8496230

  14. Distal tibial fractures and pilon fractures.

    PubMed

    Huebner, E J; Iblher, N; Kubosch, D-C; Suedkamp, N P; Strohm, P C

    2014-01-01

    Fractures of the distal tibia are often very severe injuries that generally occur in the context of high-energy trauma and present with significant concomitant soft tissue involvement. Open fractures and extensive destruction of the articular surfaces are important challenges to the treating surgeon. In consequence the outcome for distal meta- and epiphyseal tibial fractures depends largely on the severity of the soft tissue injury and its management. Conventionally, tibial pilon fractures require surgical intervention. Conservative treatment would only be considered in some exceptional cases, for example, inoperability of the patient. Controversial discussion of optimal surgical technique and optimal timing of surgery is ongoing. There is broad consensus that soft tissue consolidation must have first priority as this is the basis for both fracture healing and good long-term outcomes. Surgical intervention can be managed as a one-stage or multi-stage procedure to achieve internal or external fracture fixation. PMID:24945386

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

    PubMed

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

    2013-10-01

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

  16. Hipertricosis cervical anterior esporádica

    Microsoft Academic Search

    B. Monteagudo; M. Cabanillas; C. de las Heras; J. M. Cacharrón

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a «tuft» of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair

  17. Isolated Anterior Cervical Hypertrichosis

    Microsoft Academic Search

    B. Monteagudo; M. Cabanillas; C. de las Heras; J. M. Cacharr?n

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a «tuft» of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair

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

    PubMed Central

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

    2014-01-01

    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

  19. Tibial bone harvesting under intravenous sedation: Morbidity and patient experiences

    Microsoft Academic Search

    Jose M. Marchena; Michael S. Block; John D. Stover

    2002-01-01

    Purpose: The aims of this study were to evaluate the complication rate, the recovery, and the experience in patients undergoing tibial bone harvesting under intravenous sedation. Patients and Methods: This was a prospective study of 10 consecutive patients who underwent unilateral or bilateral sinus grafting with tibial bone grafts under intravenous sedation in a 3-month period in the oral and

  20. Arthroscopic treatment in split depression-type tibial pilon fracture.

    PubMed

    Lonjon, Guillaume; Delgrande, Damien; Solignac, Nicolas; Faivre, Bruno; Hardy, Philippe; Bauer, Thomas

    2015-02-01

    Treatment of tibial pilon fractures is complicated and often very invasive. Partial fractures with a depressed component raise the question of the choice of surgical technique. Minimally invasive surgical reduction under arthroscopic guidance appears to be a promising alternative in this type of fracture. We describe a technique for arthroscopically assisted treatment of a split depression tibial pilon fracture. PMID:24898416

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

    PubMed Central

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

    2015-01-01

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

  2. Subjective and novel objective radiographic evaluation of inflatable bone tamp treatment of articular calcaneus, tibial plateau, tibial pilon and distal radius fractures.

    PubMed

    Heiney, Jake P; Redfern, Roberta E; Wanjiku, Stephen

    2013-08-01

    There is a growing need to develop tools that allow for better reductions of difficult to treat fractures in minimally disruptive ways. One such technique has been developed using the inflatable bone tamp and a fast setting calcium phosphate. KYPHON(®) XPANDER Inflatable Bone Tamp and the KYPHON(®) Osteo Introducer(®) System were used to reduce the articular fractures and a fast-setting calcium phosphate was introduced into those voids and metal hardware was applied as deemed necessary. Subjects were skeletally mature patients treated for articular fractures of the calcaneus, tibial plateau, tibial pilon, or distal radius. Post-operative day zero and week 12 radiographs were objectively and subjectively evaluated by three independent orthopaedic surgeons. Their objective scores were then translated into subjective categories based on the Heiney-Redfern scaled scoring (H-R score) system established herein. Overall, the thorough radiographic analysis by independent reviewers indicates that the technique is capable of obtaining and maintaining articular reductions in a good or adequate manner at 12-weeks post-operatively. Introduced is a potential novel evaluation scale scoring system for these articular fractures that evaluates the important anatomic considerations reproducibly in fracture reductions. There are many potential benefits that remain speculative to this type of tool within a procedure, and therefore this tool and technique warrants further research. PMID:23601366

  3. Clinical outcome of arthroscopic reduction and suture for displaced acute and chronic tibial spine fractures.

    PubMed

    Ahn, Jin Hwan; Yoo, Jae Chul

    2005-03-01

    This paper reports the clinical outcome of the arthroscopic reduction and pull-out suture technique in acute and chronic displaced tibial spine anterior cruciate ligament (ACL) avulsion fractures. Between April 1997 and December 2000, 14 patients received an arthroscopic reduction and pull-out suturing of displaced tibial spine fractures (ACL avulsion fractures of tibia). Of 14 cases, ten were acute fractures and four were chronic nonunion fractures, in which all patients showed extension limitation. The mean follow-up period was 51 months (ranging from 30 to 80 months). At final follow-up, review of range of motion, Lachman test, anterior drawer test, KT-2000 arthrometer, Lysholm knee score, and Hospital for Special Surgery (HSS) score were evaluated. Compared to conventional pull-out suturing, several key modifications to surgical techniques were used. In all 14 patients, radiological bony union was detected at mean 12.3 weeks (range, 8-16 weeks) after surgery. All patients were able to return to their preinjury activity and sports level. At final follow-up, full range of motion was achieved in all patients. Anterior draw test, Lachman test, and KT-2000 (less than 3 mm side-to-side) were all negative in 13 patients. One female patient, who was 6 years old at the time of surgery, complained of no subjective instability, but showed Lachman grade I, and 5 mm side-to-side difference in KT-2000. She also revealed 10 degrees difference of genu recurvatum deformity. Two children (including the previously-mentioned 6-year-old female patient) showed leg-length discrepancy of 1 cm-the affected legs being longer-at final follow-up. The mean Lysholm knee scores were 95.6 (range, 92-100) and HSS knee scores were 96.4 (range, 91-100). Arthroscopic reduction with modified pull-out suturing technique in displaced tibial spine ACL avulsion fractures showed excellent union rate for both acute and chronic cases, without instability or extension limitations at minimum two-year follow-up. PMID:15756616

  4. Proximal tibial osteotomy 1970-1995.

    PubMed Central

    Fisher, D. E.

    1998-01-01

    Proximal tibial osteotomy (PTO) as a surgical treatment for selected cases of unicompartmental knee joint arthritis has been performed by the author since 1970. The results of the first 113 cases were reported in October, 1978, at the Iowa Orthopaedic Society meeting. The study was continued through 1995 to include a total of 279 osteotomies in 230 patients. Each operation was performed by the author using the surgical technique as described by Coventry. Postoperative rehabilitation and follow-up remained constant throughout the 25 year period. A detailed retrospective review of all clinical records was undertaken to determine the long term results of PTO, using revision to total knee replacement or death as end points. Eighty-three patients died and 19 were lost to follow-up. A questionnaire regarding pain, function, and the necessity of further surgery was sent to the remainder. Each patient was contacted and invited back for a clinical evaluation and radiographs. At an average 13 year follow-up, 116 patients (42%) had no symptoms and were considered a good result. This long-term review revealed that, with strict adherence to the surgical principles of obtaining and maintaining proper alignment, proximal tibial osteotomy for unicompartmental arthritis can result in good function and symptomatic relief for an average of ten to 14 years. Images Figure 1 Figure 2A Figure 2B Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 11 Figure 12 Figure 13 PMID:9807708

  5. Locking compression plate fixation of radial and tibial fractures in a young dog.

    PubMed

    Schwandt, C S; Montavon, P M

    2005-01-01

    A six-month-old, male Bernese Mountain Dog in which radius-ulna and tibia-fibula concomitant fractures were treated each with a 3.5 mm Locking Compression Plate (LCP) is presented. Both fractures were approached and plated medially. The tibial fracture had to be revised with a 4.5 mm intramedullary nail and a new 3.5 mm LCP at the second post-operative day because of fixation breakdown. The follow-up radiographs taken at days 14 and 53 revealed uneventful healing of both fractures. Implants were removed 53 days after surgery. PMID:16594453

  6. Malrotation following reamed intramedullary nailing of closed tibial fractures

    PubMed Central

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

    2012-01-01

    Background: Rotational malalignment after intramedullary tibial nailing is rarely addressed in clinical studies. Malrotation (especially >10°)of the lower extremity can lead to development and progression of degenerative changes in knee and ankle joints. The purpose of this study is to determine the incidence and severity of tibial malrotation after reamed intramedullary nailing for closed diaphyseal tibial fractures. Materials and Methods: Sixty patients (53 males and 7 females) with tibial diaphyseal fracture were included in this study. The mean age of the patients was 33.4±13.3 years. All fractures were manually reduced and fixed using reamed intramedullary nailing. A standard method using bilateral limited computerized tomography was used to measure the tibial torsion. A difference greater than 10° between two tibiae was defined as malrotation. Results: Eighteen (30%) patients had malrotation of more than 10°. Malrotation was greater than 15° in seven cases. Good or excellent rotational reduction was achieved in 70% of the patients. There was no statistically significant relation between AO tibial fracture classification and fibular fixation and malrotation of greater than 10°. Conclusions: Considering the high incidence rate of tibial malrotation following intramedullary nailing, we need a precise method to evaluate the torsion intraoperatively to prevent the problem. PMID:22719118

  7. Distal tibial metaphyseal fractures: the role of fibular fixation

    Microsoft Academic Search

    R. Varsalona; G. T. Liu

    2006-01-01

    Distal tibial extra-articular fractures are often a\\u000a result of complex high-energy trauma, which commonly\\u000a involves associated fibular fractures and soft tissue injury.\\u000a The goal of tibial fixation is to maximise fracture stability\\u000a without increasing soft tissue morbidity from surgical\\u000a intervention. The role of adjunctive fibular fixation in distal\\u000a tibial metaphyseal fractures has been controversial;\\u000a although fibular fixation has been shown

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

    PubMed

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

    2006-02-01

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

  9. Posterior tibial nerve lesions in ankle arthroscopy.

    PubMed

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

    2008-05-01

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

  10. [Custom-designed 3D tibial augmentation for knee replacement].

    PubMed

    Jirman, R; Vavrík, P; Horák, Z

    2009-02-01

    Reconstruction with the use of custom-made implants aims at optimal replacement of lost or damaged bone structures and restoration of their funkction. In this study the development and construction of a custom-made implant and the operative technique used for the treatment of an extensive tibial defect are described. The patient was a 65-year-old man treated for over 20 years for psoriatic arthritis and severe instability of the right knee, particularly in the frontal plane, with a worsening varus deformity. The radiogram showed an extensive destruction of the medial tibial condyle that also deeply involved the lateral condyle. The extent of defect made it impossible to use any commercial tibial augmentation. The geometry of the custom-designed implant for the medial tibial condyle was constructed on the basis of a 3D defect model and the shape of the medial tibial condyle of the collateral knee seen on CT scans. After its correct shape was verified on a plastic model, its coordinates were set in the software of a machine tool, and a titanium augmentation otherwise compatible with a standard knee replacement was produced.The use of such a custom implant to complete standard total knee arthroplasty has so far been demanding in terms of organisation and manufacture. Its production in the future could be facilitated by substituting titanium for plastic material such as poly-ether-ether-ketone (PEEK). Key words: custom-made implant, tibial augmentation, knee prosthesis. PMID:19268051

  11. [Isolated anterior cervical hypertrichosis].

    PubMed

    Monteagudo, B; Cabanillas, M; de las Heras, C; Cacharrón, J M

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding. PMID:19268113

  12. Disturbances in the voluntary recruitment order of anterior tibial motor units in bradykinesia of Parkinsonism 1

    PubMed Central

    Grimby, Lennart; Hannerz, Jan

    1974-01-01

    The recruitment of motor units is studied with an electromyographic technique for secure identification of single motor unit potentials. It has been shown in previous studies that the recruitment order is different in tonic and in phasic activities; in tonic activity the recruitment order is stable and low frequency units are always recruited before high frequency units; in phasic activity, however, the recruitment order is unstable and units with a higher frequency range may be recruited before units with lower frequency range. In this investigation the shifts between tonic and phasic recruitment order in voluntary contraction were compared in normal subjects and in patients with severe bradykinesia of Parkinsonism. Upon initiation of a voluntary contraction in a normal subject, phasic recruitment order may be used for a few 100 msec but tonic recruitment order then takes over. In bradykinetic patients, however, this shift from phasic to tonic recruitment order is delayed. After termination of tonic voluntary contraction in a normal subject, phasic recruitment order can again be used after a few seconds. In bradykinetic patients, however, the shift back from tonic to phasic recruitment order is also delayed. In favourable experimental situations the shift from phasic to tonic recruitment order can be normalized by passive stretch of the muscle and the shift from tonic to phasic recruitment pattern by unloading the muscle. It is discussed whether the pathological recruitment in bradykinesia might be due to disturbed gamma loop function. PMID:4813427

  13. Disturbances in the voluntary recruitment order of anterior tibial motor units in ataxia.

    PubMed Central

    Grimby, L; Hannerz, J

    1975-01-01

    The recruitment order of motor units was studied with an electromyographic technique for secure identification of single motor unit potentials. It has been shown in previous studies of normal subjects that the recruitment order in sustained voluntary contraction is predominantly stable, and that motor units which increase slowly in discharge rate with increasing contraction strength and which already attain regular discharge intervals at low frequencies are always recruited before motor units which increase more rapidly in discharge rate and which do not attain regular discharge intervals until at higher frequencies. In this study 15 patients with severe cerebellar ataxia were examined. It was shown that the recruitment order in sustained voluntary contraction in attaxia is unstable and that low- and high-frequency motor units may alternate as the unit of lowest threshold. PMID:163893

  14. Disturbances in the voluntary recruitment order of anterior tibial motor units in bradykinesia of Parkinsonism.

    PubMed

    Grimby, L; Hannerz, J

    1974-01-01

    The recruitment of motor units is studied with an electromyographic technique for secure identification of single motor unit potentials. It has been shown in previous studies that the recruitment order is different in tonic and in phasic activities; in tonic activity the recruitment order is stable and low frequency units are always recruited before high frequency units; in phasic activity, however, the recruitment order is unstable and units with a higher frequency range may be recruited before units with lower frequency range. In this investigation the shifts between tonic and phasic recruitment order in voluntary contraction were compared in normal subjects and in patients with severe bradykinesia of Parkinsonism. Upon initiation of a voluntary contraction in a normal subject, phasic recruitment order may be used for a few 100 msec but tonic recruitment order then takes over. In bradykinetic patients, however, this shift from phasic to tonic recruitment order is delayed. After termination of tonic voluntary contraction in a normal subject, phasic recruitment order can again be used after a few seconds. In bradykinetic patients, however, the shift back from tonic to phasic recruitment order is also delayed. In favourable experimental situations the shift from phasic to tonic recruitment order can be normalized by passive stretch of the muscle and the shift from tonic to phasic recruitment pattern by unloading the muscle. It is discussed whether the pathological recruitment in bradykinesia might be due to disturbed gamma loop function. PMID:4813427

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

    PubMed Central

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

    2015-01-01

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

  16. Smaller anterior cruciate ligament diameter is a predictor of subjects prone to ligament injuries: an ultrasound study.

    PubMed

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

    2015-01-01

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

  17. Anterior vitrectomy and partial capsulectomy via anterior approach to treat chronic postoperative endophthalmitis

    PubMed Central

    Güler, Mete; Y?lmaz, Turgut

    2013-01-01

    AIM To describe the results of vitrectomy and partial capsulectomy via anterior approach surgical technique in treatment of chronic postoperative endophthalmitis (CPE). METHODS Clinical records of 9 patients treated for CPE between 2006 and 2010 were reviewed retrospectively. All of these patients were treated with vitrectomy and partial capsulectomy via anterior approach. RESULTS Six of 9 patients were male. The average patients' age was (60±8.1) years. The average period between cataract extraction and onset of signs and symptoms was (3.6±1.3) weeks. The average presenting visual acuity was 0.3±0.1 and the average final post operative visual acuity was 0.7±0.2. The mean follow-up period was (28.1±8.9) weeks. In all patients, the inflammation subsided after surgery. CONCLUSION Our results suggest that anterior vitrectomy and partial capsulectomy via anterior approach may be considered as potentially useful and relatively less invasive technique to treat CPE. PMID:23550103

  18. Avoiding Graft-Tunnel Length Mismatch in Anterior Cruciate Ligament Reconstruction: The Single–Bone Plug Technique

    PubMed Central

    Grawe, Brian; Smerina, Amber; Allen, Answorth

    2014-01-01

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

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

    Microsoft Academic Search

    Scott J. Luhmann; Sara Fuhrhop; June C. O’Donnell; J. Eric Gordon

    2011-01-01

    Purpose  Tibial tubercle osteotomies (TTOs) are a seemingly straightforward technique; however problems with bony union, implant failure,\\u000a wound infections, and fractures have been reported in the literature.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  A database search identified all patients who had a TTO performed for patellofemoral instability between 1 March 2000 and\\u000a 30 July 2008 by a single surgeon. The TTO technique was modified twice during the

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

    PubMed

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

    2014-10-01

    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. PMID:25274924

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

    PubMed Central

    2010-01-01

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

  2. Mechanical analysis of fixation methods for anterior cruciate ligament reconstruction with hamstring tendon graft. An experimental study in sheep knees

    Microsoft Academic Search

    Carlo Fabbriciani; Pier Damiano Mulas; Fabio Ziranu; Laura Deriu; Donatella Zarelli; Giuseppe Milano

    2005-01-01

    This study evaluates the structural properties of the femur–anterior cruciate ligament (ACL) graft–tibia complex, comparing different graft fixation techniques in sheep knees. Four fixation devices were tested both for femoral fixation (Transfix, absorbable screw, RCI screw and Linx-HT) and tibial fixation (bone plug with metal screw, absorbable screw with staple, RCI screw and cancellous screw with spiked washer). The graft

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

    Microsoft Academic Search

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

    2012-01-01

    Background: Gender differences exist in anterior cruciate ligament (ACL) cross-sectional area and lateral tibial slope. Biomechanical principles suggest that the direction of these gender differences should induce larger peak ACL strains in females under dynamic loading.Hypothesis: Peak ACL relative strain during a simulated pivot landing is significantly greater in female ACLs than male ACLs.Study Design: Controlled laboratory study.Methods: Twenty cadaveric

  4. Total fractures of the tibial pilon.

    PubMed

    Dujardin, F; Abdulmutalib, H; Tobenas, A C

    2014-02-01

    Complete fractures of the tibial pilon are rare and their treatment difficult. The pathophysiology includes three groups: (A) high-energy trauma (motor vehicle injuries), with severe articular and soft tissue lesions, (B) rotation trauma, (skiing accidents), with modest articular and soft tissue damage, and (C) low-energy trauma in elderly people. These three groups occasion very different problems and complications. In emergency situations, these fractures should be stabilized, most often using external fixation to restore length and prepare definitive fixation. The second stage can be applied once soft tissue healing is achieved. Two methods are discussed: internal plating and definitive external fixation. The first goal of treatment is to restore the articular surface, although this does not always prevent secondary arthritis. The second is to restore correct positioning of the foot as regard to the leg. The complication rate is high. Neither of the two fixation techniques has proven to be more effective. In group B, the two methods are similar, but external fixation seems to be safer in group A. PMID:24412046

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

    PubMed Central

    van Raaij, T. M.

    2006-01-01

    We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and the mean Knee Society score score was 94.6 (70–100) for function and 87.7 (47–100) for pain. The mean Western Ontario and McMaster University Osteoarthritis Index score for knee function was 87.5 (42–100), for stiffness 82.8 (25–100) and for pain 87.3 (55–100). Radiographs showed a significant increase in posterior tibial slope of 9.4 deg and a significant decrease of patellar height according to the Blackburne–Peel method of 0.16 postoperatively. No cases of non-union, deep infection or compartment syndrome were seen. No osteoarthritic changes in the lateral or medial knee compartment were found with more than 5 years’ follow-up in 16 patients with 19 affected knees. Three out of the four dissatisfied patients had a patella infera which led to patellofemoral complaints. One patient in the study underwent a secondary superior displacement of the patella with excellent results. We conclude that in a selected group of patients with idiopathic genu recurvatum and anterior knee pain an opening wedge osteotomy of the proximal tibia can be beneficial. PMID:16521014

  6. Anterior cruciate ligament surgery in the rabbit

    PubMed Central

    2013-01-01

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

  7. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ...Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. ...ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590 Knee joint tibial (hemi-knee) metallic...

  8. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...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...

  9. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...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...

  10. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ...Drugs 8 2014-04-01 2014-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. ...ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590 Knee joint tibial (hemi-knee) metallic...

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

    PubMed

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

    2014-12-01

    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

  12. Comparison of loading rate-dependent injury modes in a murine model of post-traumatic osteoarthritis.

    PubMed

    Lockwood, Kevin A; Chu, Bryce T; Anderson, Matthew J; Haudenschild, Dominik R; Christiansen, Blaine A

    2014-01-01

    Post-traumatic osteoarthritis (PTOA) is a common long-term consequence of joint injuries such as anterior cruciate ligament (ACL) rupture. In this study we used a tibial compression overload mouse model to compare knee injury induced at low speed (1 mm/s), which creates an avulsion fracture, to injury induced at high speed (500 mm/s), which induces midsubstance tear of the ACL. Mice were sacrificed at 0 days, 10 days, 12 weeks, or 16 weeks post-injury, and joints were analyzed with micro-computed tomography, whole joint histology, and biomechanical laxity testing. Knee injury with both injury modes caused considerable trabecular bone loss by 10 days post-injury, with the Low Speed Injury group (avulsion) exhibiting a greater amount of bone loss than the High Speed Injury group (midsubstance tear). Immediately after injury, both injury modes resulted in greater than twofold increases in total AP joint laxity relative to control knees. By 12 and 16 weeks post-injury, total AP laxity was restored to uninjured control values, possibly due to knee stabilization via osteophyte formation. This model presents an opportunity to explore fundamental questions regarding the role of bone turnover in PTOA, and the findings of this study support a biomechanical mechanism of osteophyte formation following injury. PMID:24019199

  13. Tibial bone defects treated by internal bone transport using the Ilizarov method

    Microsoft Academic Search

    H.-R. Song; S.-H. Cho; K.-H. Koo; S.-T. Jeong; Y.-J. Park; J.-H. Ko

    1998-01-01

    .  \\u000a We reviewed 27 cases of tibial bone defects treated by internal bone transport using the Ilizarov method. The causes of the\\u000a bone defects were open fractures in 14 segments and infected non-unions in 13. The average length of the defects was 8.3 cm\\u000a (range, 3–20 cm). There were 21 one-level tibial transports, 3 two-level tibial transports, 1 one-level tibial

  14. Contours of the hominoid lateral tibial condyle with implications for Australopithecus

    Microsoft Academic Search

    Jason M. Organ; Carol V. Ward

    2006-01-01

    Tibial condyle shape is alleged to vary among fossil tibiae attributed to Australopithecus, and has been argued to reflect functional differences of the knee. Convex anteroposterior curvature of the lateral tibial condyle in A. africanus has been interpreted to indicate a more chimpanzee-like locomotor repertoire than the flatter lateral tibial condyles of A. afarensis (Berger and Tobias, 1996, J. Hum.

  15. The unreamed tibial nail in the treatment of distal metaphyseal fractures

    Microsoft Academic Search

    R. Mosheiff; O. Safran; D. Segal; M. Liebergall

    1999-01-01

    In recent years biological surgical solutions have been recommended in cases of distal tibial fractures, with the aim of reducing damage to soft tissues and to bone vascular supply. Between the years 1991–1995, 52 patients suffering from fractures of the distal tibial metaphysis were treated in our department with an unreamed tibial nail (UTN). Fractures were categorized in accordance with

  16. Intramedullary wiring for tibial shaft fractures in children before epiphyseal closure

    Microsoft Academic Search

    E. Sim

    1991-01-01

    Between 1958 and 1987 36 children underwent intramedullary wiring for tibial shaft fractures. Of these, 29 presented with combined tibial and fibular fractures, and 7 showed isolated tibial shaft fractures. Fractures were simple in 22 and compound in 14 patients. Mean patient age was 13 years (4–16 years). Only bending fractures with and without splinters were wired. The wiring technique

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

    NASA Technical Reports Server (NTRS)

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

    2001-01-01

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

  18. Arthroscopic management of tibial plateau fractures: surgical technique.

    PubMed

    Burdin, G

    2013-02-01

    Tibial plateau fractures are serious articular fractures that are challenging to treat. Arthroscopy-assisted percutaneous fixation is the treatment of choice in Schatzker types 1, 2, 3, and 4 fractures, as it ensures optimal reduction and stable fixation consistent with early mobilisation. The most reliable fixation method seems to be percutaneous cannulated screw fixation, which is less invasive than open plate fixation. In complex proximal tibial fractures, arthroscopy may allow an evaluation of articular fracture reduction, thereby obviating the need for extensive arthrotomy. Complementary stable fixation is crucial and should allow early mobilisation to reap the benefits of the arthroscopic assistance. This article aims to review the technical points that are useful to the successful video-assisted management of tibial plateau fractures. PMID:23347755

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

    PubMed Central

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

    2013-01-01

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

  20. Slipped upper tibial epiphysis in infantile tibia vara: three cases.

    PubMed

    Sanghrajka, A P; Hill, R A; Murnaghan, C F; Simpson, A H R W; Bellemore, M C

    2012-09-01

    We describe three cases of infantile tibia vara resulting from an atraumatic slip of the proximal tibial epiphysis upon the metaphysis. There appears to be an association between this condition and severe obesity. Radiologically, the condition is characterised by a dome-shaped metaphysis, an open growth plate and disruption of the continuity between the lateral borders of the epiphysis and metaphysis, with inferomedial translation of the proximal tibial epiphysis. All patients were treated by realignment of the proximal tibia by distraction osteogenesis with an external circulator fixator, and it is suggested that this is the optimal method for correction of this complex deformity. There are differences in the radiological features and management between conventional infantile Blount's disease and this 'slipped upper tibial epiphysis' variant. PMID:22933505

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

    PubMed

    Good, L

    1995-06-01

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

  2. Anterior knee pain after total knee arthroplasty: a narrative review.

    PubMed

    Petersen, Wolf; Rembitzki, Ingo Volker; Brüggemann, Gerd-Peter; Ellermann, Andree; Best, Raymond; Koppenburg, Andreas Gösele-; Liebau, Christian

    2014-02-01

    Anterior knee pain is one of the most common causes of persistent problems after implantation of a total knee replacement. It can occur in patients with or without patellar resurfacing. As a result of the surgical procedure itself many changes can occur which may affect the delicate interplay of the joint partners in the patello-femoral joint. Functional causes of anterior knee pain can be distinguished from mechanical causes. The functional causes concern disorders of inter- and intramuscular coordination, which can be attributed to preoperative osteoarthritis. Research about anterior knee pain has shown that not only the thigh muscles but also the hip and trunk stabilising muscles may be responsible for the development of a dynamic valgus malalignment. Dynamic valgus may be a causative factor for patellar maltracking. The mechanical causes of patello-femoral problems after knee replacement can be distinguished according to whether they increase instability in the joint, increase joint pressure or whether they affect the muscular lever arms. These causes include offset errors, oversizing, rotational errors of femoral or tibial component, instability, maltracking and chondrolysis, patella baja and aseptic loosening. In these cases, reoperation or revision is often necessary. PMID:24057656

  3. Bone tunnel enlargement on anterior cruciate ligament reconstruction

    PubMed Central

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

    2014-01-01

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

  4. Posterior tibial tendon dysfunction in the adult: current concepts.

    PubMed

    Stein, Benjamin E; Schon, Lew C

    2015-01-01

    The management of posterior tibial tendon dysfunction in adults has evolved substantially, and controversy persists regarding a specific recommended algorithm for treatment. The current focus is on early diagnosis and treatment of this disorder with joint-sparing surgeries, such as corrective osteotomies and tendon transfers, when nonsurgical modalities have been exhausted. It is helpful to be familiar with the pertinent pathophysiology and diagnostic pearls associated with posterior tibial tendon dysfunction, its treatment options, pertinent literature, and technique tips for the procedures currently being used. PMID:25745927

  5. Bilateral osteochondrosis of the distal tibial epiphysis: a case report.

    PubMed

    Turati, Marco; Afonso, David; Salazard, Bruno; Maillet Declerck, Marie; Bigoni, Marco; Glard, Yann

    2015-03-01

    Osteochondrosis is a developmental disease characterized by an alteration of endochondral ossification. Genetic causes, repetitive mechanical stresses, vascular abnormalities, hormonal imbalances, and interruption of the blood supply to the epiphyseal cartilage are all described causes of osteochondrosis and the etiology is probably multifactorial. Osteochondrosis can occur in different apophysis and epiphysis in all immature skeletons. Distal tibial epiphysis is rarely involved and most of the time unilaterally. We report on an 11-year-old female with bilateral osteochondrosis on distal tibial epiphysis. Only one other similar case has been described in the literature to date. PMID:25504104

  6. Posterior tibial vein aneurysm presenting as tarsal tunnel syndrome.

    PubMed

    Ayad, Micheal; Whisenhunt, Anumeha; Hong, EnYaw; Heller, Josh; Salvatore, Dawn; Abai, Babak; DiMuzio, Paul J

    2014-09-01

    Tarsal tunnel syndrome is a compressive neuropathy of the posterior tibial nerve within the tarsal tunnel. Its etiology varies, including space occupying lesions, trauma, inflammation, anatomic deformity, iatrogenic injury, and idiopathic and systemic causes. Herein, we describe a 46-year-old man who presented with left foot pain. Work up revealed a venous aneurysm impinging on the posterior tibial nerve. Following resection of the aneurysm and lysis of the nerve, his symptoms were alleviated. Review of the literature reveals an association between venous disease and tarsal tunnel syndrome; however, this report represents the first case of venous aneurysm causing symptomatic compression of the nerve. PMID:25199522

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

    PubMed

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

    1985-05-01

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

  8. Valgus subsidence of the tibial component in cementless Oxford unicompartmental knee replacement

    PubMed Central

    Liddle, A. D.; Pandit, H. G.; Jenkins, C.; Lobenhoffer, P.; Jackson, W. F. M.; Dodd, C. A. F.; Murray, D. W.

    2014-01-01

    The cementless Oxford unicompartmental knee replacement has been demonstrated to have superior fixation on radiographs and a similar early complication rate compared with the cemented version. However, a small number of cases have come to our attention where, after an apparently successful procedure, the tibial component subsides into a valgus position with an increased posterior slope, before becoming well-fixed. We present the clinical and radiological findings of these six patients and describe their natural history and the likely causes. Two underwent revision in the early post-operative period, and in four the implant stabilised and became well-fixed radiologically with a good functional outcome. This situation appears to be avoidable by minor modifications to the operative technique, and it appears that it can be treated conservatively in most patients. Cite this article: Bone Joint J 2014;96-B:345–9. PMID:24589789

  9. A rare case of anterior chamber dirofilariasis

    PubMed Central

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

    2015-01-01

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

  10. A rare case of anterior chamber dirofilariasis.

    PubMed

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

    2015-01-01

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

  11. Extending the Indication of Intramedullary Nailing of Tibial Fractures

    Microsoft Academic Search

    Sebastian Kuhn; Matthias Hansen; Pol M. Rommens

    2007-01-01

    Intramedullary nailing is an effective and well-established method for the treatment of a wide spectrum of tibial fractures.\\u000a Nevertheless, the handling of metaphyseal and open fracture remains challenging. Surgical and technical advancements have\\u000a opened up new possibilities to broaden the indication of intramedullary nailing in these areas.

  12. Anterior Cervical Arachnoid Cyst

    PubMed Central

    Sharifi, Give

    2013-01-01

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

  13. Outcomes of total knee arthroplasty following high tibial osteotomy

    PubMed Central

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

    2013-01-01

    Background: Total knee arthroplasty (TKA) following high tibial osteotomy (HTO) is a technically demanding procedure with varying results. The purpose of our study was to analyze the clinicoradiological results of TKA following HTO and to identify the factors that may influence the final outcome. Materials and Methods: 55 patients (58 knees) who had undergone a previous HTO were treated with a TKA from 1991 to 2009. There were 34 female and 21 male patients. The average age was 61.9 years (range 52-82 years) and the average weight was 79.5 kg (range 54-106 kg), with an average body mass index of 29.6 (range 21.8-34.6) at the time of TKA. The knee society scores (KSSs) and knee society functional scores were evaluated for every patient pre and postoperatively and the results evaluated. Results: The mean period of followup was 11.2 years (range 3-18 years) and the patients were followed up every year. The average KSS score at final followup improved from 38.5 (range 0-80 points) preoperatively to 88.5 postoperatively (range 35-95 points) (P < 0.05). The mean femorotibial angle corrected from 6.8 degrees (range 5-12°) varus preoperatively to a valgus of 4.4 (2-8°) degrees postoperatively. The average joint line height improved to an average of 9.6 mm (range 4.4-22 mm) (P < 0.01) at the last followup. The average Insall Salvatti Ratio also improved (average 1.11 preoperative - 1.21 average postoperative) (P < 0.05). The average range of motion improved to 108° (range 85°-125°) from 76° preoperative (range 55°-100°) (P < 0.01). Conclusion: Although TKA postHTO is a demanding surgery however, with newer component designs, results are comparable to primary TKA. Technical difficulties in exposure can sometimes lead to component malpositioning, which can affect the final outcome. Inadequate soft tissue balancing and limb malalignment should always be kept in mind. Regular followup to look for evidences of loosening is advised in such patients]. PMID:24133306

  14. Experimental model of tibial plateau fracture for biomechanical testing.

    PubMed

    Ali, Ahmad M; Saleh, Michael; Bolongaro, Stefano; Yang, Lang

    2006-01-01

    Although adequate reduction and stable fixation have been recognized to be the prime goals in the treatment of displaced tibial plateau fractures, the optimal fixation technique remains controversial. The lack of a reliable model and a standard methodology contribute to this situation. The purpose of this study is to develop an experimental model of a tibial plateau fracture and a testing methodology that reproduces the failure mode commonly seen in the clinical setting. Using solid-foam and composite Sawbones tibiae, three different models of bi-condylar tibial plateau fracture (solid-foam, reinforced solid-foam and composite), six specimens for each model, were created and stabilized with double plating. The specimens were subjected to cyclic axial compression with increasing maximum load until failure. A femoral component of a total knee replacement of similar size and shape to the synthetic tibial surface was used as a load applicator. The experiment was repeated on six specimens of human cadaver tibiae. Among the Sawbones specimens, only the reinforced solid-foam model was found to produce a consistent failure mode (collapse in the medial plateau) comparable to that reported clinically in the literature. This mode of failure was also confirmed by the cadaver experiments. The failure load of the reinforced solid-foam model ranged from 4150 to 4260 N with a mean +/- SD of 4201 +/- 44 N and a coefficient of variance of 0.01, whereas for the cadaver model the failure load ranged from 1675 to 6096 N with a mean +/- SD of 3768 +/- 1482 N and a coefficient of variance of 0.39. We recommend the reinforced-foam model for future mechanical tests to compare different fixation methods for tibial plateau fractures. PMID:15936763

  15. Surgical indications for distal tibial epiphyseal fractures in children.

    PubMed

    Cai, Haoqi; Wang, Zhigang; Cai, Haiqing

    2015-03-01

    The goal of this study was to investigate the treatment methods and surgical indications of distal tibial epiphyseal fractures in children. Two hundred eighty-six children with distal tibial epiphyseal fractures were included in the study. Among these patients, 202 were male and 84 were female. Mean age was 11.7 years. A retrospective study on the postoperative long-term complications and related risk factors was performed. Treatment methods were determined according to the distance of fracture displacement. A long-leg cast was applied after closed reduction for patients with primary fracture displacement less than 2 mm. For cases with more than 2 mm of fracture displacement, K-wire or screw fixation was performed. For patients with less than 2 mm of fracture displacement, closed reduction and internal fixation was performed. Open reduction was performed in patients with more than 2 mm of fracture displacement, even after closed reduction. Mean follow-up was 6.4 years. Premature physeal closure occurred in 42 patients, and, among them, varus and valgus ankle deformities occurred in 16 patients. Associated fibular fractures and cast immobilization after closed reduction for Salter-Harris type III and IV fractures were risk factors for premature physeal closure. It is not effective to determine the surgical procedure according to the distance of preoperative fracture displacement for improving the prognosis of distal tibial epiphyseal fractures in children. Conservative treatment should be performed for patients with Salter-Harris type I and II distal tibial epiphyseal fractures, and surgery should be performed in patients with Salter-Harris type III and IV distal tibial epiphyseal fractures to reduce the incidence of premature physeal closure. [Orthopedics. 2015; 38(3):e189-e195.]. PMID:25760505

  16. Structure-function relationships in the human visual system using DTI, fMRI and visual field testing: pre- and post-operative assessments in patients with anterior visual pathway compression.

    PubMed

    Rosiene, Joel; Liu, X; Imielinska, C; Ferrera, J; Bruce, J; Hirsch, J; D'Ambrosio, A

    2006-01-01

    The focus of this project is to improve our understanding of the relationships between brain structure and function in patients presenting with anterior visual pathway compression using functional MRI (fMRI), visual field(VF) maps and diffusion tensor imaging (DTI). Significant visual loss can occur when large pituitary lesions compress the optic chiasm. Surgical resection of these lesions decompresses the chiasm and can lead to visual recovery. In this preliminary study, we selected patients presenting with slowly progressive visual loss secondary to a compressive pituitary region mass. Using preoperative DTI data, we reconstructed white matter projections of the optic radiations and demonstrated a structural correlation with functional vision as quantified by formal visual field mapping and fMRI. The structural data generated through a fiber tracking algorithm may represent a potentially powerful tool to better understand functional visual deficits in patients with anterior visual pathway compression. Furthermore, we believe that specific patterns in preoperative DTI data may predict the likelihood of postoperative visual recovery in a select group of patients. PMID:16404100

  17. Arthrose due au genu varum: traitement par osteotomie tibiale de valgisation

    PubMed Central

    Moussa, Abdou Kadri; Lukulunga, Loubet Unyendje; Mahfoud, Mustapha; El Bardouni, Ahmed; Ismail, Farid; Kharmaz, Mohamed; Berrada, Mohammed Saleh; El Yaacoubi, Moradh

    2014-01-01

    Le traitement du genu varum est le plus souvent conservateur (ostéotomie tibiale de valgisation) permettant de corriger le trouble architectural afin de rétablir l'axe physiologique du membre inférieur. Le but de l’étude était d’évaluer les résultats du traitement et comparer à ceux de la littérature. Il s'est agi d'une étude rétrospective portant sur des patients présentant un genu varum qui s'est déroulée dans le Service de Chirurgie Orthopédique et Traumatologie de CHU Ibn SINA de RABAT, sur une période de 9 ans (2000 au 31 Décembre 2008). Nous avons inclus dans notre étude: les patients qui avaient un genu-varum clinique avec examen radiographique standard ainsi qu'un pangonogramme; traités par différents procédés d'ostéotomie tibiale de valgisation; avec un suivis d’ au moins deux ans. Nos critères d’évaluation ont été appréciés selon le score HSS. Nous avons colligé 115 cas de genu-varum par ostéotomie de valgisation. L’âge de nos patients variait entre 40 et 69 ans, avec une moyenne de 53 ans. Le pic de fréquence se situait entre 52et 63 ans. Le sexe féminin prédominait avec 87 cas (75,6%) avec un sex ratio 3,1. Un Indice de masse corporelle supérieur à 30 a été noté dans 44 cas (38%). Quant aux antécédents chirurgicaux,18 patients de la série (soit 14%) ont été opérés pour le genu varum d'un autre genou. Le délai de consultation a varié entre 4 mois à 6 ans, avec une moyenne de 2 ans. La douleur était le principal motif de consultation et était de siège médial dans 70% des cas et bicompartimental dans 30% cas. Il s'agissait d'une douleur mécanique dans 76% des cas, mixte 21% des cas et inflammatoire 4% des cas. La déformation du genou appréciée par l’écart intercondylien a été en moyenne de 8,7 cm avec des extrêmes de 3 cm et 33cm. Le bilan de l'imagerie médicale reposait essentiellement sur les radiographies standards du genou de face et de profil, ainsi que la goniométrie. Ces clichés nous ont permis de classer l'arthrose du genou selon Ahlbäck. 72,5% des patients, présentaient une arthrose débutante. Le pangonogramme a été réalisé pour mesurer la déviation axiale du génu varum. La déviation angulaire: HKA (angle entre le centre de la tête fémorale et le milieu de la cheville) préopératoire a varié entre 163° et 176°, soit une moyenne de 175,46°. Une correction moyenne de déviation de 11,3° a été réalisée avec des extrêmes de 7 à 19°. Cet angle de correction (DAC) qui variait de 7 à 19° a été supérieur à 15° dans 57,39%s inférieur à 15° chez 38%. 27,4% des patients avaient une déviation angulaire importante avec une arthrose avancée. Après un bilan préopératoire et une planification opératoire 73% des patients ont été opérés sous anesthésie loco-régionale. Pour l'ostéotomie tibiale de fermeture, la voie d'abord a été la voie de Gernez antérolatérale, utilisée chez 56 cas (48,6%), l'ostéotomie tibiale d'ouverture (la voie d'abord était Gernez antéro-médiale) effectuée dans 20 cas (17,3%);et l'ostéotomie curviplane, a été réalisée par une voie d'abord longitudinale médiane dans 39%. Les ostéosynthèses ont été réalisées dans 51 cas (44,3%) par les agrafes de Blount, dans 54 cas (46,9%) par la plaque en T ou en L et dans 11 cas par une plaque en col de cygne. En per-opératoire nous avons enregistré deux (02) cas de fractures du plateau tibial médial, en post-opératoire on a eu 1 cas

  18. Minimally Invasive Percutaneous Plate Osteosynthesis Does Not Increase Complication Rates in Extra-Articular Distal Tibial Fractures

    PubMed Central

    Bingol, Izzet; Yalcin, Nadir; Bicici, Vedat; Tulunay, Tolga; Yuksel, Kaan; Kilicarslan, Kasim

    2015-01-01

    Background : Selection of a treatment method in cases of unstable, nonarticular distal tibial fractures is still a matter of discussion. Intramedullary nailing, which is a “gold standard” for tibial shaft fractures, does not always work for this specific transition area between diaphysis and metaphysis. Instead, new minimally invasive techniques with special implants are popular. Aims : To determine the functional and radiological results of distal tibial fractures treated with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Study Design : Retrospective cohort analysis. Methods : Thirty distal tibial fractures treated with MIPPO method, between January 2006 and December 2010, were evaluated retrospectively. All patients were classified according to AO/OTA classification. Period of hospital stay, time of fracture union, time to allow full weight bearing, early and late complications were inquired. Functional outcomes were assessed by AOFAS scores. Results : There were 13 male and 17 female patients with an average age of 44.26 (range, 22-77 years). One superficial infection and one malunion were observed. Two patients were revised for the loss of reduction and healed uneventfully. According to the AO/OTA classification, 23 patients were 43-A1 (76.6%), 3 were 43-A2 (10%) and 4 were 43-A3 (13.3%). Post-operative mean stay of patients at the hospital was 2.6 ± 1.42 days (range, 1-7 days). Mean full weight-bearing period of the patients was found out as 13.16 ± 2.6 weeks (range, 10-22 weeks). The mean period of union of fracture for patients was found out as 19.8 ± 2.99 weeks (range, 16-34 weeks). Conclusion : Treatment of distal tibial fractures with MIPPO method provides a successful treatment strategy as long as used as per the technique, and it respects and does not harm soft tissues which allows early callus formation and rapid healing that enable the patient to walk as early as possible after the operation. The overall clinical and functional outcome is still good despite minor complications.

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

    PubMed Central

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

    2014-01-01

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

  20. TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

    PubMed Central

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

    2013-01-01

    Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic “all-inside” double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of double–tibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction. PMID:24749016

  1. Intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction.

    PubMed

    Kanaya, Atsushi; Ochi, Mitsuo; Deie, Masataka; Adachi, Nobuo; Nishimori, Makoto; Nakamae, Atsuo

    2009-08-01

    Twenty-six patients with anteroposterior (AP) laxity of the knee, associated with torn anterior cruciate ligament (ACL), were prospectively randomized for arthroscopic lower femoral tunnel placed single- or double-bundle reconstruction using hamstring tendons. We evaluated AP and rotational stabilities under regular loads (a 100-N anterior load and a 1.5-N m external-internal load) before and after ACL reconstruction, comparing single- and double-bundle reconstruction with our original device for applying quantitative tibial rotation and the navigation system intraoperatively. No significant differences were found between the two groups in AP displacement and total range of tibial rotation at 30 degrees and 60 degrees of knee flexion. We found that a lower femoral tunnel placed single-bundle reconstruction reproduced AP and rotational stability as well as double-bundle reconstruction after reconstruction intraoperatively. PMID:19263035

  2. Anterior interosseous nerve syndrome

    PubMed Central

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

    2014-01-01

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

  3. Evaluating the coupling between foot pronation and tibial internal rotation continuously using vector coding.

    PubMed

    Rodrigues, Pedro; Chang, Ryan; TenBroek, Trampas; van Emmerik, Richard; Hamill, Joseph

    2015-04-01

    Excessive pronation, because of its coupling with tibial internal rotation (TIR), has been implicated as a risk factor in the development of anterior knee pain (AKP). Traditionally, this coupling has been expressed as a ratio between the eversion range of motion and the TIR range of motion (Ev/TIR) that occurs during stance. Currently, this technique has not been used to evaluate specific injuries or the effects of sex. In addition, Ev/TIR is incapable of detecting coupling changes that occur throughout stance. Therefore, the purpose of this study was to compare the coupling between eversion and TIR in runners with (n = 19) and without AKP (n = 17) and across sex using the Ev/TIR ratio, and more continuously using vector coding. When using vector coding, significant coupling differences were noted in runners with AKP (34% to 38% stance), with runners with AKP showing relatively more TIR than eversion. Similarly significant differences were noted across sex (14%-25% and 36%-47% stance), with males transitioning from a loading to propulsive coordination pattern using a proximal to distal strategy, and female runners using a distal to proximal strategy. These differences were only detected when evaluating this coupling relationship using a continuous technique such as vector coding. PMID:25386828

  4. Evaluating the coupling between foot pronation and tibial internal rotation continuously using vector coding.

    PubMed

    Rodrigues, Pedro; Chang, Ryan; TenBroek, Trampas; van Emmerik, Richard; Hamill, Joseph

    2015-04-01

    Excessive pronation, because of its coupling with tibial internal rotation (TIR), has been implicated as a risk factor in the development of anterior knee pain (AKP). Traditionally, this coupling has been expressed as a ratio between the eversion range of motion and the TIR range of motion (Ev/TIR) that occurs during stance. Currently, this technique has not been used to evaluate specific injuries or the effects of sex. In addition, Ev/TIR is incapable of detecting coupling changes that occur throughout stance. Therefore, the purpose of this study was to compare the coupling between eversion and TIR in runners with (n = 19) and without AKP (n = 17) and across sex using the Ev/TIR ratio, and more continuously using vector coding. When using vector coding, significant coupling differences were noted in runners with AKP (34% to 38% stance), with runners with AKP showing relatively more TIR than eversion. Similarly significant differences were noted across sex (14%-25% and 36%-47% stance), with males transitioning from a loading to propulsive coordination pattern using a proximal to distal strategy, and female runners using a distal to proximal strategy. These differences were only detected when evaluating this coupling relationship using a continuous technique such as vector coding. PMID:25775699

  5. Biomechanical effects of plate area and locking screw on medial open tibial osteotomy.

    PubMed

    Luo, Chu-An; Lin, Shang-Chih; Hwa, Su-Yang; Chen, Chun-Ming; Tseng, Ching-Shiow

    2015-01-01

    Medial open high tibial osteotomy (HTO) has been used to treat osteoarthritis of the medial compartment of the knee. However, weaker plate strength, unstable plate/screw junction and improper surgery technique are highly related to the HTO outcomes. Two ?-shape plates were designed and eight variations (two supporting area × four locking stiffness) were compared by finite-element method. The computed tomography-based tibia was reconstructed and both wedge micromotion and implant stresses were chosen as the comparison indices. The construct was subjected to surgical and physiological loads. The medial-posterior region is the most loaded region and the load through the posterior leg is about four times that through the anterior leg. This indicates that the two-leg design can form a force-couple mechanism to effectively reduce the implant stresses. The use of locking screws significantly decrease the screw and hole stresses. However, the extending plate reduces the stresses of screws and holes above the wedge but makes the distal screws and holes much stressed. Wedge micromotion is affected by extending plate rather than locking screw. Three factors contribute to effective stabilisation of unstable HTO wedge: (1) intimate tibia-plate contact at medial-posterior regions, (2) sufficient rigidity at plate-screw junctions and (3) effective moment-balancing design at distal tibia-plate interfaces. PMID:24617553

  6. Anterior cruciate ligament reconstruction with double-looped semitendinosus and gracilis tendon graft directly fixed to cortical bone: 5-year results

    Microsoft Academic Search

    Francesco Giron; Paolo Aglietti; Pierluigi Cuomo; Nicola Mondanelli; Antonio Ciardullo

    2005-01-01

    Forty-three patients who had undergone an anterior cruciate ligament (ACL) reconstruction using a doubled semitendinosus and gracilis graft were prospectively reviewed at 5-year follow-up. All had suffered subacute or chronic tears of the ligament. At surgery, the femoral tunnel was drilled first through the antero-medial portal. The correct position of the femoral and tibial guide wire was checked fluoroscopically. A

  7. MR evaluation of femoral neck version and tibial torsion.

    PubMed

    Koenig, James Karl; Pring, Maya E; Dwek, Jerry R

    2012-01-01

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. PMID:21842328

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

    PubMed Central

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

    2015-01-01

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

  9. Expandable intramedullary nails for fixation of tibial shaft fractures.

    PubMed

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

    2012-12-01

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

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

    PubMed Central

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

    2009-01-01

    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

  11. Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Using In Situ Hamstring Graft With 4 Tunnels

    PubMed Central

    Wagih, Ahmad M.

    2013-01-01

    A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction have less-than-optimal results. Although overall outcomes of ACL reconstruction are favorable, there remains considerable room for improvement. Anatomically, the ACL consists of 2 major functional bundles, the anteromedial bundle and the posterolateral bundle. Biomechanically, both bundles contribute significantly to the anterior and rotational stability of the knee. Therefore anatomic double-bundle ACL reconstruction techniques may further improve the outcomes in ACL surgery. This article presents a technique for arthroscopic double-bundle ACL reconstruction that includes the use of 2 femoral and 2 tibial tunnels to restore both the anteromedial and posterolateral bundles of the ACL with minimal hardware for fixation. PMID:24749023

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

    PubMed Central

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

    2014-01-01

    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. PMID:25276609

  13. Dynamic contact mechanics on the tibial plateau of the human knee during activities of daily living.

    PubMed

    Gilbert, Susannah; Chen, Tony; Hutchinson, Ian D; Choi, Dan; Voigt, Clifford; Warren, Russell F; Maher, Suzanne A

    2014-06-27

    Despite significant advances in scaffold design, manufacture, and development, it remains unclear what forces these scaffolds must withstand when implanted into the heavily loaded environment of the knee joint. The objective of this study was to fully quantify the dynamic contact mechanics across the tibial plateau of the human knee joint during gait and stair climbing. Our model consisted of a modified Stanmore knee simulator (to apply multi-directional dynamic forces), a two-camera motion capture system (to record joint kinematics), an electronic sensor (to record contact stresses on the tibial plateau), and a suite of post-processing algorithms. During gait, peak contact stresses on the medial plateau occurred in areas of cartilage-cartilage contact; while during stair climb, peak contact stresses were located in the posterior aspect of the plateau, under the meniscus. On the lateral plateau, during gait and in early stair-climb, peak contact stresses occurred under the meniscus, while in late stair-climb, peak contact stresses were experienced in the zone of cartilage-cartilage contact. At 45% of the gait cycle, and 20% and 48% of the stair-climb cycle, peak stresses were simultaneously experienced on both the medial and lateral compartment, suggesting that these phases of loading warrant particular consideration in any simulation intended to evaluate scaffold performance. Our study suggests that in order to design a scaffold capable of restoring 'normal' contact mechanics to the injured knees, the mechanics of the intended site of implantation should be taken into account in any pre-clinical testing regime. PMID:24296275

  14. Compartment Syndrome in Open Tibial Fractures*t

    Microsoft Academic Search

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

    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

  15. Treatment of segmental tibial fractures with supercutaneous plating.

    PubMed

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

    2014-08-01

    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

  16. Titanium elastic nails for pediatric tibial shaft fractures

    PubMed Central

    Sankar, Wudbhav N.; Jones, Kristofer J.; David Horn, B.

    2007-01-01

    Purpose The purpose of our study was to investigate the safety and efficacy of elastic stable intramedullary nailing for unstable pediatric tibial shaft fractures using titanium elastic nails (TENs). To our knowledge, this is the largest series reported in the literature of this specific fixation technique. Methods We reviewed all children with tibial shaft fractures treated operatively at our tertiary care children's hospital to find those patients who underwent fixation with TENs. Between 1998 and 2005, we identified 19 consecutive patients who satisfied inclusion criteria. The average age of the patients in our series was 12.2 years (range 7.2–16 years), and mean follow-up was 15.7 months (range 6–28 months). Patient charts and radiographs were retrospectively reviewed to gather the clinical data. Outcomes were classified as excellent, satisfactory, or poor according to the Flynn classification for flexible nail fixation. Results All patients achieved complete healing at a mean of 11.0 weeks (range 6–18 weeks). At final follow-up, mean angulation was 2° (range 0°–6°) in the sagittal plane and 3° in the coronal plane (range 0°–9°). Five patients (26%) complained of irritation at the nail entry site; there were no leg length discrepancies or physeal arrests as a result of treatment. Two patients required remanipulation after the index procedure to maintain adequate alignment. According to the Flynn classification, we had 12 excellent, six satisfactory, and one poor result. Conclusion Although the indications for operative fixation of pediatric tibial shaft fractures are rare, occasionally surgical treatment is warranted. Based on our results, elastic stable intramedullary nailing with titanium elastic nails is an effective surgical technique which allows rapid healing of tibial shaft fractures with an acceptable rate of complications. PMID:19308521

  17. Fibula-pro-tibia in plating tibial non-unions

    Microsoft Academic Search

    Galal Z. Said; Mohammad M. El-Sharkawi; Hatem G. Said; Omar A. Refai

    Purpose  Plating non-unions of the tibial diaphysis often presents the technical problem of poor purchase of screws due to osteoporosis.\\u000a To improve the stabilization, insertion of one or more screws through the plate across the tibio-fibular space to the fibula\\u000a (fibula-pro-tibia plating) has been practiced. The aim of this study is to evaluate the effectiveness of the fibula-pro-tibia\\u000a plating technique in

  18. Type III-B open tibial fractures in Mozambique

    Microsoft Academic Search

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

    1996-01-01

    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

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

    PubMed Central

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

    2014-01-01

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

  20. Bicondylar tibial plateau fracture after posterior cruciate ligament reconstruction.

    PubMed

    Griesser, Michael J; McCoy, Brett W; Hussain, Waqas M; Saluan, Paul

    2015-03-01

    The authors present a report of a bicondylar tibial plateau fracture in an adolescent athlete after posterior cruciate ligament (PCL) reconstruction. The procedure was performed via arthroscopic transtibial PCL reconstruction with quadrupled semi-tendinosus and gracilis autograft. The patient recovered uneventfully postoperatively and was able to participate in high-level sports activity, such as baseball and track, with no limitations, no subjective complaints, and no episodes of instability. He continued to be asymptomatic up to 3.5 years postoperatively. Almost 4 years postoperatively, the patient reinjured the left knee during recreational noncontact football and was seen emergently. Plain radiographs, magnetic resonance image scan, and computed tomography scan at the time of injury showed a bicondylar tibial plateau fracture with intra-articular involvement. Operative intervention was undertaken for open reduction and internal fixation of the bicondylar tibial plateau fracture. A plate was placed along the medial aspect of the tibia with locking and nonlocking screws, and the joint line was restored appropriately. The patient recovered uneventfully and at the most recent follow-up had full active and passive range of motion, had no subjective or objective evidence of instability, and had returned to full activity with no restrictions. The patient had no history of multiple fractures or any medical or pharmacologic history that predisposed him to decreased bone density. This case shows a unique possible complication after transtibial PCL reconstruction in an adolescent patient. [Orthopedics. 2015; 38(3):e240-e243.]. PMID:25760514

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    2013-08-01

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

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

    PubMed Central

    2013-01-01

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

  4. The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study

    PubMed Central

    Brown, Cynthia L; Gilbert, Kerry K; Brismee, Jean-Michel; Sizer, Phillip S; Roger James, C; Smith, Michael P

    2011-01-01

    Objective To evaluate the effects of neurodynamic mobilization on the fluid dynamics of the tibial nerve in cadavers. Background Evidence showing patients benefit from neural mobilization is limited. Mechanisms responsible for changes in patient symptoms are unclear. Methods Bilateral lower limbs of six unembalmed cadavers (n?=?12) were randomized into matched pairs and dissected to expose the tibial nerve proximal to the ankle. Dye composed of Toulidine blue and plasma was injected into the nerve. The longitudinal dye spread was measured pre- and post-mobilization. The experimental group received the intervention consisting of 30 repetitions of passive ankle range of motion over the course of 1?minute. The matched control limb received no mobilization. Data were analysed using a 2×2 repeated measures ANOVA with subsequent t-tests for pairwise comparisons. Results Mean dye spread was 23.8±10.2?mm, a change of 5.4±4.7% in the experimental limb as compared to 20.7±6.0?mm, a change of ?1.5±3.9% in the control limb. The ANOVA was significant (P?0.02) for interaction between group (experimental/control) and time (pre-mobilization/post-mobilization). t-test results were significant between pre- and post-mobilization of the experimental leg (P?=?0.01), and between control and experimental limbs post-mobilization (P?0.02). Conclusion Passive neural mobilization induces dispersion of intraneural fluid. This may be clinically significant in the presence of intraneural edema found in pathological nerves such as those found in compression syndromes. PMID:22294851

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

    PubMed Central

    Franklyn, Melanie; Field, Bruce

    2013-01-01

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

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

    PubMed Central

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

    2014-01-01

    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

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

    PubMed Central

    2008-01-01

    Background Surgeons agree on the benefits of operative treatment of tibial fractures – the most common of long bone fractures – with an intramedullary rod or nail. Rates of re-operation remain high – between 23% and 60% in prior trials – and the two alternative nailing approaches, reamed or non-reamed, each have a compelling biological rationale and strong proponents, resulting in ongoing controversy regarding which is better. Methods/Design The objective of this trial was to assess the impact of reamed versus non-reamed intramedullary nailing on rates of re-operation in patients with open and closed fractures of the tibial shaft. The study to prospectively evaluate reamed intramedullary nails in tibial fractures (S.P.R.I.N.T) was a multi-center, randomized trial including 29 clinical sites in Canada, the United States and the Netherlands which enrolled 1200 skeletally mature patients with open (Gustilo Types I-IIIB) or closed (Tscherne Types 0–3) fractures of the tibial shaft amenable to surgical treatment with an intramedullary nail. Patients received a statically locked intramedullary nail with either reamed or non-reamed insertion. The first strategy involved fixation of the fracture with an intramedullary nail following reaming to enlarge the intramedullary canal (Reamed Group). The second treatment strategy involved fixation of the fracture with an intramedullary nail without prior reaming of the intramedullary canal (Non-Reamed Group). Patients, outcome assessors, and data analysts were blinded to treatment allocation. Peri-operative care was standardized, and re-operations before 6 months were proscribed. Patients were followed at discharge, 2 weeks post-discharge, and at 6 weeks, 3, 6, 9, and 12 months post surgery. A committee, blinded to allocation, adjudicated all outcomes. Discussion The primary outcome was re-operation to promote healing, treat infection, or preserve the limb (fasciotomy for compartment syndrome after nailing). The primary outcome was a composite comprising the following re-operations: bone grafts, implant exchanges, and dynamizations, in patients with fracture gaps less than 1 cm post intramedullary nail insertion. Infections and fasciotomies were considered events irrespective of the fracture gap. We planned a priori to conduct a subgroup analysis of outcomes in patients with open and closed fractures. S.P.R.I.N.T is the largest collaborative trial evaluating alternative orthopaedic surgical interventions in patients with tibial shaft fractures. The methodological rigor will set new benchmarks for future trials in the field and its results will have important impact on patient care. The S.P.R.I.N.T trial was registered [ID NCT00038129] and received research ethics approval (REB#99-077). PMID:18573205

  8. Bone bruises in anterior cruciate ligament injured knee and long-term outcomes. A review of the evidence

    PubMed Central

    Papalia, Rocco; Torre, Guglielmo; Vasta, Sebastiano; Zampogna, Biagio; Pedersen, Douglas R; Denaro, Vincenzo; Amendola, Annunziato

    2015-01-01

    Background Bone bruises are frequently associated with anterior cruciate ligament (ACL) tears as a result of trauma or direct shear stress of the bone. Purpose To review the evidence regarding the characteristics of the bone bruise associated with ACL tears, its relevance on clinical outcomes, and its progression over time. In particular, the long-term effects of the bone bruise on the knee osteochondral architecture and joint function were evaluated. Study design Review; level of evidence: 4. Methods An electronic search was performed on PubMed. Combinations of keywords included: “bone bruise AND knee”; “bone bruise AND anterior cruciate ligament”; “bone bruise AND osteo-chondral defects”. Any level of evidence studies concerning bone bruises in patients with partial or complete ACL tears were retrieved. Results A total of 25 studies were included; three of them investigated biomechanical parameters, seven were concerned with clinical outcomes, and 15 were radiological studies. Evaluation of the bone bruise is best performed using a fat-saturated T2-weighted fast spin echo exam or a short tau inversion recovery sequence where fat saturation is challenging. The location of the injury has been demonstrated to be more frequent in the lateral compartment of the joint (lateral femoral condyle and lateral tibial plateau). It is associated with ACL tears in approximately 70% of cases, often with collateral ligament or meniscal tears. Mid- and long-term outcomes demonstrated a complete healing of the marrow lesions at magnetic resonance imaging, but chondral defects detected with T1? sequences are still present 1 year after the ACL injury. Functional examination of the knee, through clinical International Knee Documentation Committee scores, did not show any correlation with the bone bruise. Conclusion Although bone bruise presence yields to higher pain levels, no correlation with functional outcomes was reported. Most studies have a short-term follow-up (<2 years) compared to the length of time it takes to develop post-traumatic osteoarthritis, so it still remains unclear whether the initial joint injury and bone bruise have a direct relationship to long-term function. PMID:25733936

  9. Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

    PubMed Central

    Ji, Hyung-Min; Baek, Ji-Hoon; Ko, Young-Bong

    2015-01-01

    Background The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. Methods Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. Results Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. Conclusions The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis. PMID:25729519

  10. Grade 3 open tibial shaft fractures treated with a circular frame, functional outcome and systematic review of literature.

    PubMed

    Dickson, D R; Moulder, E; Hadland, Y; Giannoudis, P V; Sharma, H K

    2015-04-01

    We report on the surgical and functional outcome of 22 patients with Grade 3 open tibial fractures treated with circular frame. All cases united and there were no re-fractures or amputations. All patients were assessed at a minimum of 1-year post frame removal. Assessment included clinical examination, IOWA ankle and knee scores, Olerud and Molander ankle score and EuroQol EQ-5D. Clinical scores were either good or excellent in over half of the patients in all knee and ankle scores. There was a significant positive correlation between functional outcomes and the EQ-5D score. The EQ-5D mean health state visual analogue score was comparable to the general UK population despite patients scoring less than the average UK population in three of the five domains. 36% reported some difficulties in walking and 41% had problems with pain. 14% had difficulties with self-care and 46% had difficulties with their usual activities. 14% had problems with anxiety or depression. Systematic review of the literature suggests, in the management of open tibial fractures, circular frames provide equivalent or superior surgical outcomes in comparison with other techniques. Our study finds the application of a circular frame also results in a good functional outcome in the majority of cases. PMID:25648287

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

    PubMed Central

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

    2014-01-01

    Purpose Proper femoral tunnel position is important for anatomical reconstruction of the anterior cruciate ligament (ACL). The purpose of this study was to evaluate the positions of femoral and tibial tunnels created using an accessory anteromedial portal technique in single bundle ACL reconstruction. Materials and Methods The femoral tunnel was targeted at the mid-portion of the ACL bundles. We evaluated postoperative computed tomography scans of 32 patients treated by ACL reconstruction using a free-hand low accessory anteromedial portal technique. On the tibial side, the tunnel position was evaluated using Tsukada's method. On the femoral side, the position was evaluated using 1) the quadrant method, 2) Mochizuki's method, 3) Mochizuki's method, and 4) Takahashi's method. Tunnel obliquity was also evaluated. Results The mean tibial tunnel position was located at 44.6%±2.5% anterior from the anterior margin and 48.0%±3.0% in medial from the medial margin. The mean femoral tunnel position was located at the center between the anteromedial and posterolateral bundles: Quadrant method, 26.7%±2.7%/30.0%±2.9%; Watanabe's method, 37.7%±2.5%/26.6%±2.2%; Mochizuki's method, 38.7%±2.7%; Takahashi's method, 21.8%±2.2%. The mean femoral tunnel obliquity was 57.7°±6.2° in the sagittal plane and 49.9°±5.6° in the coronal plane. Conclusions In anatomic single bundle ACL reconstruction, the low anteromedial portal technique can restore accurate position of the native footprint. Accurate femoral tunnel position facilitates recovery of stability and decreases graft failure rate. PMID:24944975

  12. Predictors of DMSA chelatable lead, tibial lead, and blood lead in 802 Korean lead workers

    Microsoft Academic Search

    A C Todd; B-K Lee; G-S Lee; K-D Ahn; E L Moshier; B S Schwartz

    2001-01-01

    OBJECTIVESTo examine the interrelations among chelatable lead (by dimercaptosuccinic acid, DMSA), tibial lead, and blood lead concentrations in 802 Korean workers with occupational exposure to lead and 135 employed controls with only environmental exposure to lead.METHODSThis was a cross sectional study wherein tibial lead, DMSA chelatable lead, and blood lead were measured. Linear regression was used to identify predictors of

  13. Adrenergic innervation of blood vessels in rat tibial nerve during Wallerian degeneration

    Microsoft Academic Search

    J. Koistinaho; K. C. Wadhwani; C. H. Latker; A. Balbo; S. I. Rapoport

    1990-01-01

    Adrenergic innervation of blood vessels in rat tibial nerve during Wallerian degeneration was examined, using the formaldehyde-induced histo-fluorescence method. The left sciatic nerve was transected at the level of the sciatic notch, whereas the right sciatic nerve was left intact and used as control. At 1, 3, 7, 14, 42, 56 or 84 days after transection, the tibial nerves of

  14. A comparison of four in vivo methods of measuring tibial torsion

    PubMed Central

    MILNER, C. E.; SOAMES, R. W.

    1998-01-01

    Tibial torsion, twisting of the tibia about its longitudinal axis, varies during development and early childhood. Knowledge of the normal range of tibial torsion at various ages and its accurate clinical measurement is important in the assessment of the extent of a torsional deformity. To evaluate tibial torsion a reliable technique for its measurement in vivo is therefore required. The aim of this study was to determine which of 4 existing in vivo methods of measuring tibial torsion was the most accurate and had the highest repeatability, by comparing them with direct measurement of the tibia. A wide range of mean values for tibial torsion was observed, using the various techniques, with none of the indirect techniques employed having a strong correlation with direct measurement of tibial torsion. The repeatability of the indirect techniques was observed to be low both in cadavers (n=4) and the living (n=3). Since none of the in vivo techniques appear to measure true tibial torsion or be of a reasonable repeatability, alternative easy to use and inexpensive methods need to be developed. Accurate clinical measurement of tibial torsion is important in the assessment of the extent of a torsional deformity. It is recommended that data gained using the methods reviewed here are interpreted with caution. PMID:9758144

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

    PubMed

    Demianiuk, R M; Guiot, L P

    2014-11-01

    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

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

    SciTech Connect

    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

    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.

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

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

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

    E-print Network

    Hull, Maury

    of implantation and the degree of match between the original and allograft meniscus affected the immediate loadContact 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

  19. Closed rupture of the posterior tibial artery secondary to a soccer injury.

    PubMed Central

    Tytherleigh, M. G.; Charnley, G. J.; Wilkins, D. C.

    1998-01-01

    Arterial damage following blunt trauma is uncommon and is usually the result of high-energy injury. We report a case of posterior tibial artery rupture after a closed distal tibial fracture, sustained during a low-energy soccer tackle. Images Figure 1 Figure 2 PMID:9771227

  20. Fibular head osteotomy: A new approach for the treatment of lateral or posterolateral tibial plateau fractures

    Microsoft Academic Search

    Baoqing Yu; Kaiwei Han; Ce Zhan; Chuncai Zhang; Hui Ma; Jiachan Su

    2010-01-01

    BackgroundA variety of surgical approaches have been employed previously for the open reduction and internal fixation of the fractures of lateral and posterolateral tibial plateau. However, the commonly used lateral approach does not provide adequate exposure and access to the posterolateral aspect of the lateral tibial plateau. We developed a new approach with osteotomy of fibular head to solve this

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

    Microsoft Academic Search

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

    2006-01-01

    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

  2. A new method of in vitro wear assessment of the UHMWPE tibial insert in total knee replacement.

    PubMed

    Affatato, Saverio; Cristofolini, Luca; Leardini, Walter; Erani, Paolo; Zavalloni, Mara; Tigani, Domenico; Viceconti, Marco

    2008-12-01

    The wear of the ultra-high-molecular-weight polyethylene (UHMWPE) tibial insert was determined using a four-station knee simulator. The bearings were subjected to flexion/extension (between 0 and 58 degrees ), anterior-posterior translation (between 0 and -5.2 mm), internal-external rotation (between -1.9 degrees and +5.7 degrees ), and a maximum axial load of 2.6 KN, as per ISO 14243-1,2,3. The wear tests were run at a frequency of 1.1 Hz for 5 million cycles, and the wear of the inserts (n = 3) was determined using the gravimetric method. The novelty of the study was a special setup developed to simulate, as realistically as possible, in vivo conditions; this involved fixing the femoral component to the distal end of a synthetic femur model by a qualified orthopedic surgeon using an approved method. After 5 million cycles, the mean weight losses were 11.16, 19.74, and 12.61 mg for specimens #1, #2, and #3, respectively. Visual and nondestructive inspections for each of the test specimens showed similar wear tracks and these were very similar to those seen on inserts retrieved after 2 years in vivo. These results show the efficacy of the new in vitro UHMWPE wear assessment method. Furthermore, a comparison between the present in vitro results and those reported in a relevant previous study provide some insight into the influence of the method used to fix the femoral component to the simulator on the wear magnitude and patterns of the tibial insert. PMID:19133022

  3. Midterm results of total knee arthroplasty after high tibial osteotomy

    Microsoft Academic Search

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

    2008-01-01

    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

  4. Tibial Metastasis from Muscle Invasive Bladder Carcinoma: An Unusual Site

    PubMed Central

    Brennan, David; Kelly, Michael E.; Nason, Gregory J.; Collins-Smyth, Coilin; McGuire, Barry B.; Lennon, Gerald M.

    2014-01-01

    We report a case of a 61-year-old gentleman who presented with frank hematuria with associated weight loss and on-going left knee pain. Subsequent investigation revealed a muscle invasive bladder carcinoma with a related unusual bone metastasis. Though bone metastases form bladder carcinoma are common, frequent deposition sites include the spinal column and pelvis. This case report is to the best of our knowledge the first reported case of a tibial metastasis for relevant bladder carcinoma. Furthermore, we reviewed the literature, relevant diagnostic and management surrounding such occurrences. PMID:24917780

  5. Evaluation of the WARP-turbo spin echo sequence for 3 Tesla magnetic resonance imaging of stifle joints in dogs with stainless steel tibial plateau leveling osteotomy implants.

    PubMed

    Simpler, Renee E; Kerwin, Sharon C; Eichelberger, Bunita M; Wall, Corey R; Thompson, James A; Padua, Abraham; Purdy, David; Griffin, John F

    2014-01-01

    Susceptibility artifacts caused by ferromagnetic implants compromise magnetic resonance imaging (MRI) of the canine stifle after tibial plateau leveling osteotomy (TPLO) procedures. The WARP-turbo spin echo sequence is being developed to mitigate artifacts and utilizes slice encoding for metal artifact reduction. The aim of the current study was to evaluate the WARP-turbo spin echo sequence for imaging post TPLO canine stifle joints. Proton density weighted images of 19 canine cadaver limbs were made post TPLO using a 3 Tesla MRI scanner. Susceptibility artifact sizes were recorded and compared for WARP vs. conventional turbo spin echo sequences. Three evaluators graded depiction quality for the tibial tuberosity, medial and lateral menisci, tibial osteotomy, and caudal cruciate ligament as sufficient or insufficient to make a diagnosis. Artifacts were subjectively smaller and local structures were better depicted in WARP-turbo spin echo images. Signal void area was also reduced by 75% (sagittal) and 49% (dorsal) in WARP vs. conventional turbo spin echo images. Evaluators were significantly more likely to grade local anatomy depiction as adequate for making a diagnosis in WARP-turbo spin echo images in the sagittal but not dorsal plane. The proportion of image sets with anatomic structure depiction graded adequate to make a diagnosis ranged from 28 to 68% in sagittal WARP-turbo spin echo images compared to 0-19% in turbo spin echo images. Findings indicated that the WARP-turbo spin echo sequence reduces the severity of susceptibility artifacts in canine stifle joints post TPLO. However, variable depiction of local anatomy warrants further refinement of the technique. PMID:24438513

  6. Clinical Applications of Anterior Segment Optical Coherence Tomography

    PubMed Central

    Lim, Su-Ho

    2015-01-01

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

  7. Diverse muscle architecture adaptations in a rabbit tibial lengthening model

    PubMed Central

    Takahashi, Mitsuhiko; Yasui, Natsuo; Enishi, Tetsuya; Sato, Nori; Mizobuchi, Takatoshi; Homma, Yukako; Sairyo, Koichi

    2014-01-01

    Summary Background: during limb lengthening, muscles are thought to increase the number of sarcomeres. However, this adaptation may differ among muscles with diverse architecture. Purpose: this study wish to clarify the differences in muscle adaptation in a rabbit model of tibial lengthening. Methods: twelve rabbits underwent tibial lengthening (0.7 mm/day for 4 weeks), with the contralateral limb serving as a control, and were euthanized after either the lengthening or the consolidation period. Six muscles around the tibia were investigated in terms of muscle belly length, muscle weight, sarcomere length and serial sarcomere number. Results: muscle belly length increased in all the lengthened muscles. No increases in muscle mass were noted. Sarcomere length increased in the ankle plantar-flexors and was kept longer than the optimal sarcomere length after the consolidation period. Nevertheless, significant increases in sarcomere number were observed in two ankle plantar-flexors. Conclusion: this study demonstrated that muscle belly length largely adapted to the lengthening. The increase in sarcomere number did not match the increase in muscle belly length. We estimated that elongation of the intramuscular aponeuroses is another mechanism of the adaptation in addition to the increase in sarcomere number.

  8. Posterior tibial tendon dysfunction: its association with seronegative inflammatory disease.

    PubMed

    Myerson, M; Solomon, G; Shereff, M

    1989-04-01

    Idiopathic inflammation and rupture of the posterior tibial tendon (PTT) has received much attention in the recent literature. In this report of the presentation of PTT dysfunction as a manifestation of seronegative inflammatory disease, we describe the clinical and laboratory features of 76 patients with inflammation and/or rupture of the PTT. Analysis of all patients identified two discrete groups. Group A patients were younger (mean age 39 years) and had multiple manifestations of inflammation at other sites of ligament and tendon attachments (enthesopathy). Other features of a systemic inflammatory disorder such as oral ulcers, conjunctivitis, colitis, and especially psoriasis were common in the latter patients and their families. Group B consisted predominantly of elderly patients (mean age 64 years) with isolated dysfunction of the PTT. These two groups differed widely in the manner of clinical presentation, demographic data, family history, HLA data, and surgical pathology. These distinctions suggest different pathogeneses for posterior tibial tendinitis. Group A demonstrated local manifestations of a systemic inflammatory disease, whereas group B exhibited the effects of mechanical trauma and degeneration. PMID:2731833

  9. Impact of posterior tibial nail malpositioning on iatrogenic injuries by distal medio-lateral interlocking screws. A cadaveric study on plastinated specimens.

    PubMed

    Wegmann, Kilian; Burkhart, Klaus Josef; Buhl, Jörg; Gausepohl, Thomas; Koebke, Jürgen; Müller, Lars Peter

    2012-12-01

    In intramedullary tibial nailing, multi-planar locking makes stabilization of proximal and distal metaphyseal fractures possible. A known complication in intramedullary nailing of the tibia is iatrogenic injury to neuro-vascular structures caused by the insertion of locking screws. As shown in previous studies, the distal positioning of the nail is important, as it determines the course of the locking bolts. The goal of the present study was to display the consequences of posterior nail malpositioning with respect to the safety of the distal medio-lateral locking screws and the available options. Human cadaveric legs were plastinated according to the sequential plastination technique after intramedullary nailing of the tibia and were then cut transversely. The tibial nails were placed centrally or posteriorly. Macroscopic analysis showed a distinct drawback of posterior nail positioning, with diminished options for the placement of the locking screws and thereby a risk of damaging the anterior and posterior neuro-vascular bundles by distal medio-lateral locking screws. PMID:23409576

  10. [Suprapatellar approach to tibial medullary nailing with electromagnetic field-guided distal locking].

    PubMed

    Rueger, J M; Rücker, A H; Hoffmann, M

    2015-04-01

    Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking. PMID:25835205

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

    PubMed

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

    2014-12-01

    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. PMID:25171755

  12. Ameliorative potential of pralidoxime in tibial and sural nerve transection-induced neuropathic pain in rats.

    PubMed

    Kaur, Gurpreet; Jaggi, Amteshwar Singh; Singh, Nirmal

    2010-01-01

    The present study was designed to investigate the ameliorative potential of pralidoxime in tibial and sural nerve transection-induced neuropathy in rats. Tibial and sural nerve transection was performed by sectioning tibial and sural nerve portions (2 mm) of the sciatic nerve, and leaving the common peroneal nerve intact. The pinprick, acetone, hot and cold tail immersion tests were performed to assess the degree of motor functions, mechanical hyperalgesia, cold allodynia, heat and cold hyperalgesia respectively. Biochemically, the tissue thio-barbituric acid reactive species (TBARS), super-oxide anion contents (the markers of oxidative stress) and total calcium levels were measured. Tibial sural nerve transection resulted in the development of mechanical hyperalgesia, cold allodynia, heat and cold hyperalgesia along with the rise in oxidative stress and calcium levels. However, administration of pralidoxime (10, 20 mg/kg intraperitoneally (i.p.)) for 14 d attenuated tibial and sural nerve transection-induced cold allodynia, mechanical, hot and cold hyperalgesia. Furthermore, pralidoxime also attenuated tibial and sural nerve transection induced increase in oxidative stress and calcium levels. It may be concluded that pralidoxime has ameliorative potential in attenuating the painful neuropathic state associated with tibial and sural nerve transection, which may possibly be attributed to decrease in oxidative stress and calcium levels. PMID:20686227

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

    PubMed Central

    2013-01-01

    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

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

    PubMed

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

    2004-01-01

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

  15. Post-stroke depression

    Microsoft Academic Search

    J. W. G. Tiller

    1992-01-01

    Depression is present in 25–30% of stroke patients: though associated with physical disability and loss of function, it cannot be explained simply as a response to the disability. The severity of depression correlates with proximity of the lesion to the left anterior frontal pole, while right hemisphere lesions show the reverse trend. Post-stroke depressions may last more than 7–8 months

  16. Segmental transports for posttraumatic lower extremity bone defects: are femoral bone transports safer than tibial?

    Microsoft Academic Search

    Emmanouil Liodakis; Mohamed Kenawey; Christian Krettek; Max Ettinger; Michael Jagodzinski; Stefan Hankemeier

    2011-01-01

    Background  The long-term outcomes following femoral and tibial segment transports are not well documented. Purpose of the study is to\\u000a compare the complication rates and life quality scores of femoral and tibial transports in order to find what are the complication\\u000a rates of femoral and tibial monorail bone transports and if they are different?\\u000a \\u000a \\u000a \\u000a \\u000a Methods  We retrospectively analyzed the medical records of

  17. Retrograde Pedal/Tibial Artery Access for Treatment of Infragenicular Arterial Occlusive Disease

    PubMed Central

    El-Sayed, Hosam F.

    2013-01-01

    Endovascular intervention has emerged as an accepted modality for treating patients with critical limb ischemia. However, this therapy poses multiple challenges to the interventionalist due to the presence of widespread multilevel disease, long and complex occlusive lesions, and the common involvement of the tibial vessels. Retrograde pedal/tibial access is a relatively new technique that allows the treatment of tibial occlusive lesions when conventional endovascular techniques fail. This article reviews the technical details and published data regarding this technique and evaluates its use in this difficult-to-treat patient population. PMID:23805338

  18. Roentgen stereophotogrammetric analysis methods for determining ten causes of lengthening of a soft-tissue anterior cruciate ligament graft construct.

    PubMed

    Smith, Conrad; Hull, M L; Howell, S M

    2008-08-01

    There are many causes of lengthening of an anterior cruciate ligament soft-tissue graft construct (i.e., graft+fixation devices+bone), which can lead to an increase in anterior laxity. These causes can be due to plastic deformation andor an increase in elastic deformation. The purposes of this in vitro study were (1) to develop the methods to quantify eight causes (four elastic and four plastic) associated with the tibial and femoral fixations using Roentgen stereophotogrammetric analysis (RSA) and to demonstrate the usefulness of these methods, (2) to assess how well an empirical relationship between an increase in length of the graft construct and an increase in anterior laxity predicts two causes (one elastic and one plastic) associated with the graft midsubstance, and (3) to determine the increase in anterior tare laxity (i.e., laxity under the application of a 30 N anterior tare force) before the graft force reaches zero. Markers were injected into the tibia, femur, and graft in six cadaveric legs whose knees were reconstructed with single-loop tibialis grafts. To satisfy the first objective, legs were subjected to 1500 cycles at 14 Hz of 150 N anterior force transmitted at the knee. Based on marker 3D coordinates, equations were developed for determining eight causes associated with the fixations. After 1500 load cycles, plastic deformation between the graft and WasherLoc tibial fixation was the greatest cause with an average of 0.8+/-0.5 mm followed by plastic deformation between the graft and cross-pin-type femoral fixation with an average of 0.5+/-0.1 mm. The elastic deformations between the graft and tibial fixation and between the graft and femoral fixation decreased averages of 0.3+/-0.3 mm and 0.2+/-0.1 mm, respectively. The remaining four causes associated with the fixations were close to 0. To satisfy the remaining two objectives, after cyclic loading, the graft was lengthened incrementally while the 30 N anterior tare laxity, 150 N anterior laxity, and graft tension were measured. The one plastic cause and one elastic cause associated with the graft midsubstance were predicted by the empirical relationships with random errors (i.e., precision) of 0.9 mm and 0.5 mm, respectively. The minimum increase in 30 N anterior tare laxity before the graft force reached zero was 5 mm. Hence, each of the eight causes of an increase in the 150 N anterior laxity associated with the fixations can be determined with RSA as long as the overall increase in the 30 N anterior tare laxity does not exceed 5 mm. However, predicting the two causes associated with the graft using empirical relationships is prone to large errors. PMID:18601444

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

    PubMed Central

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

    2014-01-01

    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

  20. Travoprost induced granulomatous anterior uveitis.

    PubMed

    Chiam, Patrick

    2011-01-01

    Purpose. To report a case of granulomatous anterior uveitis caused by travoprost. Methods. Single observational case report. Results. A 71-year-old who was fit and healthy presented with bilateral granulomatous anterior uveitis 2 months after he was started on travoprost in both eyes. There was no past history of uveitis. Blood test and radiological investigation were unremarkable. Travoprost was stopped. The uveitis resolved on topical steroid treatment. A rechallenge with travoprost was attempted in one eye. The inflammation recurred in this eye only. This subsided with the cessation of travoprost alone without topical steroid. Conclusion. This is the first case report of travoprost causing granulomatous anterior uveitis. The uveitis recurred with a rechallenge. Changing the prostaglandin analogue to another topical treatment may be adequate to cease the inflammation. PMID:22606464

  1. How to Minimize Rotational Conflict between Femoral & Tibial Component in Total Knee Arthroplasty: The Use of Femoro-Tibial Axial Synchronizer (Linker)

    PubMed Central

    Seo, Jai-Gon; Moon, Young-Wan; Kim, Sang-Min

    2015-01-01

    Purpose The purpose of this study was to investigate the correlation between rotational axes of femur and tibia with the use of Linker. Materials and Methods This study was carried out from August 2009 to February 2010 on 54 patients (106 knees), who were diagnosed with simultaneous bilateral total knee arthroplasty. With the use of postoperative computed tomography scans, it was investigated how much the rotational angle of femoral and tibial components matched. Results The tibial component was internally rotated for the femoral component at an angle of 0.8°. The femoral component was externally rotated for the surgical transepicondylar axis (TEA) at an angle of 1.6 (range: from 4.8° of internal rotation to 7.9° of external rotation, SD=2.2°), and the tibial component was externally rotated for the surgical TEA at an average angle of 0.9 (range: from 5.1° of internal rotation to 8.3° of external rotation, SD=3.1°). Conclusion The femoro-tibial synchronizer helped to improve the orientation and positioning of both femoral component and tibial component, and also increase the correlation of the rotational axes of the two components. PMID:25683995

  2. A case of bilateral tibial hemimelia type VIIa

    PubMed Central

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

    2013-01-01

    Congenital absence of tibia is a rare anomaly, and may be total or partial, unilateral or bilateral. Total absence is more frequent than partial, unilateral absence occurs more often than bilateral, with right limb more commonly affected than the left. In partial defect, almost always the distal end of the bone is affected, and of the bilateral cases, there may be total absence on both sides, or total on one side and partial on the other. Males are slightly more commonly affected than the females. Though, the family history is usually negative for congenital abnormalities and other diseases, there is a considerable chance of occurrence of congenital defect of the tibia or of other abnormalities, in near or remote relatives. We report a case of newborn having bilateral tibial hemimelia type VIIa. PMID:23901205

  3. Review of evolution of tunnel position in anterior cruciate ligament reconstruction

    PubMed Central

    Rayan, Faizal; Nanjayan, Shashi Kumar; Quah, Conal; Ramoutar, Darryl; Konan, Sujith; Haddad, Fares S

    2015-01-01

    Anterior cruciate ligament (ACL) rupture is one of the commonest knee sport injuries. The annual incidence of the ACL injury is between 100000-200000 in the United States. Worldwide around 400000 ACL reconstructions are performed in a year. The goal of ACL reconstruction is to restore the normal knee anatomy and kinesiology. The tibial and femoral tunnel placements are of primordial importance in achieving this outcome. Other factors that influence successful reconstruction are types of grafts, surgical techniques and rehabilitation programmes. A comprehensive understanding of ACL anatomy has led to the development of newer techniques supplemented by more robust biological and mechanical concepts. In this review we are mainly focussing on the evolution of tunnel placement in ACL reconstruction, focusing on three main categories, i.e., anatomical, biological and clinical outcomes. The importance of tunnel placement in the success of ACL reconstruction is well researched. Definite clinical and functional data is lacking to establish the superiority of the single or double bundle reconstruction technique. While there is a trend towards the use of anteromedial portals for femoral tunnel placement, their clinical superiority over trans-tibial tunnels is yet to be established. PMID:25793165

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

    PubMed

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

    2001-04-01

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

  5. Treatment of chronic anterior knee instabilities with combined intra- and extra-articular transfer augmented with carbon-PLA fibers.

    PubMed

    Witvoet, J; Christel, P

    1985-06-01

    In the treatment of old chronic anterior knee instabilities by anterior cruciate ligament (ACL) insufficiency, isolated reconstruction of the ACL is insufficient because of an associated stretching of the lateral capsule and lateral collateral ligament. A combined intra- and extra-articular transfer (consisting of the central one-third of the patellar tendon, the prepatellar tissue, and the central one-third of the quadriceps tendon) is necessary to repair ACL instability. Augmentation of the autogenous transfer with polylactic acid-coated carbon fibers has several advantages. It improves the transfer's strength by reinforcing its weak zones; gives initial strength during graft remodeling and vascularization, thus avoiding cast immobilization; and allows early active rehabilitation and possibly return to sports activity. The surgical technique is based on biomechanical and biologic principles. The transfer remains attached to the tibial tubercle, passing through a tibial tunnel, through the intercondylar notch, behind the lateral femoral condyle in a bony groove, then on the lateral aspect of the condyle, beneath the lateral collateral ligament, and ending close to Gerdy's tubercle. The preliminary results in 30 patients are encouraging. The subjective and objective results are similar to those previously obtained with nonreinforced methods of repair, except that there is an early return to normal activities. PMID:3995816

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

    PubMed

    Nuccion, S L; Hame, S L

    2001-02-01

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

  7. Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament.

    PubMed

    Fleming, B; Beynnon, B D; Johnson, R J; McLeod, W D; Pope, M H

    1993-01-01

    This study was designed to compare the displacement patterns of an isometer, used to determine graft placement during reconstruction, with the actual tensions on an anterior cruciate ligament substitute. In cadaveric specimens, a Kevlar anterior cruciate ligament substitute was implanted in three separate femoral sites, each of which was subsequently fixed to two different tibial sites. The initial tension of the Kevlar substitute was set to 22 or 33 N at 20 degrees of knee flexion. The displacement patterns for each position were recorded during passive flexion-extension using the isometer. Using a custom-designed tensiometer, the tensile forces on the substitute after rigid fixation at the tibia and femur were measured. During passive flexion-extension, the maximum change in tension of the anterior cruciate ligament substitute, measured by the tensiometer, was correlated with the maximum change in displacement between attachment sites, measured by the isometer. The coefficient of determination was equal to 0.15, indicating that the isometer may not accurately predict the tensions developed in the substitute. PMID:8427374

  8. Study of the anatomy of the tibial nerve and its branches in the distal medial leg

    PubMed Central

    Torres, André Leal Gonçalves; Ferreira, Marcus Castro

    2012-01-01

    Objective Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel. Methods Bilateral dissections were performed on 26 fresh cadavers and the locations of the tibial nerve bifurcation and its branches were measured in millimeters. For the calcaneal branches, the amount and their respective nerves of origin were also analyzed. Results The tibial nerve bifurcation occurred under the tunnel in 88% of the cases and proximally in 12%. As for the calcaneal branches, the medial presented with one (58%), two (34%) and three (8%) branches, with the most common source occurring in the tibial nerve (90%) and the lower with a single branch per leg and lateral plantar nerve as the most common origin (70%). Level of Evidence, V Expert opinion. PMID:24453596

  9. Nerve sheath ganglion of the tibial nerve presenting as a Baker's cyst: a case report.

    PubMed

    Tseng, Kuo-Fung; Hsu, Horng-Chaung; Wang, Fu-Cheng; Fong, Yi-Chin

    2006-09-01

    Nerve sheath ganglion is a relatively rare clinical entity commonly found in the peroneal nerve in the lower limb or the ulnar nerve in the upper extremity. It is rarely found in the tibial nerve. The occurrence of a nerve sheath ganglion in a patient's tibial nerve has been identified. The initial presentation of the tumor mass has been very similar to that of a Baker's cyst, namely a soft undulating popliteal mass. Yet, the case also presented symptoms and signs of tibial nerve compressive neuropathy. We present here a rare case of nerve sheath ganglion of the tibial nerve. Clinical courses of the patient were reviewed, and relevant issues were discussed with a thorough literature review. PMID:16570194

  10. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ...FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3590 Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a)...

  11. Tarsal tunnel syndrome associated with a perforating branch from posterior tibial artery: A case report.

    PubMed

    Kosiyatrakul, Arkaphat; Luenam, Suriya; Phisitkul, Phinit

    2015-03-01

    Tarsal tunnel syndrome, a compressive neuropathy of the tibial nerve or its branches with in the tarsal tunnel, is an uncommon condition. Various etiologies of the syndrome have been described. We report a rare case of tarsal tunnel syndrome associated with a perforating branch from the posterior tibial artery. A 56-year-old woman presented with 1-year history of paresthesia and hypoesthesia in the medial and lateral plantar area of the left foot. Tinel's sign was elicited at the tarsal tunnel. Electrodiagnostic studies confirmed the diagnosis of left tarsal tunnel syndrome. Intraoperatively, the perforating branch from posterior tibial artery which traveled through a split in the tibial nerve was encountered. The patient's symptom improved significantly at 2 years after tarsal tunnel release and vascular ligation. Only a minor degree of paresthesia remains in the forefoot. PMID:25682417

  12. Delayed peroneal nerve palsy after total knee arthroplasty--a rare complication of tibial osteolysis.

    PubMed

    Deshmukh, Ajit J; Kuczynski, Bozena; Scuderi, Giles R

    2014-03-01

    We present a case of peroneal nerve palsy which occurred 12 years after primary total knee arthroplasty as a result of extensive tibial osteolysis. The tibial osteolytic cyst extended through a cortical defect in the proximal tibia into the anterolateral compartment of the leg causing compressive neuropathy of the peroneal nerve. Imaging included radiographs, CT scan and MRI. At revision surgery, the tibial component was found loose with significant proximal tibial osteolysis. The cyst in the leg was decompressed through the cortical defect in the proximal tibia and analysis of cystic fluid revealed polyethylene debris. At 7-year follow-up after revision, the osteolytic cyst had resolved but the peroneal palsy did not recover. PMID:24262809

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

    Microsoft Academic Search

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

    1997-01-01

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

  14. Treatment of tibial plateau fractures with high strength injectable calcium sulphate

    Microsoft Academic Search

    Baoqing Yu; Kaiwei Han; Hui Ma; Chuncai Zhang; Jiachan Su; Jie Zhao; Jingfeng Li; Yushu Bai; Hao Tang

    2009-01-01

    The aim of this article is to discuss the clinical efficacy of high strength injectable calcium sulphate (MIIGX3) in the treatment\\u000a of tibial plateau fractures. Thirty-one patients with tibial plateau fractures treated with MIIGX3 were included. Postoperative\\u000a radiographic study was used to evaluate congruity of the articular surface, bone regrowth, and the absorption process of MIIGX3.\\u000a Rasmussen’s score system was

  15. Double-bundle PCL reconstruction using tibial double cross-pin fixation

    Microsoft Academic Search

    Hong Chul Lim; Ji Hoon Bae; Joon Ho Wang; Jae Hyuk Yang; Chang Woo Seok; Hak Jun Kim; Seung Joo Kim

    2010-01-01

    The purpose of this study was to assess the clinical results of arthroscopic double-bundle posterior cruciate ligament (PCL)\\u000a reconstruction using double cross-pin fixation on the tibial side. Twenty-two patients who underwent PCL reconstruction using\\u000a an Achilles tendon allograft with double cross-pins for tibial fixation were evaluated. There were 19 men and 3 women with\\u000a mean age 36 years (range 18–59), and

  16. Imaging of Anterior Knee Pain

    Microsoft Academic Search

    Stephen R. Christian; M. Bret Anderson; Ronald Workman; William F. Conway; Thomas L. Pope

    2006-01-01

    nterior knee pain (AKP) is a common complaint in primary care and orthopedic clinics. In fact, in the sports medicine clinic, up to 25% of patients with knee complaints have symptoms of anterior knee pain (1). Adolescent females and other young individuals are at particular risk for AKP. In these individuals, symptoms are usually related to increased use, fre- quently

  17. Anatomic Anterior Cruciate Ligament Reconstruction With a Flexible Reamer System and 70° Arthroscope

    PubMed Central

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

    2013-01-01

    Anterior cruciate ligament (ACL) reconstruction techniques continue to evolve as surgeons seek to improve surgical process and outcome measures. On the basis of published data showing improved biomechanics, many surgeons now attempt to better re-create native ACL anatomy in reconstruction. Use of flexible reamer technology and a 70° arthroscope allows for excellent visualization of the native ACL anatomy, as well as precise and independent drilling of the tibial and femoral reconstruction tunnels, while offering several surgical and technical advantages compared with other drilling techniques. This technical note with accompanying video describes our use of the Smith & Nephew Clancy anatomic cruciate guide/flexible drill system (Smith & Nephew, London, England) with a 70° arthroscope. PMID:24400174

  18. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

    PubMed Central

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments. PMID:25197599

  19. Lower tibial than peroneal compound muscle action potential amplitude in neuromuscular diseases.

    PubMed

    Rubin, Devon I; Whaley, Nathaniel R

    2010-10-01

    The pattern of findings on nerve conduction studies is an important component of an electrodiagnostic evaluation to assess for peripheral neuromuscular disorders. The aim of this study was to determine the extent to which a lower tibial compound muscle action potential (CMAP) amplitude compared with the peroneal CMAP amplitude is more indicative of specific neuromuscular disorders such as S1 radiculopathies, sciatic neuropathies, or peripheral neuropathies. The electromyographic (EMG) findings of 921 patients who had undergone an EMG of the lower extremity and in whom the EMG study was interpreted as normal or a single neuromuscular diagnosis was identified were retrospectively reviewed to determine the frequency of an absolutely lower tibial than peroneal CMAP amplitude. Thirty-five (7%) healthy subjects had a lower tibial than peroneal CMAP amplitude (i.e., the absolute value of the tibial CMAP was lower than the absolute value of the peroneal CMAP), despite both values being in normal range. The finding on nerve conduction study of an absolutely lower tibial than peroneal CMAP occurred in a significantly higher proportion of patients with a diffuse polyneuropathy (24%) and S1 radiculopathies (21%) compared with controls. The findings suggest that in subjects in whom lower extremity nerve conduction study demonstrates an absolutely lower tibial than peroneal CMAP amplitude, neuromuscular disorders such as a polyneuropathy or S1 radiculopathy should be considered. PMID:20844444

  20. Passive Posterior Tibial Subluxation on Routine Knee MRI as a Secondary Sign of PCL Tear

    PubMed Central

    Degnan, Andrew J.; Maldjian, Catherine; Adam, Richard J.; Harner, Christopher D.

    2014-01-01

    The posterior drawer test is an accurate clinical test to diagnose posterior cruciate ligament (PCL), indicating laxity of the PCL that allows posterior tibial translation. This study aimed to determine whether posterior tibial translation relative to the femur on routine MRI could serve as an additional sign of PCL tear. Routine knee MRI in eleven patients (7 males, 4 females) with arthroscopically confirmed isolated PCL tears were reviewed independently by two musculoskeletal radiologists. Measurements of tibial translation were made in the medial and lateral compartments of patients and controls (10 males, 12 females) without clinical or MRI evidence of ligament injury. Significant medial compartment posterior tibial translation was present in patients with PCL tear compared to controls (+2.93?mm versus +0.03?mm, P = 0.002) with excellent interobserver agreement (intraclass correlation coefficient (ICC) = 0.94). No significant difference in lateral compartment tibial translation was observed (+0.17?mm versus ?0.57?mm, P = 0.366) despite excellent interobserver agreement (ICC = 0.96). Posterior tibial translation in the midmedial compartment may be a secondary sign of isolated PCL tear on routine knee MRI with passive extension without manipulation or weight bearing. Additional work in a larger cohort may better address the accuracy of this finding. PMID:25587446

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

    PubMed Central

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

    2014-01-01

    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

  2. Dissection of left iliac artery during anterior lumbar interspace fusion: Report of a case.

    PubMed

    Fischer, Uwe M; Davies, Mark G; Sayed, Hosam El

    2015-04-01

    Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period. PMID:24848500

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

    PubMed

    García David, S; Cortijo Martínez, J A; Navarro Bermúdez, I; Maculé, F; Hinarejos, P; Puig-Verdié, L; Monllau, J C; Hernández Hermoso, J A

    2014-01-01

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

  4. Anterior spinal cord syndrome of unknown etiology

    PubMed Central

    Klakeel, Merrine; Thompson, Justin; McDonald, Frank

    2015-01-01

    A spinal cord injury encompasses a physical insult to the spinal cord. In the case of anterior spinal cord syndrome, the insult is a vascular lesion at the anterior spinal artery. We present the cases of two 13-year-old boys with anterior spinal cord syndrome, along with a review of the anatomy and vasculature of the spinal cord and an explanation of how a lesion in the cord corresponds to anterior spinal cord syndrome. PMID:25552812

  5. Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

  6. Secondary anterior crocodile shagreen of Vogt

    Microsoft Academic Search

    R C Tripathi; A J Bron

    1975-01-01

    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

  7. Evaluation of stress-related anterior lower leg pain with magnetic resonance imaging and intracompartmental pressure measurement.

    PubMed

    Kiuru, Martti J; Mantysaari, Matti J; Pihlajamaki, Harri K; Ahovuo, Juhani A

    2003-01-01

    The purpose of this work was to evaluate stress-related anterior lower leg pain with clinical examination, magnetic resonance imaging, and measurement of anterior tibial compartment pressure findings. All medical data were gathered from 24 conscripts with stress-related anterior lower leg pain. Twenty exhibited bilateral symptoms. In 22 of the 44 cases, the intracompartmental pressure was pathological. Symptoms were exhibited for longer periods by patients with chronic exertional compartment syndrome (CECS) than by other patients (p < 0.01). At rest, magnetic resonance imaging revealed no abnormal findings in the soft tissues of the legs but showed bone abnormalities in 35 symptomatic legs. Thirty-three exhibited bone stress injuries, and two exhibited leg traction periostitis. On magnetic resonance imaging, there was no difference in bone findings between patients with and without CECS (p > 0.05). Stress-related anterior lower leg pain can be related to CECS, bone stress injury, and traction periostitis. Clinical diagnosis is unreliable. CECS and bone stress injury or traction periostitis can occur separately or together. PMID:12546246

  8. Posterior tibial plateau fracture: a new treatment-oriented classification and surgical management

    PubMed Central

    Chen, Hong-Wei; Chen, Chang-Qing; Yi, Xian-Hong

    2015-01-01

    Purpose: To establish a classification system for the different types of posterior tibial plateau fractures (PTPF), and to explore the fracture patterns and early results of treatment. Methods: 39 PTPFs patients who received surgeries through posteromedial or (and) posterolateral knee approaches were analyzed retrospectively. Results: There were 5 types of PTPFs identified in the new classification system: posteromedial split fracture (type I, 7 patients), posterolateral split fracture (type II, 5 patients), posterolateral depression fracture (type III, 11 patients), posterolateral split and depression fracture (type IV, 2 patients), and posteromedial split combined with posterolateral depression fracture (type V, 14 patients). All patients underwent surgeries safely without complications. The average follow up was 18.1 months (12-30 months). The average weight-bearing durations were 15.6 weeks (12-20 weeks). Based on Rasmussen functional scoring system, 20 cases were regarded as excellent, 14 were good, 5 were fair, and 0 was poor. There was significant change in the Rasmussen functional score before (8.38 ± 2.87) and after surgery (24.20 ± 3.44). According to Rasmussen radiology system, 28 cases were excellent, 8 cases were good, 3 were fair, and none was poor. There was also a significant difference detected between pre-operation (6.77 ± 2.27) and post-operation (16.41 ± 2.65). Conclusion: This study presents a new classification system for the different types of PTPFs based on the treatment. The classification is clinically relevant and can be used to guide the surgical management. PMID:25785019

  9. Cementless reconstruction of massive tibial bone loss in revision total knee arthroplasty.

    PubMed

    Whiteside, L A

    1989-11-01

    Reconstruction of massive proximal tibial defects caused by failed cemented total knee arthroplasty (TKA) was evaluated using cancellous allograft and a rigidly fixed tibial component. Twenty patients with massive tibial defects requiring revision TKA were operated on using this technique from December 1984 to December 1986. All these had tight mediolateral capsular structures so that satisfactory varus-valgus stability was achieved. Only three had competent posterior cruciate ligaments. The tibial component had a cobalt chromium tray with a six-inch-long smooth stem, porous undersurface, and peripheral smooth pegs. Fixation was augmented with four cancellous screws that passed through the periphery of the tray and penetrated the cortical surface of the tibia. Good fixation of the tibial component was achieved in all cases at the time of surgery. All patients achieved full weight bearing within six months, and all but two were free of walking aids at one year postoperation. None of the patients developed apparent loosening of the femoral or tibial components. Two patients complained of mild pain and one who had revision of a painful but nonloosened cemented TKA complained of severe pain. Range of motion was 93 degrees +/- 7.6 degrees. Roentgenographic evaluation showed progressive increase in radiodensity in the grafted areas one year after surgery in all knees. One knee was revised for recurrent dislocation one year postoperation and had a biopsy of the allografted area. This biopsy showed trabeculae with empty lacunae surrounded by viable new bone. Allograft reconstruction of the proximal tibia for failed cemented TKA was highly successful using morselized allograft and rigid fixation of the tibial component.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2805500

  10. Fact or fiction? Iatrogenic hallux abducto valgus secondary to tibial sesamoidectomy.

    PubMed

    Canales, Michael B; DeMore, Matthew; Bowen, Michael F; Ehredt, Duane J; Razzante, Mark C

    2015-01-01

    First ray function and hallux misalignment after isolated tibial sesamoidectomy have been topics of debate. Although sesamoidectomy has been proved to be effective in the relief of sesamoid pain, many foot and ankle surgeons remain hesitant to perform the procedure fearing a possible joint perturbation. To our knowledge, the present study is the first to evaluate both laboratory and clinical evidence of the association between isolated tibial sesamoidectomy and hallux abducto valgus deformity. The bench study consisted of 10 cadaveric limbs that were dissected and prepared for testing. Controlled valgus loads were applied before and after tibial sesamoidectomy. No significant difference was found in the joint position after sesamoidectomy in both the rectus (p = .36) and the dorsiflexed (p = .062) positions. The clinical evaluation consisted of a retrospective cohort of 5 females; all of whom underwent isolated tibial sesamoidectomy. The pre- and postoperative radiographs and self-reported pain scores (visual analog scale) were compared. None of the patients developed a postoperative hallux abducto valgus deformity. Neither the hallux abductus angle (p = .180) nor the intermetatarsal angle 1-2 (p = .180) changed significantly in the postoperative setting. The visual analog scale pain scores changed from a mean of 6.8 to 1, a significant difference (p = .042). Based on our observations and clinical experience, we believe that isolated tibial sesamoidectomy does not have a significant effect on the position of the first metatarsophalangeal joint when meticulous surgical technique is used to excise the sesamoid. Isolated tibial sesamoidectomy can provide substantial pain relief and appears to be a safe treatment for a variety of conditions affecting the tibial sesamoid. PMID:25441270

  11. Ovine Model for Critical-Size Tibial Segmental Defects

    PubMed Central

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

    2014-01-01

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

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

    PubMed Central

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

    2013-01-01

    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

  13. High energy tibial plateau fractures treated with hybrid external fixation

    PubMed Central

    2011-01-01

    Management of high energy intra-articular fractures of the proximal tibia, associated with marked soft-tissue trauma, can be challenging, requiring the combination of accurate reduction and minimal invasive techniques. The purpose of this study was to evaluate whether minimal intervention and hybrid external fixation of such fractures using the Orthofix system provide an acceptable treatment outcome with less complications. Between 2002 and 2006, 33 patients with a median ISS of 14.3 were admitted to our hospital, a level I trauma centre, with a bicondylar tibial plateau fracture. Five of them sustained an open fracture. All patients were treated with a hybrid external fixator. In 19 of them, minimal open reduction and stabilization, by means of cannulated screws, was performed. Mean follow-up was 27 months (range 24 to 36 months). Radiographic evidence of union was observed at 3.4 months (range 3 to 7 months). Time for union was different in patients with closed and grade I open fractures compared to patients with grade II and III open fractures. One non-union (septic) was observed (3.0%), requiring revision surgery. Pin track infection was observed in 3 patients (9.1%). Compared to previously reported series of conventional open reduction and internal fixation, hybrid external fixation with or without open reduction and minimal internal fixation with the Orthofix system, was associated with satisfactory clinical and radiographic results and limited complications. PMID:21756337

  14. Electrodiagnostic Examination of the Tibial Nerve in Clinically Normal Ferrets

    PubMed Central

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

    2010-01-01

    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

  15. 75 MHz Ultrasound Biomicroscopy of Anterior Segment of Eye

    PubMed Central

    Silverman, Ronald H.; Cannata, Jonathan; Shung, K. Kirk; Gal, Omer; Patel, Monica; Lloyd, Harriet O.; Feleppa, Ernest J.; Coleman, D. Jackson

    2006-01-01

    Very high frequency ultrasound (35–50 MHz) has had a significant impact upon clinical imaging of the anterior segment of the eye, offering an axial resolution as small as 30 ?m. Higher frequencies, while potentially offering even finer resolution, are more affected by absorption in ocular tissues and even in the fluid coupling medium. Our aim was to develop and apply improved transducer technology utilizing frequencies beyond those routinely used for ultrasound biomicroscopy of the eye. A 75-MHz lithium niobate transducer with 2 mm aperture and 6 mm focal length was fabricated. We scanned the ciliary body and cornea of a human eye six years post-LASIK. Spectral parameter images were produced from the midband fit to local calibrated power spectra. Images were compared with those produced using a 35 MHz lithium niobate transducer of similar fractional bandwidth and focal ratio. The 75-MHz transducer was found to have a fractional bandwidth (?6 dB) of 61%. Images of the post-LASIK cornea showed higher stromal backscatter at 75 MHz than at 35 MHz. The improved lateral resolution resulted in better visualization of discontinuities in Bowman’s layer, indicative of microfolds or breaks occurring at the time of surgery. The LASIK surface was evident as a discontinuity in stromal backscatter between the stromal component of the flap and the residual stroma. The iris and ciliary body were visualized despite attenuation by the overlying sclera. Very high frequency ultrasound imaging of the anterior segment of the eye has been restricted to the 35–50 MHz band for over a decade. We showed that higher frequencies can be used in vivo to image the cornea and anterior segment. This improvement in resolution and high sensitivity to backscatter from the corneal stroma will provide benefits in clinical diagnostic imaging of the anterior segment. PMID:17147058

  16. An implantable telemetry device to measure intra-articular tibial forces.

    PubMed

    D'Lima, Darryl D; Townsend, Christopher P; Arms, Steven W; Morris, Beverly A; Colwell, Clifford W

    2005-02-01

    Tibial forces are important because they determine polyethylene wear, stress distribution in the implant, and stress transfer to underlying bone. Theoretic estimates of tibiofemoral forces have varied between three and six times the body weight depending on the mathematical models used and the type of activity analyzed. An implantable telemetry system was therefore developed to directly measure tibiofemoral compressive forces. This system was tested in a cadaver knee in a dynamic knee rig. A total knee tibial arthroplasty prosthesis was instrumented with four force transducers located at the four corners of the tibial tray. These transducers measured the total compressive forces on the tibial tray and the location of the center of pressure. A microprocessor performed analog-to-digital signal conversion and performed pulse code modulation of a surface acoustic wave radio frequency oscillator. This signal was then transmitted through a single pin hermetic feed-through tantalum wire antenna located at the tip of the stem. The radio frequency signal was received by an external antenna connected to a receiver and to a computer for data acquisition. The prosthesis was powered by external coil induction. The tibial transducer accurately measured both the magnitude and the location of precisely applied external loads. Successful transmission of the radio frequency signal up to a range of 3m was achieved through cadaveric bone, bone cement, and soft tissue. Reasonable accuracy was obtained in measuring loads applied through a polyethylene insert. The implant was also able to detect unicondylar loading with liftoff. PMID:15598457

  17. TransMedial All-Inside Posterior Cruciate Ligament Reconstruction Using a Reinforced Tibial Inlay Graft

    PubMed Central

    Nancoo, Tamara J.; Lord, Breck; Yasen, Sam K.; Smith, James O.; Risebury, Michael J.; Wilson, Adrian J.

    2013-01-01

    Surgical reconstruction of the posterior cruciate ligament (PCL) is technically demanding. Potential challenges include visualization of the tibial footprint and drilling of the tibial tunnel without damaging posterior neurovascular structures, as well as graft selection, deployment, tensioning, and fixation. We present a novel TransMedial all-inside arthroscopic technique (technique designed by A. J. Wilson with support from Arthrex) using a single hamstring tendon graft, fixed with adjustable cortical suspensory devices. The technique simplifies the difficult steps encountered during PCL reconstruction and is safe and reproducible. All arthroscopic viewing is accomplished from the lateral portal, and femoral socket preparation is performed from the medial side with specially contoured instruments, which allow accurate marking, measuring, and anatomic positioning of the graft. The quadrupled semitendinosus graft can be augmented with composite polymer tape for increased strength and initial stability. We use outside-in drilling to create retrograde femoral and tibial sockets. Cortical suspensory fixation on the tibial side can be supplemented with anchor fixation. We use an arthroscopic tibial inlay technique that better approximates native knee anatomy. This also avoids the “killer turn,” a problem seen in transtibial PCL reconstruction techniques, which theoretically induces graft laxity due to abrasion with cyclic loading. This technique can be further adapted to allow a modified double-bundle or TriLink graft (technique designed by A. J. Wilson with support from Arthrex.). PMID:24400186

  18. Sequential avulsions of the tibial tubercle in an adolescent basketball player.

    PubMed

    Huang, Ying Chieh; Chao, Ying-Hao; Lien, Fang-Chieh

    2010-05-01

    Tibial tubercle avulsion is an uncommon fracture in physically active adolescents. Sequential avulsion of tibial tubercles is extremely rare. We reported a healthy, active 15-year-old boy who suffered from left tibial tubercle avulsion fracture during a basketball game. He received open reduction and internal fixation with two smooth Kirschner wires and a cannulated screw, with every effort to reduce the plate injury. Long-leg splint was used for protection followed by programmed rehabilitation. He recovered uneventfully and returned to his previous level of activity soon. Another avulsion fracture happened at the right tibial tubercle 3.5 months later when he was playing the basketball. From the encouragement of previous successful treatment, we provided him open reduction and fixation with two small-caliber screws. He recovered uneventfully and returned to his previous level of activity soon. No genu recurvatum or other deformity was happening in our case at the end of 2-year follow-up. No evidence of Osgood-Schlatter disease or osteogenesis imperfecta was found. Sequential avulsion fractures of tibial tubercles are rare. Good functional recovery can often be obtained like our case if we treat it well. To a physically active adolescent, we should never overstate the risk of sequential avulsion of the other leg to postpone the return to an active, functional life. PMID:20093955

  19. Ceramic hemi-unicondylar arthroplasty in an adolescent patient with idiopathic tibial chondrolysis.

    PubMed

    Dombroski, Derek; Garino, Jonathan; Lee, Gwo-Chin

    2009-06-01

    Despite recent advances in cartilage regeneration and restoration procedures, isolated, large, full-thickness cartilage lesions in young patients continue to pose significant challenges to patients and orthopedic surgeons. Treatment options for this difficult problem have traditionally included arthrodesis, osteotomy, osteochondral allograft, and prosthetic reconstruction. We present a case of an adolescent patient with isolated idiopathic lateral tibial chondrolysis treated with a custom ceramic hemi-unicondylar hemiarthroplasty. Preoperatively, a 3-dimensional computed tomography scan of the patient's knee was obtained to begin manufacturing a conforming custom ceramic insert that would articulate between the tibial base plate and the patient's native lateral femoral cartilage. Through a lateral parapatellar approach, the tibial preparation was carried out using the Zimmer M/G unicompartmental knee system (Warsaw, Indiana), and the tibial base plate was cemented into position in the standard fashion. A custom, conforming, prefabricated ceramic insert (CeramTec, Memphis, Tennessee) was then inserted onto the tibial base plate. At 5-year follow-up, this salvage procedure was successful in relieving pain and restoring function in this young patient. There were no signs of implant loosening or lysis. Magnetic resonance imaging of the knee at last follow-up revealed that the cartilage thickness of the patient's lateral femoral condyle remained unchanged. Unicondylar hemiarthroplasty performed in patients with large unipolar lesions in the knee can provide durable and reliable pain relief. Ceramic is a viable material that can be considered for articulation with native cartilage. PMID:19634815

  20. Comparison of the tibial mechanical joint orientation angles in dogs with cranial cruciate ligament rupture

    PubMed Central

    Fuller, Mark C.; Kapatkin, Amy S.; Bruecker, Kenneth A.; Holsworth, Ian G.; Kass, Philip H.; Hayashi, Kei

    2014-01-01

    Use of the tibial mechanical joint orientation angles is now the standard of care for evaluating tibial deformities, although they have not been used to evaluate dogs with cranial cruciate ligament (CrCL) rupture. The objective of this study was to compare the tibial mechanical joint orientation angles and tibial plateau angle (TPA) between dogs with bilateral CrCL rupture (BR) and unilateral CrCL rupture with (UR-SR) and without subsequent contralateral CrCL rupture (UR-w/o-SR) as risk factors for subsequent contralateral CrCL rupture. Twenty dogs (21.7%) were classified as BR, 38 (41.3%) were classified as UR-SR, and 34 (37.0%) were classified as UR-w/o-SR. The tibial mechanical joint orientation angles and TPA, in the range studied (< 35°), were not statistically different for dogs with BR, UR-SR, and UR-w/o-SR, and were not significant risk factors for subsequent contralateral CrCL rupture. PMID:25082991

  1. Tendon-to-bone healing using autologous bone marrow-derived mesenchymal stem cells in ACL reconstruction without a tibial bone tunnel-A histological study-

    PubMed Central

    Kanazawa, Tomonoshin; Soejima, Takashi; Noguchi, Kouji; Tabuchi, Kousuke; Noyama, Megumi; Nakamura, Kei-ichiro; Shiba, Naoto

    2014-01-01

    Summary Background: after anterior cruciate ligament (ACL) reconstruction, it is necessary to integrate free tendon graft biologically to the bone. In the present study, to verify whether a structure identical to the normal ligament-bone insertion could be regenerated at the tendon-bone interface without bone tunnel, we designed ACL reconstruction model without a tibial bone tunnel. Moreover, to enhance the integration process in this model, bone marrow-derived mesenchymal stem cells (bMSCs) were transplanted, and histological changes investigated. Our first hypothesis was that the grafted tendon would be anchored at part of the tendon-bone interface even if a bone tunnel was not created. Second hypothesis was that application of bMSCs at the tendon-bone interface would yield results histologically superior to those in controls. Methods: bilateral ACL reconstruction using our originally designed method was performed. Autologous bMSCs with the carrier were transplanted between the bottom of the grafted tendon and the bone pit of the tibia in the experimental limb, whereas the control limb received the carrier only. At 4 and 8 weeks after the operation, histological comparison between bMSCs and the control group was carried out. Results/Conclusions: even in our present ACL reconstruction model without a tibial bone tunnel, integration via chondroid tissue was seen at part of the tendon-bone interface. However, there were no appreciable differences between the groups. In ACL reconstruction, to enhance the tendon-bone integration without a bone tunnel would lead to save the graft length and prevent from bone tunnel complications (ex. Bone-tunnel enlargement after surgery). PMID:25332936

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

    PubMed Central

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

    2014-01-01

    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

  3. A Qualitative Study of Recovery from Type III-B and III-C Tibial Fractures

    PubMed Central

    Shauver, Melissa S.; Aravind, Maya S.; Chung, Kevin C.

    2011-01-01

    The literature has shown that long-term outcomes for both below-knee amputation and reconstruction following type III-B and III-C tibial fracture are poor. Yet, patients often report satisfaction with their treatment and/or outcomes. The aim of this study is to explore the relationship between patient outcomes and satisfaction after open tibial fractures via qualitative methodology. Twenty patients who were treated for open tibial fractures at one institution were selected using purposeful sampling and interviewed in-person in a semi-structured manner. Data were analyzed using grounded theory methodology. Despite reporting marked physical and psychosocial deficits, participants relayed high satisfaction. We hypothesize that the use adaptive coping techniques successfully reduces stress, which leads to an increase in coping self-efficacy that results in the further use of adaptive coping strategies, culminating in personal growth. This stress reduction and personal growth leads to satisfaction despite poor functional and emotional outcomes. PMID:20948418

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

    PubMed

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

    2014-07-01

    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

  5. Cannulated screw and hexapodal fixator reconstruction for compound upper tibial fractures

    PubMed Central

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

    2014-01-01

    Objectives: The aim of the treatment of tibial plateau fractures is to obtain a pain-free and fully functional knee with closed reduction, percutaneous cannulated screw fixation and hexapodal external fixator reconstruction for high energy compound upper tibial fractures. Methods: Patients with comminuted tibial plateau fractures underwent closed reduction, percutaneous fixation with cannulated screws, and reconstruction with hexapodal external fixator. The follow-up period was 24 months. Results: The clinical and radiological results were good or excellent. The average knee flexion was 125°. Conclusion: Our results are successful in the initial stage, however, it should be pointed out that during the long term follow-up osteoarthritis may develop leading to worsening of the condition. Level of Evidence IV, Case Series. PMID:24644420

  6. Topographic distribution of the tibial somatosensory evoked potential using coherence.

    PubMed

    Melges, D B; Infantosi, A F C; Miranda de Sá, A M F L

    2008-12-01

    The objective of the present study was to determine the adequate cortical regions based on the signal-to-noise ratio (SNR) for somatosensory evoked potential (SEP) recording. This investigation was carried out using magnitude-squared coherence (MSC), a frequency domain objective response detection technique. Electroencephalographic signals were collected (International 10-20 System) from 38 volunteers, without history of neurological pathology, during somatosensory stimulation. Stimuli were applied to the right posterior tibial nerve at the rate of 5 Hz and intensity slightly above the motor threshold. Response detection was based on rejecting the null hypothesis of response absence (significance level alpha= 0.05 and M = 500 epochs). The best detection rates (maximum percentage of volunteers for whom the response was detected for the frequencies between 4.8 and 72 Hz) were obtained for the parietal and central leads mid-sagittal and ipsilateral to the stimulated leg: C4 (87%), P4 (82%), Cz (89%), and Pz (89%). The P37-N45 time-components of the SEP can also be observed in these leads. The other leads, including the central and parietal contralateral and the frontal and fronto-polar leads, presented low detection capacity. If only contralateral leads were considered, the centro-parietal region (C3 and P3) was among the best regions for response detection, presenting a correspondent well-defined N37; however, this was not observed in some volunteers. The results of the present study showed that the central and parietal regions, especially sagittal and ipsilateral to the stimuli, presented the best SNR in the gamma range. Furthermore, these findings suggest that the MSC can be a useful tool for monitoring purposes. PMID:19148367

  7. Can Ultrasound of the Tibial Nerve Detect Diabetic Peripheral Neuropathy?

    PubMed Central

    Riazi, Sheila; Bril, Vera; Perkins, Bruce A.; Abbas, Sherif; Chan, Vincent W.S.; Ngo, Mylan; Lovblom, Leif E.; El-Beheiry, Hossam; Brull, Richard

    2012-01-01

    OBJECTIVE Peripheral nerve imaging by portable ultrasound (US) may serve as a noninvasive and lower-cost alternative to nerve conduction studies (NCS) for diagnosis and staging of diabetic sensorimotor polyneuropathy (DSP). We aimed to examine the association between the size of the posterior tibial nerve (PTN) and the presence and severity of DSP. RESEARCH DESIGN AND METHODS We performed a cross-sectional study of 98 consecutive diabetic patients classified by NCS as subjects with DSP or control subjects. Severity was determined using the Toronto Clinical Neuropathy Score. A masked expert sonographer measured the cross-sectional area (CSA) of the PTN at 1, 3, and 5 cm proximal to the medial malleolus. RESULTS Fifty-five patients had DSP. The mean CSA of the PTN in DSP compared with control subjects at distances of 1 (23.03 vs. 17.72 mm2; P = 0.004), 3 (22.59 vs. 17.69 mm2; P < 0.0001), and 5 cm (22.05 vs. 17.25 mm2; P = 0.0005) proximal to the medial malleolus was significantly larger. Although the area under the curve (AUC) for CSA measurements at all three anatomical levels was similar, the CSA measured at 3 cm above the medial malleolus had an optimal threshold value for identification of DSP (19.01 mm2) with a sensitivity of 0.69 and a specificity of 0.77 by AUC analysis. CONCLUSIONS This large study of diabetic patients confirms that the CSA of the PTN is larger in patients with DSP than in control subjects, and US is a promising point-of-care screening tool for DSP. PMID:23033242

  8. Temporary bridging external fixation in distal tibial fracture.

    PubMed

    Lavini, F; Dall'Oca, C; Mezzari, S; Maluta, T; Luminari, E; Perusi, F; Vecchini, E; Magnan, B

    2014-12-01

    Fractures that involve the distal area of the tibia are associated with a high percentage of complications. Soft tissue oedema, swelling, blisters, skin abrasions and open wounds could compromise the outcome of these lesions. The waiting time before surgery with ORIF is mostly due to soft tissue conditions. Early application of a simple joint-spanning external fixator would achieve the initial goal of stability and the respect of soft tissue, thereby decreasing the time necessary for definitive treatment. A total of 40 consecutive patients (22 male and 18 female) with a mean age of 52 years (range 17-82 years) with distal tibial fracture treated between January 2010 and January 2013 were evaluated. Early temporary external fixation was the first treatment step. Twenty patients had pilon fractures, characterised by the intra-articular involvement of the distal tibia with metaphyseal extension, and 20 patients had malleolar fracture-dislocation. Patients were divided into two groups, A and B. Group A comprised 10 patients with ankle fracture-dislocation and bone fragmentation, who were treated with a temporary bridging external fixation that was maintained after ORIF to exploit ligamentotaxis during the first phases of bone healing. In Group B (30 patients), the external fixation was removed after ORIF. The results of the study are in line with the recent literature: temporary external fixation in high-energy trauma and fracture-dislocation of the ankle enables soft tissue to be restored, which facilitates postoperative assessment of bone fragments by CT scan. The complication rate in this study was 5% in patients with malleolar fractures and 20% in patients with pilon fractures. The maintenance of temporary external fixation after ORIF synthesis during the entire first stage of bone healing seems to be a good method of treatment that has a low rate of soft tissue complications. PMID:25457321

  9. Complete anterior knee dislocation 16 years after cruciate-retaining total knee arthroplasty.

    PubMed

    Sato, Yusuke; Saito, Masahiko; Akagi, Ryuichiro; Suzuki, Masahiko; Kobayashi, Tatsuya; Sasho, Takahisa

    2012-04-01

    Anterior dislocation after total knee arthroplasty (TKA) is rare; 9 cases have been reported in the English literature. Five patients sustained subluxation, with recurvatum as the clinical manifestation, and 4 patients sustained complete dislocation, usually accompanying other serious complications.This article describes a case of complete dislocation that developed atraumatically 16 years after TKA and was characterized by dislocation in extension and spontaneous reduction in flexion. Revision TKA was planned, with several alternative procedures under consideration, ranging in degree of invasiveness from simple polyethylene exchange to conversion to a hinge-typed prosthesis. Intraoperatively, extensive areas of blackened synovium and posterior-dominant polyethylene wear existed medially and laterally. Considering the patient's age of 82 years, low activity level in activities of daily living, edematous skin, and number of stable components, we performed simple polyethylene exchange to a cruciate-retaining component that left the partial metal defect in the tibial plate untouched. Successful outcome was achieved for >2 years. The dislocation mechanism was polyethylene thinning, leading to relative valgus and anteroposterior instability that aggravated the anterior cruciate ligament dysfunction, which is speculated as the inherent key causative factor in every TKA.Complete dislocation, usually accompanying other complications, requires prompt treatment because the possibility of serious consequences exists. Due to the absence of a gold standard, the treatment of choice needs to be made on a case-by-case basis. PMID:22495865

  10. The impact of trauma centre designation on open tibial fracture management

    PubMed Central

    Williams, D; Hunter, J; Vesely, M; Nielsen, D

    2013-01-01

    Introduction The British Orthopaedic Association/British Association of Plastic, Reconstructive and Aesthetic Surgeons guidelines for the management of open tibial fractures recommend early senior combined orthopaedic and plastic surgical input with appropriate facilities to manage a high caseload. The aim of this study was to assess whether becoming a major trauma centre has affected the management of patients with open tibial fractures. Methods Data were obtained prospectively on consecutive open tibial fractures during two eight-month periods: before and after becoming a trauma centre. Results Overall, 29 open tibial fractures were admitted after designation as a major trauma centre compared with 15 previously. Of the 29 patients, 21 came directly or as transfers from another accident and emergency deparment (previously 8 of 15). The time to transfer patients admitted initially to local orthopaedic departments has fallen from 205.7 hours to 37.4 hours (p=0.084). Tertiary transferred patients had a longer hospital stay (16.3 vs 14.9 days) and had more operations (3.7 vs 2.6, p=0.08) than direct admissions. As a trauma centre, there were improvements in time to definitive skeletal stabilisation (4.7 vs 2.2 days, p=0.06), skin coverage (8.3 vs 3.7 days, p=0.06), average number of operations (4.2 vs 2.3, p=0.002) and average length of hospital admission (26.6 vs 15.3 days, p=0.05). Conclusions The volume and management of open tibial fractures, independent of fracture grade, has been directly affected by the introduction of a trauma centre enabling early combined senior orthopaedic and plastic surgical input. Our data strongly support the benefits of trauma centres and the continuing development of trauma networks in the management of open tibial fractures. PMID:23827288

  11. The effect of graft fixation sequence on force distribution in double-bundle anterior cruciate ligament reconstruction

    PubMed Central

    Chen, Chih-Hui; Gadikota, Hemanth R.; Gill, Thomas J.

    2011-01-01

    Purpose This paper investigated the effect of graft fixation sequence on knee joint biomechanics after a double-bundle ACL reconstruction. Method Two independently published biomechanical studies that investigated the biomechanics of double-bundle ACL reconstructions using similar robotic testing systems were compared. In each study, ten human cadaveric knees were tested under three different conditions: intact, ACL deficient, and ACL reconstructed using a double-bundle technique with the anteromedial (AM) graft fixed at 60° of flexion and the posterolateral (PL) graft fixed at full extension. In one study (Study A), the AM graft was fixed first; while in another study (Study B), the PL graft was fixed first. Knee kinematics, in situ forces of the ACL and the ACL grafts were measured under two loading conditions: an anterior tibial load of 134 N and a combined tibial torques (10 N·m valgus and 5 N·m internal tibial torques) in both studies. Result When AM graft was fixed first, the in situ force of the AM graft was lower than the native AM bundle at all flexion angles. The in situ force in the PL graft, however, was higher than the native PL bundle at all flexion angles. When the PL graft was fixed first, the in situ force of the AM graft was higher than the native AM bundle, while the in situ forces of the PL graft were lower than the native PL bundle at all flexion angles. Both studies demonstrated that the double-bundle ACL reconstructions can closely restore the normal knee joint kinematics. Conclusion Even though the grafts were fixed using similar initial tensions and at same flexion angles, the sequence of fixing the two grafts in a double-bundle ACL reconstruction could alter the in situ forces in the grafts and affect the knee kinematics. These data imply that in clinical application of a double-bundle ACL reconstruction, the sequence of graft fixation should be an important surgical parameter. PMID:21082163

  12. Intramedullary nail fixation of fibular fractures associated with tibial shaft and pilon fractures.

    PubMed

    Stewart, Christopher M; Kiner, Dirk; Nowotarski, Peter

    2013-05-01

    Treatment of distal tibial fractures is technically challenging. The purpose of this study was to evaluate the use of distally locked retrograde Ender nail fixation of axially stable fibular fractures associated with these distal tibia fractures. During a 4-year span, we treated 23 fibular fractures, associated with either distal tibial metaphyseal or articular fractures, with a retrograde 3.5-mm Ender nail. The surgical protocol along with radiographic and clinical outcomes is presented. Using this technique, we have achieved excellent fibular union with minimal complications. PMID:23609789

  13. Internal Rotation of the Tibial Component is Frequent in Stiff Total Knee Arthroplasty

    Microsoft Academic Search

    Martin Bédard; Kelly G. Vince; John Redfern; Stacy R. Collen

    Background  Stiffness complicating TKA is a complex and multifactorial problem. We suspected internally rotated components compromised\\u000a motion because of pain, patellar maltracking, a tight medial flexion gap, and limited femoral rollback on a conforming lateral\\u000a tibial condyle.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We sought to determine: (1) the incidence of internal rotation of the femoral and tibial components in stiff TKAs; (2) if\\u000a revision surgery that

  14. Analysis of bleb morphology after trabeculectomy with Visante anterior segment optical coherence tomography

    Microsoft Academic Search

    Christopher Kai-shun Leung; Doris Wai-fong Yick; Yolanda Yuen-ying Kwong; Felix Chi-hong Li; Dexter Yu-lung Leung; Shaheeda Mohamed; Clement Chee-yung Tham; Chi Chung-chai; Dennis Shun-Chiu Lam

    2007-01-01

    Background: To describe the use of anterior segment optical coherence tomography (OCT) in imaging intrableb morphology after trabeculectomy.Methods: 14 post-trabeculectomy eyes from 11 primary open angle glaucoma and 3 primary angle closure glaucoma subjects were studied. The blebs were classified with reference to slit lamp morphology and bleb function. They included diffuse filtering (n = 7), cystic (n = 2),

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

    Microsoft Academic Search

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

    2003-01-01

    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.

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

    PubMed

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

    2014-09-01

    Although it is clear that opening-wedge high tibial osteotomy (HTO) changes alignment in the coronal plane, which is its objective, it is not clear how this procedure affects knee kinematics throughout the range of joint movement and in other planes. Our research question was: how does opening-wedge HTO change three-dimensional tibiofemoral and patellofemoral kinematics in loaded flexion in patients with varus deformity?Three-dimensional kinematics were assessed over 0° to 60° of loaded flexion using an MRI method before and after opening-wedge HTO in a cohort of 13 men (14 knees). Results obtained from an iterative statistical model found that at six and 12 months after operation, opening-wedge HTO caused increased anterior translation of the tibia (mean 2.6 mm, p < 0.001), decreased proximal translation of the patella (mean -2.2 mm, p < 0.001), decreased patellar spin (mean -1.4°, p < 0.05), increased patellar tilt (mean 2.2°, p < 0.05) and changed three other parameters. The mean Western Ontario and McMaster Universities Arthritis Index improved significantly (p < 0.001) from 49.6 (standard deviation (sd) 16.4) pre-operatively to a mean of 28.2 (sd 16.6) at six months and a mean of 22.5 (sd 14.4) at 12 months. The three-dimensional kinematic changes found may be important in explaining inconsistency in clinical outcomes, and suggest that measures in addition to coronal plane alignment should be considered. PMID:25183593

  17. Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: A systematic review

    PubMed Central

    Patel, Sonika A.; Hageman, Jason; Quatman, Carmen E.; Wordeman, Samuel C.; Hewett, Timothy E.

    2013-01-01

    Background Bone bruising is commonly observed on magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) injury. Objectives The primary objective of this study was to determine if the location and prevalence of tibial and femoral bone bruises after ACL injury can be explained by specific injury mechanism(s). The secondary objective was to determine whether the bone bruise literature supports sex-specific injury mechanism(s). We hypothesized that most studies would report bone bruising in the lateral femoral condyle (LFC) and on the posterior lateral tibial plateau (LTP). Methods MEDLINE, PubMed, and SCOPUS were searched for studies that reported bone bruise prevalence and location in ACL-injured subjects. Sex differences in bone bruise patterns were assessed. Time from injury to imaging was assessed to account for confounding effects on bone bruise size and location. Results Thirty-eight studies met the inclusion/exclusion criteria. Anterior-posterior location of bone bruises within the tibiofemoral compartment was assessed in eleven studies. Only five of these studies reported bone bruise locations on both the tibia and the femur. The most common bone bruise combination in all five studies was on the LFC and the posterior LTP. Sex differences were only assessed in three studies, and only one reported significantly greater prevalence of LTP bruising in females. Conclusion Bone bruise patterns in the current literature support a valgus-driven ACL injury mechanism. However, more studies should report the specific locations of tibial and femoral bone bruises. There is insufficient evidence in the literature to determine whether there are sex-specific bone bruise patterns in ACL-injured subjects. PMID:24158783

  18. Increased in-vivo tibiofemoral cartilage contact deformation in anterior cruciate ligament-deficiency

    PubMed Central

    Van de Velde, Samuel K.; Bingham, Jeffrey T.; Hosseini, Ali; Kozanek, Michal; DeFrate, Louis E.; Gill, Thomas J.; Li, Guoan

    2010-01-01

    Objective To investigate the in-vivo cartilage contact biomechanics of the tibiofemoral joint following anterior cruciate ligament (ACL) injury. Methods Eight patients with an isolated ACL injury in one knee and the contralateral side intact participated in the study. Both knees were imaged using a specific MR sequence to create three-dimensional knee models of bone and cartilage. Next, each patient performed a lunge as images were recorded with a dual fluoroscopic system from 0° to 90° of flexion. The three-dimensional knee models and fluoroscopic images were used to reproduce the in-vivo knee position at each flexion angle. With these series of knee models, the location of tibiofemoral cartilage contact, size of contact area, cartilage thickness at the contact area, and magnitude of cartilage contact deformation were compared between the intact and ACL-deficient knees. Results Rupture of the ACL changed the cartilage contact biomechanics from 0° to 60° of flexion in the medial knee compartment. The location of peak cartilage contact deformation on the tibial plateaus was more posterior and lateral; the contact area was smaller; the average cartilage thickness at the tibial cartilage contact area was thinner; and the resultant magnitude of cartilage contact deformation was increased, compared with the contralateral knee. Similar changes were observed in the lateral compartment, with increased cartilage contact deformation from 0° to 30° of knee flexion in ACL deficiency. Conclusion ACL deficiency alters the in-vivo cartilage contact biomechanics, by shifting the contact location to smaller regions of thinner cartilage, and increasing the magnitude of cartilage contact deformation. PMID:19950260

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

    PubMed Central

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

    2013-01-01

    Pediatric anterior cruciate ligament (ACL) tears present a technical dilemma for orthopaedic surgeons. Multiple surgical techniques have been described to protect the distal femoral and proximal tibial physes. We present an ACL reconstruction technique performed on a 12-year-old girl with open physes who sustained an ACL tear after a noncontact twisting injury while playing soccer. A hamstring autograft reconstruction was performed by use of a posteromedial portal to drill the femoral tunnel in an all-epiphyseal fashion at the anatomic footprint of the native ACL. This case provides a new surgical technique to achieve anatomic fixation for ACL reconstruction in a skeletally immature individual using a posteromedial portal to drill a physeal-sparing lateral femoral tunnel for anatomic ACL reconstruction. This advancement may make drilling the femoral tunnel less technically challenging compared with other proposed methods while maintaining the lateral wall of the distal femur. PMID:24892013

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

    PubMed Central

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

    2012-01-01

    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

  1. Experiments on anterior regeneration in Eurythoe complanata (\\

    Microsoft Academic Search

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

    2003-01-01

    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

  2. Anterior commissure carcinoma: I-histopathologic study

    Microsoft Academic Search

    Mohamed Rifai; Hany Khattab

    2000-01-01

    Objectives: To study the behavior of anterior commissure carcinoma regarding its tendency for cartilage invasion. Methods: Histopathological examination of the region of the anterior commissure (AC) was done with whole organ section in 30 randomly selected specimens. Serial sections were prepared and examined histopathologically for evidence of microscopic cartilage invasion in the region of the AC. Results: Microscopic involvement of

  3. Anterior pericardial tracheoplasty for congenital tracheal stenosis.

    PubMed

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

    1991-11-01

    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

  4. Internal Mechanical Conditions in the Soft Tissues of the Residual Limb in Trans-Tibial Amputees

    E-print Network

    Gefen, Amit

    conditions that evolve in the muscle flap of the residual limb of TTA patients after donning the prostheticInternal Mechanical Conditions in the Soft Tissues of the Residual Limb in Trans- Tibial Amputees 1 necrosis caused by prosthetic misfit. These complications often lead to further amputation and even death

  5. Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

    PubMed

    Uzun, Metin; Kara, Adnan; Ada?, Müjdat; Karslio?lu, Bülent; Bülbül, Murat; Beksaç, Burak

    2014-01-01

    Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2?cm (range, 0.5-2?cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening. PMID:25544899

  6. Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?

    PubMed Central

    Uzun, Metin; Kara, Adnan; Ada?, Müjdat; Karslio?lu, Bülent; Bülbül, Murat; Beksaç, Burak

    2014-01-01

    Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function. Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI). Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2?cm (range, 0.5–2?cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90. Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening. PMID:25544899

  7. Removal of a Well-Fixed Trabecular Metal Monoblock Tibial Component

    Microsoft Academic Search

    Gregg R. Klein; Harlan B. Levine; Mark A. Hartzband

    2008-01-01

    The use of porous tantalum (Trabecular Metal; Zimmer, Inc, Warsaw, Ind) in hip and knee reconstruction has become increasingly popular over the past few years. Widespread clinical use of porous tantalum tibial components for primary total knee arthroplasty has been tempered in part by the perceived difficulty in removing this implant after bone ingrowth has occurred. We present an easy,

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

    Microsoft Academic Search

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

    2006-01-01

    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

  9. An implantable telemetry device to measure intra-articular tibial forces

    Microsoft Academic Search

    Darryl D. D’Lima; Christopher P. Townsend; Steven W. Arms; Beverly A. Morris; Clifford W. Colwell

    2005-01-01

    Tibial forces are important because they determine polyethylene wear, stress distribution in the implant, and stress transfer to underlying bone. Theoretic estimates of tibiofemoral forces have varied between three and six times the body weight depending on the mathematical models used and the type of activity analyzed. An implantable telemetry system was therefore developed to directly measure tibiofemoral compressive forces.

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

    E-print Network

    Delp, Scott

    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

  11. Baseline Vitamin D Status is Predictive of Longitudinal Change in Tibial BMD in Knee Osteoarthritis (OA)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    With its lack of effective treatment and high prevalence, the public health impact of OA is substantial. Peri-articular bone in OA can be evaluated with the medial:lateral tibial BMD ratio (M:L BMD) obtained from dual x-ray absorptiometry (DXA). Higher M:L BMD is associated with medial OA features...

  12. TIBIAL PLATEAU PROXIMAL AND DISTAL BONE BEHAVE SIMILARLY: BOTH ARE ASSOCIATED WITH FEATURES OF KNEE OSTEOARTHRITIS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is a growing imperative to understand how changes in peri-articular bone relate to pathological progression of knee osteoarthritis (KOA). Peri-articular bone density can be measured using dual x-ray absorptiometry (DXA). The medial:lateral tibial BMD ratio (M:L BMD) is associated with MRI and...

  13. Posterior tibial tendon entrapment within an intact ankle mortise: a case report.

    PubMed

    Hunter, Allison M; Bowlin, Christopher

    2015-01-01

    The present case report demonstrates a rare finding associated with irreducible ankle fracture dislocations. To our knowledge, posterior tibial tendon entrapment with an intact ankle mortise has not yet been documented in published studies. In the case of our patient, a high-energy, 12-ft fall resulted in a comminuted intra-articular fracture of the medial malleolus, confirmed by the initial radiographs. Preoperative magnetic resonance imaging showed the Achilles tendon to be ruptured and the posterior tibial tendon to be both displaced and entrapped between the medial malleolar fracture fragments, preventing initial closed reduction. At operative repair for the ruptured Achilles tendon and the medial malleolus fracture, the posterior tibial tendon was removed from the fracture site and was found to be intact with no evidence of laceration or rupture. The tendon was returned back to its anatomic position, and the tendon sheath was reapproximated. Although uncommon, it is important that entrapment of the posterior tibial tendon be considered in cases of irreducible ankle fracture. This injury type can be addressed during open reduction internal fixation to achieve reduction. PMID:25441277

  14. COMPARTMENT SYNDROME IN TIBIAL SHAFT FRACTURE MISSED BECAUSE OF A LOCAL NERVE BLOCK

    Microsoft Academic Search

    N HYDER; S. KESSLER; A. G. JENNINGS; P. G. DE BOER

    1996-01-01

    Compartment syndrome is a serious complication of frac- tures of the tibial shaft and its clinical presentation and eval- uation have been well documented (Holden 1975; Kikuchi, Hasue and Watanabe 1978). The most important diagnostic feature is the presence of inappropriate pain even after stabi- lisation of the fracture by a cast or by external or internal fixation. Pain is

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

    Microsoft Academic Search

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

    2009-01-01

    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

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

    Microsoft Academic Search

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

    2005-01-01

    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

  17. Diabetic Ankle Fracture with Distal Tibial and Fibular Varus Corrected Using the Ilizarov Methodology

    Microsoft Academic Search

    Sutpal Singh; Albert Kim

    The authors describe a case report of a patient with tibial and fibular fractures with a non- displaced intra-articular fracture that was initially treated in the emergency room unsuccessfully, resulting in a varus deformity. Corrective surgical treatment included the use of an external fixation device using the Ilizarov methodology for several months. After a two- year follow up, there was

  18. Limb salvage treatment for Gollop-Wolfgang complex (femoral bifurcation, complete tibial hemimelia, and hand ectrodactyly).

    PubMed

    Wada, Akifusa; Nakamura, Tomoyuki; Fujii, Toshio; Urano, Noriko; Yanagida, Haruhisa; Takamura, Kazuyuki; Taketa, Mayuki; Oketani, Yutaka; Kubota, Hideaki

    2013-09-01

    We reported the findings from three patients with Gollop-Wolfgang complex and demonstrated the results of five limb salvage treatments for this condition. All three femoral bifurcations were accompanied by ipsilateral complete tibial hemimelia. Two patients showed contralateral complete or partial tibial hemimelia, and one patient had hand ectrodactyly. The five limb salvage treatments included resection of the anteromedial bifurcated femur in three limbs, foot centralization in five limbs, tibiofibular fusion in one limb with partial tibial hemimelia, fibular transfer (Brown's procedure) in three limbs with complete tibial hemimelia, and callus distraction lengthening in one limb. The duration from the first operation to the final follow-up ranged from 3.5 to 5.4 years. None of the three knees treated by fibular transfer achieved a successful functional result, but all of the knees were ultimately able to withstand weight bearing. Early knee disarticulation and resection of the protruded bifurcated femur, followed by fitting of a modern prosthesis is likely to be the best treatment for patients with Gollop-Wolfgang syndrome. We note that limb salvage treatment is an alternative in patients who opt to retain their feet and refuse amputation. PMID:23660549

  19. Matched-pair analysis of all-polyethylene versus metal-backed tibial components.

    PubMed

    Udomkiat, P; Dorr, L D; Long, W

    2001-09-01

    Forty-eight matched pairs of osteoarthritic knees from patients who underwent primary total knee arthroplasty with a round-on-round, Apollo Knee System were studied to evaluate the outcome between all-polyethylene and metal-backed tibial components. Patients were matched for patient factors, preoperative deformities, cruciate salvage or sacrifice, and surgical technique. At the last follow-up (average, 38.4 months), there was no statistically significant difference in terms of knee scores, patient self-assessment, and radiographic outcomes. No component required revision, and no revisions were pending. Maintenance of these results over time would project into better long-term success for all-polyethylene tibial components because of the amount of wear and osteolysis with current modular metal-backed tibial components. We advocate the use of a more cost-effective all-polyethylene tibial component in elderly patients (>70 years old) who are not likely to need the versatility of exchange of a modular polyethylene insert because of wear. PMID:11547366

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

    PubMed Central

    Busse, Jason W.; Bhandari, Mohit; Guyatt, Gordon H.; Heels-Ansdell, Diane; Kulkarni, Abhaya V.; Mandel, Scott; Sanders, David; Schemitsch, Emil; Swiontkowski, Marc; Tornetta, Paul; Wai, Eugene; Walter, Stephen D.

    2011-01-01

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

  1. Early urbanization and mobility at Tell Brak, NE Syria: the evidence from femoral and tibial external shaft shape.

    PubMed

    So?tysiak, Arkadiusz

    2015-04-01

    Urbanization at Tell Brak began in the late 5th millennium BCE and the site reached its maximum size in the Late Chalcolithic (LC) 3, ca. 3900-3600 BCE. During that time, a large midden was formed at the edge of the early city, now known as Tell Majnuna. Rescue excavations at Tell Majnuna revealed several clusters of commingled human remains and a cemetery on the top. Several human skeletons dated to the LC 3 and Early Bronze Age (EBA) were found also at Tell Brak itself and it was possible to investigate differences in cross-sectional femoral and tibial shaft shapes between LC 3 and EBA to test the hypothesis that rapid and extensive urbanization in the LC 3 induced increase in mobility. External midshaft and subtrochanteric measurements of at least 152 femora and measurements of 55 tibiae at the nutrient foramen were taken to investigate the differences in the level of terrestrial mobility between four LC 3 and one EBA chronological subsets. Also the correlation was examined between shaft cross-sectional shapes and frequency of linear enamel hypoplasia (LEH) in canines, as a proxy indicator of population stress. Due to post-mortem damage, sex assessment was based only on the size of measured bones. In spite of the limited quality of the gathered data, significant differences in femoral midshaft shape in males were observed between the LC 3 and EBA subsets and the average shape index scores appeared to be correlated with the LEH frequencies. No such result was obtained for females, suggesting that only males were more mobile in the LC 3 and their mobility level was associated with general population stress. In contrast, in females the average shape of subtrochanteric femoral cross-section was more variable between temporal subsets. The patterns of temporal differences in tibial cross-section at the nutrient foramen were not conclusive due to the small sample size. Obtained results suggest that males in the LC 3, the period of rapid urbanization, were more mobile than in the EBA, when the population size was considerably smaller. This mobility may have been related to need of searching for alternative resources for the overpopulated early city. PMID:25511782

  2. Human parathyroid hormone-(1-38) restores cancellous bone to the immobilized, osteopenic proximal tibial metaphysis in rats

    NASA Technical Reports Server (NTRS)

    Ma, Y. F.; Jee, W. S. S.; Ke, H. Z.; Lin, B. Y.; Liang, X. G.; Li, M.; Yamamoto, N.

    1994-01-01

    The purpose of this study was to determine if human parathyroid hormone-(1-38) (PTH) can restore cancellous bone mass to the established osteopenic, immobilized proximal tibial metaphyses (PTM) of female rats. The right hindlimbs of six-month-old female Sprague-Dawley rats were immobilized by bandaging the right hindlimbs to the abdomen. After 30 days of right hindlimb immobilization (RHLI), the rats were subcutaneously injected with 200 microgram hPTH(1-38)/kg/day for 15 (short-term) or 75 (longer-term) days. Static bone histomorphometry was performed on the primary spongiosa, while both static and dynamic histomorphometry were performed on the secondary spongiosa of the right PTM. Immobilization for 30 days without treatment decreased trabecular bone area, number and thickness in both primary and secondary spongiosa, and induced an increase in eroded perimeter and a decrease in tissue referent-bone formation rate (BFR/TV) in the secondary spongios. These changes reached a new steady state thereafter. Treatment with 200 microgram hPTH(1-38)/kg/day for 15 days, beginning at 30 days post immobilization (IM), significantly increased trabecular bone area, thickness and number in both primary and secondary spongiosa despite continuous IM when compared to the age-related and IM controls. The short-term (15 days) PTH treatment significantly increased labeling perimeter, mineral apposition rate and BFR/TV in the secondary spongiosa and stimulated longitudinal bone growth as compared to the age-related and IM controls. PTH treatment for longer-term (75 days) further increased trabecular bone area, thickness and number as compared to aging and IM controls and short-term (15 days) PTH treated groups. The bone formation indices in the secondary spongiosa of these longer-term treated rats were lower than that of short-term (15 days) PTH treated group, but they were still higher than those of IM and age-related controls. Our findings indicate that PTH treatment stimulates cancellous bone formation, restores and adds extra cancellous bone to the established, disuse-osteopenic proximal tibial metaphysis of continuously RHLI female rats. These results suggest that PTH may be a useful agent in treatment disuse-induced osteoporosis in humans.

  3. The influence of body proportions on femoral and tibial midshaft shape in hunter-gatherers.

    PubMed

    Shaw, Colin N; Stock, Jay T

    2011-01-01

    Variation in femoral and tibial diaphyseal shape is used as an indicator of adaptation to patterns of terrestrial mobility. Recent experimentation has implied that lower limb diaphyseal shape may be primarily influenced by lower limb length, and less so by mobility patterns. If valid, this would, at most, render previous interpretations of mobility patterns based on analyses of diaphyseal shape questionable, and, at least, require additional standardization that considers the influence of limb length. Although the consequences could be profound, this implication has yet to be directly tested. Additionally, the influence of body breadth on tibial shape (and to a lesser extent femoral shape) remains uncertain. Tibial and femoral cross-sectional midshaft shape measurements, taken from nine Pleistocene and Holocene skeletal populations, were compared against lower limb length, limb segment length, and bi-iliac breadth. Generally, limb length and limb segment length do not significantly influence femoral or tibial midshaft shape. After controlling for body mass greater bi-iliac breadth is associated with a relative mediolateral strengthening of the femoral midshaft, while the influence of a wider body shape (BIB/length) is associated with a relative M-L strengthening of the tibia and femur of males, and the tibia of females. We conclude that; (1) mechanical interpretations of lower limb diaphyseal shape are most parsimonious due to the lack of evidence for a consistent relationship between segment length and shape; however, (2) further work is required to investigate the influence of bi-iliac breadth on both femoral and tibial midshaft shape. PMID:20623683

  4. Surface pretreatment for prolonged survival of cemented tibial prosthesis components: full- vs. surface-cementation technique

    PubMed Central

    Marx, Rudolf; Qunaibi, Mutaz; Wirtz, Dieter Christian; Niethard, Fritz Uwe; Mumme, Thorsten

    2005-01-01

    Background One of few persisting problems of cemented total knee arthroplasty (TKA) is aseptic loosening of tibial component due to degradation of the interface between bone cement and metallic tibial shaft component, particularly for surface cemented tibial components. Surface cementation technique has important clinical meaning in case of revision and for avoidance of stress shielding. Degradation of the interface between bone cement and bone may be a secondary effect due to excessive crack formation in bone cement starting at the opposite metallic surface. Methods This study was done to prove crack formation in the bone cement near the metallic surface when this is not coated. We propose a newly developed coating process by PVD layering with SiOx to avoid that crack formation in the bone cement. A biomechanical model for vibration fatigue test was done to simulate the physiological and biomechanical conditions of the human knee joint and to prove excessive crack formation. Results It was found that coated tibial components showed a highly significant reduction of cement cracking near the interface metal/bone cement (p < 0.01) and a significant reduction of gap formation in the interface metal-to-bone cement (p < 0.05). Conclusion Coating dramatically reduces hydrolytic- and stress-related crack formation at the prosthesis interface metal/bone cement. This leads to a more homogenous load transfer into the cement mantle which should reduce the frequency of loosening in the interfaces metal/bone cement/bone. With surface coating of the tibial component it should become possible that surface cemented TKAs reveal similar loosening rates as TKAs both surface and stem cemented. This would be an important clinical advantage since it is believed that surface cementing reduces metaphyseal bone loss in case of revision and stress shielding for better bone health. PMID:16262888

  5. Fatigue load of current tibial intramedullary nail designs: a simulated study.

    PubMed

    Wagner, Mark; Liu, Qi; Ellis, Thomas J

    2011-06-01

    Comminuted tibial shaft fractures are traditionally treated with statically locked intramedullary nailing and protected weight bearing until fracture callous is evident. The purpose of this study was to demonstrate that a simulation of immediate full weight bearing following intramedullary nailing of these fractures does not result in implant failure.A comminuted fracture model was created using 2 pieces of polyvinyl chloride (PVC) pipe. Ten-millimeter-diameter tibial nails (Synthes, Paoli, Pennsylvania; Styker, Mahwah, New Jersey; Zimmer, Warsaw, Indiana; Smith & Nephew, Memphis, Tennessee) were inserted within the PVC pipe and secured proximally and distally with 2 or 3 locking bolts. The constructs were cycled in axial compression for 500,000 cycles or until implant failure. The tests were conducted using a modified staircase method (200 N per step), and the fatigue strength was identified for each of the tibial nail designs. When 2 interlocking bolts were placed proximally and distally, the fatigue strength was between 900 and 1100 N for the Stryker nail, 1100 and 1300 N for the Zimmer nail, 1200 and 1400 N for the Synthes nail, and 1400 and 1600 N for the Smith & Nephew nail. Adding a third interlocking bolt proximally and distally to the Smith & Nephew nail increased the fatigue strength by 13% to between 1700 and 1900 N. In all cases, implant failures occurred through the proximal or distal interlocking bolts.Biomechanical tests suggest that current tibial nail designs may permit immediate full weight bearing of comminuted tibial shaft fractures with minimal risk of implant failure. This may facilitate mobilization in the early postoperative period, especially in the multiply injured patient. PMID:21667907

  6. Predictive Radiographic Markers For Concomitant Ipsilateral Ankle Injuries In Tibial Shaft Fractures

    PubMed Central

    Schottel, Patrick C.; Berkes, Marschall B.; Little, Milton T. M.; Lazaro, Lionel E.; Nguyen, Joseph T.; Helfet, David L.; Lorich, Dean G.

    2015-01-01

    STRUCTURED ABSTRACT Objectives To quantify the radiographic tibia and fibula shaft fracture characteristics that are associated with a concomitant ipsilateral ankle injury. Design Retrospective case-control study. Setting Academic level I trauma center. Patients Seventy-one adult patients with an operatively treated tibial shaft fracture met the inclusion/exclusion criteria. Intervention Preoperative radiographs were categorized according to tibia and fibula fracture pattern, location and spatial relationship to each other. Preoperative CT scans were then evaluated to assess for the presence of an articular ankle injury. Main Outcome Measurements 1) incidence of concomitant tibial shaft fracture and ipsilateral ankle injury; and 2) statistical association between tibia and fibula fracture characteristics in patients with and without an ipsilateral ankle fracture. Results Thirty-five of 71 (49.3%) tibial shaft fracture patients had a concomitant ipsilateral ankle injury. Of these, 31 (88.6%) ankle injuries occurred in patients with a spiral pattern tibia fracture of the distal third diaphysis (p<0.001). A spiral pattern tibia fracture, a distal one-third tibial shaft fracture location or a spiral pattern fibula fracture all were significantly associated with the presence of an ipsilateral ankle injury (p=<0.001; p=0.001; and p=0.002). Patients with either a transverse pattern or absent fibula fracture, a non-spiral pattern tibia fracture or a midshaft diaphyseal tibia fracture location were significantly less likely to have an associated ankle injury (p=<0.001; p=<0.001; and p=0.012) Conclusions Ipsilateral ankle fractures are commonly associated with tibial shaft fractures, specifically distal one-third spiral type injuries. Recognition of an associated ankle injury is important as it can alter operative and postoperative management. Clinical studies are needed to examine patient outcomes with or without ipsilateral ankle injury to determine the clinical significance of this entity. PMID:23760178

  7. Somatosensory event-related potential changes to painful stimuli during hypnotic analgesia: anterior cingulate cortex and anterior temporal cortex intracranial recordings.

    PubMed

    Kropotov, J D; Crawford, H J; Polyakov, Y I

    1997-07-01

    The present study examined neurophysiological correlates of pain and pain control by recording intracranial somatosensory event-related potentials (SERPs) to painful cutaneous stimuli in two female patients with obsessive-compulsive disorder bearing multiple intracranial electrodes during conditions of (a) attention and (b) hypnotically suggested analgesia. Intracranial electrodes were located in the anterior cingulate cortex, amygdala, temporal cortex, and parietal cortex. No changes were observed in the SERPs of the hypnotically unresponsive patient. In the hypnotically responsive patient, reduced pain perception during suggested hypnotic analgesia was accompanied by (a) a significant reduction of the positive SERP component within the range of 140-160 ms post-stimulus in the left anterior cingulate cortex (Shaltenbrandt atlas: 29.12/ -7.42/32.41), and (b) a significant enhancement of the negative SERP component within the range of 200-260 ms in the left anterior temporal cortex (Brodmann area 21). No significant changes were observed in the amygdala or the scalp-recorded Fz. The present study is the first to demonstrate the involvement of the anterior cingulate cortex and the anterior temporal cortex in the control of pain with hypnotically suggested analgesia. PMID:9161887

  8. Ameloblastoma of the anterior mandible

    PubMed Central

    Hariram; Mohammad, Shadab; Malkunje, Laxman R.; Singh, Nimisha; Das, Sugata; Mehta, Gagan

    2014-01-01

    Ameloblastoma or adamantinoma is the rarest of the three forms of tumor of the odontogenic type. They are benign, locally aggressive neoplasms arising from ameloblasts, which typically occur at the angle of the mandible, and are often associated with an un-erupted tooth and must, therefore, be differentiated from a dentigerous cyst which will be centered on the crown. When in the maxilla (less common), they are located in the premolar region, and can extend up in the maxillary sinus. Ameloblastoma is reported to constitute about 1-3% of tumors and cysts of the jaws. The tumor is by far more common in the mandible than in the maxilla and shows predilection for various parts of the mandible in different racial groups. The relative frequency of the mandible to maxilla is reported as varying from 80-20% to 99-1%. Here, we are representing a case of ameloblastoma of anterior mandible which was considered as a rare site of occurrence. PMID:25298718

  9. A simple method for reconstruction of severely damaged primary anterior teeth

    PubMed Central

    Eshghi, Alireza; Esfahan, Raha Kowsari; Khoroushi, Maryam

    2011-01-01

    Restoration of severely decayed primary anterior teeth is often considered as a special challenge by pedodontists. This case report presents a 5-year-old boy with severely damaged maxillary right canine. Subsequent to root canal treatment, a reversed (upside-down) metal post was put into the canal and composite build-up was performed. This new method offers a simple, practical and effective procedure for reconstruction of severely decayed primary anterior teeth, which re-establishes function and esthetics for time the tooth should be present and functional in the child's mouth. PMID:22135694

  10. Ultrasound elasticity imaging of human posterior tibial tendon

    NASA Astrophysics Data System (ADS)

    Gao, Liang

    Posterior tibial tendon dysfunction (PTTD) is a common degenerative condition leading to a severe impairment of gait. There is currently no effective method to determine whether a patient with advanced PTTD would benefit from several months of bracing and physical therapy or ultimately require surgery. Tendon degeneration is closely associated with irreversible degradation of its collagen structure, leading to changes to its mechanical properties. If these properties could be monitored in vivo, it could be used to quantify the severity of tendonosis and help determine the appropriate treatment. Ultrasound elasticity imaging (UEI) is a real-time, noninvasive technique to objectively measure mechanical properties in soft tissue. It consists of acquiring a sequence of ultrasound frames and applying speckle tracking to estimate displacement and strain at each pixel. The goals of my dissertation were to 1) use acoustic simulations to investigate the performance of UEI during tendon deformation with different geometries; 2) develop and validate UEI as a potentially noninvasive technique for quantifying tendon mechanical properties in human cadaver experiments; 3) design a platform for UEI to measure mechanical properties of the PTT in vivo and determine whether there are detectable and quantifiable differences between healthy and diseased tendons. First, ultrasound simulations of tendon deformation were performed using an acoustic modeling program. The effects of different tendon geometries (cylinder and curved cylinder) on the performance of UEI were investigated. Modeling results indicated that UEI accurately estimated the strain in the cylinder geometry, but underestimated in the curved cylinder. The simulation also predicted that the out-of-the-plane motion of the PTT would cause a non-uniform strain pattern within incompressible homogeneous isotropic material. However, to average within a small region of interest determined by principal component analysis (PCA) would improve the estimation. Next, UEI was performed on five human cadaver feet mounted in a materials testing system (MTS) while the PTT was attached to a force actuator. A portable ultrasound scanner collected 2D data during loading cycles. Young's modulus was calculated from the strain, loading force and cross sectional area of the PTT. Average Young's modulus for the five tendons was (0.45+/-0.16GPa) using UEI. This was consistent with simultaneous measurements made by the MTS across the whole tendon (0.52+/-0.18GPa). We also calculated the scaling factor (0.12+/-0.01) between the load on the PTT and the inversion force at the forefoot, a measurable quantity in vivo. This study suggests that UEI could be a reliable in vivo technique for estimating the mechanical properties of the human PTT. Finally, we built a custom ankle inversion platform for in vivo imaging of human subjects (eight healthy volunteers and nine advanced PTTD patients). We found non-linear elastic properties of the PTTD, which could be quantified by the slope between the elastic modulus (E) and the inversion force (F). This slope (DeltaE/DeltaF), or Non-linear Elasticity Parameter (NEP), was significantly different for the two groups: 0.16+/-0.20 MPa/N for healthy tendons and 0.45+/-0.43 MPa/N for PTTD tendons. A receiver operating characteristic (ROC) curve revealed an area under the curve (AUC) of 0.83+/-0.07, which indicated that the classifier system is valid. In summary, the acoustic modeling, cadaveric studies, and in vivo experiments together demonstrated that UEI accurately quantifies tendon mechanical properties. As a valuable clinical tool, UEI also has the potential to help guide treatment decisions for advanced PTTD and other tendinopathies.

  11. Anterior instability in the throwing shoulder.

    PubMed

    Savoie, Felix H; O'Brien, Michael J

    2014-06-01

    The disabled throwing shoulder is a multifactorial problem. Laxity of the glenohumeral joint is necessary to achieve a satisfactory velocity. Normal wear and tear with throwing may convert this normal amount of excessive translation into instability. Instability in the throwing athlete manifests itself in 2 forms: traumatic anterior instability that happens to occur in a throwing athlete and excessive anterior subluxation because of overuse that occurs in conjunction with the disabled throwing shoulder. In most cases, it is difficult to determine by physical examination or imaging how much laxity is too much; therefore, the managing physician should always err on the side of caution. A trial of rest and rehabilitation should always be attempted before any consideration of surgery. The multifactorial issues in the disabled throwing athlete should be corrected during this phase of treatment, including assessment and treatment of hip abnormalities, restoration of satisfactory core strength, correction of scapular dyskinesis, and an evaluation and correction of any biomechanical abnormalities in the throwing mechanism. Surgical management of anterior instability in the throwing shoulder depends on the mechanism of injury. The traumatic anterior instability patient is managed by acute surgical repair without a shift, utilizing mattress sutures to prevent suture chondromalacia on the humeral head or glenoid. The anterior laxity management centers on the posterior superior labrum, although occasionally the anterior labrum or capsule may be involved as well. Overall, symptomatic anterior instability is less common in the throwing shoulder. Jobe and colleagues are credited with the first successful technique for the correction of anterior instability in the throwing athlete, the anterior capsulolabral reconstruction by a subscapularis split. The success of this technique paved the way for the adoption of the current arthroscopic techniques that are utilized to correct instability in the throwing athlete. PMID:24787726

  12. Study of the post-natal effects of chemopreventive agents on ethylnitrosourea-induced transplacental carcinogenesis in rats. II. Influence of low-molecular-weight polypeptide factors from the thymus, pineal gland, bone marrow, anterior hypothalamus, brain cortex and brain white substance

    Microsoft Academic Search

    Valerij A. Alexandrov; Vladimir G. Bespalov; Vjacheslav G. Morozov; Vladimir Kh. Khavinson; Vladimir N. Anisimov

    1996-01-01

    The influence of the polypeptide factors extracted from thymus, pineal gland, bone marrow, anterior hypothal- amus, brain cortex or brain white substance on N-ethyl-ZV- nitrosourea (ENU)-induced transplacental carcinogenesis was studied in rats. ENU was given to pregnant rats as a single i.v. exposure at a dose of 75 mg\\/kg body weight on the 21st day of gestation. The polypeptide factors

  13. Correlation of Radiographic Patellofemoral Indices with Tibial Tubercle Transfer Distance in Fulkerson Osteotomy Pl

    PubMed Central

    Edwards, Alan; Larson, Evan; Albright, John

    2014-01-01

    Background A laterally tracking patella is commonly seen in patients with chronic recurrent lateral patellar dislocations. Clinical appearance of the J-sign occurs when the patella is congruent with the trochlear groove in flexion and moves over the lateral border of the femoral condyle as the lower leg reaches complete extension. A Fulkerson osteotomy procedure corrects this maltracking of the patella by medially transferring the tibial tubercle. There are many radiographic patellofemoral indices that can be used describe this incongruence about the patelloformal joint. The current literature supports the use of the tibial tubercle-trochlear groove (TT- TG) index in determining the appropriate amount medialization of the extensor mechanism. However there is little agreement in how far to transfer the tibial tubercle to best achieve maximum patello- femoral congruency. It is the senior author's belief that lateral patellar edge (LPE) measure on voluntary quadriceps active hyperextension MRI scan has the strongest correlation with final operative tibial tubercle transfer distance needed to achieve maximum patellofemoral congruency. Purpose The purpose of this study was to show that the voluntary quadriceps active hyperextension MRI measurement of lateral patellar edge (LPE) has the strongest correlation with tibial tubercle transfer distance required to achieve maxium patellofemoral congruency intraoperatively in the terminal 30 degrees of active knee extension compared to all other patellofemoral indices measured on axial MRI scans with the knee in voluntary active knee extension to 30 degrees of flexion, passive full extension, and voluntary quadriceps active hyperextension. Study Design Retrospective case series via review of the electronic medical record. Methods Forty-three Fulkerson osteotomy patient charts were reviewed retrospectively. Three different pre-operative axial MRI views were then examined and measured for Tibial Tubercle- Troch-lear Groove (tt-tg), lateral patellar edge (LPE), bisect offset (BSO), and lateral patellar displacement (LPD). Each patient had three MRIs: one with the knee resting in extension, one in voluntary quadriceps active hyperextension, and one in voluntary quadriceps active 30 degree flexion. Statistics were then calculated using Statistical Package for the Social Sciences (SPSS) (IBM corp). Results Tibial tubercle transfer distances required to achieve congruency intraoperatively correlated moderately (0.500-0.300) and were statistically significant (alpha. 050) for passive extension MRI measurement of TT-TG (Pearson- 0.403, alpha 0.010) and LPD (Pearson. 362, alpha 0.022); voluntary quadriceps active hyperextension TT-TG (Pearson 0.487, alpha, 0.001); voluntary quadriceps active flexion TT-TG (Pearson. 548, alpha< 0.001), LPE (Pearson. 332, alpha 0.029), and LPD (Pearson 0.446 alpha. 003). Conclusion The hypothesis that voluntary quadriceps active hyperextension MRI LPE measurement best correlated with tibial tubercle transfer distance was incorrect. The data collected showed correlation and statistical significance for voluntary quadriceps active flexion LPE with required tibal tubercle transfer distance (Pearson 0.34, alpha 0.026). The MRI measurement that best correlated with tibial tubercle transfer distance was voluntary quadriceps active flexion measure of TT-TG (Pearson. 556, alpha< 0.001). PMID:25328455

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

    PubMed Central

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

    2014-01-01

    The aim of this study was to evaluate the clinical value of multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI) in the diagnosis and treatment of complex fractures of the tibial plateau. A total of 71 patients with complex fractures of the tibial plateau (estimated Schatzker classifications III, V and VI) were included in this study. The X-ray, MDCT and MRI data obtained from the patients were analyzed. MDCT was the most sensitive method in the diagnosis of tibial articular surface collapse, cruciate ligament tibial avulsion fracture, degree of fracture comminution and degree of fracture displacement (P<0.01). MRI was the most sensitive method in the diagnosis of injuries of the cruciate and collateral ligaments, menisci and cartilage peeling of the articular surfaces (P<0.01). MDCT and MRI were demonstrated to be more sensitive than X-rays for the diagnosis of insidious damage around the knee. PMID:24348790

  15. Tibial changes in experimental disuse osteoporosis in the monkey

    NASA Technical Reports Server (NTRS)

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

    1983-01-01

    The mechanical properties and structural changes in the monkey tibia with disuse osteoporosis and during subsequent recovery are investigated. Bone mending stiffness is evaluated in relation to microscopic changes in cortical bone and Norland bone mineral analysis. Restraint in the semireclined position is found to produce regional losses of bone most obviously in the anterior-proximal tibiae. After six months of restraint, the greatest losses of bone mineral in the proximal tibiae range from 23 percent to 31 percent; the largest changes in bone stiffness range from 36 percent to 40 percent. Approximately eight and one-half months of recovery are required to restore the normal bending properties. Even after 15 months of recovery, however, the bone mineral content does not necessarily return to normal levels. Histologically, resorption cavities in cortical bone are seen within one month of restraint; by two and one-half months of restraint there are large resorption cavities subperiosteally, endosteally, and intracortically. After 15 months of recovery, the cortex consists mainly of first-generation haversian systems. After 40 months, the cortex appears normal, with numerous secondary and tertiary generations of haversian systems.

  16. Arthroscopic Treatment of Acute Tibial Avulsion Fracture of the Posterior Cruciate Ligament Using the TightRope Fixation Device

    PubMed Central

    Gwinner, Clemens; Kopf, Sebastian; Hoburg, Arnd; Haas, Norbert P.; Jung, Tobias M.

    2014-01-01

    Avulsion fracture of the posterior cruciate ligament from its tibial insertion is a rare condition. Early surgical treatment has been regarded as necessary, but the optimal surgical technique remains unclear. The purpose of this technical note is to present a novel all-inside arthroscopic reconstruction technique for bony tibial avulsion fractures of the posterior cruciate ligament using the TightRope device (Arthrex, Naples, FL). PMID:25126507

  17. Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

    PubMed

    Malham, Gregory M; Limb, Rebecca J; Claydon, Matthew H; Brazenor, Graeme A

    2013-12-01

    Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up. The literature regarding surgical treatments for Bertolotti's syndrome is reviewed. The technique for an anterior retroperitoneal approach is described. This approach has been safe and effective in providing long term symptomatic relief to our two patients. Further studies comparing the outcomes of anterior versus posterior pseudoarthrectomy will guide the management of this condition. PMID:23969004

  18. Radiographic assessment of anterior titanium mesh cages.

    PubMed

    Eck, K R; Lenke, L G; Bridwell, K H; Gilula, L A; Lashgari, C J; Riew, K D

    2000-12-01

    Carbon fiber and titanium cage implantation for anterior column support during spinal fusions is an alternative to the use of more traditional structural allografts and autografts. The authors report instrumentation and cage failure for patients who underwent spinal fusion with structural titanium mesh cages implanted into the anterior column a minimum of 2 years after surgery. They wanted to determine whether plain radiographic techniques can be used to critically assess disk space and corpectomy fusions after implantation of these radioopaque cages. Fifty patients having undergone spinal fusions using structural titanium mesh cages in the anterior column had 99 anterior levels fused with at least 1 (maximum of 2) titanium mesh cage, resulting in a total of 131 cages used. The cages were examined for evidence of settling, migration, or failure. The anterior and posterior instrumentation was assessed for evidence of failure, and the spine was examined for evidence of successful fusion. Radiographic cage settling (>2 mm) into the vertebral body end plates was observed, but cage migration or failure were not. An average lordotic correction of 10 degrees was observed, with loss of correction into kyphosis from immediately after operation to final follow-up averaging 2 degrees. As an average of all reviewers, using a strict radiographic fusion assessment, definite or probable anterior fusion was graded at 81% of the levels, probably not or no at 5% of the levels, and could not be assessed at 14% of the levels. Definite or probable posterior fusion as an average of all reviewers was graded at 44% of the posterior fusion levels, questionable at 4%, no at 5%, and could not be assessed at 47%. The use of anterior-only, posterior-only, or anterior and posterior instrumentation with structural titanium mesh cages in the anterior spine along with proper autogenous bone grafting techniques provided anterior column support with a low rate of radiographic complications. Acceptable anterior spinal fusion rates, as assessed by a consensus agreement of reviewers, were observed primarily by evaluation of the fusion mass around the cages (extracage fusion), because intracage fusion was difficult to assess. PMID:11132981

  19. Increase in the Tibial Slope Reduces Wear after Medial Unicompartmental Fixed-Bearing Arthroplasty of the Knee

    PubMed Central

    Schröder, Christian; Steinbrück, Arnd; Pietschmann, Matthias F.; Jansson, Volkmar; Müller, Peter E.

    2015-01-01

    Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of a medial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental knee prosthesis (Univation) in vitro with a customised, four-station, and servohydraulic knee wear simulator, which exactly reproduced the walking cycle (International Organisation for Standardisation (ISO) 14243-1:2002(E)). The medial prostheses were inserted with 3 different posterior tibial slopes: 0°, 4°, and 8° (n = 3 in each group). Results. The wear rate decreased significantly between 0° and 4° slope from 10.4 (SD 0.62) mg/million cycles to 3.22 (SD 1.71) mg/million cycles. Increasing the tibial slope to 8° did not significantly change the wear rate. Discussion. As an increase in the tibial slope reduced the wear rate in a fixed-bearing prosthesis, a higher tibial slope should be recommended. However, other factors that are influenced by the tibial slope (e.g., the tension of the ligament) must also be considered. PMID:25654123

  20. Increase in the tibial slope reduces wear after medial unicompartmental fixed-bearing arthroplasty of the knee.

    PubMed

    Weber, Patrick; Schröder, Christian; Schwiesau, Jens; Utzschneider, Sandra; Steinbrück, Arnd; Pietschmann, Matthias F; Jansson, Volkmar; Müller, Peter E

    2015-01-01

    Introduction. Unicompartmental arthroplasty of the knee in patients with isolated medial osteoarthritis gives good results, but survival is inferior to that of total knee prosthesis. Knees may fail because positioning of the prosthesis has been suboptimal. The aim of this study was to investigate the influence of the tibial slope on the rate of wear of a medial fixed-bearing unicompartmental knee arthroplasty. Materials and Methods. We simulated wear on a medial fixed-bearing unicompartmental knee prosthesis (Univation) in vitro with a customised, four-station, and servohydraulic knee wear simulator, which exactly reproduced the walking cycle (International Organisation for Standardisation (ISO) 14243-1:2002(E)). The medial prostheses were inserted with 3 different posterior tibial slopes: 0°, 4°, and 8° (n = 3 in each group). Results. The wear rate decreased significantly between 0° and 4° slope from 10.4 (SD 0.62) mg/million cycles to 3.22 (SD 1.71) mg/million cycles. Increasing the tibial slope to 8° did not significantly change the wear rate. Discussion. As an increase in the tibial slope reduced the wear rate in a fixed-bearing prosthesis, a higher tibial slope should be recommended. However, other factors that are influenced by the tibial slope (e.g., the tension of the ligament) must also be considered. PMID:25654123

  1. Giant Subcutaneous Leiomyosarcoma of Anterior Abdominal Wall

    PubMed Central

    2014-01-01

    Subcutaneous leiomyosarcomas are rare tumors accounting for 1% to 2% of all superficial soft tissue malignancies. Although they may arise anywhere in the body, they most frequently occur in the lower extremities. The incidence of subcutaneous LMS affecting the anterior abdominal wall is very rare. We herein report the case of a patient with a giant subcutaneous leiomyosarcoma arising in the anterior abdominal wall. It was diagnosed by histopathology and immunohistochemistry and treated accordingly. PMID:25506027

  2. Anterior versus posterior plating in cervical corpectomy.

    PubMed

    ElSaghir, H; Böhm, H

    2000-01-01

    This is a prospective study comparing anterior and posterior plating in cervical corpectomy. Each group comprised 30 patients who were candidates for corpectomy. In the first group, anterior plating was done using Orosco-type titanium plates. In the second group, lateral mass plating was done. In all cases, titanium cages were used to replace the removed vertebral body or bodies. The mean follow-up was 12.68 months (SD 3.85 months). Pseudarthrosis was not encountered in either group. Posterior plating was better than anterior plating in terms of the stability of the construct and problems related to the hardware. Screw breakage was encountered in seven patients with anterior plating (23.33%). This complication was not seen in the group with posterior plating. The difference between the groups was statistically significant (chi-square = 7.92, p = 0.004). Screw loosening was encountered in 2 patients in the group with anterior plating and in only 1 patient in the group with posterior plating. The difference between the incidence of screw loosening in both groups was not statistically significant (chi-square = 0.35, p = 0.5). Sinking-in of the cage was encountered in 7 cases with anterior plating and in only 3 cases with posterior plating. However, the difference between the groups was not statistically significant (chi-square = 1.92, p = 0.16). PMID:11110134

  3. Lacrimal sac compression by an anterior ethmoidal mucocele presenting as a late complication of dacryocystorhinostomy

    PubMed Central

    Olaleye, Oladejo; Salleh, Shizalia; David, Don; Bickerton, Richard

    2013-01-01

    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

  4. [Anterior bridges with the IPS-Empress-2 System after alveolar ridge augmentation. A case report].

    PubMed

    Zawta, C; Bernhard, M

    2000-01-01

    The success of a prosthesis is judged according to optimal function, good chewing comfort, adequate phonetics and white and pink esthetics. The aim of a treatment is to approach the perfection of nature. For anterior bridgework, the all-ceramic System IPS Empress 2 offers light transmission and reflection comparable to that of natural teeth, provided that the pink esthetics are optimised in the preprosthetic phase. The provision of an anterior bridge in the IPS Empress 2-system is presented here in the form of a case report. After extraction of the anterior teeth, a ridge augmentation including preparation of the pontic bed was carried out. The type of post and core, preparation and cementation are important parameters for the success of all-ceramic restorations. PMID:10670274

  5. Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

    PubMed Central

    Sabesan, Vani J; Danielsky, Paul J; Childs, Abby; Valikodath, Tom

    2015-01-01

    The management of a combination of fracture and multiligament knee injury (MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI’s in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI’s with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

  6. Tibial baseplate fracture associated with polyethylene wear and osteolysis after total knee arthroplasty?

    PubMed Central

    Cankaya, Deniz; Yilmaz, Serdar; Deveci, Alper; Ozkurt, Bulent

    2013-01-01

    INTRODUCTION Fracture of the tibial baseplate following total knee arthroplasty is very rare given the developments in modern prosthesis design. Tibial baseplate fracture secondary to polyethylene wear, osteolysis and component malalignment in an elderly obese patient is reported in the present article. PRESENTATION OF CASE A 69-year-old woman had undergone total knee arthroplasty eleven years prior to presentation and reported nine months of chronic pain, which was caused by a neglected fracture of the baseplate. DISCUSSION We discuss the prevention of implant fracture after total knee arthroplasty and address the risk factors associated with this complication. CONCLUSION The present case emphasizes the importance of properly informing patients and encouraging them to report such complaints immediately to allow for early revision and prevention of component fracture, especially in patients with risk factors such as obesity and component, malalignment. PMID:24441434

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

    PubMed Central

    2013-01-01

    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

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

    PubMed Central

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

    2014-01-01

    Bone metastasis resulting from carcinoma of the cervix is rare, particularly in the isolated distal appendicular bone. A 43-year-old female was diagnosed with a right tibial tumor with progressive right knee pain for three months, which was diagnosed as poorly differentiated metastatic squamous cell carcinoma, and further confirmed by biopsy of the proximal tibia. The patient was diagnosed with cervical squamous cell carcinoma with tibial metastasis following further examination, despite a lack of gynecological symptoms. In contrast to the poor outcome commonly observed in patients with bone metastasis, the patient survived and remained disease-free 41 months after surgical excision of the metastatic tumor and radical hysterectomy followed by chemoradiotherapy. The present case is one of the few documented cases of metastasis to the tibia arising from carcinoma of the uterine cervix and may be the first regarding isolated metastasis at this site. PMID:25364422

  9. Effects of incision closure method on infection prevalence following tibial plateau leveling osteotomy in dogs.

    PubMed

    Atwood, Chase; Maxwell, Mac; Butler, Ryan; Wills, Robert

    2015-04-01

    The goal of this study was to retrospectively investigate the effect of incisional closure with either stainless steel skin staples or intradermal poliglecaprone 25 on the prevalence of surgical site infection following tibial plateau leveling osteotomy in dogs. Medical records were reviewed for dogs treated with unilateral tibial plateau leveling osteotomy at Memphis Veterinary Specialists between 2006 and 2013. Procedures (n = 306) from 242 dogs were included in the study. The association of potential risk factors with the occurrence of postoperative infection was assessed using logistic regression. A value of P < 0.05 was considered significant. Weight and administration of postoperative antimicrobials were found to significantly influence surgical site infection prevalence. No significant association was noted between closure method and prevalence of postoperative infection. PMID:25829557

  10. Sensory reinnervation of muscle spindles after repair of tibial nerve defects using autogenous vein grafts

    PubMed Central

    Pang, Youwang; Hong, Qingnan; Zheng, Jinan

    2014-01-01

    Motor reinnervation after repair of tibial nerve defects using autologous vein grafts in rats has previously been reported, but sensory reinnervation after the same repair has not been fully investigated. In this study, partial sensory reinnervation of muscle spindles was observed after repair of 10-mm left tibial nerve defects using autologous vein grafts with end-to-end anastomosis in rats, and functional recovery was confirmed by electrophysiological studies. There were no significant differences in the number, size, or electrophysiological function of reinnervated muscle spindles between the two experimental groups. These findings suggest that repair of short nerve defects with autologous vein grafts provides comparable results to immediate end-to-end anastomosis in terms of sensory reinnervation of muscle spindles. PMID:25206863

  11. Cervical Cord Decompression Using Extended Anterior Cervical Foraminotomy Technique

    PubMed Central

    Kim, Sung-Duk; Lee, Cheol-Young; Kim, Hyun-Woo; Jung, Chul-Ku; Kim, Jong Hyun

    2014-01-01

    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

  12. Weight bearing and velocity in trans-tibial and trans-femoral amputees

    Microsoft Academic Search

    M. E. JONES; G. M. BASHFORD; J. M. MANN

    The purpose of this study was to review the clinical utility of static weight bearing (SWB) and maximal self-selected ambulatory velocity as objective quantifiable measures in an outpatient lower limb prosthetic clinic. Seventy-three (n=73) consecutive trans-tibial (TTA) and trans-femoral amputees (TFA) attending an outpatient prosthetic clinic were studied. Prosthetic weight bearing was measured on a bathroom scale (mass in kg),

  13. Matched-pair analysis of all-polyethylene versus metal-backed tibial components

    Microsoft Academic Search

    Pacharapol Udomkiat; Lawrence D Dorr; William Long

    2001-01-01

    Forty-eight matched pairs of osteoarthritic knees from patients who underwent primary total knee arthroplasty with a round-on-round, Apollo Knee System were studied to evaluate the outcome between all-polyethylene and metal-backed tibial components. Patients were matched for patient factors, preoperative deformities, cruciate salvage or sacrifice, and surgical technique. At the last follow-up (average, 38.4 months), there was no statistically significant difference

  14. Tibial Inlay Press-fit Fixation Versus Interference Screw in Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Ettinger, Max; Büermann, Sarah; Calliess, Tilman; Omar, Mohamed; Krettek, Christian; Hurschler, Christof; Jagodzinski, Michael; Petri, Maximilian

    2013-01-01

    Reconstruction of the posterior cruciate ligament (PCL) by a tibial press-fit fixation of the patellar tendon with an accessory bone plug is a promising approach because no foreign materials are required. Until today, there is no data about the biomechanical properties of such press-fit fixations. The aim of this study was to compare the biomechanical qualities of a bone plug tibial inlay technique with the commonly applied interference screw of patellar tendon PCL grafts. Twenty patellar tendons including a bone block were harvested from ten human cadavers. The grafts were implanted into twenty legs of adult German country pigs. In group P, the grafts were attached in a press-fit technique with accessory bone plug. In group S, the grafts were fixed with an interference screw. Each group consisted of 10 specimens. The constructs were biomechanically analyzed in cyclic loading between 60 and 250 N for 500 cycles recording elongation. Finally, ultimate failure load and failure mode were analyzed. Ultimate failure load was 598.6±36.3 N in group P and 653.7±39.8 N in group S (not significant, P>0.05). Elongation during cyclic loading between the 1st and the 20th cycle was 3.4±0.9 mm for group P and 3.1±1 mm for group S. Between the 20th and the 500th cycle, elongation was 4.2±2.3 mm in group P and 2.5±0.9 mm in group S (not significant, P>0.05). This is the first study investigating the biomechanical properties of tibial press-fit fixation of the patellar tendon with accessory bone plug in posterior cruciate ligament reconstruction. The implant-free tibial inlay technique shows equal biomechanical characteristics compared to an interference screw fixation. Further in vivo studies are desirable to compare the biological behavior and clinical relevance of this fixation device. PMID:24416479

  15. Mechanical properties of the normal human tibial cartilage-bone complex in relation to age

    Microsoft Academic Search

    M Ding; M Dalstra; F Linde; I Hvid

    1998-01-01

    Objective. This study investigates the age-related variations in the mechanical properties of the normal human tibial cartilage-bone complex and the relationships between cartilage and bone.Design. A novel technique was applied to assess the mechanical properties of the cartilage and bone by means of testing the cartilage-bone complex.Background. Up to now, mechanical testing of cartilage and bone has been reported separately,

  16. Simultaneous transarticular intramedullary nailing of the tibia and total knee replacement in tibial nonunion and osteoarthrosis

    Microsoft Academic Search

    H. Kiefer

    1999-01-01

    Summary  \\u000a The combined manifestation of a nonunion of the proximal tibia and an osteoarthrosis of both knee joints is not very common.\\u000a Yet, this was a kind of “unhappy triad” for a 86 year old lady suffering from a nonunion after one year of conservative treatment\\u000a of a proximal tibial shaft fracture. Her quality of life has already been reduced

  17. The first Italian family with tibial muscular dystrophy caused by a novel titin mutation

    Microsoft Academic Search

    Tiina Suominen; Sini Penttilä; Alessandro Malandrini; Maria Alessandra Carluccio; Mauro Mondelli; Annabella Marozza; Antonio Federico; Alessandra Renieri; Peter Hackman; Maria Teresa Dotti; Bjarne Udd

    2010-01-01

    Tibial muscular dystrophy (TMD) or Udd myopathy is an autosomal dominant distal myopathy with late onset, at first described\\u000a in the Finnish population. We report here the first Italian cases of TTN mutated titinopathy. The proband, a 60 year-old female, had the first muscular signs at the age of 59 years, with difficulty\\u000a in walking and right foot drop. Muscle imaging showed

  18. Bone allograft provides bone healing in the medial opening high tibial osteotomy

    Microsoft Academic Search

    Veljko Santic; Anton Tudor; Branko Sestan; Dalen Legovic; Luka Sirola; Ivan Rakovac

    2010-01-01

    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

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

    PubMed Central

    Sferopoulos, N.K

    2014-01-01

    Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes. Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts). Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group. Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes. PMID:25317215

  20. Determination of the temperature rise within UHMWPE tibial components during tribological loading

    Microsoft Academic Search

    Mathias C. Galetz; Tobias Uth; Markus A. Wimmer; Peter Adam; Uwe Glatzel

    2010-01-01

    The wear of ultrahigh molecular weight polyethylene (UHMWPE) is considered as one of the major reasons for revision of artificial joints. While in vivo measurements have shown a significant temperature increase in knee implants, the amount of heat dissipated within the UHMWPE tibial component and its influence on the friction behavior when paired with a cobalt–chromium (CoCrMo) femoral component is

  1. Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

    PubMed Central

    Baek, Seung-Wook; Kim, Chul-Woong

    2013-01-01

    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

  2. Meta-analysis of reamed versus unreamed intramedullary nailing for open tibial fractures

    PubMed Central

    2014-01-01

    Background Open fractures of the tibial diaphysis are usually caused by high-energy trauma and associated with severe bone and soft tissue injury. Reamed and unreamed intramedullary nailing are often used for treatment of tibial injury. The purpose of this study was to investigate the clinical efficacy of reamed versus unreamed intramedullary nailing for open tibial fractures (OTF). Methods A meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using databases containing the Cochrane Library, PubMed, EMbase, Chinese Biomedical Database, Chinese VIP information, and WanFang Database. Randomized and semi-randomized controlled clinical trials of both reamed and unreamed intramedullary nailing for OTF treatment were analyzed using Reviewer Manager (RevMan5.0) software. Results A total of 695 references were initially identified from the selected databases. However, only four studies were assessed, matching all the eligibility criteria conducted by two independent reviewers. The result showed that there was no statistical difference in healing rate, secondary surgery rate, implant failure rate, osteofascial compartment syndrome, and infection during the postoperative period between reamed and unreamed nails in OTF. Conclusions Findings of this study suggest that there was no statistical difference between reamed and unreamed intramedullary nailing in clinical treatment of OTF. However, the result of this meta-analysis should be cautiously accepted due to some limitations, and further studies are still needed. PMID:25149501

  3. EMG and tibial shock upon the first attempt at barefoot running.

    PubMed

    Olin, Evan D; Gutierrez, Gregory M

    2013-04-01

    As a potential means to decrease their risk of injury, many runners are transitioning into barefoot running. Habitually shod runners tend to heel-strike (SHS), landing on their heel first, while barefoot runners tend to mid-foot or toe-strike (BTS), landing flat-footed or on the ball of their foot before bringing down the rest of the foot including the heel. This study compared muscle activity, tibial shock, and knee flexion angle in subjects between shod and barefoot conditions. Eighteen habitually SHS recreational runners ran for 3 separate 7-minute trials, including SHS, barefoot heel-strike (BHS), and BTS conditions. EMG, tibial shock, and knee flexion angle were monitored using bipolar surface electrodes, an accelerometer, and an electrogoniometer, respectively. A one-way MANOVA for repeated measures was conducted and several significant changes were noted between SHS and BTS, including significant increases in average EMG of the medial gastrocnemius (p=.05), average and peak tibial shock (p<.01), and the minimum knee flexion angle (p<.01). Based on our data, the initial change in mechanics may have detrimental effects on the runner. While it has been argued that BTS running may ultimately be less injurious, these data indicate that habitually SHS runners who choose to transition into a BTS technique must undertake the process cautiously. PMID:23643493

  4. Treatment of fractures of the tibial tuberosity in adolescent soccer players.

    PubMed

    Ares, Oscar; Seijas, Roberto; Cugat, Ramón; Alvarez, Pedro; Aguirre, Mario; Catala, Jordi

    2011-02-01

    Fractures of the tibial tuberosity are uncommon injuries that mainly occur in 14 to 16 year-old adolescents involved in sports activities. The mechanism of injury is related to jumping while practicing sports. This retrospective study presents the outcome of fractures of the tibial tuberosity in a series of 18 adolescent soccer players treated with the same surgical technique in one center. The hypothesis was that our surgical technique with two parallel screws, one proximal and one distal to the physis, avoids physis injury and has no repercussions on growth. The average age was 14.7 years. All patients were male. The fractures included 4 type IIA, 3 type IIB, 6 type IIIA, and 5 type IIIB (Ogden classification). All patients underwent open reduction and internal fixation consisting of screw placement parallel to the joint surface, sparing the tibial physis. There were no complications in any case, and all patients were able to resume their previous sports activities. The technique used appeared to be safe. Screws were removed in 8 patients owing to local discomfort. All patients achieved the same competition level as before the injury. PMID:21473450

  5. Effect of dietary calcium, phosphorus, chloride, and zeolite on the development of tibial dyschondroplasia.

    PubMed

    Edwards, H M

    1988-10-01

    The effect of synthetic zeolite was investigated on the development of tibial dyschondroplasia in young broilers fed diets in which the dietary levels of calcium, phosphorus, and chloride ranged from adequate to deficient. In the first two experiments the calcium level was maintained at .65% and four combinations were fed of .30% and .15% chloride and .75% and .50% phosphorus with and without 1% zeolite. Feeding the high phosphorus diet caused a high incidence of tibial dyschondroplasia that was lowered by feeding 1% zeolite. In both experiments the feeding of zeolite at a low level of dietary phosphorus caused a significant lowering of 16-day weight and bone ash. In the third experiment, when diets containing all combinations of .65% and .80% calcium and .50% and .60% phosphorus were fed, the addition of 1% zeolite caused a significant lowering of the 16-day weight, bone ash, and incidence, score, and percentage severe tibial dyschondroplasia. Once again as in the previous two experiments, there was a significant interaction between dietary phosphorus level and zeolite and 16-day weight and bone ash. Feeding zeolite significantly decreased phytate phosphorus retention. PMID:2848229

  6. Selective Activation of the Human Tibial and Common Peroneal Nerves with a Flat Interface Nerve Electrode

    PubMed Central

    Schiefer, M A; Freeberg, M; Pinault, G J C; Anderson, J; Hoyen, H; Tyler, D J; Triolo, R J

    2013-01-01

    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

  7. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings.

    PubMed

    Reinitz, Steven D; Currier, Barbara H; Van Citters, Douglas W; Levine, Rayna A; Collier, John P

    2014-06-23

    This investigation analyzed retrieved sequentially crosslinked and annealed (SXL) ultra-high molecular weight polyethylene bearings to determine whether the material is chemically stable in vivo. A series of retrieved tibial and acetabular components were analyzed for changes in ketone oxidation, crosslink density, and free radical concentration. Oxidation was observed to increase with in vivo duration, and the rate of oxidation in tibial inserts was significantly greater than in acetabular liners. SXL acetabular bearings oxidized at a rate comparable to gamma-sterilized liners, while SXL tibial inserts oxidized at a significantly faster rate than their gamma-sterilized counterparts. A significant decrease in crosslink density with increased mean ketone oxidation index was observed, suggesting that in vivo oxidation may be causing material degradation. Furthermore, a subsurface whitened damage region was also found in a subset of the bearings, indicating the possibility of a clinically relevant decrease in mechanical properties of these components. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2014. PMID:24956572

  8. Distal Tibial Metaphyseal Fractures: Does Blocking Screw Extend the Indication of Intramedullary Nailing?

    PubMed Central

    Moongilpatti Sengodan, Mugundhan; Vaidyanathan, Singaravadivelu; Karunanandaganapathy, Sankaralingam; Subbiah Subramanian, Sukumaran; Rajamani, Samuel Gnanam

    2014-01-01

    Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9?mm and at the fracture site was 22.9?mm. Mean length of distal fracture segment was 4.6?cm. Mean varus/valgus alignment was 10.3?degrees preoperatively and 1.7?degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing. PMID:24967128

  9. Tibia-based referencing for standard proximal tibial radiographs during intramedullary nailing.

    PubMed

    Bible, Jesse E; Choxi, Ankeet A; Dhulipala, Sravan C; Evans, Jason M; Mir, Hassan R

    2013-11-01

    Limited information exists to define standard tibial radiographs. The purpose of this study was to define new landmarks on the proximal tibia for standard anteroposterior and lateral radiographs. In 10 cadaveric knees, fibular head bisection was considered the anteroposterior image, and femoral condyle overlap the lateral image. In another 10 knees, a "twin peaks" anteroposterior view, showing the sharpest profile of the tibial spines, was used. The "flat plateau" lateral image was obtained by aligning the femoral condyles then applying a varus adjustment with overlap of the tibial plateaus. Medial peritendinous approaches were performed, and an entry reamer used to open the medullary canal. A priori analysis showed good to excellent intra-/inter-observer reliability with the new technique (intra-class correlation coefficient ICC 0.61-0.90). The "twin peaks" anteroposterior radiograph was externally rotated 2.7±2.1° compared to the standard radiograph with fibular head bisection. Portal position and incidence of damage to intra-articular structures did not significantly differ between groups (P>.05). The "twin peaks" anteroposterior view and "flat plateau" lateral view can safely be used for nail entry portal creation in the anatomic safe zone. Tibia-based radiographic referencing is useful for intramedullary nailing cases in which knee or proximal tibiofibular joint anatomy is altered. PMID:24340326

  10. Cancellous bone adaptation to tibial compression is not sex dependent in growing mice

    PubMed Central

    Lynch, Maureen E.; Main, Russell P.; Xu, Qian; Walsh, Daniel J.; Schaffler, Mitchell B.; Wright, Timothy M.

    2010-01-01

    Mechanical loading can be used to increase bone mass and thus attenuate pathological bone loss. Because the skeleton's adaptive response to loading is most robust before adulthood, elucidating sex-specific responses during growth may help maximize peak bone mass. This study investigated the effect of sex on the response to controlled, in vivo mechanical loading in growing mice. Ten-week-old male and female C57Bl/6 mice underwent noninvasive compression of the left tibia. Peak loads of ?11.5 N were applied, corresponding to +1,200 ?? at the tibial midshaft in both sexes. Cancellous bone mass, architecture, and dynamic formation in the proximal metaphysis were compared between loaded and control limbs via micro-computed tomography and histomorphometry. The strain environment of the proximal metaphysis during loading was characterized using finite element analysis. Both sexes responded to tibial compression through increased bone mass and altered architecture. Cancellous bone mass and tissue density were enhanced in loaded limbs relative to control limbs in both sexes through trabecular thickening and reduced separation. Changes in mass were due to increased cellular activity in loaded limbs compared with control limbs. Adaptation to loading increased the proportion of load transferred by the cancellous bone in the proximal metaphysis. For all cancellous measures, the response to tibial compression did not differ between male and female mice. When similar strains are engendered in males and females, the adaptive response in cancellous bone to mechanical loading does not depend on sex. PMID:20576844

  11. The Morphometry of Soft Tissue Insertions on the Tibial Plateau: Data Acquisition and Statistical Shape Analysis

    PubMed Central

    Zheng, Liying; Harner, Christopher D.; Zhang, Xudong

    2014-01-01

    This study characterized the soft tissue insertion morphometrics on the tibial plateau and their inter-relationships as well as variabilities. The outlines of the cruciate ligament and meniscal root insertions along with the medial and lateral cartilage on 20 cadaveric tibias (10 left and 10 right knees) were digitized and co-registered with corresponding CT-based 3D bone models. Generalized Procrustes Analysis was employed in conjunction with Principal Components Analysis to first create a geometric consensus based on tibial cartilage and then determine the means and variations of insertion morphometrics including shape, size, location, and inter-relationship measures. Step-wise regression analysis was conducted in search of parsimonious models relating the morphometric measures to the tibial plateau width and depth, and basic anthropometric and gender factors. The analyses resulted in statistical morphometric representations for Procrustes-superimposed cruciate ligament and meniscus insertions, and identified only a few moderate correlations (R2: 0.37–0.49). The study provided evidence challenging the isometric scaling based on a single dimension frequently employed in related morphometric studies, and data for evaluating cruciate ligament reconstruction strategies in terms of re-creating the native anatomy and minimizing the risk of iatrogenic injury. It paved the way for future development of computer-aided personalized orthopaedic surgery applications improving the quality of care and patient safety, and biomechanical models with a better population or average representation. PMID:24788908

  12. Autonomous Mathematical Reconstruction of Polyethylene Tibial Inserts to Measure Low Wear Volumes

    PubMed Central

    Knowlton, Christopher B.; Wimmer, Markus A.

    2013-01-01

    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

  13. Giant Anterior Cervical Osteophyte Leading to Dysphagia

    PubMed Central

    Hwang, Jin Seop; Chough, Chung Kee

    2013-01-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress. PMID:24757489

  14. Giant anterior cervical osteophyte leading to Dysphagia.

    PubMed

    Hwang, Jin Seop; Chough, Chung Kee; Joo, Won Il

    2013-09-01

    Large anterior cervical osteophytes can occur in degeneration of the cervical spine or in diffuse idiopathic skeletal hyperostosis(DISH). Large osteophytes can produce otolaryngological symptoms such as dysphagia, dysphonia, and foreign body sensation. We describe a DISH patient with giant anterior cervical osteophyte causing chronic dysphagia and dysphonia. A 56-year-old man presented with increasing dysphagia, dysphonia, neck pain and neck stiffness. Physical examination of the neck showed a non-tender and hard mass on the left side at the level of C4-5. Radiography showed extensive ossification of anterior longitudinal ligament along the left anterolateral aspect of vertebral bodies from C2 to T1. The ossification was espe cially prominent at the level of C4-5 and linear breakage was noted at same level. Esophagogram revealed a filling defect along the pharynx and lateral displacement of the esophagus. Giant anterior cervical osteophyte was removed through the leftsided anterolateral cervical approach to the spine. Anterior cervical interbody fusion at C4-5 was followed by posterior cervical fixation using lateral mass screws from C3 to C6. After surgery, dysphagia and dysphonia improved immediately. One year later, cervical CT showed bone fusion at C4-5 bodies and no recurrence of osteophyte. DISH is a common cause of anterior cervical osteophyte leading to progressive dysphagia. Keeping this clinical entity in the differential diagnosis is important in patients with progressive neck stiffness, dysphagia or dysphonia. And surgical treatment of symptomatic anterior cervical osteophyte due to DISH should be considered with a solid fusion procedure preventing postoperative instability or osteophyte progress. PMID:24757489

  15. Anterior petroclinoid fold fenestration: an adjunct to clipping of postero-laterally projecting posterior communicating aneurysms.

    PubMed

    Nossek, Erez; Setton, Avi; Dehdashti, Amir R; Chalif, David J

    2014-10-01

    Proximally located posterior communicating artery (PCoA) aneurysms, projecting postero-laterally in proximity to the tentorium, may pose a technical challenge for microsurgical clipping due to obscuration of the proximal aneurysmal neck by the anterior petroclinoid fold. We describe an efficacious technique utilizing fenestration of the anterior petroclinoid fold to facilitate visualization and clipping of PCoA aneurysms abutting this aspect of the tentorium. Of 86 cases of PCoA aneurysms treated between 2003 and 2013, the technique was used in nine (10.5 %) patients to allow for adequate clipping. A 3 mm fenestration in the anterior petroclinoid ligament is created adjacent and lateral to the anterior clinoid process. This fenestration is then widened into a small wedge corridor by bipolar coagulation. In all cases, the proximal aneurysm neck was visualized after the wedge fenestration. Additionally, an adequate corridor for placement of the proximal clip blade was uniformly established. All cases were adequately clipped, with complete occlusion of the aneurysm neck and fundus with preservation of the PCoA. There were two intraoperative ruptures not related to creation of the wedge fenestration. One patient experienced post-operative partial third nerve palsy, which resolved during follow-up. We describe a technique of fenestration of the anterior petroclinoid fold to establish a critical and safe corridor for both visualization and clipping of PCoA aneurysms. PMID:24817080

  16. Variables Associated With Return to Sport Following Anterior Cruciate Ligament Reconstruction: A Systematic Review

    PubMed Central

    Czuppon, Sylvia; Racette, Brad A.; Klein, Sandra E.; Harris-Hayes, Marcie

    2014-01-01

    Background As one of the purposes of anterior cruciate ligament reconstruction (ACLR) is to return athletes to their pre-injury activity level, it is critical to understand variables influencing return to sport. Associations between return to sport and variables representing knee impairment, function and psychological status have not been well studied in athletes following ACLR. Purpose The purpose of this review is to summarize the literature reporting on variables proposed to be associated with return to sport following anterior cruciate ligament reconstruction. Study Design Systematic Review Methods Medline, Embase, CINAHL and Cochrane databases were searched for articles published before November 2012. Articles included in this review met these criteria: 1) included patients with primary ACLR, 2) reported at least one knee impairment, function or psychological measure, 3) reported a return to sport measure and 4) analyzed the relationship between the measure and return to sport. Results Weak evidence existed in sixteen articles suggesting variables associated with return to sport included higher quadriceps strength, less effusion, less pain, greater tibial rotation, higher Marx Activity score, higher athletic confidence, higher pre-operative knee self-efficacy, lower kinesiophobia and higher pre-operative self-motivation. Conclusion Weak evidence supports an association between knee impairment, functional, and psychological variables and return to sport. Current return to sport guidelines should be updated to reflect all variables associated with return to sport. Utilizing evidence-based return to sport guidelines following ACLR may ensure athletes are physically and psychologically capable of sports participation, which may reduce re-injury rates and the need for subsequent surgery. PMID:24124040

  17. Fixed functional therapy with an anterior bite plane.

    PubMed

    Zaboulian, Jubin; Ghassemi, Bahram

    2014-01-01

    This clinical case report describes the treatment of Class II tendency in a patient using fixed functional appliance therapy. The appliance used was the fixed flat bite plane, consisting of an incisal acrylic located palatal to the maxillary anteriors that connected to maxillary first molar bands via heavy-gauge wires. The case reviewed involves a white male, age twelve, four months at the beginning of treatment. The patient exhibited a Class II end on molar relationship skeletal pattern with an ANB of 3 degrees and corresponding incisal overjet of 2mm, with 90% overbite. At the conclusion of treatment, fixed functional bite plane therapy resulted in improved overbite, molar canine class I relationship. The results of this case suggest use of the fixed appliance can be successful in improving function, esthetics and increased stability of post treatment both dentally and skeletally in the Class II tendency patient with severe overbite with minimal patient compliance. PMID:25745703

  18. Visualization of Torn Anterior Cruciate Ligament Using 3-Dimensional Computed Tomography

    PubMed Central

    Uozumi, Hiroaki; Aizawa, Toshimi; Sugita, Takehiko; Kunii, Tomonori; Abe, Shun; Itoi, Eiji

    2013-01-01

    Recently, a remnant-preserving anterior cruciate ligament (ACL) reconstruction technique has been developed. However, the preoperative condition of remnant ACL is occasionally difficult to evaluate by magnetic resonance imaging. The purpose of this study is to evaluate the accuracy of pre-operative visualization of remnant ACL using three-dimensional computed tomography (3D-CT). The remnant ACL in 25 patients was examined by 3DCT before ACL reconstruction surgery. Findings on 3D-CT images and arthroscopy were compared. The 3D-CT images were classified into 4 groups: Group A, remnant fibers attached to the posterior cruciate ligament (PCL); Group B, those located between the PCL and the lateral wall; Group C, those attached to the lateral wall; and Group D, no identifiable remnant fibers on the tibial side. These groups were made up of 4, 3, 9 and 9 patients, respectively. Findings on 3D-CT images were identical to those during arthroscopy in 20 of 25 cases (80%). Remnant ACL can be accurately evaluated using 3D-CT in 80% of cases of torn ACL. This novel method is a useful technique for pre-operative assessment of remnant ACL. PMID:24191182

  19. Current practice variations in the management of anterior cruciate ligament injuries in Croatia

    PubMed Central

    Mahnik, Alan; Mahnik, Silvija; Dimnjakovic, Damjan; Curic, Stjepan; Smoljanovic, Tomislav; Bojanic, Ivan

    2013-01-01

    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

  20. Arthroscopic treatment of a large lateral femoral notch in acute anterior cruciate ligament tear.

    PubMed

    Tauber, Mark; Fox, Michael; Koller, Heiko; Klampfer, Helmut; Resch, Herbert

    2008-11-01

    A 24-year-old professional soccer player suffered an acute anterior cruciate ligament tear associated with a radiologically evident impression fracture of the lateral femoral condyle, the so-called "lateral femoral notch sign". Following MRI validation of the injury with detection of an additional lateral meniscus tear, arthroscopy was carried out 3 days after the injury. Due to the extended impression of about 5 mm, arthroscopically assisted closed reduction of the depression fracture was performed. A 3.2 mm tunnel was drilled at the lateral femoral condyle in a supero-inferior direction using an ACL tibial guide and the depressed area could be restored using an elevator. The resulting subchondral bone defect in the femoral condyle was filled with freeze-dried human cancellous bone allograft. As a one-stage procedure ACL reconstruction was carried out using a hamstring tendon technique. At 1-year follow up the patient has returned to full sporting function, including playing soccer with a radiographically reduced lateral femoral notch sign. PMID:18060552

  1. Evaluation of manual test for anterior cruciate ligament injury using a body-mounted sensor

    NASA Astrophysics Data System (ADS)

    Yoshida, R.; Sagawa, K.; Tsukamoto, T.; Ishibashi, Y.

    2007-12-01

    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.

  2. Evaluation of MRI Versus Arthroscopy in Anterior Cruciate Ligament and Meniscal Injuries

    PubMed Central

    Kashikar, Shivali Vaibhav; Lakhkar, Bhushan Narayan; Ahsan, Mohammad Saleem

    2014-01-01

    Aims and Objectives: To find out the incidence of ACL & meniscal injuries, to co-relate MRI findings with arthroscopy by calculating Sensitivity, Specificity, Positive And Negative Predictive Values (PPV & NPV) keeping arthroscopy as a gold standard, to find out the degree of subluxation and to grade it and to find a threshold value of fluid in knee. Settings and Design: Prospective analytical study. Materials and Methods: MRI of 230 patients with 71 arthroscopic co- relation in year 2012-14 was analysed. Statistical Analysis: Descriptive statistics using Chi square test and predictive values was done. The spearman correlation coefficient was done by using statistical software SPSS 17.0. Results: The sensitivity, specificity, PPV and NPV was calculated (in %). For ACL it was 87.87, 81.57, 80.55, 88.57 for MM 93.54, 87.50, 85.29, 94.59 and for LM 77.77, 81.81, 72.41, 85.71 respectively. We found 35.6% incidence of anterior tibial subluxation with maximum patients having grade 1 category subluxation. Two hundred and one cases showed joint fluid in lateral aspect of the suprapatellar pouch (AP diameter >10mm) with internal derangement. Conclusion: MRI is helpful in diagnosing meniscal and cruciate ligament injuries. Arthroscopy still remains gold standard for definitive diagnosis. PMID:25654007

  3. Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse

    Microsoft Academic Search

    Lucas W. M. Janssen; Cornells F. van Dijke

    1994-01-01

    PURPOSE: This study was undertaken to determine the outcome and changes produced by an endorectal anterior wall repair in objective functional parameters using anorectal manometry and defecography and to asses their usefulness in the selection of patients for the operation. METHODS: Between 1986 and 1990, we performed a prospective study of 76 consecutive patients with symptomatic rectocele and\\/or an anterior

  4. Anterior thoracic posture increases thoracolumbar disc loading.

    PubMed

    Harrison, Deed E; Colloca, Christopher J; Harrison, Donald D; Janik, Tadeusz J; Haas, Jason W; Keller, Tony S

    2005-04-01

    In the absence of external forces, the largest contributor to intervertebral disc (IVD) loads and stresses is trunk muscular activity. The relationship between trunk posture, spine geometry, extensor muscle activity, and the loads and stresses acting on the IVD is not well understood. The objective of this study was to characterize changes in thoracolumbar disc loads and extensor muscle forces following anterior translation of the thoracic spine in the upright posture. Vertebral body geometries (C2 to S1) and the location of the femoral head and acetabulum centroids were obtained by digitizing lateral, full-spine radiographs of 13 men and five women volunteers without previous history of back pain. Two standing, lateral, full-spine radiographic views were obtained for each subject: a neutral-posture lateral radiograph and a radiograph during anterior translation of the thorax relative to the pelvis (while keeping T1 aligned over T12). Extensor muscle loads, and compression and shear stresses acting on the IVDs, were calculated for each posture using a previously validated biomechanical model. Comparing vertebral centroids for the neutral posture to the anterior posture, subjects were able to anterior translate +101.5 mm+/-33.0 mm (C7-hip axis), +81.5 mm+/-39.2 mm (C7-S1) (vertebral centroid of C7 compared with a vertical line through the vertebral centroid of S1), and +58.9 mm+/-19.1 mm (T12-S1). In the anterior translated posture, disc loads and stresses were significantly increased for all levels below T9. Increases in IVD compressive loads and shear loads, and the corresponding stresses, were most marked at the L5-S1 level and L3-L4 level, respectively. The extensor muscle loads required to maintain static equilibrium in the upright posture increased from 147.2 N (mean, neutral posture) to 667.1 N (mean, translated posture) at L5-S1. Compressive loads on the anterior and posterior L5-S1 disc nearly doubled in the anterior translated posture. Anterior translation of the thorax resulted in significantly increased loads and stresses acting on the thoracolumbar spine. This posture is common in lumbar spinal disorders and could contribute to lumbar disc pathologies, progression of L5-S1 spondylolisthesis deformities, and poor outcomes after lumbar spine surgery. In conclusion, anterior trunk translation in the standing subject increases extensor muscle activity and loads and stresses acting on the intervertebral disc in the lower thoracic and lumbar regions. PMID:15168237

  5. Postoperative radiographic and clinical assessment of the treatment of posterior tibial plafond fractures using a posterior lateral incisional approach.

    PubMed

    Ruokun, Huang; Ming, Xie; Zhihong, Xiao; Zhenhua, Fang; Jingjing, Zhao; Kai, Xiao; Jing, Li

    2014-01-01

    The purpose of the present study was to evaluate the postoperative radiographic and functional outcomes of reduction and fixation of a posterior plafond fracture using a posterolateral approach. We included 38 patients with a tibial plafond fracture. Fixation was most commonly performed using screws, T plates, or meta plates. The average follow-up period was 38 (range 25 to 72) months. The clinical outcomes of these patients were evaluated using the American Orthopaedic Foot Ankle Society score. The radiographs of the included patients were evaluated twice within 2 months by 3 experienced orthopedic trauma surgeons, who performed the retrospective radiographic review. Articular step off measures included the radiographic appearance of the reduction using picture archiving and communication system measurement tools. All 32 patients showed radiologic evidence of bony union at the follow-up visit; 6 patients were lost to follow-up. The American Orthopaedic Foot Ankle Society average score was 92 points; 21 patients (93.7%) had excellent scores (90 to 100 points), 9 patients (28.1%) had good scores (80 to 89 points), and 2 patients (6.2%) had fair scores (<80 points). Excellent to good outcomes were noted in 93.7% of the patients. One patient developed a superficial infection. Another patient experienced a sural cutaneous nerve injury. The radiographic articular step off was measured as 1 mm or less in 29 patients (90.6%) and 1 to 2 mm in 3 patients (9.4%). One patient (3.1%) developed symptomatic post-traumatic arthritis. The posterolateral approach allowed for good exposure and buttress fixation of the posterior plafond fractures with few local complications. The anatomic repositioning and stable fixation resulted in good functional and subjective outcomes. PMID:25154653

  6. Effect of extra-osseous talotarsal stabilization on posterior tibial nerve strain in hyperpronating feet: a cadaveric evaluation.

    PubMed

    Graham, Michael E; Jawrani, Nikhil T; Goel, Vijay K

    2011-01-01

    Excessive abnormal strain or tension on the posterior tibial nerve in feet exhibiting talotarsal instability has been considered one of the possible etiologic factors of tarsal tunnel syndrome. The suggested treatment options in such cases include stabilization of the talotarsal joint complex in a corrected position, which might help minimize the abnormal forces placed on the posterior tibial nerve due to over stretching. The primary goal of this study was to quantify strain on the posterior tibial nerve in feet exhibiting hyperpronation caused by talotarsal instability, before and after an extra-osseous talotarsal stabilization (EOTTS) procedure. We hypothesized that the excessive strain placed on the posterior tibial nerve in hyperpronating cadaveric feet would be reduced significantly after intervention using the HyProCure(®) EOTTS device. Posterior tibial nerve strain was quantified in 9 fresh-frozen cadaver specimens. A miniature differential variable reluctance transducer was used to measure nerve elongation as the foot was moved from its neutral to a maximally pronated position, before and after intervention. The mean elongation of the posterior tibial nerve (with respect to a fixed reference point) decreased by 43% after the EOTTS procedure (i.e., from 5.91 ± 0.91 mm to 3.38 ± 1.20 mm; N = 27). The reduction was statistically significant at p < .001. HyProCure(®) was effective in stabilizing the talotarsal joint complex, thus reducing the excessive amount of strain placed on the posterior tibial nerve. Clinical implications of this study suggest the use of EOTTS devices in the treatment of tarsal tunnel syndrome. PMID:21907596

  7. An Unruptured Anterior Communicating Artery Aneurysm with Bilateral Infraoptic Anterior Cerebral Arteries. Case Report and Review of the Literature

    PubMed Central

    Chua, Michelle H.; Thomas, Ajith J.; Fusco, Matthew R.

    2014-01-01

    Variations of the anterior cerebral artery-anterior communicating artery complex are commonly identified in aneurysm surgery. An infraoptic course of the anterior cerebral artery is exceedingly rare. Robison first described this anomaly from an anatomic dissection in 1959. A unilateral anomalous infraoptic anterior cerebral artery is more common than anomalies of bilateral infraoptic anterior cerebral arteries. We present the case of an unruptured aneurysm at the anterior communicating artery in a patient with bilateral infraoptic anterior cerebral arteries, identified by computed tomography angiography and verified during surgery. Implications for aneurysm formation and surgical treatment are discussed. PMID:25599046

  8. Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis

    Microsoft Academic Search

    Toby O. Smith; Leigh Davies; Caroline B. Hing

    2010-01-01

    There is no consensus in the literature regarding the optimal timing of surgical reconstruction of the ruptured anterior cruciate\\u000a ligament (ACL). Previous authors have suggested that early reconstruction may facilitate an early return to work or sport\\u000a but may increase the incidence of post-operative complications such as arthrofibrosis. This study systematically reviewed\\u000a the literature to determine whether ACL reconstruction should

  9. Anterior cruciate ligament insufficiency: does delay in index surgery affect outcome in recreational athletes

    Microsoft Academic Search

    A. D. Tambe; S. P. Godsiff; S. Mulay; M. Joshi

    2006-01-01

    The aim of the study was to see if delay in anterior cruciate ligament (ACL) reconstruction affects post-reconstruction outcome in recreational athletes. Sixty-two recreational athletes who had arthroscopic ACL reconstructions using quadruple hamstring grafts between 1997 and 2000 were retrospectively evaluated. Patients with less than 2 years’ follow-up, those with multi-ligament injuries, reconstructions for previous failed repairs, those whose injury date

  10. Transcriptional profiles of multiple genes in the anterior kidney of channel catfish vaccinated with an attenuated Aeromonas hydrophila

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A total of 22 uniquely expressed sequence tags (ESTs) were identified from channel catfish anterior kidney subtractive cDNA library at 12h post vaccination with an attenuated A. hydrophila (AL09-71 N+R). Of the 22 ESTs, six were confirmed to be significantly (P<0.05) induced by the vaccination. Of 8...

  11. Evaluation of meniscal mechanics and proteoglycan content in a modified anterior cruciate ligament transection model.

    PubMed

    Fischenich, Kristine M; Coatney, Garrett A; Haverkamp, John H; Button, Keith D; DeCamp, Charlie; Haut, Roger C; Haut Donahue, Tammy L

    2014-07-01

    Post-traumatic osteoarthritis (PTOA) develops as a result of traumatic loading that causes tears of the soft tissues in the knee. A modified transection model, where the anterior cruciate ligament (ACL) and both menisci were transected, was used on skeletally mature Flemish Giant rabbits. Gross morphological assessments, elastic moduli, and glycosaminoglycan (GAG) coverage of the menisci were determined to quantify the amount of tissue damage 12 weeks post injury. This study is one of the first to monitor meniscal changes after inducing combined meniscal and ACL transections. A decrease in elastic moduli as well as a decrease in GAG coverage was seen. PMID:24749144

  12. [Anterior cruciate ligament ganglion: a case report].

    PubMed

    Casas-Duhrkop, D; Ares, O; Seijas, R; Cugat, R; Català, J

    2013-01-01

    Intraarticular ganglions are rare and they are usually incidental findings of MRIs and arthroscopies. We report the case of a male athlete with this condition affecting the anterior cruciate ligament. The most frequent symptoms include pain that worsens with activity, and motion limitations. The MRI shows the typical signs of a ganglion and it is the most specific and sensitive test. Arthroscopy is used for both the diagnosis and the treatment of this condition. A late diagnosis turns arthroscopic resection into a complicated or impossible procedure that at times warrants extensive debridement of the anterior cruzate ligament. PMID:24707614

  13. 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."

  14. Adolescent Differences in Knee Stability Following Computer-Assisted Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Christino, Melissa A.; Vopat, Bryan G.; Waryasz, Gregory R.; Mayer, Alexander; Reinert, Steven E.; Shalvoy, Robert M.

    2014-01-01

    Anterior cruciate ligament (ACL) surgery is being increasingly performed in the adolescent population. Computer navigation offers a reliable way to quantitatively measure knee stability during ACL reconstruction. A retrospective review of all adolescent patients (<18 years old) who underwent computer-assisted primary single bundle ACL reconstruction by a single surgeon from 2007 to 2012 was performed. The average age was 15.8 years (SD 3.3). Female adolescents were found to have higher internal rotation than male adolescents both pre- (25.6° vs 21.7°, P=0.026) and post-reconstruction (20.1° vs 15.1°, P=0.005). Compared to adults, adolescents demonstrated significantly higher internal rotation both pre- (23.3° vs 21.5°, P=0.047) and post-reconstruction (17.1° vs 14.4°, P=0.003). They also had higher total rotation both pre- (40.9° vs 38.4°, P=0.02) and post-reconstruction when compared to adults (31.56° vs 28.67°, P=0.005). In adolescent patients, anterior translation was corrected more than rotation. Females had higher pre- and residual post-reconstruction internal rotation compared to males. When compared to adults, adolescents had increased internal rotation and total rotation both pre-and post-reconstruction. PMID:25568734

  15. Measurement of tibial nerve excursion during ankle joint dorsiflexion in a weight-bearing position with ultrasound imaging

    PubMed Central

    2012-01-01

    Background The ability of peripheral nerves to stretch and slide is thought to be of paramount importance to maintain ideal neural function. Excursion in peripheral nerves such as the tibial can be measured by analysis of ultrasound images. The aim of this study was to assess the degree of longitudinal tibial nerve excursion as the ankle moved from plantar flexion to dorsiflexion in a standardised weight-bearing position. The reliability of ultrasound imaging to measure tibial nerve excursion was also quantified. Methods The tibial nerve was imaged over two separate sessions in sixteen asymptomatic participants in a weight-bearing position. Longitudinal nerve excursion was calculated from a three-second video loop captured by ultrasound imaging using frame-by-frame cross-correlation analysis. Intraclass correlation coefficients (ICC) with 95% confidence intervals (CI) were used to assess the intra-rater reliability. Standard error of the measurement (SEM) and smallest real difference (SRD) were calculated to assess measurement error. Results Mean nerve excursion was 2.99 mm SEM ± 0.22 mm. The SRD was 0.84 mm for session 1 and 0.66 mm for session 2. Intra-rater reliability was excellent with an ICC = 0.93. Conclusions Assessment of real-time ultrasound images of the tibial nerve via frame-by-frame cross-correlation analysis is a reliable non-invasive technique to assess longitudinal nerve excursion. The relationship between foot posture and nerve excursion can be further investigated. PMID:22397397

  16. Early results of a novel technique for anterior vaginal wall prolapse repair: anterior vaginal wall darn

    PubMed Central

    2014-01-01

    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

  17. THE EXOSKELETON AND INSECT PROPRIOCEPTION. I. RESPONSES OF TIBIAL CAMPANIFORM SENSILLA TO EXTERNAL AND MUSCLE-GENERATED FORCES IN THE AMERICAN COCKROACH, PERIPLANETA AMERICANA

    Microsoft Academic Search

    SASHA N. ZILL; DAVID T. MORAN

    SUMMARY 1. The tibial campaniform sensilla are a group of mechanoreceptors in the cockroach leg that respond to cuticular strain. Each sensillum consists of a single bipolar neurone whose dendrite inserts into an ovoid cuticular cap embedded in the exoskeleton. 2. The tibial campaniform sensilla are consistently separable into two subgroups with mutually perpendicular cap orientation: the long axis of

  18. Predisposing factors for anterior cruciate ligament injury

    Microsoft Academic Search

    Antonis Papoutsidakis

    2011-01-01

    Lecture 5In sports, especially in football, one of the most common knee injuries is the anterior cruciate ligament (ACL) tear, which usually (70%) occurs through non-contact mechanisms that include; sudden deceleration, landing and pivoting manoeuvres which are repeatedly performed. Studies have shown that the incidence of ACL tear in female athletes is two to eight times higher than in men

  19. Anterior Intramuscular Transposition of the Ulnar Nerve

    Microsoft Academic Search

    Peter Tang; Kevin D. Plancher; Shariff K. Bishai

    2006-01-01

    Summary: Though the literature is unclear, ulnar nerve anterior submuscular transposition has a role in the surgical treatment of cubital tunnel syndrome in the primary and revision setting. Along with the submuscular transposition technique, this article reviews some of the history of cubital tunnel syndrome treatment, the strengths and criticisms of each of the procedures, and the literature as of

  20. Dislocating anterior horn of the medial meniscus

    Microsoft Academic Search

    H Pinar; D Akseki; M Bozkurt; O Karao?lan

    1998-01-01

    Dislocating anterior horn of the medial meniscus was found in 15 knees of 13 patients during arthroscopic examinations done between 1992 and 1995. All of them were available for follow-up evaluation (4 by telephone). There were 11 men and 2 women (average age, 28 years; range, 17 to 49 years). Nine knees had a history of trauma. Only 1 knee

  1. Pain after Anterior Mesh Hernia Repair

    Microsoft Academic Search

    Simon Willem Nienhuijs; Oliver B. A. Boelens; Luc J. A. Strobbe

    2005-01-01

    BACKGROUND: The results of a randomized clinical trial comparing the Lichtenstein procedure, mesh plug repair, and the Prolene Hernia System provided a database for analyzing chronic pain after anterior mesh hernia repair to determine the characteristics and identify risk factors. STUDY DESIGN: A total of 334 patients with primary inguinal hernia were randomly allocated to receive one of the three

  2. Accelerated rehabilitation after anterior cruciate ligament reconstruction

    Microsoft Academic Search

    K. Donald Shelbourne; Paul Nitz

    1990-01-01

    To overcome many of the complications after ACL reconstruction (prolonged knee stiffness, limitation of complete extension, delay in strength recovery, anterior knee pain), yet still maintain knee stability, we devel oped a rehabilitation protocol that emphasizes full knee extension on the first postoperative day and immediate weightbearing according to the patient's tolerance. Of 800 patients who underwent intraarticular ACL patellar

  3. Graft healing in anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Chih-Hwa Chen

    2009-01-01

    Successful anterior cruciate ligament reconstruction with a tendon graft necessitates solid healing of the tendon graft in the bone tunnel. Improvement of graft healing to bone is crucial for facilitating an early and aggressive rehabilitation and ensuring rapid return to pre-injury levels activity. Tendon graft healing in a bone tunnel requires bone ingrowth into the tendon. Indirect Sharpey fiber formation

  4. Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014.

    PubMed

    Ayscue, Patrick; Van Haren, Keith; 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

    2014-10-10

    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

  5. Compressive neuropathy of the posterior tibial nerve at the lower calf caused by a ruptured intramuscular baker cyst.

    PubMed

    Moon, Seock Ho; Im, Sun; Park, Geun-Young; Moon, Su-Jin; Park, Hye-Jeong; Choi, Hyun-Sook; Jo, Yil Ryun

    2013-08-01

    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

  6. Compressive Neuropathy of the Posterior Tibial Nerve at the Lower Calf Caused by a Ruptured Intramuscular Baker Cyst

    PubMed Central

    Moon, Seock Ho; Im, Sun; Park, Geun-Young; Moon, Su-Jin; Park, Hye-Jeong; Choi, Hyun-Sook

    2013-01-01

    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

  7. Site Specific Effects of Zoledronic Acid during Tibial and Mandibular Fracture Repair

    PubMed Central

    Yu, Yan Yiu; Lieu, Shirley; Hu, Diane; Miclau, Theodore; Colnot, Céline

    2012-01-01

    Numerous factors can affect skeletal regeneration, including the extent of bone injury, mechanical loading, inflammation and exogenous molecules. Bisphosphonates are anticatabolic agents that have been widely used to treat a variety of metabolic bone diseases. Zoledronate (ZA), a nitrogen-containing bisphosphonate (N-BP), is the most potent bisphosphonate among the clinically approved bisphosphonates. Cases of bisphosphonate-induced osteonecrosis of the jaw have been reported in patients receiving long term N-BP treatment. Yet, osteonecrosis does not occur in long bones. The aim of this study was to compare the effects of zoledronate on long bone and cranial bone regeneration using a previously established model of non-stabilized tibial fractures and a new model of mandibular fracture repair. Contrary to tibial fractures, which heal mainly through endochondral ossification, mandibular fractures healed via endochondral and intramembranous ossification with a lesser degree of endochondral ossification compared to tibial fractures. In the tibia, ZA reduced callus and cartilage formation during the early stages of repair. In parallel, we found a delay in cartilage hypertrophy and a decrease in angiogenesis during the soft callus phase of repair. During later stages of repair, ZA delayed callus, cartilage and bone remodeling. In the mandible, ZA delayed callus, cartilage and bone remodeling in correlation with a decrease in osteoclast number during the soft and hard callus phases of repair. These results reveal a more profound impact of ZA on cartilage and bone remodeling in the mandible compared to the tibia. This may predispose mandible bone to adverse effects of ZA in disease conditions. These results also imply that therapeutic effects of ZA may need to be optimized using time and dose-specific treatments in cranial versus long bones. PMID:22359627

  8. Potential sites of compression of tibial nerve branches in foot: a cadaveric and imaging study.

    PubMed

    Ghosh, Sanjib Kumar; Raheja, Shashi; Tuli, Anita

    2013-09-01

    Hypertrophy of abductor hallucis muscle is one of the reported causes of compression of tibial nerve branches in foot, resulting in tarsal tunnel syndrome. In this study, we dissected the foot (including the sole) of 120 lower limbs in 60 human cadavers (45 males and 15 females), aged between 45 and 70 years to analyze the possible impact of abductor hallucis muscle in compression neuropathy of tibial nerve branches. We identified five areas in foot, where tibial nerve branches could be compressed by abductor hallucis. Our findings regarding three of these areas were substantiated by clinical evidence from ultrasonography of ankle and sole region, conducted in the affected foot of 120 patients (82 males and 38 females), aged between 42 and 75 years, who were referred for evaluation of pain and/or swelling in medial side of ankle joint with or without associated heel and/or sole pain. We also assessed whether estimation of parameters for the muscle size could identify patients at risk of having nerve compression due to abductor hallucis muscle hypertrophy. The interclass correlation coefficient for dorso-planter thickness of abductor hallucis muscle was 0.84 (95% CI, 0.63-0.92) and that of medio-lateral width was 0.78 (95% CI, 0.62-0.88) in the imaging study, suggesting both are reliable parameters of the muscle size. Receiver operating characteristic curve analysis showed, if ultrasonographic estimation of dorso-plantar thickness is >12.8 mm and medio-lateral width > 30.66 mm in patients with symptoms of nerve compression in foot, abductor hallucis muscle hypertrophy associated compression neuropathy may be suspected. PMID:23255292

  9. A Staged Surgical Treatment Outcome of Type 3 Open Tibial Fractures

    PubMed Central

    Uysal, Emin; Özmeriç, Ahmet

    2014-01-01

    Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport. PMID:24967129

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

    PubMed

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

    2005-10-01

    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 used. Eighty-five knees that were subjected to valgus HTO were evaluated both preoperatively and postoperatively according to the Insall-Salvati Index (ISI), Blackburne-Peel Index (BPI), and Caton Index (CI) to assess any alteration of patellar tendon height that was present. All cases underwent closing wedge osteotomy with three staples or plate internal fixation and were allowed early range of motion. Significant decrease in mean patellar height ratios was detected according to all three indexes at 85 months of mean follow-up. The percentages of the decrease were 8.26% in ISI, 9.08% in BPI, and 6.34% in CI. Two knees showed patella infera according to ISI, one according to BPI and three according to CI. There were no significant correlations between the indexes and clinical status of the patients. Elevation of patella relative to the femur in closing wedge valgus HTO procedure due to the shortening of the segment between tibial tuberosity and joint line is normally expected. A significant decrease in patellar height according to ISI suggests that there should be patellar tendon shortening as patellar height cannot be changed. BPI and CI for determining patellar height in valgus HTO do not accurately measure the alteration of patella because they may affect the tibial inclination and antero-posterior translation of the proximal fragment. Another measuring system based on femoral reference points should be proposed to determine the exact change of patellar height in the valgus HTO procedure. PMID:15645214

  11. In vivo tibial stiffness is maintained by whole bone morphology and cross-sectional geometry in growing female mice

    PubMed Central

    Main, Russell P.; Lynch, Maureen E.; van der Meulen, Marjolein C.H.

    2010-01-01

    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

  12. Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

    PubMed Central

    2014-01-01

    Background Currently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing. Methods Anatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes®). Statistical analysis was performed by Student's t test. Results Retrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p?tibial nail meets the requirements of maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures. PMID:24886667

  13. 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.

  14. Fixation and reconstruction of severe tibial shaft fractures with vascularized fibular grafting

    Microsoft Academic Search

    Ping Zhen; Xing-Yan Liu; Hao Lu; Xu-Sheng Li

    2011-01-01

    Introduction  Based on the considerable experience for management of combined bone and composite soft-tissue defects in the limbs by free\\u000a vascularized fibula or osteocutaneous fibular flap grafting, the authors present the effective alternative for management\\u000a of the severe comminuted tibial shaft fractures in one-stage reconstructive technique.\\u000a \\u000a \\u000a \\u000a \\u000a Method  Twenty-six patients were male and 12 were female, and their mean age was 32 years (range

  15. Minimizing the complications of intramedullary nailing for distal third tibial shaft and metaphyseal fractures

    PubMed Central

    Yaligod, Vishwanath; Rudrappa, Girish H.; Nagendra, Srinivas; Shivanna, Umesh M.

    2013-01-01

    Background The complications of intramedullary nailing of distal third tibial shaft and metaphyseal fractures have a direct impact on ankle and hind foot function. Methods We retrospectively evaluated 28 patients. Unreamed nail was negotiated across the well reduced fracture till subchondral bone and fixed with 2 to 3 distal locking screws in different planes. Results Fracture union rate was 85%. Three out of 28 patients had malalignment. Mean ankle, hindfoot functional score was 85. Conclusion Complications can be minimized by impacting the unreamed nail till the subchondral bone while maintaining the fracture well reduced and by using multiple distal locking screws in different planes. PMID:24719527

  16. Growth arrest of the proximal tibial physis with recurvatum and valgus deformity of the knee.

    PubMed

    Domzalski, Marcin; Mackenzie, William

    2009-10-01

    Two cases of asymmetrical closure of the proximal tibial epiphysis without a clear aetiological factor were presented. In both cases premature closure of the growth plate resulted in progressive recurvatum and valgus deformity of the knee with leg length discrepancy. The correction of deformity was obtained using Taylor Spatial frame with excellent results at 2 years follow-up. We hypothesize that repetitive trauma or chronic overloading during sports activities might be a factor of growth arrest in reported cases. Orthopedic surgeons should be aware of the possibility of subtle physeal injuries, causing angular deformities, in the cases of even minor knee trauma in skeletally immature population. PMID:19446461

  17. A vascularised gracilis flap with tibial bone for the reconstruction of the Achilles tendon.

    PubMed

    Uchikawa, Yumiko; Yazawa, Masaki; Kishi, Kazuo

    2013-10-01

    Rupture of the Achilles tendon is a very common trauma. Reconstruction of a chronic Achilles tendon defect is challenging for reconstructive surgeons, and several methods have been described. The ideal reconstruction would result in the patients resuming the activity level they were accustomed to before the injury. In our patient, the Achilles tendon was reconstructed using the gracilis muscle flap, and the flap was fixed using a fragment of the tibial bone, yielding satisfactory results. In this report, we describe this procedure employed and provide a description of the case. PMID:23612186

  18. Computer-Assisted Navigation in High Tibial Osteotomy: A Systematic Review of the Literature

    PubMed Central

    Picardo, Natasha E; Khan, Wasim; Johnstone, David

    2012-01-01

    High tibial osteotomy (HTO) is a procedure which aims to change the mechanical axis of the lower limb, transferring the body weight across healthy articular cartilage. Several studies have shown that accurate correction is the leading predictor for success. In this article, we systematically review the computer-assisted techniques that have been used in attempts to increase the accuracy of the surgery and improve postoperative outcomes. The results of the cadaveric and clinical studies to date are presented and the benefits and pitfalls of navigation are discussed. PMID:22896778

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

    Microsoft Academic Search

    T. M. van Raaij; J. de Waal Malefijt

    2006-01-01

    We analysed 20 patients with 24 knees affected by idiopathic genu recurvatum who were treated with an anterior opening wedge osteotomy of the proximal tibia because of anterior knee pain. We managed to attain full satisfaction in 83% of the patients with a mean follow-up of 7.4 years. The mean Hospital for Special Surgery score was 90.3 (range 70.5–99.5), and

  20. Surgeon Age as the Major Factor in Recommendation of Uni-compartmental Knee Replacement versus High Tibial Osteotomy

    PubMed Central

    Dietz, Frederick R.; Kelman, Mark G.

    2012-01-01

    This case report concerns surgical decision making. The subject is a 59 year old male orthopaedic surgeon with medial compartment knee arthritis. Both high tibial valgus osteotomy and uni-compartmental knee replacement would be appropriate with similar outcomes reported in the literature. Surprisingly, almost all young surgeons recommended a uni-compartmental knee replacement and almost all older surgeons recommended a high tibial osteotomy. We discuss the reasons that surgeon age, which is clearly irrelevant to the optimal decision, is the dominant determinant of surgical recommendation for this patient. PMID:23576917

  1. Early Tibiotalocalcaneal Arthrodesis Intramedullary Nail for Treatment of a Complex Tibial Pilon Fracture (AO/OTA 43-C).

    PubMed

    Hsu, Andrew R; Szatkowski, Jan P

    2014-08-24

    Management of severely comminuted, complete articular tibial pilon fractures (AO/OTA 43-C) remains a challenge, with few treatment options providing good clinical outcomes. Open reduction and internal fixation of the tibial plafond, tibiotalar arthrodesis, and salvage hindfoot reconstruction procedures are all associated with surgical complications and functional limitations. In this report, we present a case of a complex pilon fracture in a patient with multiple medical comorbidities and socioeconomic disadvantages that was successfully and acutely treated with a retrograde tibiotalocalcaneal hindfoot arthrodesis nail. At final follow-up examination, the patient had decreased pain, a stable plantigrade foot, and could ambulate with normal shoes without any assistive devices. PMID:25156100

  2. A dural arteriovenous fistula of the anterior cranial fossa angiographically mimicking an anterior ethmoidal artery aneurysm.

    PubMed

    Chen, Zhi; Tang, Weihua; Liu, Zhi; Li, Fei; Feng, Hua; Zhu, Gang

    2010-10-01

    Venous aneurysm or varix at the venous side of the fistula commonly exist in dural arteriovenous fistula (DAVF) of the anterior cranial fossa, which may be initially mistaken with aneurysm on computed tomography and magnetic resonance imaging, but always identified by angiography. We report a very unusual case of anterior cranial fossa DAVF angiographically mimicking an anterior ethmoidal artery aneurysm, which was ultimately corrected by surgery. A 41-year-old male presented with right frontal intraparenchymal hematoma with intraventricular extension. Angiography revealed a vascular lesion adjacent to the anterior fossa mimicking an anterior ethmoidal artery aneurysm, which was surgically proven to be a partially thrombosed venous varix of drainaging vein originated from the cribriform plate. A diagnosis of anterior cranial fossa DAVF was made, and venous varix was excised. Follow-up angiography after the operation revealed complete disappearance of the lesion. Our case illustrates a unique occasion that a proximal venous varix without obvious outflow angiographically in DAVF might be mistaken with an aneurysm. PMID:19555408

  3. Surgical treatment of aneurysms of the anterior cerebral artery.

    PubMed

    Chalif, D J; Weinberg, J S

    1998-10-01

    Cerebral aneurysms occur on the anterior cerebral artery in three locations: the anterior communicating artery, the pericallosal artery, and the A1 segment. Anterior communicating artery aneurysms show great morphologic variability and are the most frequent aneurysms seen in modern series. The anatomy, management, neuroradiology, surgical technique, and clinical outcome referable to each location on the anterior cerebral artery are discussed in this article. PMID:9738108

  4. Arthroscopic Anterior Shoulder Stabilization of Collision and Contact Athletes

    Microsoft Academic Search

    Augustus D. Mazzocca; Fred M. Brown; Dominic S. Carreira; Jennifer Hayden; Anthony A. Romeo

    2005-01-01

    Background:Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques.Study Design:Case series; Level of evidence, 4Purpose:To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision

  5. What affects continence after anterior resection of the rectum?

    Microsoft Academic Search

    Giacomo Batignani; Iacopo Monaci; Ferdinando Ficari; Francesco Tonelli

    1991-01-01

    Functional results after anterior rectal resections are commonly considered satisfactory but variable percentages of postoperative incontinence are often reported. Continence was evaluated after 20 low anterior resections (LAR) and 13 high anterior resections (HAR) by means of clinical assessment, anorectal manometry, and evacuation proctography. Whereas all HAR patients had perfect continence, 10 patients (50 percent of the LAR group had

  6. BRAINA JOURNAL OF NEUROLOGY Anterior insular cortex is necessary for

    E-print Network

    Knight, Robert T.

    that observing others' suffering and pain elicits activations of the anterior insular and the anterior cingulateBRAINA JOURNAL OF NEUROLOGY Anterior insular cortex is necessary for empathetic pain perception in empathetic pain. Therefore, whether these regions are `necessary' for empathetic pain remains unknown. Herein

  7. A New Method to Measure Post-Traumatic Joint Contractures in the Rabbit Knee

    PubMed Central

    Hildebrand, Kevin A.; Holmberg, Michael; Shrive, Nigel

    2013-01-01

    A new device and method to measure rabbit knee joint angles are described. The method was used to measure rabbit knee joint angles in normal specimens and in knee joints with obvious contractures. The custom-designed and manufactured gripping device has two clamps. The femoral clamp sits on a pinion gear that is driven by a rack attached to a materials testing system. A 100 N load cell in series with the rack gives force feedback. The tibial clamp is attached to a rotatory potentiometer. The system allows the knee joint multiple degrees-of-freedom (DOF). There are two independent DOF (compression-distraction and internal-external rotation) and two coupled motions (medial-lateral translation coupled with varus-valgus rotation; anterior-posterior translation coupled with flexion-extension rotation). Knee joint extension-flexion motion is measured, which is a combination of the materials testing system displacement (converted to degrees of motion) and the potentiometer values (calibrated to degrees). Internal frictional forces were determined to be at maximum 2% of measured loading. Two separate experiments were performed to evaluate rabbit knees. First, normal right and left pairs of knees from four New Zealand White (NZW) rabbits were subjected to cyclic loading. An extension torque of 0.2 Nm was applied to each knee. The average change in knee joint extension from the first to the fifth cycle was 1.9 deg ± 1.5 deg (mean ± sd) with a total of 49 tests of these eight knees. The maximum extension of the four left knees (tested 23 times) was 14.6 deg ± 7.1 deg, and of the four right knees (tested 26 times) was 12.0 deg ± 10.9 deg. There was no significant difference in the maximum extension between normal left and right knees. In the second experiment, nine skeletally mature NZW rabbits had stable fractures of the femoral condyles of the right knee that were immobilized for five, six or 10 weeks. The left knee served as an unoperated control. Loss of knee joint extension (flexion contracture) was demonstrated for the experimental knees using the new methodology where the maximum extension was 35 deg ± 9 deg, compared to the unoperated knee maximum extension of 11 deg ± 7 deg, 10 or 12 weeks after the immobilization was discontinued. The custom gripping device coupled to a materials testing machine will serve as a measurement test for future studies characterizing a rabbit knee model of post-traumatic joint contractures. PMID:14986415

  8. Flap Coverage of Anterior Abdominal Wall Defects

    PubMed Central

    Sacks, Justin M.; Broyles, Justin M.; Baumann, Donald P.

    2012-01-01

    Reconstruction of complex defects of the anterior abdomen is both challenging and technically demanding for reconstructive surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, the authors review pertinent anatomy and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the anterior abdomen. PMID:23372457

  9. [Anterior cruciate ligament injuries in children].

    PubMed

    Tercier, S; Zambelli, P-Y

    2013-07-17

    An increasing number of anterior cruciate ligament injuries are now seen in children and girls seem to be equally affected. Such neglected or untreated lesions could be the cause of early degenerative changes. Recently, many authors support the trend toward early surgical management in skeletally immature patients with complex meniscal tear or recurrent knee instability after proper rehabilitation. Improvement in pediatric knowledge and surgical techniques tend to support a tendency for more surgical treatment in children. The type of management is choosing according to history and physical examination. Magnetic resonance imaging is a useful tool not only for diagnosis but also for surgical treatment planning. We usually recommend anterior cruciate ligament reconstruction in children with knee instability or with further damages to the joint. PMID:23971325

  10. Anterior petrosal approach for brainstem cavernoma.

    PubMed

    Mare, Pandurang B; Churi, Omkar N; Misra, Basant K

    2014-01-01

    Brainstem cavernomas (BC) comprise about 5-18% of intracranial vascular malformations. The annual hemorrhage rate varies depending on the study design ranging from as low as 0.25% per patient-year in a retrospective study[2] to 1.6-3.1% per patient-year in prospective studies.[45] The annual event rate is significantly higher in deep (brainstem, diencephalon) and infratentorial cavernomas when compared to their counterparts in other locations.[5] The management of BC can be conservative or surgical depending upon the mode of clinical presentation. Surgical excision of a BC is a challenge because of critical anatomy. We present a case of BC, which was totally excised with anterior petrosal approach. Anterior petrosal approach has been used for excision of BC in only 17 cases until now.[6] The use of preoperative diffusion tensor imaging, tractography, intra-operative navigation, and cranial nerve monitoring will help in reducing the morbidity. PMID:25685235

  11. Diagnostic use of composite in anterior aesthetics.

    PubMed

    Portalier, L

    1996-09-01

    The success of anterior restorative procedures is in direct proportion to the ability of the practitioner to master new techniques and materials, which constantly improves the level of aesthetics and ultimately the final results achieved. However, unless a harmonious integration is achieved involving the two "bioaesthetic" parameters-the gingival architectural design and the dental architectural design-the final result will not be satisfactory. The learning objective of this article is to illustrate the use of composite resin as an "architect" to build predictable and successful anterior restorations through more reliable diagnostics of natural aesthetics and function. Freedom of composite build-up is outlined, and the use of composite in moving and opening of the gingival crest is described. Direct and indirect diagnostic use of composite in dental procedures is outlined in a detailed clinical procedure. PMID:9242138

  12. Complications of rigid anterior chamber implants.

    PubMed

    Moses, L

    1984-07-01

    Despite accurate lens sizing, 100 eyes with rigid anterior chamber implants showed a high incidence of lens-related trauma postoperatively: pigment dispersion (pseudoguttata), angle recession, peripheral anterior synechiae, iris erosion/atrophy, iris holes from stretching, angle fibrosis, haptic tip erosion into sclera and iris, neovascularization of peripheral iris and angle, lens rotation through iridectomy and into ciliary body, lens tilting with corneal endothelial touch, high refractive cylinder with long intraocular lenses, pigment proliferation onto iris surface, partial slippage of the intraocular lens into vitreous following intracapsular procedure, and pupillary-block glaucoma. Vision results were good. Glaucoma and cystoid macular edema rates were low. Bullous keratopathy and retinal detachment didn't occur. High endothelial cell loss was associated with those lenses that "propellered" and those that tilted and touched endothelium. The adverse findings may be static or may represent a continuing process of tissue damage. PMID:6472816

  13. Anterior Insular Cortex and Emotional Awareness

    PubMed Central

    Gu, Xiaosi; Hof, Patrick R.; Friston, Karl J.; Fan, Jin

    2014-01-01

    This paper reviews the foundation for a role of the human anterior insular cortex (AIC) in emotional awareness, defined as the conscious experience of emotions. We first introduce the neuroanatomical features of AIC and existing findings on emotional awareness. Using empathy, the awareness and understanding of other people’s emotional states, as a test case, we then present evidence to demonstrate: 1) AIC and anterior cingulate cortex (ACC) are commonly coactivated as revealed by a meta-analysis, 2) AIC is functionally dissociable from ACC, 3) AIC integrates stimulus-driven and top-down information, and 4) AIC is necessary for emotional awareness. We propose a model in which AIC serves two major functions: integrating bottom-up interoceptive signals with top-down predictions to generate a current awareness state and providing descending predictions to visceral systems that provide a point of reference for autonomic reflexes. We argue that AIC is critical and necessary for emotional awareness. PMID:23749500

  14. A One-wire Method for Anatomic Reduction of Tibial Fractures with Ilizarov Frame

    PubMed Central

    Bettella, Lorenzo

    2008-01-01

    Traditional external fixator techniques do not always correct minor residual malalignment. We asked whether using a one-wire method that corrects minor malalignment with an olive traction wire placed in the plane of the deformity allowed (1) uniform healing, (2) proper alignment, and (3) adequate reduction of fracture gaps. We retrospectively evaluated 72 patients in whom we used closed tibial fracture reduction using a circular external frame. We identified the plane of the residual deformity after alignment on a traction table using a C-arm. In this plane, the final correction was performed with traction through an olive wire. Satisfactory alignment (less than 3° deviation from normal) was obtained in 68 of the 72 patients (94%), and satisfactory reduction (gaps less than 2 mm) attained in 51 (71%). In no case was the fracture site opened surgically. Four patients underwent additional alignment correction with conical washers outside the operating room but no other efforts were needed to obtain further reduction after the initial surgery. Fractures healed in an average of 20 weeks. We observed no major infections. The Ilizarov frame has been a valuable tool to achieve alignment and anatomic or near anatomic reduction of closed tibial fractures. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18825469

  15. Effect of medial opening wedge high tibial osteotomy on intraarticular knee and ankle contact pressures.

    PubMed

    Suero, Eduardo M; Sabbagh, Yaman; Westphal, Ralf; Hawi, Nael; Citak, Musa; Wahl, Friedrich M; Krettek, Christian; Liodakis, Emmanouil

    2015-04-01

    High tibial osteotomy (HTO) is a commonly used surgical technique for treating moderate osteoarthritis (OA) of the medial compartment of the knee by shifting the center of force towards the lateral compartment. Previous studies have documented the effects of HTO on the biomechanics of the knee. However, the effects of the procedure on the contact pressures within the ankle joint have not been as well described. Seven cadavers underwent an HTO procedure with sequential 5° valgus realignment of the leg up to 15° of correction. An axial force of up to 550?N was applied and the intraarticular pressure was recorded. Minor valgus realignment of the proximal tibia does not significantly alter the biomechanics of the ankle. However, moderate-to-large changes in proximal tibial alignment result in significantly decreased tibiotalar contact surface area and in changes in intraarticular ankle pressures. These findings are clinically relevant, as they provide a biomechanical rationale for the diagnosis and treatment of ankle symptoms in the setting of lower limb malalignment or after alignment correction procedures. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:598-604, 2015. PMID:25418964

  16. Changes in cardiac output and tibial artery flow during and after progressive LBNP

    NASA Technical Reports Server (NTRS)

    1980-01-01

    A 3.0 MHz Pulsed Doppler velocity meter (PD) was used to determine blood velocities in the ascending aorta from the suprasternal notch before, during and after progressive 5 min stages of lower body negative pressure (LBNP) in 7 subjects. Changes in stroke volume were calculated from the systolic velocity integrals. A unique 20 MHz PD was used to estimate bloodflow in the posterior tibial artery. With -20 torr mean stroke volume fell 11% and then continued to decline by 48% before LBNP was terminated. Mean tibial flow fell progressively with LBNP stress, due to an increase in reverse flow component and a reduction in peak forward flow and diameter. Stroke volume increased and heart rate fell dramatically during the first 15 sec of recovery. The LBNP was terminated early in 2 subjects because of vasovagal symptons (V). During V the stroke volume rose 86% which more than compensated for the drop in heart rate. This implies that V is accompanied by a paradoxical increase in venous return and that the reduction in HR is the primary cardiovascular event. During the first 15 sec of recovery these 2 subjects had a distinctive marked rise to heart rate reminiscent of the Bainbridge reflex.

  17. Reflex neuromodulation of bladder function elicited by posterior tibial nerve stimulation in anesthetized rats.

    PubMed

    Kovacevic, Mario; Yoo, Paul B

    2015-02-15

    Although posterior tibial nerve stimulation (PTNS) has been shown in both clinical and animal studies to elicit bladder-inhibitory reflexes, our understanding of the role of posterior tibial nerve (PTN) afferents that elicit these responses is significantly limited. To this end, we investigated the effects of frequency-dependant PTNS in urethane-anesthetized rats undergoing repeated urodynamic fills. Nerve stimulation trials (10 min) resulted in statistically significant inhibition of the urinary bladder, both during and after nerve stimulation (P < 0.05). PTNS applied at 5 Hz resulted in both acute and prolonged changes that corresponded to 38.0% and 34.1% reductions in the bladder contraction frequency, respectively. In contrast, PTNS applied at 10 Hz could only elicit an acute decrease (22.9%) in bladder activity. Subsequent electrical activation of individual PTN branches (lateral or medial plantar nerves) confirmed that these bladder reflexes are mediated by specific subsets of the PTN trunk. Both acute and prolonged inhibition of the bladder were achieved by electrical stimulation of the lateral plantar (10 and 20 Hz) and medial plantar (5 and 10 Hz) nerves. Finally, we report a bladder-excitatory reflex that is elicited by electrical activation of either the PTN trunk or lateral plantar nerve at 50 Hz. This study shows that multiple bladder reflexes are tuned to specific subsets of nerve afferents and stimulation frequencies, each of which provide novel insights into the physiological effects of PTNS. PMID:25428124

  18. Crosslink density, oxidation and chain scission in retrieved, highly cross-linked UHMWPE tibial bearings.

    PubMed

    Reinitz, Steven D; Currier, Barbara H; Levine, Rayna A; Van Citters, Douglas W

    2014-05-01

    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

  19. Initial mechanical stability of cementless highly-porous titanium tibial components

    SciTech Connect

    Stone, Timothy Brandon [Los Alamos National Laboratory; Amer, Luke D [Los Alamos National Laboratory; Warren, Christopher P [Los Alamos National Laboratory; Cornwell, Phillip [Los Alamos National Laboratory; Meneghini, R Michael [UNIV OF CONNECTICUT HEALTH CENTER

    2008-01-01

    Cementless fixation in total knee replacement has seen limited use since reports of early failure surfaced in the late 80s and early 90s. However the emergence of improved biomaterials, particularly porous titanium and tantalum, has led to a renewed interest in developing a cementless tibial component to enhance long-term survivorship of the implants. Cement is commonly employed to minimize micromotion in new implants but represents a weak interface between the implant and bone. The elimination of cement and application of these new biomaterials, which theoretically provide improved stability and ultimate osseointegration, would likely result in greater knee replacement success. Additionally, the removal of cement from the procedure would help minimize surgical durations and get rid of the time needed for curing, thereby the chance of infection. The purpose of this biomechanical study was twofold. The first goal was to assess whether vibration analysis techniques can be used to evaluate and characterize initial mechanical stability of cementless implants more accurately than the traditional method of micromotion determination, which employs linear variable differential transducers (LVDTs). Second, an evaluative study was performed to determine the comparative mechanical stability of five designs of cementless tibial components under mechanical loading designed to simulate in vivo forces. The test groups will include a cemented Triathlon Keeled baseplate control group, three different 2-peg cementless baseplates with smooth, mid, and high roughnesses and a 4-peg cement/ess baseplate with mid-roughness.

  20. Tarsal tunnel syndrome secondary to schwannoma of the posterior tibial nerve.

    PubMed

    Hallahan, Katrina; Vinokur, Jessica; Demski, Sarah; Faulkner-Jones, Beverly; Giurini, John

    2014-01-01

    Schwannoma is a benign tumor that arises from the peripheral nerve sheath. It presents as a discrete, often tender, and palpable nodule associated with neurogenic pain or paresthesia when compressed or traumatized. The growth rate is usually slow, and these lesions seldom exceed 2 cm in diameter. We report the case of a large schwannoma arising from the posterior tibial nerve located in the posterior medial ankle. The core needle biopsy findings were suggestive of a schwannoma, with spindle cells strongly and uniformly immunostaining for S-100 protein. The mass was marginally excised. The surgical specimen consisted of a grossly encapsulated white-yellow mass with irregular contours, measuring 3.7 × 3.5 × 2.7 cm. The cut surface showed areas of pin-point hemorrhage. The patient did not encounter any motor deficits; however, early results showed some subjective numbness. Few reports have been published of schwannomas arising from the tibial nerve. Marginal excision appears to be the recommended therapy for this tumor, without any evidence of recurrence at 9 months of follow-up. PMID:23954095

  1. A rare case of intraneural ganglion cyst involving the tibial nerve

    PubMed Central

    Patel, Purvak

    2012-01-01

    Cystic lesions around the knee are a relatively common occurrence. Several types of cysts have been reported, including synovial, bursal, and ganglion. Ganglion cysts are not lined by synovial cells. Their location is highly variable, with occurrences described in the fat pads near the tibia or femur, muscles, nerves, and arteries. Intraneural ganglia are rare nonneoplastic cysts caused by the accumulation of thick mucinous fluid within the epineurium of peripheral nerves, encased in a dense fibrous capsule. These cysts can cause compression of the adjacent nerve fascicles, resulting in pain, paresthesias, weakness, muscle denervation, and atrophy. They are most commonly manifested by local and radiating pain, but sensory and motor deficits have also been described. Involvement of the tibial nerve is exceptionally rare, with <15 reported cases in the literature. We present a case of intraneural tibial ganglion cyst in a young woman. We also discuss the imaging features, differential considerations, proposed pathogenesis and anatomic origin, and treatment of this rare entity. PMID:22481843

  2. Dipyrone has no effects on bone healing of tibial fractures in rats

    PubMed Central

    Gali, Julio Cesar; Sansanovicz, Dennis; Ventin, Fernando Carvalho; Paes, Rodrigo Henrique; Quevedo, Francisco Carlos; Caetano, Edie Benedito

    2014-01-01

    OBJECTIVE: To evaluate the effect of dipyrone on healing of tibial fractures in rats. METHODS: Fourty-two Wistar rats were used, with mean body weight of 280g. After being anesthetized, they were submitted to closed fracture of the tibia and fibula of the right posterior paw through manual force. The rats were randomly divided into three groups: the control group that received a daily intraperitoneal injection of saline solution; group D-40, that received saline injection containing 40mg/Kg dipyrone; and group D-80, that received saline injection containing 80mg/Kg dipyrone. After 28 days the rats were sacrificed and received a new label code that was known by only one researcher. The fractured limbs were then amputated and X-rayed. The tibias were disarticulated and subjected to mechanical, radiological and histological evaluation. For statistical analysis the Kruskal-Wallis test was used at a significance level of 5%. RESULTS: There wasn't any type of dipyrone effect on healing of rats tibial fractures in relation to the control group. CONCLUSION: Dipyrone may be used safely for pain control in the treatment of fractures, without any interference on bone healing. Level of Evidence II, Controlled Laboratory Study. PMID:25246852

  3. The response of the rat tibial growth plates to distal periosteal division.

    PubMed Central

    Taylor, J F; Warrell, E; Evans, R A

    1987-01-01

    The growth plate chondrocytes have been examined in the tibiae of normal immature rats and in similar rats after circumferential distal periosteal release. In control rats, calculation of the growth rate as the product of the rate of cell proliferation and the maximum hypertrophic cell height correlated with gross measurements. The labelling index also correlated with the calculated growth rate. During the period 28 to 46 days of age there was little change in the growth rate but a diminution in the height of the hypertrophic cells. Unilateral circumferential periosteal division produced bilateral increases in tibial growth rate and in the activity of both the proliferative and hypertrophic zones as part of the systemic response to the trauma. There was a 1% ipsilateral increase in tibial length, as compared to the contralateral side, which appeared to be related principally to an increase in the number of proliferative cells. This simple method of stimulating bone growth can usefully be undertaken at the same time as other operative procedures. PMID:3654353

  4. Early outcome of arthroscopic Bankart's repair for recurrent traumatic anterior shoulder instability

    PubMed Central

    Saccomanni, Bernardino

    2013-01-01

    Background/objectives Despite the improvements in the methods of arthroscopic stabilization of anterior shoulder instability, a recurrence rate of as high as 30% is reported in the literature. In this context, we report the outcome of arthroscopic Bankart repair in anterior shoulder instability, with the use of bio-absorbable suture anchors for patients that were followed up for at least two years from the date of surgery. The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. We would like to report the 2-year clinical outcomes of bio-absorbable suture anchors used in traumatic anterior dislocations of the shoulder. Methods Data from 79 shoulders in 74 patients were collected over 4 years (2005–2009). Each patient was followed up over a period of 2 years. The patients underwent arthroscopic Bankart repair using bio-absorbable suture anchors for their anterior shoulder instability. These surgeries were performed at a single institution by a single surgeon over the time period. The patients were assessed with two different outcome measurement tools. The University of California at Los Angeles (UCLA) shoulder rating scale and the Simple Shoulder Test (SST) score. The scores were calculated before surgery and at the 2-year follow-up. The recurrence rates, range of motion as well post-operative function and return to sporting activities were evaluated. Results SST results from the 12 domains showed a significant improvement from a mean of 6.1 ± 3.1 to 11.1 ± 1.8 taken at the 2-year follow-up (p < 0.0001). Data from the UCLA scale showed a pre and post-operative mean of 20.2 ± 5.0 and 32.4 ± 4.6 respectively (p < 0.0001). 34 had excellent post-operative scores, 35 had good scores, 1 had fair score and 3 had poor scores. 75% of the patients returned to sports while 7.6% developed a recurrence of shoulder dislocation or subluxation. Conclusion Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent post-operative shoulder motion and low recurrence rates.

  5. Glandular Odontogenic Cyst of the Anterior Mandible

    PubMed Central

    Raju, Srinivasa Pathapati; Reddy, Sridhar Padala; Ananthnag, Jakkula

    2015-01-01

    Context: Glandular odontogenic cyst (GOC) is a rare cyst occurring in the middle-age people with mandibular anterior as the common site of occurrence. Case Report: We report a case of massive GOC in a 65-year-old female with an emphasis on its clinical course, histological features, and treatment modalities. Conclusion: The aggressiveness and recurrences of GOC warrants clinicians for the careful examination, treatment, and long-term follow-up. PMID:25789251

  6. Imaging of the anterior cruciate ligament

    PubMed Central

    Ng, Wing Hung Alex; Griffith, James Francis; Hung, Esther Hiu Yee; Paunipagar, Bhawan; Law, Billy Kan Yip; Yung, Patrick Shu Hang

    2011-01-01

    The anterior cruciate ligament (ACL) is an important structure in maintaining the normal biomechanics of the knee and is the most commonly injured knee ligament. However, the oblique course of the ACL within the intercondylar fossa limits the visualization and assessment of the pathology of the ligament. This pictorial essay provides a comprehensive and illustrative review of the anatomy and biomechanics as well as updated information on different modalities of radiological investigation of ACL, particularly magnetic resonance imaging. PMID:22474639

  7. Complications of anterior compartment vaginal surgery

    Microsoft Academic Search

    Eric S. Rovner

    2007-01-01

    Many complications can be associated with anterior compartment surgery of the vagina. With the integration of synthetic materials\\u000a into the surgical armamentarium for the repair of stress urinary incontinence in the form of midurethral slings, and for the\\u000a repair of vaginal prolapse as a primary procedure or to augment an existing repair, the spectrum of complications related\\u000a to this type

  8. Surgical Management of Anterior Cruciate Ligament Injuries

    Microsoft Academic Search

    Mark E. Steiner

    An anterior cruciate ligament (ACL) injury produces an athletic disability that is the most common knee injury to require\\u000a a ligament reconstruction. Recent research has contributed to a better understanding of all aspects of this injury, but it\\u000a is particularly in the areas of kinematics, graft placement, and graft fixation that the greatest improvements have occurred.\\u000a Controversy abounds in the

  9. Graft healing in anterior cruciate ligament reconstruction

    Microsoft Academic Search

    Max Ekdahl; James H.-C. Wang; Mario Ronga; Freddie H. Fu

    2008-01-01

    Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood\\u000a biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge\\u000a of this process have been made based primarly on animal models. According to the findings of this review, some surgical and\\u000a postoperative variables are known to

  10. Mucoid degeneration of the anterior cruciate ligament

    Microsoft Academic Search

    Robrecht Motmans; Frank Verheyden

    2009-01-01

    Mucoid degeneration of the anterior cruciate ligament (ACL) is a rare cause of knee pain. We report a case of a patient with\\u000a mucoid degeneration of the ACL, presenting with posterior knee pain and no history of a major knee trauma. On clinical examination,\\u000a the active range of motion showed a flexion deficit. The posterior knee pain was induced by

  11. An in vivo study of hindfoot 3D kinetics in stage II posterior tibial tendon dysfunction (PTTD) flatfoot based on weight-bearing CT scan

    PubMed Central

    Zhang, Y.; Xu, J.; Wang, X.; Huang, J.; Zhang, C.; Chen, L.; Wang, C.; Ma, X.

    2013-01-01

    Objective The objective of this study was to evaluate the rotation and translation of each joint in the hindfoot and compare the load response in healthy feet with that in stage II posterior tibial tendon dysfunction (PTTD) flatfoot by analysing the reconstructive three-dimensional (3D) computed tomography (CT) image data during simulated weight-bearing. Methods CT scans of 15 healthy feet and 15 feet with stage II PTTD flatfoot were taken first in a non-weight-bearing condition, followed by a simulated full-body weight-bearing condition. The images of the hindfoot bones were reconstructed into 3D models. The ‘twice registration’ method in three planes was used to calculate the position of the talus relative to the calcaneus in the talocalcaneal joint, the navicular relative to the talus in talonavicular joint, and the cuboid relative to the calcaneus in the calcaneocuboid joint. Results From non- to full-body-weight-bearing condition, the difference in the talus position relative to the calcaneus in the talocalcaneal joint was 0.6° more dorsiflexed (p = 0.032), 1.4° more everted (p = 0.026), 0.9 mm more anterior (p = 0.031) and 1.0 mm more proximal (p = 0.004) in stage II PTTD flatfoot compared with that in a healthy foot. The navicular position difference relative to the talus in the talonavicular joint was 3° more everted (p = 0.012), 1.3 mm more lateral (p = 0.024), 0.8 mm more anterior (p = 0.037) and 2.1 mm more proximal (p = 0.017). The cuboid position difference relative to the calcaneus in the calcaneocuboid joint did not change significantly in rotation and translation (all p ? 0.08). Conclusion Referring to a previous study regarding both the cadaveric foot and the live foot, joint instability occurred in the hindfoot in simulated weight-bearing condition in patients with stage II PTTD flatfoot. The method used in this study might be applied to clinical analysis of the aetiology and evolution of PTTD flatfoot, and may inform biomechanical analyses of the effects of foot surgery in the future. Cite this article: Bone Joint Res 2013;2:255–63. PMID:24324193

  12. Toxic anterior-segment syndrome (TASS)

    PubMed Central

    Cetinkaya, Servet; Dadaci, Zeynep; Aksoy, Hüsamettin; Acir, Nursen Oncel; Yener, Halil Ibrahim; Kadioglu, Ekrem

    2014-01-01

    Purpose To evaluate the clinical findings and courses of five patients who developed toxic anterior-segment syndrome (TASS) after cataract surgery and investigate the cause. Materials and methods In May 2010, on the same day, ten patients were operated on by the same surgeon. Five of these patients developed TASS postoperatively. Results Patients had blurred-vision complaints on the first day after the operation, but no pain. They had different degrees of diffuse corneal edema, anterior-chamber reaction, fibrin, hypopyon, iris atrophies, and dilated pupils. Their vision decreased significantly, and their intraocular pressures increased. Both anti-inflammatory and antiglaucomatous therapies were commenced. Corneal edema and inflammation resolved in three cases; however, penetrating keratoplasty was needed for two cases and additional trabeculectomy was needed for one case. Although full investigations were undertaken at all steps, we could not find the causative agent. Conclusion TASS is a preventable complication of anterior-segment surgery. Recognition of TASS, differentiating it from endophthalmitis, and starting treatment immediately is important. Controlling all steps in surgery, cleaning and sterilization of the instruments, and training nurses and other operation teams will help us in the prevention of TASS. PMID:25336907

  13. Surgical anatomy of the anterior clinoid process.

    PubMed

    Huynh-Le, Phuong; Natori, Yoshihiro; Sasaki, Tomio

    2004-04-01

    We studied the surgical anatomy of the anterior clinoid process (ACP) and its adjacent structures in cadaver heads. We paid special attention to the anatomical relationships between the ACP and adjacent structures to determine the surgical landmarks for safe anterior clinoidectomy. Thirty-five cadaver heads were dissected and the ACP regions were examined in 55 skull sides. We observed that in eight sides the ACP had been pneumatized from the sphenoid sinus. The caroticoclinoid foramen was revealed in only eight sides. The extra-ocular nerves ran forward to the superior orbital fissure at the inferolateral aspect of the ACP, with the oculomotor nerve being closest. The posterolateral area of the carotico-oculomotor membrane was thin and incomplete in nine sides. The study clarified the anatomical relationship between the ACP and its surrounding structures, and identified the major variations experienced. We used these to identify anatomical landmarks to assist the surgeon in the planning of a safe and effective anterior clinoidectomy. PMID:14975418

  14. A rare embryologic variation: Carotid-anterior cerebral artery anastomosis or infraoptic course of the anterior cerebral artery

    Microsoft Academic Search

    Ph. Mercier; S. Velut; D. Fournier; F. Lescalie; G. Guy; J. Pillet; P. Cronier

    1989-01-01

    Summary Carotid-anterior cerebral artery anastomosis constitutes an anomaly of the anterior part of the arterial circle of the brain. The anterior cerebral a. arises a few millimeters above the emergence of the internal carotid from the cavernous sinus, at the usual level of origin of the ophthalmic a. It travels medially, beneath the optic n., and then describes a curve

  15. Video-assisted limited anterior thoracotomy approach for lingular segmentectomy and left anterior descending coronary artery bypass

    Microsoft Academic Search

    Toshiya Ohtsuka; Jun Matsumoto; Jun Nakajima; Shinichi Takamoto

    Minimally invasive cardiothoracic combined surgery was performed successfully in an octogenerian with left anterior descending coronary artery disease and concurrent adenocarcinoma in the lingular segment of emphysematous lung. Through a limited anterior 4th intercostal thoracotomy, left anterior descending coronary artery bypass grafting without cardiopulmonary bypass was carried out using the left internal thoracic artery (LITA) and the interposed vein graft,

  16. Modified anterior approach to the bladder neck: simple and reproducible procedure for anterior bladder neck transection during robot-assisted radical prostatectomy.

    PubMed

    Shimbo, Masaki; Hattori, Kazunori; Endo, Fumiyasu; Matsushita, Kazuhito; Iwabuchi, Toshihisa; Tobisu, Kenichi; Muraishi, Osamu

    2014-09-01

    To evaluate the feasibility and reproducibility of a simple technique for identifying the initial cutting point of the bladder neck during robot-assisted radical prostatectomy. To precisely identify the prostatovesical junction, we first pulled the anterior bladder wall in an upward direction with the second arm to identify the precise location of the prostatovesical junction where anterior bladder neck dissection is initiated. After one experienced surgeon had established this technique, three surgeons who were less experienced in robot-assisted radical prostatectomy utilized this method for 50 consecutive robot-assisted radical prostatectomy cases. The pathological results and the time required to transect the anterior bladder wall were evaluated. There were no cases of positive resection margin on the site of bladder neck. The mean resection time was not significantly different when comparing less experienced surgeons with the experienced surgeon (P?=?0.29). In conclusion, this method is a simple and reproducible way to identify the bladder neck during robot-assisted radical prostatectomy. This technique is also useful (for laparoscopic or open radical prostatectomy) even in difficult scenarios, such as post-transurethral resection of prostate cases. PMID:24825076

  17. Intragrade intramedullary nailing of an open tibial shaft fracture in a patient with concomitant ipsilateral total knee arthroplasty.

    PubMed

    Greco, Nicholas; Goyal, Kanu; Tarkin, Ivan

    2015-03-01

    Open tibial shaft fracture occurring below an ipsilateral total knee arthroplasty (TKA) is a unique injury pattern that presents an additional degree of complexity to an already challenging treatment algorithm. Tibial shaft fracture is a surgical emergency requiring respect for the soft-tissue envelope and consideration of the biomechanical and biologic factors involved in healing. Treatment with an intramedullary nail relative to other types of internal or external fixation methods optimizes these factors and minimizes the risks of nonunion, malunion, infection, soft-tissue compromise, and reoperation, which are prevalent after this fracture. However, tibial shaft fracture associated with an ipsilateral TKA complicates standard treatment principles and increases the risks after surgery. In many instances, this type of injury pattern in a patient with medical comorbidities that would impede fracture and wound healing would make a limb amputation the preferred method of treatment. However, in this case report, we examine treatment options for an open tibial shaft fracture in the setting of an ipsilateral TKA and propose a method of limb salvage in a patient with medical comorbidities sustaining this injury pattern. PMID:25750957

  18. A three-dimensional analysis of the geometry and curvature of the proximal tibial articular surface of hominoids

    Microsoft Academic Search

    Emily K. Landis; Pushpak Karnick

    2006-01-01

    This study uses new three-dimensional imaging techniques to compare the articular curvature of the proximal tibial articular surface of hominoids. It has been hypothesized that the curvature of the anteroposterior contour of the lateral condyle in particular can be used to differentiate humans and apes and reflect locomotor function. This study draws from a large comparative sample of extant hominoids

  19. Incarceration of the intermeniscal ligament in tibial eminence injury: a block to closed reduction identified using MRI.

    PubMed

    Archibald-Seiffer, Noah; Jacobs, John; Zbojniewicz, Andrew; Shea, Kevin

    2015-05-01

    Tibial eminence fractures are a relatively uncommon injury, but most frequently occur in children and adolescents with open physes. Entrapment of the intermeniscal ligament or the meniscus itself can occur in the setting of a tibial eminence fracture and when present, poses a significant obstacle to successful closed or surgical reduction. Identification of these entrapped structures on preoperative imaging may be helpful to the physicians caring for these patients and assist with preoperative planning. We present a case of a 13-year-old male who sustained a tibial eminence fracture while playing football. Review by the orthopedic surgeon identified entrapment of the intermeniscal ligament. Subsequently, a closed reduction attempt under anesthesia prior to surgery was unsuccessful and arthroscopy was needed to remove the entrapped intermeniscal ligament and reduce the tibial eminence fracture. Pre-operative knowledge of entrapped soft tissue structures under the fracture plane, particularly the meniscus and intermeniscal ligament, provides the surgeon with valuable insight as to how to best counsel patients on the success of treatment options, how to best prepare for operative treatment, and can guide the surgeon during open reduction to maximize treatment success. PMID:25283983

  20. Low-conforming all-polyethylene tibial component not inferior to metal-backed component in cemented total knee arthroplasty

    Microsoft Academic Search

    Gunnar Adalberth; Kjell G. Nilsson; Sven Byström; Kurt Kolstad; Jan Milbrink

    2000-01-01

    In a prospective, randomized study of 40 patients, the quality of fixation of cemented metal-backed versus all-polyethylene tibial components of the unconstrained anatomic graduated component total knee arthroplasty design was studied during 2 years using radiostereometric analysis (RSA). The shape, as well as the articulating geometry, of the implants was identical, as was the operative technique and the postoperative regimen.

  1. Outcome Comparison between Free Muscle and Free Fasciocutaneous Flaps for Reconstruction of Distal Third and Ankle Traumatic Open Tibial Fractures

    Microsoft Academic Search

    Sukru Yazar; Chih-Hung Lin; Yu-Te Lin; Ali Engin Ulusal; Fu-Chan Wei

    2006-01-01

    Background: The advantages of free muscle flaps for reconstruction of lower extremity defects have been largely reported to be superior to those of fascio- cutaneous flaps. Methods: One hundred seventy-four patients received 177 microsurgical free tissue transfers for distal third and ankle open tibial fractures. Patients were divided into two groups. In group I, 96 patients received 98 free muscle

  2. Contact Mechanics of the Medial Tibial Plateau After Implantation of a Medial Meniscal AllograftA Human Cadaveric Study

    Microsoft Academic Search

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

    2000-01-01

    The goal of this study was to determine how well a medial meniscal allograft restores the normal contact mechanics of the medial tibial plateau at the time of implantation. We measured maximum pressure, mean pressure, and contact area of the intact human cadaveric knee, the knee after meniscectomy, the knee with the original meniscus removed and reimplanted as an autograft,

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

    Microsoft Academic Search

    Annette W-Dahl; Sören Toksvig-Larsen; Ewa M Roos

    2005-01-01

    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

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

    E-print Network

    Scharer, John E.

    Comparison of a New Braid Fixation System to an Interlocking Intramedullary Nail for Tibial) and polymethylmethacrylate bone cement with an interlocking intramedullary (IM) nail fixation in an ovine model. Study Design at 12 weeks after surgery compared with an interlocking IM nail repair. Clinical Relevance--A Nitinol

  5. Clinical results of reversed V-shaped high tibial corticotomy with minimally invasive surgery without internal fixation devices.

    PubMed

    Madadi, Firooz; Eajazi, Alireza; Madadi, Firoozeh; Daftari Besheli, Laleh; Rokni, Reza; Abbasian, Mohammad Reza; Bigdeli, Mohammad Reza

    2010-06-01

    High tibial osteotomy is a method of treating knee osteoarthritis due to genu varum in advanced stages. High tibial osteotomy-associated problems continue to be reported. The purpose of this study was to investigate the clinical results of a new, innovative method of high tibial osteotomy with 3- to 13-year follow-up. Between 1996 and 2006, our new surgical method was performed on 293 patients with medial compartment osteoarthritis and genu varum. All patients were examined preoperatively, 6 months postoperatively, and at final follow-up. The Hospital for Special Surgery Knee Scoring System (HSS) was used at final follow-up, and limb alignment and patient satisfaction were reassessed. Immediate postoperative complications included varus recurrence, knee instability, and peroneal nerve palsy, and no signs of tibial nonunion or infection were observed. At final follow-up, 3 cases of genu recurvatum, 2 cases of peroneal nerve palsy, and 25 cases of loss of correction were observed. Average postoperative HSS score was 85 (range, 47-97), and 97.8% of the patients were satisfied. This new method is a good alternative for the correction of genu varum because it requires a small incision, is soft tissue friendly, is a corticotomy instead of an osteotomy, requires no internal or external fixation devices, has a shorter duration and an acceptable complication and recurrence rate, and results in satisfactory HSS scores and higher patient satisfaction rates. PMID:20806771

  6. EVALUATION OF THE EFFICACY OF VITAMIN D3 OR ITS METABOLITES ON THIRAM-INDUCED TIBIAL DYSCHONDROPLASIA IN CHICKENS

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Two trials were conducted to determine if thiram-induced tibial dyschondroplasia (TD) in chickens was linked to a vitamin D deficiency and calcium homeostasis dysregulation, and whether feeding vitamin D fortified diets may prevent it. Day-old chickens were given grower diets containing different vi...

  7. Long-term anabolic effects of prostaglandin-E2 on tibial diaphyseal bone in male rats

    NASA Technical Reports Server (NTRS)

    Jee, Webster S. S.; Ke, Hua Zhu; Li, Xiao Jian

    1991-01-01

    The effects of long-term prostaglandin E2 (PGE2) on tibial diaphyseal bone were studied in 7-month-old male Sprague-Dawley rats given daily subcutaneous injections of 0, 1, 3 and 6 mg PGE2/kg/day for 60, 120 and 180 days. The tibial shaft was measured by single photon absorptiometry and dynamic histomorphometric analyses were performed on double-fluorescent labeled undecalcified tibial diaphyseal bone samples. Exogenous PGE2 administration produced the following transient changes in a dose-response manner between zero and 60 days: (1) increased bone width and mineral density; (2) increased total tissue and total bone areas; (3) decreased marrow area; (4) increased periosteal and corticoendosteal lamellar bone formation; (5) activated corticoendosteal lamellar and woven trabecular bone formation; and (6) activated intracortical bone remodeling. A new steady-state of increased tibial diaphyseal bone mass and elevated bone activities were observed from day 60 onward. The elevated bone mass level attained after 60 days of PGE2 treatment was maintained at 120 and 180 days. These observations indicate that the powerful anabolic effects of PGE2 will increase both periosteal and corticoendosteal bone mass and sustain the transient increase in bone mass with continuous daily administration of PGE2.

  8. A Novel Technique for Anterior Vaginal Wall Prolapse Repair: Anterior Vaginal Wall Darn

    PubMed Central

    Köse, Osman; Sa?lam, Hasan S.; Kumsar, ?ükrü; Budak, Salih; Adsan, Öztu?

    2013-01-01

    Aim. The aim of this study is to introduce a new technique, anterior vaginal wall darn (AVWD), which has not been used before to repair the anterior vaginal wall prolapse, a common problem among women. Materials and Methods. Forty-five women suffering from anterior vaginal wall prolapse were operated on with a new technique. The anterior vaginal wall was detached by sharp and blunt dissection via an incision beginning from the 1?cm proximal aspect of the external meatus extending to the vaginal apex, and the space between the tissues that attach the lateral walls of the vagina to the arcus tendineus fascia pelvis (ATFP) was then darned. Preoperation and early postoperation evaluations of the patients were conducted and summarized. Results. Data were collected six months after operation. Cough stress test (CST), Pelvic Organ Prolapse Quantification (POP-Q) evaluation, Incontinence Impact Questionnaire (IIQ-7), and Urogenital Distress Inventory (UDI-6) scores indicated recovery. According to the early postoperation results, all patients were satisfied with the operation. No vaginal mucosal erosion or any other complications were detected. Conclusion. In this initial series, our short-term results suggested that patients with grade II-III anterior vaginal wall prolapsus might be treated successfully with the AVWD method. PMID:23476121

  9. Analysis of Arterial Mechanics During Head-Down-Tilt Bed Rest

    NASA Technical Reports Server (NTRS)

    Elliott, Morgan B.; Martin, David S.; Westby, Christian M.; Stenger, Michael B.; Platts, Steven H.

    2014-01-01

    Carotid, brachial, and tibial arteries reacted differently to HDTBR. Previous studies have not analyzed the mechanical properties of the human brachial or anterior tibial arteries. After slight variations during bed-rest, arterial mechanical properties and IMT returned to pre-bed rest values, with the exception of tibial stiffness and PSE, which continued to be reduced post-bed rest while the DC remained elevated. The tibial artery remodeling was probably due to decreased pressure and volume. Resulting implications for longer duration spaceflight are unclear. Arterial health may be affected by microgravity, as shown by increased thoracic aorta stiffness in other ground based simulations (Aubert).

  10. Treatment of anterior cruciate ligament injuries, part 2.

    PubMed

    Beynnon, Bruce D; Johnson, Robert J; Abate, Joseph A; Fleming, Braden C; Nichols, Claude E

    2005-11-01

    Anterior cruciate ligament tears, common among athletes, are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. A total of 3810 studies published between January 1994 and the present were identified and reviewed to determine the current state of knowledge regarding the treatment of anterior cruciate ligament injuries. Part 1 of this article focused on studies pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of and risk factors for injuries related to it, the natural history of the ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, indications for the treatment of anterior cruciate ligament injuries, as well as nonoperative and operative treatments. Part 2 includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after anterior cruciate ligament reconstruction, and the effects of sex, age, and activity level on the outcome of such reconstructive surgery. PMID:16230470

  11. The field defects of anterior temporal lobectomy: a quantitative reassessment of Meyer's loop.

    PubMed

    Barton, Jason J S; Hefter, Rebecca; Chang, Bernard; Schomer, Don; Drislane, Frank

    2005-09-01

    Temporal lobectomy is often complicated by superior quadrantanopia. The relation of field loss to sagittal resection length can inform us about the functional anatomy of Meyer's loop, with ramifications for surgical planning. However, the literature has produced highly variable results. We studied 29 patients with anterior temporal lobectomies using Goldmann perimetry. 24 patients had post-operating neuroimaging, with which we assessed resection length relative to each patient's temporo-occipital dimensions. For the field defect we calculated the proportion of area lost for three isopters. We found a significant correlation between resection size and field loss for both nasal and temporal defects. Linear regressions suggested an anterior limit of Meyer's loop at 24 to 28 mm from the anterior temporal pole, and involvement of the lower quadrant when resections reached 70 to 79 mm, with significant inter-subject variability. The nasal defect was 15% greater than the temporal defect for all degrees of quadrantanopia, with no difference between right and left hemispheres. Macular involvement began when field defects reached 61% of quadrant area, corresponding to a resection of about 58 mm. Patterns of field loss showed that the lower margins were most often horizontal or with a slight slope towards fixation, rather than true wedge defects. We conclude that field loss is related to resection length and that Meyer's loop extends more anteriorly than estimated in traditional surgical studies, in agreement with modern MRI and dissection studies. The patterns of field loss support a revised retinotopic model in which the most anterior fibers of Meyer's loop represent the superior field, not the vertical meridian as traditionally proposed. PMID:15917289

  12. Treatment of Anterior Femoroacetabular Impingement with Combined Hip Arthroscopy and Limited Anterior Decompression

    PubMed Central

    Clohisy, John C; McClure, J Thomas

    2005-01-01

    Anterior femoroacetabular impingement results from abnormal abutment of the anterolateral femoral head-neck junction with the anterior acetabular-labral complex resulting in pain and progressive hip dysfunction. This under-recognized problem could be the manifestation of acetabular or proximal femoral deformity, and when left untreated leads to the development of osteoarthritis of the hip. Conservative treatment is usually unsuccessful and the optimal surgical treatment for these disorders needs to be determined. We present our technique for treating femoral (cam) impingement which combines hip arthroscopy and a limited open anterior head-neck osteoplasty as a less invasive and more conservative surgical approach, which still adequately addresses the anatomy and pathophysiology of this disease. PMID:16089092

  13. MRI appearances of the anterior fibulocalcaneus muscle: a rare anterior compartment muscle.

    PubMed

    Upadhyay, Bhavin; Amiras, Dimitri

    2015-05-01

    MRI of a 62-year-old female presenting with ankle pain demonstrated an accessory muscle within the anterior compartment of the lower leg. The muscle originated from the fibula and anterior crural septum. The tendon passed anterior to the lateral malleolus and inserted at the critical angle of Gissane on the calcaneus. This muscle was initially described in the anatomic literature by Lambert and Atsas in 2010. To our knowledge, this is the first time the MRI appearances of this muscle has been described in the radiological literature. Awareness of the fibulocalcaneal muscle is important as it may represent a cause of ankle pain. In addition, the tendon could potentially be harvested for use in reconstructive procedures. PMID:25293700

  14. The pattern of tibial nerve excursion with active ankle dorsiflexion is different in older people with diabetes mellitus

    PubMed Central

    Boyd, Benjamin S.; Gray, Andrew T.; Dilley, Andrew; Wanek, Linda; Topp, Kimberly S.

    2013-01-01

    Background The peripheral nervous system has an inherent capability to tolerate the gliding (excursion), stretching (increased strain), and compression associated with limb motions necessary for functional activities. The biomechanical properties during joint movements are well studied but the influence of other factors such as limb pre-positioning, age and the effects of diabetes mellitus are not well established for the lower extremity. The purposes of this pilot study were to compare the impact of two different hip positions on lower extremity nerve biomechanics during an active ankle dorsiflexion motion in healthy individuals and to determine whether nerve biomechanics are altered in older individuals with diabetes mellitus. Methods Ultrasound imaging was used to quantify longitudinal motion of the tibial nerve and transverse plane motion of the tibial and common fibular nerves in the popliteal fossa during active ankle movements. Findings In healthy individuals, ankle dorsiflexion created mean tibial nerve movement of 2.18 millimeters distally, 1.36 millimeters medially and 3.98 millimeters superficially. When the hip was in a flexed position there was a mean three-fold reduction in distal movement. In people with diabetes mellitus there was significantly less distal movement of the tibial nerve in the neutral hip position and less superficial movement of the nerve in both hip positions compared to healthy individuals. Interpretation We have documented reductions in tibial nerve excursion due to limb pre-positioning thought to pre-load the nervous system using a non-invasive methodology. Thus, lower limb pre-positioning impacts nerve biomechanics during ankle motions common in functional activities. Additionally, our findings indicate that nerve biomechanics have the potential to be altered in older individuals with diabetes mellitus compared to younger healthy individuals. PMID:22809735

  15. Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes

    PubMed Central

    Zargham, Mahtab; Alizadeh, Farshid; Tadayyon, Farhad; Khorrami, Mohammad-Hatef; Nouri-Mahdavi, Kia; Gharaati, Mohammad Reza; Izadpanahi, Mohammad Hossein; Yazdani, Mohammad; Mazdak, Hamid

    2013-01-01

    Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP). Materials and Methods: Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic – craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Results: Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A. Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery. PMID:24516492

  16. The patella ligament insertion angle influences quadriceps usage during walking of anterior cruciate ligament deficient patients.

    PubMed

    Shin, Choongsoo S; Chaudhari, Ajit M; Dyrby, Chris O; Andriacchi, Thomas P

    2007-12-01

    Following ACL injury a reduction in the peak knee flexion moment during walking (thought to be created by a decrease of quadriceps contraction) has been described as an adaptation to reduce anterior tibial translation (ATT) relative to the femur. However, the amount of ATT caused by quadriceps contraction is influenced by the patellar ligament insertion angle (PLIA). The purpose of this study was to test the hypothesis that quadriceps usage during walking correlates to individual anatomical variations in the extensor mechanism as defined by PLIA. PLIA and gait were measured for ACL-deficient knees, using subjects' contralateral knees as controls. In ACL-deficient knees, PLIA was negatively correlated (R2 = 0.59) to peak knee flexion moment (balanced by net quadriceps moment), while no correlation was found in contralateral knees. Reduction in peak flexion moment in ACL-deficient knees compared to their contralateral knees was distinctive in subjects with large PLIA, possibly to avoid excessive ATT. These results suggest that subject-specific anatomic variability of knee extensor mechanism may account for the individual variability previously observed in adaptation to a quadriceps reduction strategy following ACL injury. The average (+/-1 SD) PLIA of ACL-deficient knees (21.1 +/- 3.4 degrees) was less than the average PLIA of contralateral knees (23.9 +/- 3.1 degrees). This altered equilibrium position of the tibiofemoral joint associated with reduced PLIA and adaptations of gait patterns following ACL injury may be associated with degenerative changes in the articular cartilage. In the future, individually tailored treatment and rehabilitation considering individuals' specific extensor anatomy may improve clinical outcomes. PMID:17593539

  17. Tibial lengthening for unilateral Crowe type-IV developmental dysplasia of the hip

    PubMed Central

    Wan, Jun; Zhang, Xiang-Sheng; Ling, Lin; Fan, Jing; Li, Zhi-Hong

    2014-01-01

    Background: Developmental dysplasia of the hip (DDH) is associated with chronic pain and limping which especially has a negative impact on the patients’ daily activities, body image, and self-esteem. Although total hip arthroplasty remains the first choice for treatment of DDH in adults, minimally invasive alternative approaches are being increasingly favored both by the surgeon and the patients with severe DDH. This study aimed to evaluate the outcome of these patients treated with a mono-lateral external fixator-based tibial lengthening procedure. Materials and Methods: During the period of month between June 1999 and January 2006, 13 (mean ages 20.8 years) adult patients with unilateral Crowe type-IV DDH were treated by tibial lengthening using a mono-lateral external fixator over an intramedullary nail. Bone healing, infection, gait correction and improvement in body image were assessed during postoperative followup. Patients’ overall health status at the end of followup was assessed using the short form-36 (SF-36) health survey. Results: Patients were followed up for an average of 7.3 years. Successful bone healing was observed in all 13 patients and no further surgeries were indicated. A mean external fixation index of 12.4 days/cm was achieved. Bone formation fell in good to excellent categories with a mean consolidation index of 50.1 days/cm. Pin-tract infections were observed in two patients. The degree of limping was reduced from severe or moderate preoperatively to mild postoperatively. Neither equinus deformity nor painful degenerative osteoarthritis and hip dysfunction were observed in any of the patients studied. The SF-36 questionnaire survey showed that all patients were satisfied with their outcomes. Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type-IV DDH. Mono-lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator-related complications. PMID:25143648

  18. A retrospective analysis of medial opening wedge high tibial osteotomy for varus osteoarthritic knee

    PubMed Central

    Pornrattanamaneewong, Chaturong; Numkanisorn, Surin; Chareancholvanich, Keerati; Harnroongroj, Thossart

    2012-01-01

    Background: Medial opening wedge high tibial osteotomy (MOWHTO) has proven to be an effective treatment for varus osteoarthritic knees. Various methods of fixation with different implant types and using either bone grafts or bone substitutes have been reported. We performed non-locking T-buttress plate fixation with autologous iliac bone graft augmentation, which is defined here as the traditional method, and locking compression plate fixation without any bone graft or bone substitute. We aimed to compare bone union and complications of these two MOWHTO techniques. Materials and Methods: Between June 2005 and December 2007, 50 patients who underwent MOWHTO (a total of 60 knees) were retrospectively reviewed and classified into two groups: group A, which consisted of 26 patients (30 knees) was treated using T-buttress plate fixation with autologous iliac bone graft augmentation and group B, which consisted of 24 patients (30 knees) was operated upon using a medial high tibial locking compression plate without any augmentation. Demographic characteristics and radiographic outcomes, including union rate, time to union, medial osteotomy defects, and complications, were collected and compared between the two groups. The progress of all patients was followed for at least 2 years. Results: All osteotomies united within 12 weeks after surgery. Group B had slightly longer time to union than group A (10.3 weeks and 9.5 weeks, respectively; P = 0.125). A significantly higher incidence of medial defects after osteotomy was reported in the locking compression plate group (P = 0.001). A total of 5 (8.3%) knees had complications. In group A, one knee had a superficial wound infection and another knee had a lateral tibial plateau fracture without significant loss of correction. In group B, one knee had screw penetration into the knee joint and two knees had local irritation that required the removal of the hardware. Conclusion: Locking compression plate fixation without the use of bone grafts or bone substitutes provides a satisfactory union rate and an acceptable complication rate when compared to the traditional MOWHTO technique. Thus, we recommend using this technique for treating unicompartmental medial knee osteoarthritis. PMID:22912522

  19. Randomized Trial of Reamed and Unreamed Intramedullary Nailing of Tibial Shaft Fractures

    PubMed Central

    2008-01-01

    Background: There remains a compelling biological rationale for both reamed and unreamed intramedullary nailing for the treatment of tibial shaft fractures. Previous small trials have left the evidence for either approach inconclusive. We compared reamed and unreamed intramedullary nailing with regard to the rates of reoperations and complications in patients with tibial shaft fractures. Methods: We conducted a multicenter, blinded randomized trial of 1319 adults in whom a tibial shaft fracture was treated with either reamed or unreamed intramedullary nailing. Perioperative care was standardized, and reoperations for nonunion before six months were disallowed. The primary composite outcome measured at twelve months postoperatively included bone-grafting, implant exchange, and dynamization in patients with a fracture gap of <1 cm. Infection and fasciotomy were considered as part of the composite outcome, irrespective of the postoperative gap. Results: One thousand two hundred and twenty-six participants (93%) completed one year of follow-up. Of these, 622 patients were randomized to reamed nailing and 604 patients were randomized to unreamed nailing. Among all patients, fifty-seven (4.6%) required implant exchange or bone-grafting because of nonunion. Among all patients, 105 in the reamed nailing group and 114 in the unreamed nailing group experienced a primary outcome event (relative risk, 0.90; 95% confidence interval, 0.71 to 1.15). In patients with closed fractures, forty-five (11%) of 416 in the reamed nailing group and sixty-eight (17%) of 410 in the unreamed nailing group experienced a primary event (relative risk, 0.67; 95% confidence interval, 0.47 to 0.96; p = 0.03). This difference was largely due to differences in dynamization. In patients with open fractures, sixty of 206 in the reamed nailing group and forty-six of 194 in the unreamed nailing group experienced a primary event (relative risk, 1.27; 95% confidence interval, 0.91 to 1.78; p = 0.16). Conclusions: The present study demonstrates a possible benefit for reamed intramedullary nailing in patients with closed fractures. We found no difference between approaches in patients with open fractures. Delaying reoperation for nonunion for at least six months may substantially decrease the need for reoperation. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence. PMID:19047701

  20. Voluntary Modulation of Anterior Cingulate Response to Negative Feedback

    PubMed Central

    Shane, Matthew S.; Weywadt, Christina R.

    2014-01-01

    Anterior cingulate and medial frontal cortex (dACC/mFC) response to negative feedback represents the actions of a generalized error-monitoring system critical for the management of goal-directed behavior. Magnitude of dACC/mFC response to negative feedback correlates with levels of post-feedback behavioral change, and with proficiency of operant learning processes. With this in mind, it follows that an ability to alter dACC/mFC response to negative feedback may lead to representative changes in operant learning proficiency. To this end, the present study investigated the extent to which healthy individuals would show modulation of their dACC/mFC response when instructed to try to either maximize or minimize their neural response to the presentation of contingent negative feedback. Participants performed multiple runs of a standard time-estimation task, during which they received feedback regarding their ability to accurately estimate a one-second duration. On Watch runs, participants were simply instructed to try to estimate as closely as possible the one second duration. On Increase and Decrease runs, participants performed the same task, but were instructed to “try to increase [decrease] their brain's response every time they received negative feedback”. Results indicated that participants showed changes in dACC/mFC response under these differing instructional conditions: dACC/mFC activity following negative feedback was higher in the Increase condition, and dACC activity trended lower in the Decrease condition, compared to the Watch condition. Moreover, dACC activity correlated with post-feedback performance adjustments, and these adjustments were highest in the Increase condition. Potential implications for neuromodulation and facilitated learning are discussed. PMID:25376010