RESUMEN
BACKGROUND: The ligaments implicated in the earliest stages of developing a progressive collapsing foot deformity are poorly understood. Commonly employed cadaveric flatfoot models are created from simultaneous transection of multiple ligaments, making it difficult to assess early changes in pressure distribution from ligaments critical for maintaining load distribution. A serial transection of ligaments may provide insight into changes in pressure distribution under the foot to identify a potential combination of ligaments that may be involved in early deformities. METHODS: Specimens were loaded using a custom designed axial and tendon loading system. Plantar pressure data for the forefoot and hindfoot were recorded before and after six sequential ligament complex transections. FINDINGS: Sectioning the plantar fascia (first) and short/long plantar ligaments (second) failed to generate appreciable differences in load distribution. Dividing the spring ligament (third) led to changes in hindfoot load distribution with a shift towards the lateral column indicative of hindfoot valgus angulation. All subsequent conditions resulted in similar patterns in hindfoot plantar load distribution. An anterior shift in the center of pressure only occurred after transection of all six ligament complexes. INTERPRETATION: Loss of the plantar fascia and short/long plantar ligaments are not critical in maintaining plantar load distribution or contact area. However, the additional loss of the spring ligament caused notable changes in hindfoot load distribution, indicating the combination of these three ligament complexes is particularly critical for preventing peritalar subluxation. Minimal changes in load distribution occurred when performing additional transections to reach a complete flatfoot deformity.
Asunto(s)
Pie Plano , Ligamentos , Presión , Soporte de Peso , Pie Plano/fisiopatología , Humanos , Ligamentos/fisiopatología , Cadáver , Pie/fisiopatología , Masculino , Anciano , Femenino , Estrés Mecánico , Modelos BiológicosAsunto(s)
Síntomas del Sistema Urinario Inferior , Prolapso de Órgano Pélvico , Vejiga Urinaria Hiperactiva , Humanos , Prolapso de Órgano Pélvico/fisiopatología , Femenino , Síntomas del Sistema Urinario Inferior/fisiopatología , Síntomas del Sistema Urinario Inferior/etiología , Síntomas del Sistema Urinario Inferior/terapia , Síntomas del Sistema Urinario Inferior/diagnóstico , Vejiga Urinaria Hiperactiva/fisiopatología , Vejiga Urinaria Hiperactiva/etiología , Vejiga Urinaria Hiperactiva/diagnóstico , Vejiga Urinaria Hiperactiva/terapia , Vejiga Urinaria de Baja Actividad/fisiopatología , Vejiga Urinaria de Baja Actividad/etiología , Vejiga Urinaria de Baja Actividad/diagnóstico , Vejiga Urinaria de Baja Actividad/terapia , Resultado del Tratamiento , Vejiga Urinaria/fisiopatología , Ligamentos/fisiopatología , Procedimientos Quirúrgicos UrológicosRESUMEN
Purpose: Management of Anderson and D'Alonzo type II odontoid fractures continues to be controversial despite extensive research and increasing prevalence. To the authors' knowledge, the three odontoid ligaments, the alar ligament, the vertical portion of the cruciate ligament, and the transverse ligament, have not been biomechanically examined in type II odontoid fracture in spite of their potential significance in management. Therefore, this study aims to explore the intersegmental rotations of the craniovertebral junction following Anderson and D'Alonzo type II odontoid fracture and various combinations of ligament ruptures. Methods: A validated C0-C7 cervical spine finite element model was employed to address the research objectives. The model was subjected to flexion-extension, lateral bending, and axial rotation under eight distinct injury conditions apart from the intact state. Prescribed rotations were applied to the top of the cranium while the C7 inferior surface was fixed. Rotation-moment data were retrieved from the model. Results: Type II odontoid fracture caused mixed forms of instability considering flexion-extension. In lateral bending, the fracture alone did not have a significant effect, whereas the disruption of ligaments led to moderate rotation increments. Notably, in axial rotation, the fracture was the most crucial factor for stability. Conclusions: Overall, type II odontoid fracture was found to be the main destabilizing element. Nonetheless, the vertical cruciate and the transverse ligament played a modest role in stabilization. The alar ligament provided minimal or no stability. Furthermore, instances were observed where both the vertical cruciate and the transverse ligament were necessary to prevent more instability.
Asunto(s)
Ligamentos , Apófisis Odontoides , Fracturas de la Columna Vertebral , Humanos , Apófisis Odontoides/fisiopatología , Apófisis Odontoides/diagnóstico por imagen , Fracturas de la Columna Vertebral/fisiopatología , Ligamentos/fisiopatología , Ligamentos/lesiones , Rotación , Análisis de Elementos Finitos , Fenómenos Biomecánicos , Inestabilidad de la Articulación/fisiopatología , Rango del Movimiento Articular/fisiología , Modelos Biológicos , MasculinoRESUMEN
BACKGROUND: There have been no definitive guidelines on the treatment method and specific points in the body. PURPOSE: The aim of the study was to investigate the effects of extracorporeal shockwave therapy on treating the main tendons and ligaments of knee osteoarthritis. METHOD: A total of 36 patients with knee osteoarthritis were enrolled in trial and organized into two groups: 3-wk extracorporeal shockwave therapy for the intervention group and 3-wk sham extracorporeal shockwave therapy for control group. Both groups received the same physical therapies: (1) transcutaneous electrical nerve stimulation, (2) magnetic field treatment, and (3) quadricep muscle strength training. Evaluation was performed before the start of treatment, at third week after the start of treatment, and 1 wk after the end of treatment. The study used randomized controlled trials (level of evidence, 1). RESULT: Eextracorporeal shockwave therapy group had significant improvement in WOMAC pain score, physical function, and total score (mean difference = -2.8, P < 0.001; -5.1, P = 0.02; -8.3, P = 0.004, respectively), Visual Analog Scale score (mean difference = -2.3, P < 0.001), and the distance of 6-min walk test (mean difference = 28.7, P = 0.01) in the 1 wk after the end of treatment. Statistical significance in WOMAC pain, physical function, and total scores (mean difference = -3.0, P = 0.001; -5.6, P = 0.02; -9.3, P = 0.004, respectively) and Visual Analog Scale score (mean difference = -1.2, P = 0.027) was observed between the extracorporeal shockwave therapy group and control group. CONCLUSIONS: Extracorporeal shockwave therapy for the tendons and ligaments has clinical benefits for pain and physical function improvement in knee osteoarthritis. In addition, improvement in physical performance was observed in the short-term follow-up.
Asunto(s)
Artralgia/rehabilitación , Tratamiento con Ondas de Choque Extracorpóreas/métodos , Osteoartritis de la Rodilla/rehabilitación , Anciano , Artralgia/etiología , Femenino , Humanos , Articulación de la Rodilla/fisiopatología , Ligamentos/fisiopatología , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/complicaciones , Dimensión del Dolor , Rendimiento Físico Funcional , Tendones/fisiopatología , Resultado del TratamientoRESUMEN
ABSTRACT: The objective of this report was to introduce a new suture augmentation of coracoclavicular (CC) and acromioclavicular ligament reconstruction for acute Rockwood grade III to V acromioclavicular dislocations.From January 2015 to January 2019, 43 patients with Rockwood III to VI acute acromioclavicular dislocations were retrospectively reviewed. For comparison, another series of 28 patients treated with double Endobutton technique from January 2011 to December 2014 were reviewed. A Pâ<â.05 was considered statistical significance.The mean follow-up period of the 2 series were 39.69â±â7.42âmonths (range, 24-54âmonths) and 37.86â±â8.23âmonths (range, 26-48âmonths) (Pâ>â.05), respectively. There were significant differences regarding CC space (11.62â±â2.54âmm vs 16.78â±â5.53âmm; Pâ<â.05), CC reduction loss (5.56â±â4.73âmm vs 26.25â±â4.42âmm; Pâ<â.05), and acromioclavicular space (6.89â±â1.87âmm vs 7.95â±â2.37âmm; Pâ<â.05). There were significant differences regarding the disabilities of the arm, shoulder, and hand questionnaire (3.3â±â2.8 vs 5.32â±â4.37; Pâ<â.05) and University of California-Los Angeles shoulder rating scale (31.19â±â2.48 vs 29.24â±â2.48; Pâ<â.05). The excellent to good percentages were 100% (nâ=â32) and 85% (nâ=â23), respectively.In conclusion, the suture augmentation of acromioclavicular and CC ligament reconstruction is a reliable technique for acute acromioclavicular dislocation with minimal complications.Type of study/level of evidence: Therapeutic IIa.
Asunto(s)
Articulación Acromioclavicular/cirugía , Ligamentos/cirugía , Suturas/normas , Articulación Acromioclavicular/fisiopatología , Adulto , Femenino , Humanos , Ligamentos/fisiopatología , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Estudios Retrospectivos , Luxación del Hombro/cirugía , Suturas/efectos adversos , Resultado del TratamientoAsunto(s)
Fibrilación Atrial/cirugía , Aleteo Atrial/cirugía , Ablación por Catéter/métodos , Sistema de Conducción Cardíaco/fisiopatología , Ligamentos/cirugía , Válvula Mitral/cirugía , Anciano , Fibrilación Atrial/fisiopatología , Femenino , Frecuencia Cardíaca , Humanos , Ligamentos/fisiopatología , Persona de Mediana Edad , Válvula Mitral/fisiopatología , Estudios ProspectivosRESUMEN
The uterosacral ligaments (USLs) are important anatomical structures that support the uterus and apical vagina within the pelvis. As these structures are over-stretched, become weak, and exhibit laxity, pelvic floor disorders such as pelvic organ prolapse occur. Although several surgical procedures to treat pelvic floor disorders are directed toward the USLs, there is still a lot that is unknown about their function. This manuscript presents a review of the current knowledge on the mechanical properties of the USLs. The anatomy, microstructure, and clinical significance of the USLs are first reviewed. Then, the results of published experimental studies on the in vivo and ex vivo, uniaxial and biaxial tensile tests are compiled. Based on the existing findings, research gaps are identified and future research directions are discussed. The purpose of this exhaustive review is to help new researchers navigate scientific literature on the mechanical properties of the USLs. The use of these structures remains very popular in reconstructive surgeries that restore and augment the support of pelvic organs, especially as synthetic surgical mesh implants continue to be highly controversial.
Asunto(s)
Ligamentos , Prolapso de Órgano Pélvico , Mallas Quirúrgicas , Útero , Vagina , Animales , Femenino , Humanos , Ligamentos/fisiopatología , Ligamentos/cirugía , Prolapso de Órgano Pélvico/fisiopatología , Prolapso de Órgano Pélvico/cirugía , Útero/fisiopatología , Útero/cirugía , Vagina/fisiopatología , Vagina/cirugíaRESUMEN
Beyond pulmonary vein isolation, the two main additional strategies: Cox-Maze procedure or targeting of electrical signatures (focal bursts, rotational activities, meandering wavelets), remain controversial. High-density mapping of these arrhythmias has demonstrated firstly that a patchy lesion set is highly proarrhythmogenic, favoring macro-re-entry through conduction slowing and providing pivots for localized re-entry. Secondly, discrete anatomical structures such as the Vein or Ligament of Marshall (VOM/LOM) and the coronary sinus (CS) have epicardial muscular bundles that are more frequently involved in re-entry than previously thought. The Marshall Bundle can be ablated at any point along its course from the mid-to-distal coronary sinus to the left atrial appendage. If necessary, the VOM may be directly ablated using ethanol infusion to eliminate PV contributions and produce conduction block across the mistral isthmus. Ethanol ablation of the VOM, supplemented with RF ablation, may be more effective in producing conduction block at the mitral isthmus than repeat RF ablation alone.
Asunto(s)
Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Ligamentos/cirugía , Fibrilación Atrial/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Ligamentos/fisiopatologíaRESUMEN
BACKGROUND: Anterior-posterior compression (APC) type II pelvis fracture is caused by the destruction of pelvic ligaments. This study aims to explore ligaments injury in APC type II pelvic injury. METHOD: Fourteen human cadaveric pelvis samples with sacrospinous ligament (SPL), sacrotuberous ligament (SBL), anterior sacroiliac ligament (ASL), and partial bone retaining unilaterally were acquired for this study. They were randomly divided into hemipelvis restricted and unrestricted groups. We recorded the separation distance of the pubic symphysis and anterior sacroiliac joint, external rotation angle, and force when ASL ruptured. We observed the external rotation damage to the pelvic bone and ligaments. RESULT: When ASL failed, there was no significant difference in pubic symphysis separation (28.6 ± 8.4 mm to 23.6 ± 8.2 mm, P = 0.11) and anterior sacroiliac joint separation (11.4 ± 3.8 mm to 9.7 ± 3.9 mm, P = 0.30) between restricted and unrestricted groups. The external rotation angle (33.9 ± 5.5° to 48.9 ± 5.2°, P < 0.01) and force (553.9 ± 82.6 N to 756.6 ± 41.4 N, P < 0.01) were significantly different. Pubic symphysis separation between two groups ranged from 14 to 40 mm. In the restricted group, both SBL and SPL were injured. SPL ruptured first, and then SBL and the interosseous sacroiliac ligament were damaged while the posterior ligament remained unharmed. In the unrestricted group, interosseous sacroiliac ligament and posterior sacroiliac ligaments were damaged, while SBL and SPL were not. When the ASL, SBL, and SPL all failed, pubic symphysis and anterior sacroiliac joint separation between two groups increased significantly (from 28.6 ± 8.4 to 42.0 ± 7.6 mm, 11.4 ± 3.8 to 16.7 ± 4.2 mm respectively, all P < 0.05). CONCLUSION: Pelvic external rotation injury is either hemipelvic restricted or unrestricted, which can result in different outcomes. When the ASL ruptures, the unrestricted group needs greater external rotation angle and force, without SBL or SPL injury, while both SBL and SPL were injured in another group. When ASL fails in two groups, pubic symphysis separation fluctuates considerably. Finally, when the ASL ruptures, SBL and SPL may be undamaged.
Asunto(s)
Fracturas por Compresión/etiología , Fracturas por Compresión/fisiopatología , Ligamentos/lesiones , Huesos Pélvicos/lesiones , Adulto , Fenómenos Biomecánicos , Cadáver , Femenino , Humanos , Ligamentos/fisiopatología , Masculino , Persona de Mediana Edad , RoturaRESUMEN
BACKGROUND: Pelvic organ prolapse is common, but the underlying etiologies are poorly understood, which limits our current prevention and treatment options. OBJECTIVE: Our primary objective was to compare the uterosacral ligament histologic features in women with and without prolapse using the novel pelvic organ prolapse histologic quantification system. Our secondary aim was to determine whether composite histologic findings in uterosacral ligaments are associated with prolapse risk factors. STUDY DESIGN: This was a prospective cohort study in which paracervical uterosacral ligament biopsies were performed at the time of hysterectomy for primary prolapse or other benign gynecologic indications and processed for histologic evaluation. The pelvic organ prolapse quantification system was used to determine the prolapse stage. In this study, 9 prominent histologic features were semiquantitatively scored using the pelvic organ prolapse histologic quantification system in a blinded fashion and compared between prolapse and control groups. Unbiased principal component analysis of these scores was independently performed to identify potential relationships between histologic measures and prolapse risk factors. RESULTS: The histologic scores of 81 prolapse and 33 control ligaments were analyzed. Compared with the control group, women in the prolapse group were significantly older and more likely to be in the menopausal phase. There was no difference in the number of vaginal deliveries, body mass index, hormone use, or smoking status between the groups. To control for baseline differences, patients were also stratified by age over 40 years and menopausal status. Compared with the control group, the prolapse ligaments in the premenopausal group had significantly more loss of smooth muscle fibers within the fascicles (P<.001), increased inflammatory infiltrates of neutrophils within the tissue and perineural inflammatory cells (P<.01 and P=.04, respectively), and reduced neointimal hyperplasia (P=.02). Prolapse ligaments in the postmenopausal group exhibited elevated adipose content compared with that of the control group (P=.05). Amount of fibrillar collagen, total nonvascular smooth muscle, and muscle fiber vesicles of prolapse ligaments did not differ in either the premenopausal or postmenopausal group compared with that of the control group. Unbiased principal component analysis of the histologic scores separated the prolapse ligaments into 3 phenotypes: (1) increased adipose accumulation, (2) increased inflammation, and (3) abnormal vasculature, with variable overlap with controls. Posthoc analysis of these subgroups demonstrated a positive correlation between increasing number of vaginal deliveries and body mass index with increasing adipose content in the adipocyte accumulation and inflammatory phenotype and increasing neointimal hyperplasia in the vascular phenotype. However, only the relationship between vaginal delivery and adipocytes was significant in the adipose phenotype (R2=0.13; P=.04). CONCLUSION: Histologic phenotypes exist in pelvic support ligaments that can be distinguished using the pelvic organ prolapse histologic quantification system and principle component analysis. Vaginal delivery is associated with aberrant adipose accumulation in uterosacral ligaments. Our findings support a multifactorial etiology for pelvic organ prolapse contributing to altered smooth muscle, vasculature, and connective tissue content in crucial pelvic support structures. To confirm these associations and evaluate the biomechanical properties of histologic phenotypes of prolapse, larger studies are warranted. Closing this gap in knowledge will help optimize personalized medicine and help identify targets for prevention and treatment of this complex condition.
Asunto(s)
Ligamentos/fisiopatología , Prolapso de Órgano Pélvico/fisiopatología , Sacro , Útero , Estudios de Casos y Controles , Estudios de Cohortes , Femenino , Humanos , Persona de Mediana Edad , Fenotipo , Estudios Prospectivos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
The ligament of Marshall (LOM) is a remnant of the embryonic sinus venosus and left cardinal vein, and contains fat and fibrous tissues, blood vessels, muscle bundles, nerve fibers, and ganglia. The complexity of LOM's structure makes it as a source of triggers and drivers as well as substrates of re-entry for atrial arrhythmias, especially for atrial fibrillation (AF). LOM also serves as a portion of left atrial macro-re-entrant circuit, especially peri-mitral isthmus re-entrant circuit. Experimental studies demonstrate that the LOM acts as a sympathetic conduit between the left stellate ganglion and the ventricles, and participates in the initiation and maintenance of ventricular arrhythmias. Endocardial or epicardial catheter ablation or ethanol infusion into the vein of Marshall may serve as an important adjunct therapy to pulmonary vein isolation in patients with advanced stage of AF, and may help alleviate ventricular arrhythmias as well.
Asunto(s)
Arritmias Cardíacas/cirugía , Ablación por Catéter/métodos , Ligamentos/anatomía & histología , Arritmias Cardíacas/fisiopatología , Fibrilación Atrial/fisiopatología , Fibrilación Atrial/cirugía , Etanol/administración & dosificación , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Infusiones Intravenosas , Ligamentos/fisiopatología , Ligamentos/cirugía , Venas Pulmonares/cirugíaRESUMEN
Although various studies have proposed vascular and mechanical factors, the etiology of Kienböck disease is unknown. Kienböck theorized that lunatomalacia resulted from traumatic disruption of blood supply and bony nutrition to the lunate. Extraosseous supply to the lunate, as far as volar or dorsal vessels are concerned, is still controversial. This study evaluated the extraosseous nutrient foramina from the dorsal and volar aspects of lunate specimens. A total of 913 specimens from the Hamann-Todd Osteological Collection in Cleveland, Ohio, were examined. The nutrient artery foramina on left and right lunate specimens were examined from dorsal and volar aspects. The number of nutrient artery foramen was tabulated. Age, sex, and race data were collected. Specimens were divided into groups according to the number of nutrient artery foramina, and the dorsal and volar foramina were compared. The average number of foramina on the dorsal aspect of the lunate (1.71) was greater than the volar aspect (1.64), except in specimens younger than 35 years. A greater number of specimens had 3 or more foramina on the dorsal side compared with the volar aspect. Based on this study, there was significant contribution of dorsal arterial vessels to the blood supply of lunate specimens older than 35 years, which contrasts with findings in earlier studies. The disruption of dorsal intercarpal and radiocarpal ligaments leading to the disruption of the dorsal arterial arches may contribute to vascular insufficiency of the lunate and should be evaluated further in the etiopathogenesis of Kienböck disease. [Orthopedics. 2021;44(2):e243-e247.].
Asunto(s)
Hueso Semilunar/irrigación sanguínea , Adulto , Arterias/patología , Arterias/fisiopatología , Cadáver , Humanos , Ligamentos/patología , Ligamentos/fisiopatología , Masculino , Osteonecrosis/etiología , Osteonecrosis/patología , Osteonecrosis/fisiopatologíaRESUMEN
The critical clinical and scientific insights achieved through knowledge of in vivo musculoskeletal soft tissue strains has motivated the development of relevant measurement techniques. This review provides a comprehensive summary of the key findings, limitations, and clinical impacts of these techniques to quantify musculoskeletal soft tissue strains during dynamic movements. Current technologies generally leverage three techniques to quantify in vivo strain patterns, including implantable strain sensors, virtual fibre elongation, and ultrasound. (1) Implantable strain sensors enable direct measurements of tissue strains with high accuracy and minimal artefact, but are highly invasive and current designs are not clinically viable. (2) The virtual fibre elongation method tracks the relative displacement of tissue attachments to measure strains in both deep and superficial tissues. However, the associated imaging techniques often require exposure to radiation, limit the activities that can be performed, and only quantify bone-to-bone tissue strains. (3) Ultrasound methods enable safe and non-invasive imaging of soft tissue deformation. However, ultrasound can only image superficial tissues, and measurements are confounded by out-of-plane tissue motion. Finally, all in vivo strain measurement methods are limited in their ability to establish the slack length of musculoskeletal soft tissue structures. Despite the many challenges and limitations of these measurement techniques, knowledge of in vivo soft tissue strain has led to improved clinical treatments for many musculoskeletal pathologies including anterior cruciate ligament reconstruction, Achilles tendon repair, and total knee replacement. This review provides a comprehensive understanding of these measurement techniques and identifies the key features of in vivo strain measurement that can facilitate innovative personalized sports medicine treatment.
Asunto(s)
Ligamentos/lesiones , Ligamentos/fisiopatología , Traumatismos de los Tendones/fisiopatología , Animales , Fenómenos Biomecánicos , Humanos , Ligamentos/diagnóstico por imagen , Traumatismos de los Tendones/diagnóstico por imagen , Tendones/diagnóstico por imagen , Tendones/fisiopatología , UltrasonografíaRESUMEN
Pelvic organ prolapses (POP) notably reduces the quality of life in elderly populations due to bladder and bowel dysfunction, incontinence, and coital problems. Extracellular matrix (ECM) disorder is a pivotal event in the progression of POP, but to date, its specific underlying mechanism remains unclear. The ligaments of patients with POP and healthy controls were collected to compare the expression of Homeobox11 (HOXA11) and transforming growth factor ß (TGFß1) via immunohistochemical analysis. HOXA11 and TGFß1 were overexpressed or knocked down in fibroblast cells to explore their effects on the expression of collagen and matrix metalloproteinases (MMPs). HOXA11 and TGFß1 were greatly reduced in the ligaments of patients with POP. The overexpression and downregulation of HOXA11 and TGFß1 can mediate ECM disorder via regulating expression of collagen (Col) and MMPs. In addition, HOXA11 and TGFß1 exerted synergistic effect on the expression of Col and MMPs. The present study identified that HOXA11 and TGFß1 serve critical roles in mediating ECM disorders, which may be of clinical significance for the diagnosis and treatment of patients with POP.
Asunto(s)
Matriz Extracelular/metabolismo , Proteínas de Homeodominio/metabolismo , Prolapso de Órgano Pélvico/metabolismo , Adulto , Animales , Línea Celular , China , Colágeno/metabolismo , Matriz Extracelular/fisiología , Femenino , Fibroblastos/metabolismo , Proteínas de Homeodominio/genética , Humanos , Ligamentos/metabolismo , Ligamentos/fisiopatología , Metaloproteinasa 2 de la Matriz/metabolismo , Ratones , Persona de Mediana Edad , Factor de Crecimiento Transformador beta1/genética , Factor de Crecimiento Transformador beta1/metabolismo , Útero/metabolismoRESUMEN
Uterosacral ligaments (USLs) provide structural support to the female pelvic floor, and a loss of USL structural integrity or biomechanical function may induce pelvic organ prolapse (POP). Alterations in extracellular matrix composition and organization dictate USL mechanical function. Changes in USL microstructure and corresponding mechanical properties, however, are not fully understood, nor is it understood how microstructure and mechanics change with onset and progression of POP. This is due, in part, as USL properties are primarily characterized along a single direction (uniaxial test), whereas the USL is loaded in multiple directions simultaneously within the body. Biaxial testing permits the acquisition of biomechanical data from two axes simultaneously, and thus simulates a more physiologic assessment compared to the traditional uniaxial testing. Therefore, the objective of this study was to quantify the biaxial biomechanical properties and histological composition of the USL in post-menopausal women with and without POP at various stages. Potential correlations between tissue microstructural composition and mechanical function were also examined. Tangential modulus was lower and peak stretch higher in POP III/IV compared to non-POP and POP I/II in the main in vivo loading direction; however, no significant differences in mechanical properties were observed in the perpendicular loading direction. Collagen content positively correlated to tangential modulus in the main in vivo loading direction (r = 0.5, p = 0.02) and negatively correlated with the peak stretch in both the main in vivo (r = -0.5, p = 0.02) and perpendicular loading directions (r = -0.3, p = 0.05). However, no statistically significant differences in USL composition were observed, which may be due to the small sample size and high variability of small sections of human tissues. These results provide first step towards understanding what microstructural and mechanical changes may occur in the USL with POP onset and progression. Such information may provide important future insights into the development of new surgical reconstruction techniques and graft materials for POP treatment.
Asunto(s)
Ligamentos/fisiopatología , Prolapso de Órgano Pélvico/fisiopatología , Posmenopausia , Útero/fisiopatología , Anciano , Femenino , Humanos , Ligamentos/patología , Persona de Mediana Edad , Diafragma Pélvico/patología , Diafragma Pélvico/fisiopatología , Prolapso de Órgano Pélvico/patología , Útero/patologíaRESUMEN
BACKGROUND: The Pringle maneuver is often used in liver surgery to minimize bleeding during liver transection. Many authors have demonstrated that intermittent use of the Pringle maneuver is safe and effective when performed appropriately. However, some studies have reported that the Pringle maneuver is a significant risk factor for portal vein thrombosis. In this study, we evaluated the effectiveness of portal vein flow after the Pringle maneuver and the impact that massaging the hepatoduodenal ligament after the Pringle maneuver has on portal vein flow. MATERIALS AND METHODS: Patients treated with the Pringle maneuver for hepatectomies performed to treat hepatic disease at our hospital between August 2014 and March 2019 were included in the study (N = 101). We divided these patients into two groups, a massage group and nonmassage group. We measured portal vein blood flow with ultrasonography before and after clamping of the hepatoduodenal ligament. We also evaluated laboratory data after the hepatectomy. RESULTS: Portal vein flow was significantly lower after the Pringle maneuver than before clamping of the hepatoduodenal ligament. The portal vein flow after the Pringle maneuver was improved following massage of the hepatoduodenal ligament. After hepatectomy, serum prothrombin time was significantly higher and serum C-reactive protein was significantly lower in the massage group than in the nonmassage group. CONCLUSION: Massaging the hepatoduodenal ligament after the Pringle maneuver is recommended in order to quickly recover portal vein flow during hepatectomy and to improve coagulability.
Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Hepatectomía/métodos , Ligamentos/fisiopatología , Neoplasias Hepáticas/cirugía , Masaje/métodos , Vena Porta/fisiopatología , Recuperación de la Función/fisiología , Anciano , Femenino , Humanos , Hígado/irrigación sanguínea , Hígado/cirugía , Neoplasias Hepáticas/diagnóstico , MasculinoRESUMEN
BACKGROUND: Knee pain is a common symptom in the community. There is a wide range of conditions that can cause pain. Identifying the type and severity of the condition is important for effective management. There are several guidelines for the appropriate imaging of patients presenting with knee pain. Presentation is generally divided into a post-traumatic group and those without known trauma (including arthritis). OBJECTIVE: The aim of this article is to discuss the approach to imaging of the knee with reference to Diagnostic Imaging Pathways and illustrate some of the conditions that may be encountered. DISCUSSION: The initial workup is typically done in general practice to determine which patients require referral for specialist management and which patients can be cared for in the community. Most cases presented in this article are patients referred from primary care to a metropolitan radiology practice during a six-month period, and they represent examples of some of the more common pathologies.
Asunto(s)
Traumatismos de la Rodilla/diagnóstico por imagen , Rodilla/diagnóstico por imagen , Medicina General/instrumentación , Medicina General/métodos , Medicina General/tendencias , Humanos , Traumatismos de la Rodilla/fisiopatología , Ligamentos/diagnóstico por imagen , Ligamentos/lesiones , Ligamentos/fisiopatología , Imagen por Resonancia Magnética/métodos , Menisco/diagnóstico por imagen , Menisco/lesiones , Menisco/fisiopatología , Osteoartritis/diagnóstico por imagen , Osteoartritis/fisiopatología , Articulación Patelofemoral/diagnóstico por imagen , Articulación Patelofemoral/lesiones , Articulación Patelofemoral/fisiopatología , Radiografía/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
Engineered soft tissue products-both tendon and ligament-have gained tremendous interest in regenerative medicine as alternatives to autograft and allograft treatments due to their potential to overcome limitations such as pain and donor site morbidity. Tendon engineered grafts have focused on the replication of native tendon tissue composition and architecture in the form of scaffolds using synthetic or natural biomaterials seeded with cells and factors. However, these approaches suffer due to static culture environments that fail to mimic the dynamic tissue environment and mechanical forces required to promote tenogenic differentiation of cultured cells. Mechanical stimulation is sensed by cellular mechanosensors such as integrins, focal adhesion kinase, and other transmembrane receptors which promote tenogenic gene expression and synthesis of tendon extracellular matrix components such as Type I collagen. Thus, it is imperative to apply biological and biomechanical aspects to engineer tendon. This review highlights the origin of tendon tissue, its ability to sense forces from its microenvironment, and the biological machinery that helps in mechanosensation. Additionally, this review focuses on use of bioreactors that aid in understanding cell-microenvironment interactions and enable the design of mechanically competent tendon tissue. We categorize these bioreactors based on functional features, sample size/type, and loading regimes and discuss their application in tendon research. The objective of this article is to provide a perspective on biomechanical considerations in the development of functional tendon tissue.
Asunto(s)
Materiales Biocompatibles/química , Tendones/fisiopatología , Ingeniería de Tejidos/métodos , Animales , Fenómenos Biomecánicos , Biomimética , Biofisica/métodos , Reactores Biológicos , Cadherinas/metabolismo , Diferenciación Celular , Células Cultivadas , Colágeno/química , Colágeno Tipo I/química , Elasticidad , Matriz Extracelular/metabolismo , Regulación de la Expresión Génica , Humanos , Integrinas/metabolismo , Ligamentos/fisiopatología , Células Madre/citología , Estrés Mecánico , Tendones/metabolismo , Tendones/patología , Tenocitos/citología , Andamios del Tejido , ViscosidadRESUMEN
PURPOSE: Medial release during total knee arthroplasty (TKA) is used to correct ligament imbalance in knees with varus deformity. However, questions remain on whether residual ligament imbalance would be related to inferior clinical results. The purposes of the present study were to measure the intraoperative joint gap and to evaluate the effect of intraoperative soft tissue condition on the new Knee Society Score (KSS 2011) at 2-year follow-up, without the maneuver of additional medial release to correct the asymmetrical gap balance. METHODS: Varus-valgus gap angle and joint gap were measured using a tensor device without medial release for 100 knees with preoperative varus deformity. The knees were categorized according to the varus-valgus gap angle and the laxity. The preoperative and postoperative clinical outcomes using KSS 2011 were compared between the groups. RESULTS: The average varus-valgus angles had a residual imbalance of 2.8° varus and 1.3° varus in extension and flexion, respectively. In comparison, according to varus-valgus joint gap angle and knee laxity in extension and flexion, no significant differences were found in postoperative range of motion and subscale of KSS 2011 among the groups. CONCLUSION: Intraoperative asymmetrical joint gap and physiological laxity do not affect early clinical results after TKA. LEVEL OF EVIDENCE: III.