Contribution of cartilage to size and shape of radial head circumference: magnetic resonance imaging analysis of 78 elbows.

BACKGROUND: The aims of our study were to quantify cartilage thickness at the minimum and maximum diameters of the radial head circumference and to investigate its influence on the size and shape of the proximal radius. METHODS: We analyzed high-definition magnetic resonance imaging scans of 78 healthy elbows in 19 men and 20 women, with a mean age of 28 (21-32) years. All measurements were estimated in the axial plane just distal to the fovea radialis. Maximum and minimum bone diameters, maximum and minimum total diameters (including cartilage thickness), and cartilage thickness were calculated. Cartilage thickness was measured at 4 different points: (1) at the articular side of the maximum diameter (point A), (2) at the nonarticular side of the maximum diameter (point B), (3) at the medial side of the minimum diameter (point C), and (4) at the lateral side of the minimum diameter (point D). Pearson correlation and t test were used for the statistical analysis. RESULTS: Mean maximum and minimum bone diameters and maximum and minimum total diameters were 22.2, 21.5, 24.0, and 23.2 mm, respectively. All differences between diameters were statistically significant. Mean cartilage thickness at points A, C, and D was 1.7, 0.8, and 0.8 mm, respectively. No measurable cartilage thickness was found at point B. No significant correlation was found between bone diameters and cartilage thickness. CONCLUSIONS: Cartilage surface significantly increases and modifies the size and shape of the radial head. The observation that cartilage thickness varies between subjects and does not correlate with bone parameters suggests that the diameters of the radial head cannot be inferred from indirect measurements of dry bones or radiographs.

Normal Magnetic Resonance Imaging Anatomy of the Anterolateral Knee Ligament With a T2/T1-Weighted 3-Dimensional Sequence: A Feasibility Study.

PURPOSE: The anatomy of the lateral knee compartment has been recently further explored with description of the anterolateral knee ligament (ALL). The purpose of this study was to confirm the presence of ALL on cadaveric knees and to describe its normal anatomy in young healthy volunteers, utilizing a high-resolution 3-dimensional (3D) pulse sequence. METHODS: Dissection was performed on 9 cadaveric knees in order to confirm the presence of ALL. Conventional 2-dimensional sequences of 10 knees at 1.5 T and 10 knees at 3 T, with a slice thickness of 2-4 mm, were reviewed for the presence of ALL. A 3D T2/T1-weighted gradient echo sequence (constructive interference in steady state [CISS]), yielding in-plane resolution of 0.4 mm × 0.4 mm × 0.4 mm, was applied in 14 healthy volunteers (26 knees). All 3D images were manipulated using multiplanar reconstruction (MPR) and the presence and width of ALL were recorded. RESULTS: Cadaveric dissection disclosed the presence of ALL in 8 of 9 knees. Conventional knee MR imaging depicted ALL only on coronal images (18 of 20) whereas the CISS revealed ALL on 24 of 26 studied knees (92.3%). ALL has a mean thickness of 1.1 ± 0.27 mm measured on coronal MR images. CONCLUSIONS: ALL can be thoroughly assessed in young healthy individuals with the use of high-resolution 3D MR imaging with MPR at 1.5 T.

The ulnar greater sigmoid notch "coverage angle": bone and cartilage contribution. Magnetic resonance imaging anatomic study on 78 elbows.

BACKGROUND: To study the degree of coverage provided by the greater sigmoid notch (GSN) to the humeral trochlea, as well as the contribution of the olecranon and coronoid process cartilage tips to this angle, and its variations. METHODS: We recruited 39 healthy volunteers, comprising 19 women and 20 men, with a mean age of 28 years (range, 21-32 years). High-definition magnetic resonance images were obtained for the right and left elbows. Four angles were measured on the sagittal plane passing through the coronoid and olecranon tips: angle A, identified by 2 lines from the trochlea center to the olecranon bone-cartilage junction and olecranon cartilage tip; angle B, identified by 2 lines from the trochlea center to the olecranon and coronoid bone-cartilage junction; angle C, identified by 2 lines from the trochlea center to the coronoid bone-cartilage junction and coronoid cartilage tip; and GSN coverage angle (GSN-ca), defined as the sum of angles A, B, and C. Pearson correlation tests, t tests, and intraclass correlation coefficients were used for statistical analyses. RESULTS: The mean angle A, angle B, and angle C values were 6° (range, 2°-12°), 182° (range, 153°-204°), and 9° (range, 2°-16°), respectively. No correlations were found between these 3 angles. The mean GSN-ca was 198° (range, 167°-222°), and the GSN-ca was less than 180° in 8% of the cases. No significant differences emerged for side or gender or for total length of the ulna. CONCLUSION: The GSN showed significantly different shapes on the sagittal plane that we defined as closed type when the GSN-ca was greater than 180° (92%) and as open type when the GSA-ca was less than 180° (8%). The cartilage tip contribution varied and was not correlated with that of bone.

Posterior root of lateral meniscus: the detailed anatomic description on 3T MRI.

BACKGROUND: Although there have been some attempts to reveal the anatomy of the posterior root of the lateral meniscus (PRLM) through cadaver studies, arthroscopy, or imaging, it has not yet been described fully. PURPOSE: To describe clearly the unique features of the PRLM, including its course, configuration, and size, using 3.0-T magnetic resonance imaging (MRI). MATERIAL AND METHODS: A total of 105 knee 3.0-T MR examinations of 103 patients with arthroscopically proven intact PRLM were reviewed retrospectively. Based on fat-saturated, proton-density-weighted (PDW) axial/coronal images and PDW sagittal images, the course, configuration, and attachment sites of the PRLM were evaluated. RESULTS: The majority of PRLM (76.2%) had two attachment sites: the medial tubercle along the intertubercular crest, just posteromedial to the tibial attachment of the anterior cruciate ligament (ACL), and the posterior slope of the lateral tubercle. The remaining cases (23.8%) had a solitary insertion on the intertubercular area (17 cases), or the posterior slope of the lateral tubercle (eight cases). The PRLM of the intertubercular area appeared as a dark signal line parallel to the tibial plateau on the mid-sagittal image and dark signal foci traversing the intertubercular crest on contiguous coronal images. CONCLUSION: The PRLM inserts mainly in the intertubercular area with a thin, long anterior extension to the point just posteromedial to the tibial attachment of the ACL. It is well delineated on PDW 3.0-T MRI as a dark signal line parallel to the tibial plateau on mid-sagittal images and dark signal foci traversing the intertubercular crest on contiguous coronal images.

Are gender-specific femoral implants for total knee arthroplasty necessary?

The purpose of this study was to determine the effect of gender on epiphyseal morphology and using this information to determine if an implant product line with a single width provides sufficient bone coverage for the entire population of knees being replaced. Morphology of the distal femoral epiphysis from 420 continuous knees was acquired with a surgical navigation system during primary TKA. A three-dimensional model of the distal femur was generated and used to determine the anterioposterior (AP) and mediolateral (ML) dimensions on 19 different virtual knee sections. Female knees had smaller AP and ML dimensions than male knees. The ML width of the distal femoral epiphysis was associated with femur length, not gender. Measurements derived from surgical navigation confirm that distal femoral epiphysis dimensions are related to femur length only independently of gender.

Jaws of knowledge: an analysis of temporomandibular joint insights in dental training-a quasi-experiment study.

Objectives: To access the knowledge of undergraduate and postgraduate students of the dental college on basic anatomy, physiology, clinical examination, and pathology of the temporomandibular joint (TMJ). Materials and Methods: A total of 610 undergraduate and postgraduate students of dental college, were included in this study. The questionnaire was pretested for validation and distributed online through Google forms. Results: A pairwise comparison showed that the percentage of correct answers for interns significantly differed from that of IV Bachelor of Dental Surgery (P=0.050) and postgraduate students (P=0.048) (below average: up to 6 correct answers, good: 7-11 correct answers, excellent: 12 or more correct answers). Conclusion: TMJ diseases are common in daily life but frequently go undiagnosed and untreated due to a lack of clinical expertise. This demonstrates the necessity of providing instructions that give students in-depth knowledge and abilities for TMJ issues in clinical practice.

Restoring Hip Joint Anatomy With the Robotic Arm-Assisted System in Hip Fractures: Expanding the Applications for Hip Surgery.

Total hip arthroplasty (THA) has improved the life quality of osteoarthritic patients, yet challenges persist. The robotic arm-assisted system, integrated into THA, aims to refine implant positioning, enhance precision, reduce errors, and restore the hip joint's anatomy, including hip center, femoral offset, and limb length. We present the first use of the system for the treatment of a subcapital femoral neck hip fracture. A 62-year-old female suffering a left subcapital hip fracture underwent THA using the robotic arm-assisted system. After acetabular registration, accurate component placement was achieved, and a 9-mm limb length discrepancy was addressed. The patient had an unremarkable recovery with a reported Harris hip score of 96.5 at 18 months postsurgery. Robotic-guided navigation in THA, as showcased in this case, ensures accurate implant positioning by restoring the anatomical features of the hip joint. Its potential extends beyond conventional applications, hinting at future use in trauma, revision, and oncology cases. While promising, future adaptations should consider soft tissue dynamics to ensure joint stability and overall success.

A Comparison of the Change in Mandibular Condyle/Fossa Relationship with the Use of Anatomic Teeth and Semi-anatomic Teeth in Complete Denture Prosthesis.

The association between dental occlusion and mandibular condyle/fossa relation has long been debated and still remains one of the most controversial issues in Prosthodontics. The aim of the study was to evaluate the effect of two different tooth forms on the condyle/fossa relation recorded during jaw relation process. Twenty edentulous patients were selected with good neuromuscular control. For each patient two pairs of dentures were fabricated with anatomic teeth and semi-anatomic teeth. Condylar position was recorded using a digital volume tomography (DVT) following the process of jaw relation (following extra oral tracing). Subsequent laboratory remounting, the denture insertion was done and DVTs were taken again for both the dentures separately. Two methods were used to evaluate the condyle/fossa relation viz. (1) Zhang's method (2) Brewka's method. The obtained values were then subjected to statistical analysis. The statistical significance was set as at 0.05 %. The mandibular concentricity were analysed during the process of jaw relation and after the insertion of dentures with the two different tooth forms. Statistical analysis indicated that no statistically significant difference of the influence of different posterior tooth forms on the condyle/fossa relation recorded during jaw relation (p < 0.05). Thus within limitations of this study it was concluded that the condyle/fossa relation established during jaw relation does not change with the change in posterior tooth form used.

Challenges in osteoarthritis treatment.

Osteoarthritis (OA) is the most common form of arthritis and a degenerative joint cartilage disease that is the most common cause of disability in the world among the elderly. It leads to social, psychological, and economic costs with financial consequences. The principles of OA treatment are to reduce pain and stiffness as well as maintain function. In recent years, due to a better understanding of the underlying pathophysiology of OA, a number of potential therapeutic advances have been made, which include tissue engineering, immune system manipulation, surgical technique, pharmacological, and non-pharmacological treatments. Despite this, there is still no certain cure for OA, and different OA treatments are usually considered in relation to the stage of the disease. The purpose of the present review is to summarize and discuss the latest results of new treatments for OA and potential targets for future research.

Comparison of the morphology of the anterior cruciate ligament and related bony structures between pigs and humans.

Introduction: Pigs are widely used for clinical research on the anterior cruciate ligament (ACL) because of the similarity of the knee structure to the human knee. But evidence to support the suitability of using porcine samples to guide clinical practices is limited. This study aims to explore the qualitative and quantitative morphological features of the porcine knee and ACL, and to compare these with data on humans reported in literature. Methods: Nineteen porcine knees were used for this study. The bone structures were measured on coronal X-ray images. The length of the ACL was measured using a caliper. The ACL bone insertion sites were marked and measured on a digital photograph. The lengths of the long and short axis of the ACL isthmus were measured on the X-ray microscopy reconstructed images. The outcomes were compared with previously reported data on humans using an abstract independent-samples T test. Results: Qualitative observation indicated a similar location, orientation and general morphology of the porcine ACL to human ACLs. The major difference was the location of the ACL tibial insertion with respect to the anterior horn of the lateral meniscus (AHLM). The porcine ACL was split into AM and PL bundles by the AHLM, while the AHLM was adjacent to the anterolateral border of the ACL tibial insertion in human knees. The quantitative comparison showed no significant difference between the human and porcine ACL in terms of the length of the ACL, the width of the femoral condyle and tibial plateau, and the tibial interspinal width. However, the CSA, the lengths of the long and short axis of the ACL isthmus, and the femoral and tibial insertion areas of the porcine ACL were all significantly larger than the reported features in human knees. Conclusion: The location, orientation and basic morphology of the porcine ACL and knee are similar to humans. However, the two-bundle structure is more distinct in a porcine ACL, and the dimensions of the porcine ACL are generally larger. This study may provide useful information to researchers when assessing the feasibility and limitations of using porcine samples for research on the human ACL and knee.

Inflammatory disease of the costotransverse joints: US evaluation in 15 symptomatic patients.

The costotransverse joints (CTJs) are small arthrodial joints which articulate with the costal tuberosity on the transverse process of the thoracic vertebrae. CTJs are composed of oval-shaped facets with a major axis, vertical at the upper vertebrae and almost horizontal at the lower vertebrae. This position explains the different movements of the ribs: the cranial ribs move on the sagittal plane and the caudal ribs on the transverse plane. Movements in directions other than these usual CTJ spatial planes can cause inflammation resulting in a stinging pain in the space between the scapula and thoracic spine. We studied 15 subjects with paravertebral pain compatible with CTJ pathology. Mean age was 29 years, 11 females/4 males. In 12 patients, the non-dominant limb was affected. US imaging was carried out using linear 12 MHz and 9 MHz probes. Scanning was performed following the long axis of the rib (transverse plane) and the short axis (sagittal plane). Sagittal scanning is the method of choice for detection of possible joint effusion and comparison with undamaged joints above and below. US identified joint effusion correlating with the site of pain in all patients. Thickening of the posterior costotransverse capsular ligament was detected in six patients mainly affecting the first thoracic vertebrae. Power Doppler showed intraarticular hypervascularization in four patients. US imaging should be performed as a first-line examination in the evaluation of patients with stinging pain in the paravertebral region. US evidence of effusion within the joints is a sure sign of involvement of these structures.

Localization of Hand and Wrist Anatomic Structures Among Physical Medicine and Rehabilitation Residents: Implication of Ultrasonography in Palpation Skill Verification.

Objective: The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification. Methods: PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US. Results: Overall palpation accuracy for 16 joint line and soft tissue structures was 40.6%. There was no significant difference in palpation accuracy with advanced educational level (37.5% in PGY-2, 33.8% in PGY-3, 50% in PGY-4, p = 0.12). The percentage of combined accurate palpation and less than one centimeter error in accurate palpation revealed a significant improvement along the advancement of PGY training (50%, 61.3%, 69.8% in PGY-2, 3, 4 respectively, p = 0.01). Conclusions: This study demonstrated an overall suboptimal accuracy of hand and wrist palpation skills by PM&R residents and a need to improve palpation skills among PM&R residents.

Prediction of time to prosthesis implantation as a function of joint anatomy in patients with developmental dysplasia of the hip.

BACKGROUND: Developmental dysplasia of the hip (DDH) can lead to pain and premature secondary osteoarthritis at an early stage. Joint-preserving osteotomy is an established solution to this problem. In contrast, a conservative approach would result in pain persistence, ultimately raising the patients question for a possible date of expected prosthesis implantation. The aim of the study was to identify the relationship between the dysplastic hip anatomy and the time of prosthesis implantation in order to enable prognostic predictions in younger patients with symptomatic DDH. MATERIALS AND METHODS: Data from 129 hips who received THA due to secondary DDH osteoarthritis were evaluated. The preoperative hip anatomy was evaluated for AI and LCE angle. Multiple linear regression analyses were then used to correlate the influence of these parameters with the patient's age at the time of surgery. In addition, a graphical relationship was derived by the method of power least squares curve fitting with second-degree polynomials. RESULTS: The mean age for THA was 54.3 ± 11 years. The time of surgery correlated significantly with LCE (0.37) and AI (- 0.3) (p < 0.001). The mean age of patients with LCE angle ≤ 10° was 41.9 ± 14.0 years, for LCE 11-20° 52.7 ± 9.5 years, and for LCE 21-30° 57.0 ± 10.3 years. The following formula could then be determined for the calculation of the potential patient age at the time of THA as a function of LCE angle: age pTHA = 40.2 + 0.8 × LCE angle - 0.01 × (LCE angle)2. CONCLUSION: A significant correlation between the extent of dysplasia and the time of prosthesis implantation was identified. In particular, the LCE and the AI correlated strongly with the time of implantation. The more dysplastic the angles were, the sooner the THA was necessary. Using the calculations presented in this study, the probable age of prosthesis implantation can be prognosticated and included in a counseling session about treatment options for DDH.

Amendment of the OMERACT ultrasound definitions of joints' features in healthy children when using the DOPPLER technique.

BACKGROUND: Recently preliminary ultrasonography (US) definitions, in B mode, for normal components of pediatric joints have been developed by the OMERACT US group. The aim of the current study was to include Doppler findings in the evaluation and definition of normal joint features that can be visualized in healthy children at different age groups. METHODS: A multistep approach was used. Firstly, new additional definitions of joint components were proposed during an expert meeting. In the second step, these definitions, along with the preliminary B-mode-US definitions, were tested for feasibility in an exercise in healthy children at different age groups. In the last step, a larger panel of US experts were invited to join a web-based consensus process in order to approve the developed definitions using the Delphi methodology. A Likert scale of 1-5 was used to assess agreement. RESULTS: Physiological vascularity and fat pad tissue were identified and tested as two additional joint components in healthy children. Since physiological vascularity changes over the time in the growing skeleton, the final definition of Doppler findings comprised separate statements instead of a single full definition. A total of seven statements was developed and included in a written Delphi questionnaire to define and validate the new components. The final definitions for fat pad and physiological vascularity agreed by the group of experts reached 92.9% and 100% agreement respectively in a web survey. CONCLUSION: The inclusion of these two additional joints components which are linked to detection of Doppler signal in pediatric healthy joints will improve the identification of abnormalities in children with joint pathologies.

Interprofessional approach for teaching functional knee joint anatomy.

Profound knowledge in functional and clinical anatomy is a prerequisite for efficient diagnosis in medical practice. However, anatomy teaching does not always consider functional and clinical aspects. Here we introduce a new interprofessional approach to effectively teach the anatomy of the knee joint. The presented teaching approach involves anatomists, orthopaedists and physical therapists to teach anatomy of the knee joint in small groups under functional and clinical aspects. The knee joint courses were implemented during early stages of the medical curriculum and medical students were grouped with students of physical therapy to sensitize students to the importance of interprofessional work. Evaluation results clearly demonstrate that medical students and physical therapy students appreciated this teaching approach. First evaluations of following curricular anatomy exams suggest a benefit of course participants in knee-related multiple choice questions. Together, the interprofessional approach presented here proves to be a suitable approach to teach functional and clinical anatomy of the knee joint and further trains interprofessional work between prospective physicians and physical therapists as a basis for successful healthcare management.

Anatomical variations of the trochlear notch angle: MRI analysis of 78 elbows.

BACKGROUND: Little is known about the anatomical variations of the trochlear notch angle, nor do we know whether the cartilaginous layer modifies the trochlear bony contour. Our aim was to assess the variability of the bony and cartilaginous trochlear notch angles. MATERIALS AND METHODS: We assessed 78 healthy elbows (39 patients, 19 females and 20 males) with a mean age of 28 years (range 21-32). High-definition MRI coronal scans at the level of the flexion-extension axis were performed. The cartilage thickness, the notch angle, and trochlear width were calculated at the level of the deepest point of the trochlear sulcus, the edge of the lateral and medial ridge. Patient height was used as indirect measurement of humerus length. Pearson correlation and Student's t tests were performed. RESULTS: Mean cartilage thickness was 1.00 mm (range 0.62-1.83), with significant differences between the medial trochlear ridge and the other landmarks. The notch angle ranged from 124° to 156° (mean 142°) with no differences between the bony and cartilage layers. Trochlear width ranged from 1.57 to 2.75 cm (mean 2.24) and correlated with humerus length. No correlation emerged between the trochlear notch angle, trochlear width, or humerus length. The only significant difference between sexes was the width value, with a wider trochlea in males. CONCLUSIONS: The trochlear notch angle varies considerably, determining anatomical variations in trochlear shape which ranges from less concave to more concave types. Moreover, the cartilaginous layer does not modify this angle at the level examined. These findings may be relevant to anatomical implant design for distal humerus hemiarthroplasty.

POSTEROSUPERIOR SURGICAL ACCESS ROUTE FOR TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS: RESULTS FROM 84 SURGICAL CASES.

OBJECTIVE: To evaluate the results from surgical treatment of 84 cases of acute acromioclavicular dislocation, using a posterosuperior access route. METHODS: Eighty-four cases of acute acromioclavicular dislocation (grade III in the Allman-Tossy classification) operated between November 2002 and May 2010 were evaluated. The patients' mean age was 34 years. The diagnoses were made using clinical and radiographic evaluations. The patients were operated by the same surgical team, within three weeks of the date of the trauma, using a posterosuperior approach to the shoulder to access the top of the base of the coracoid process for placement of two anchors, which were used in reducing the dislocation. The minimum follow-up was 12 months. The postoperative clinical-radiographic evaluation was done using the modified Karlsson criteria and the University of California at Los Angeles (UCLA) score. RESULTS: 92.8% of the 84 patients treated presented good or excellent results, and 7.2% presented fair or poor results, using the UCLA assessment score. According to the modified Karlsson criteria, 76.2% were assessed as grade A, 17.9% as grade B and 5.9% as grade C. CONCLUSION: The posterosuperior access route to the shoulder is a new option for accessing the coracoid process and treating acromioclavicular dislocation, with clinical and radiographic results equivalent to those in the literature.

A three-dimensional anatomy of the posterolateral compartment of the knee: the use of a new technology in the study of musculoskeletal anatomy.

BACKGROUND: Recently, an interest has developed in understanding the anatomy of the posterior and posterolateral knee. The posterolateral compartment of the knee corresponds to a complex arrangement of ligaments and myotendinous structures. Undiagnosed lesions in this compartment are the main reason for failure of the anterior and posterior cruciate ligament reconstructions. Understanding the anatomy of these structures is essential to assist in the diagnosis and treatment of these lesions. The aim of this study was to better understand the relationship between these structures of the knee using three-dimensional technology. METHODS: Ten knees were included from cadaver lower limbs of adult patients. The skin and subcutaneous tissue were removed leaving only the muscle groups and ligaments. The neurovascular bundles and their ramifications were preserved. Images were acquired from the dissections using a Nikon D40 camera with AF-S Nikkor 18-55 mm (1:3.5 5.6 GII ED) and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images were processed using Callipyan 3D and AnaBuilder software, which transforms the two images into one anaglyphic image. RESULTS: During the dissection of the knees, twelve pictures were acquired and transformed into anaglyphic images. CONCLUSION: The use of three-dimensional images in this study demonstrates that this technique is useful to improve the knowledge in anatomy of the knee as well as for knee reconstruction surgery.