Effects of chronic ankle instability after grade I ankle sprain on the post-traumatic osteoarthritis.

BACKGROUND: Untreated acute ankle sprains often result in chronic ankle instability (CAI) and can ultimately lead to the development of post-traumatic osteoarthritis (PTOA). At present, a typical animal model of ankle instability in mice is established by transecting the ligaments around the ankle joint. This study aimed to establish a grade I acute ankle sprain animal model by rapid stretching of peri-ankle joint ligaments. Furthermore, we tried to explore the pathophysiological mechanism of ankle osteoarthritis. METHODS: In all, 18 male C57BL/6 J mice (7 weeks) were randomly divided into three groups: calcaneofibular ligament (CFL) laxity group, deltoid ligament (DL) laxity group, and SHAM group. One week after the surgical procedure, all mice were trained to run in the mouse rotation fatigue machine daily. The mice were tested on the balance beam before surgery and three days, 4 weeks, 8 weeks, and 12 weeks after surgery. Footprint analyses were performed on each mouse before surgery and 12 weeks after surgery. Micro-CT scanning was then performed to evaluate the degeneration of ankle joints and histological staining was performed to analyze and evaluate PTOA caused by ankle joint instability. RESULTS: After surgery, the mice in the CFL and DL laxity groups took longer to cross the balance beam and slipped more often than those in the SHAM group (p < 0.05). The step length and width in the CFL and DL laxity groups were significantly shorter and smaller than those in the SHAM group 12 weeks after surgery (p < 0.05). There was a significant increase in the bone volume fraction (BV/TV) in the CFL and DL laxity groups compared with the SHAM group (p < 0.05). Histological staining results suggested obvious signs of PTOA in the CFL and DL laxity groups. CONCLUSIONS: Based on CFL and DL laxity in a mouse ankle instability model, this study suggests that grade I ankle sprain can contribute to chronic ankle instability, impair motor coordination and balance, and eventually lead to PTOA of ankle with significant degeneration of its adjacent joints.

Cervical motion analysis using wearable inertial sensors to patients with cervical ossification of posterior longitudinal ligament.

This study aimed to clarify cervical kinematics during daily activities, including level walking and stair ascending, in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL). Eighteen patients with myelopathy caused by C-OPLL and 18 healthy controls were recruited to participate in the study. The sagittal cervical kinematics during level walking and stair ascent were quantitatively assessed using a motion analysis system based on wearable inertial sensors. The Japanese Orthopaedic Association score, Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and deep sensation in the lower extremities were assessed in all participants. Nine of 18 patients with C-OPLL presented with deep sensory disturbances. Patients with C-OPLL with deep sensory disturbances exhibited different sagittal plane cervical motion patterns than healthy controls during level walking and stair ascent. During the first phase of stair ascent, both patients with C-OPLL and healthy controls flexed their necks to the same degree; however, during the middle and final phases of stair ascent and all phases of level walking, the mean cervical flexion angle of patients with C-OPLL with deep sensory disturbances was significantly higher than that of patients with C-OPLL without deep sensory disturbance and healthy controls. Our data suggest that patients with C-OPLL presenting with deep sensory disturbances are likely to walk with their necks flexed and gaze downward to observe their steps throughout their daily lives. This habitual neck posture may lead to a vicious cycle of cervical kyphosis and worsening of compressive myelopathy.

In non-elite athletes, women are more likely to return to sports after anterior cruciate ligament reconstruction: a retrospective cohort study.

BACKGROUND: The desire to return to sports (RTS) and return to performance at preinjury level (RTSP) is a common motivator for athletes undergoing anterior cruciate ligament (ACL) reconstructive surgery. However, for non-elite athletes little is known about the patient and surgical variables influencing RTS/RTSP. Purpose was to determine which patient or surgical variables had an effect on RTS/RTSP in non-elite athletes. We also analyzed whether patients that RTS and RTSP have more confidence in the knee and less difficulty pivoting. METHODS: A single-centre retrospective cohort study. All patients who had undergone primary hamstring ACL reconstruction within a 5-year period were included. Patients were asked about their pre- and postoperative sports participation using the Tegner Activity Score (TAS) as well as about their RTS/RTSP. Confidence in the knee and difficulty with pivoting were asked about. To determine the potential adverse effect of patient variables at the time of surgery (sex, age, height, weight, TAS preop) and surgical variables (graft diameter, surgical technique, concomitant injury) influencing RTS/RTSP, univariate and multivariate logistic regression analysis were used. RESULTS: 370 ACL reconstructions were included. Average follow-up was 4.6 years (SD 1.4). RTS rate was 65% and RTSP 43%. Median preinjury TAS was 7 (Q1:6, Q3:8)), postoperative 6 (Q1:4, Q3:7). Multivariate analysis showed that women were more likely to RTS (OR 2.40, 1.16-4.97). A lower preinjury TAS (OR 0.80, 0.67-0.95) resulted in higher RTSP levels. None of the surgical variables had a significant influence on RTS or RTSP. Patients who returned to sports or to preinjury-level performance displayed significantly more confidence in the operated knee and less difficulty pivoting than non-returning patients. CONCLUSION: Our study shows that 65% of non-elite athletes with an ACL reconstruction returned to sports, 43% at preinjury level. Women were over twice more likely to RTS than men. Preinjury TAS significantly influences RTSP, with a lower preinjury TAS leading to a higher percentage of RTSP. Patients returning to both scored better in their self-reported confidence in the knee and difficulty pivoting than non-returning patients. LEVEL OF EVIDENCE: Retrospective cohort III.

A systematic review of the outcomes of partial ulnar collateral ligament tears of the elbow in athletes treated non-operatively with platelet-rich plasma injection.

Background: This study aimed to analyze the effects of platelet-rich plasma (PRP) for partial ulnar collateral ligament (UCL) tears in athletes and predicted positive outcomes. Methods: The researchers systematically reviewed the PubMed, Cochrane CENTRAL, MEDLINE, Scopus, and Google Scholar databases to identify studies with clinical outcomes of PRP for partial UCL tears. They excluded studies that did not stratify data by tear type or included surgical management. Results: Five studies with 156 patients were included. The timing, amount, platelet concentration, type, and number of PRP injections were highly variable among the studies. However, 75% (n = 97/127) of athletes returned to sport (RTS) at a weighted average of 82.1 days (37-84) after PRP injection. One study showed significant improvements in patient-reported outcomes. Two studies showed positive outcomes in the modified Conway scale, complete reconstitution of the UCL in 87% of patients on MRI, and significant improvement in the humeral-ulnar joint space after PRP injection via ultrasound. The Coleman methodology score (CMS) averaged 48/100, indicating an overall poor quality of evidence. Conclusion: This review demonstrates favorable RTS, clinical, and radiographic outcomes in patients receiving PRP for partial UCL tears, but the literature remains heterogeneous and of low quality. Level of Evidence: III.

Late (≥60 years old) and middle adulthood (40-59 years old) patients achieve similar improvement in patient-reported outcomes following ACL reconstruction.

PURPOSE: This study aimed to compare the range of motion (ROM), surgical outcomes, and patient-reported outcome measures (PROMs) following anterior cruciate ligament (ACL) reconstruction outcomes in patients 60 years or older at the time of surgery to 40- to 59-year-old patients. METHODS: In this retrospective cohort study from 2015 to 2022, a 3:1 propensity match was performed to match late adulthood patients (≥60 years old) undergoing ACL reconstruction with middle adulthood (40-59 years old) ACL reconstruction patients. Patients were matched based on sex, ACL graft utilized and concomitant procedures performed during ACL reconstruction. Statistical analysis compared demographics, preoperative injury management, surgical outcomes, PROMs, and minimal clinical important difference (MCID) and substantial clinical benefit (SCB) achievement rates for all ACL reconstruction patients included. RESULTS: Twenty late adulthood and 60 middle adulthood patients who underwent ACL reconstruction were included in the final cohort. Patients who were 60 years or older experienced no difference in reoperation rate (n.s.), incidence of retears (n.s.) or ROM (n.s.) at 1 year post-operatively. There were also no differences in International Knee Documentation Committee (ΔIKDC) (31.3 ± 19.1 vs. 34.2 ± 18.2, n.s.) or ΔPCS-12 (12.4 ± 9.8 vs. 12.9 ± 10.8, n.s.) scores at 1 year post-operatively. Furthermore, the younger and older patient cohorts demonstrated similar rates of achieving the MCID (80.0% vs. 83.3%, n.s.) and SCB (50.0% vs. 61.7%, n.s.) scores for IKDC. CONCLUSION: Patients 60 years or older and 40- to 59-year-old patients demonstrated similar outcomes after undergoing ACL reconstruction with allograft. This study concludes that ACL reconstruction in late adulthood can still be a successful treatment option and should allow surgeons to feel more comfortable when performing indicated surgical intervention for older patients who experience an ACL tear. LEVEL OF EVIDENCE: Level III, Therapeutic III, retrospective cohort study.

Posterior Tibial Slope Measured on Plain Radiograph Versus MRI and Its Association With Revision Anterior Cruciate Ligament Reconstruction: A Matched Case-Control Study.

BACKGROUND: Posterior tibial slope (PTS) has been identified as a possible modifiable risk factor for anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) failure. However, the findings in the literature are inconsistent. This may be explained by several different reasons, including different measurement methods, differing definitions of ACLR failure, and possible inclusion of suboptimal films. PURPOSE: To compare PTS values obtained using plain radiographs (XR-PTS) in a young (≤21 years of age), skeletally mature patient population with those obtained using magnetic resonance imaging (MRI), as well as to quantify the number of suboptimal lateral knee radiographs obtained across an integrated health care system and determine the potential effect of including these radiographs on summary statistics of XR-PTS. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Skeletally mature adolescent and young adult patients ≤21 years of age were identified from the ACLR registry of Kaiser Permanente. The cases of concern were patients requiring revision ACLR. The controls were patients who had an ACLR and did not require a revision procedure. The XR-PTS measurements were made on plain radiographs by a single blinded reviewer. These results were compared with measurements obtained using MRI. The quality of each plain radiograph was evaluated by measuring posterior/distal femoral condylar overlap and length of tibial diaphysis captured on the radiograph. Summary statistics with and without inclusion of measurements made on suboptimal radiographs were calculated. RESULTS: Of the initial 634 patients with ACLR (317 case-control pairs), 561 (88.5%) had radiographs available and were included for the analysis comparing radiograph to MRI slope measurements. For the evaluation of slope between case and control pairs with radiograph information available, there were 257 case-control pairs; there were 124 pairs when those with suboptimal radiographs were excluded. There was no difference in MRI-measured lateral tibial posterior slope or medial tibial posterior slope for the 257 case-control pairs with XR-PTS information and for the 124 pairs with optimal radiographs. XR-PTS in the revision cohort was significantly steeper than in the control group when suboptimal radiographs were included in the analysis. There was no difference when patients with suboptimal radiographs were excluded. PTS measurements made on plain radiographs were larger than those made on MRI. There was a poor correlation between measurements made using these 2 modalities (r = 0.22 for radiograph and medial PTS). CONCLUSION: This study did not find a significantly steeper XR-PTS in patients who had to undergo revision ACLR when suboptimal radiographs were not included in the analysis. The present study's results confirmed the findings from a previous study of the same patient population that used MRI. However, there was poor correlation between PTS measurements made using plain radiograph and MRI.

Association between diabetes mellitus and ossification of the spinal ligament: a systematic review and meta-analysis.

PURPOSE: Ossification of the spinal ligament (OSL) is a spinal disorder characterized by abnormal bone formation in the spinal ligaments. Although clinical studies suggested that diabetes mellitus (DM) was associated with OSL, no consistent conclusion was drawn about the relationship between DM and the onset of OSL. METHODS: Studies with data on DM and OSL were retrieved by searching PubMed, Embase, Web of Science, and Cochrane Library from inception to August 23, 2023. Pooled estimates of odds ratios (ORs) with 95% confidence interval (95% CI) were calculated using random-effects models. Statistical analyses were performed by R 4.2.2 software. RESULTS: A total of 17 studies with 70,945 participants were included. The quantitative findings demonstrated that a higher risk of DM was related to the onset of OSL (OR = 2.19, 95% CI: 1.27-3.79, p = 0.008). Subgroup analysis showed a higher rate of DM in OSL patients from Japan (OR = 3.29, 95% CI: 1.51-7.17, [Formula: see text] = 0.009) than from other regions. Moreover, patients with OSL had a higher rate of DM in age < = 60 group (OR = 3.46, 95% CI: 1.14-10.50, p = 0.035) than age > 60 group (OR = 2.26, 95% CI: 1.07-4.79, p = 0.036). CONCLUSION: DM is significantly associated with an increased risk of developing OSL, especially in Japanese and people under 60 years old. Further studies with more participants were warranted to confirm the findings and provide new insights into the prevention and treatment of OSL.

Importance of gap evaluation in the ossification of posterior longitudinal ligament lesions using 3-dimensional computed tomography.

BACKGROUND CONTEXT: Evaluating the gaps within the ossification of the posterior longitudinal ligament (OPLL) lesions, which may contribute to neurological symptoms, using conventional imaging techniques is challenging. OBJECTIVE: This study aimed to investigate the importance of evaluating gaps using 3-dimensional computed tomography (3D-CT) and their association with the occurrence of magnetic resonance imaging (MRI) T2 high intensity in the spinal cord. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Retrospective analysis of 116 patients diagnosed with cervical OPLL. OUTCOME MEASURES: Presence of gaps in OPLL, presence of T2 high intensity in the cervical spinal cord, and OPLL thickness were evaluated. METHODS: Lateral X-ray, CT, and reconstructed 3D-CT images were reviewed to assess lesion characteristics and the presence of gaps. MRI was used to evaluate the change in spinal cord signal intensity. The relationship among gap presence, lesion morphology, and MRI T2 high intensity in the spinal cord was examined. RESULTS: A significant difference in gap detection accuracy was observed between CT and 3D-CT (p=.0054). CT demonstrated false-positive results in the detection of gaps as compared with 3D-CT. The presence of gaps was significantly associated with an increased likelihood of MRI T2 high intensity in the spinal cord (p=.037). Patients with thicker lesions and smaller space available for the spinal cord (SAC) were more likely to exhibit T2 high intensity. Meanwhile, patients with gaps co-occurring with T2 high intensity exhibited significantly thinner lesions (p=.011) and larger SACs (p=.0002). Patients with gaps had a significantly lower JOA scores (p=.0035), which indicates that patient with gaps are likely to exhibit more severe clinical neurological symptoms. CONCLUSION: 3D-CT showed superiority in accurately identifying gaps within OPLL lesions, while CT demonstrated false-positive results in the detection of gaps. Furthermore, the gap presence was a risk factor for MRI T2 high intensity in the spinal cord, independent of lesion thickness. In addition, gaps are related to more severe clinical symptoms. This study highlighted the importance of evaluating gaps within OPLL lesions using 3D-CT to clarify neurological pathogenesis.

Anterior Cruciate Ligament Rupture: Evidence-Based Concepts on Reconstruction, Repair and Future Developments.

The anterior cruciate ligament (ACL) is a vital but frequently injured structure. An ACL injury can result in dysfunction, meniscal injuries, and the early onset of osteoarthritis. This article aims to discuss favourable reconstruction techniques through a literature review with consideration for novel methods in order to identify superior methods that provide a patient's return to function. Current surgical options include reconstruction using different types of autografts and allografts.

Frequency dependence and harmonic distortion of stapes displacement and intracochlear pressure in response to very high level sounds.

Previous reports have suggested that intracochlear pressures (PIC) measured at the base of the cochlea increase directly proportionally with stapes displacement (DStap) in response to moderately high (<130 dB SPL) level sounds. Consistent with this assumption, we have reported that for low frequency sounds (<1 kHz), stapes displacement and intracochlear pressures increase linearly with sound pressure level (SPL) for moderately high levels (<130 dB SPL), but saturate at higher exposure levels (>130 dB SPL). However, the magnitudes of each response were found to be frequency dependent, thus the relationship between DStap and PIC may vary at higher frequencies or higher levels. In order to further examine this frequency and level dependence, measurements of DStap and PIC were made in cadaveric human temporal bones prepared with a mastoidectomy and extended facial recess to expose the ossicular chain. PIC was measured in scala vestibuli (PSV) and scala tympani (PST) simultaneously with SPL in the external auditory canal (PEAC) and laser Doppler vibrometry (LDV) measurements of stapes velocity (VStap). Consistent with prior reports, DStap and PSV increased proportionally with sound pressure level in the ear canal up to a frequency-dependent saturation point, above which both DStap and PSV showed a distinct deviation from proportionality with PEAC, suggesting that their relationship may remain constant at these high frequencies. Likewise, while the asymptotic value, and SPL at which saturation occurred were frequency dependent in both DStap and PSV, the reduction in gain with increasing SPL above this level was constant above this level at all frequencies, and the magnitude of responses at harmonics of the driving frequency increased with increasing level, consistent with harmonic distortion via peak clipping. Importantly, this nonlinear distortion shifts the energy arriving at the inner ear to higher frequencies than are present in incident stimulus, thus exposing the high frequency sensitive components of the auditory system to more noise than would be expected from measurement of that stimulus on its own. Overall, responses suggest that the cochlear representation of very high-level air conducted stimuli is limited by nonlinearities in the middle ear, and that this peak limiting leads to increased high frequency cochlear exposures than are present in the driving stimulus.

Impact of Incidental Dural Tears on Postoperative Outcomes in Patients Undergoing Cervical Spine Surgery: A Multicenter Retrospective Cohort Study.

BACKGROUND CONTEXT: Incidental dural tear (DT) during cervical spine surgery is a feared complication. However, its impact on patient-reported outcomes (PROs) remains unclear. PURPOSE: To determine the influence of DTs on PROs one year after cervical spine surgery. STUDY DESIGN: Retrospective cohort. PATIENT SAMPLE: Patients undergoing elective cervical spine surgery for cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and cervical disc herniation. OUTCOME MEASURES: Analysis included patients' characteristics, perioperative complications, and PROs both preoperatively and at one year postoperatively. METHODS: This study enrolled consecutive patients who underwent elective cervical spine surgery at 13 high-volume spine centers. All patients were required to complete questionnaires both preoperatively and one year postoperatively, which included PROs such as numerical rating scales of pain or dysesthesia for each part of the body, Neck Disability Index NDI, and Core Outcome Measures Index. Patients were divided into two groups based on the presence (DT+) or absence (DT-) of dural injury. Comparisons were made regarding patient background, perioperative complications, and pre- and postoperative PROs. Propensity score matching was also utilized to adjust for patient background, and further comparisons were made regarding complication rates and PROs. RESULTS: Out of 2,704 patients, dural tears were identified in 97 (3.6%) cases. The DT+ group had a significantly higher proportion of fixation surgeries, upper cervical surgeries, OPLL, and revision surgeries. Perioperative complications were significantly higher in the DT+ group, including intraoperative nerve damage, postoperative paralysis, surgical site infections (SSI), and cerebrovascular complications. Outcomes collected from 2,163 patients (79.9%) revealed significantly more severe neck and upper limb pain in the DT+ group. After propensity score matching, significant differences persisted in postoperative paralysis and SSI in the DT+ group, but no significant differences were observed in PROs. CONCLUSIONS: Patients with dural tears showed nearly equivalent postoperative outcomes at one year following cervical spine surgery compared to those without dural tears. However, the incidence of perioperative complications was higher, emphasizing the need for careful management.

Bone-patellar tendon-bone, hamstring, and quadriceps tendon autografts for anterior cruciate ligament reconstruction in skeletally immature patients: a systematic review.

INTRODUCTION: Historically, anterior cruciate ligament (ACL) ruptures in the paediatric age group were managed conservatively with bracing, casting, activity modification, and physical therapy. However, most of these patients had to reduce their sports activities, and secondary damages to the affected knee were prevalent. SOURCE OF DATA: Published scientific literature in Embase, Web of Science, PubMed, and Google Scholar databases. AREAS OF AGREEMENT: ACL reconstruction in children with open physes patients is debated. Any damage to the physes around the knee could lead to growth abnormalities and axial deviation of the knee. AREAS OF CONTROVERSY: Different grafts are available and suitable for ACL reconstruction in skeletally immature patients; however, which graft performs better remains unclear. GROWING POINTS: This systematic review compared bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT) autografts for ACL reconstruction in skeletally immature patients. The joint laxity, Patient-reported outcome measures (PROMs), return to sport, and complications were compared. AREAS TIMELY FOR DEVELOPING RESEARCH: In skeletally immature patients, HT, BPTB, and QT autografts for ACL reconstruction yielded good outcomes. Comparative studies are strongly required to establish the most suitable autograft.

Younger age, hyperextended knee, concomitant meniscectomy and large prerevision anterior tibial translation are associated with graft failure after the revision anterior cruciate ligament reconstruction.

Purpose: Graft failure following revision anterior cruciate ligament (ACL) reconstruction is higher than after primary ACL reconstruction. However, data regarding revision surgery is scarce. We aimed to evaluate the associated factors for failure after revision ACL reconstruction. Methods: Fifty-four patients (mean age: 24.7 ± 10.0 years) who underwent revision ACL reconstruction at our hospital with ≥1 year follow-up were retrospectively examined. Patients were divided into Group F (graft failure) and Group N (no graft failure) groups. Univariate analysis was conducted to identify factors associated with graft failure. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal thresholds for differentiating between the two groups. Results: Graft failure was observed in 7 of 54 patients (13.0%). In the univariate analysis, significant differences were observed for age at the initial surgery (Group F: 15.6 ± 1.5, Group N: 20.9 ± 8.1), age at the revision surgery (Group F: 18.0 ± 2.8, Group N: 25.7 ± 10.3), presence of hyperextended knee (Group F: 85.7%, Group N: 14.9%), concomitant meniscectomy (Group F: 42.9%, Group N: 14.9%), prerevision space for the ACL (sACL) (Group F: 7.2 ± 3.4 mm, Group N: 13.4 ± 4.7 mm) and preoperative anterior tibial translation (ATT) (Group F: 5.0 ± 1.4 mm, Group N: 2.7 ± 3.1 m). ROC analysis of preoperative sACL and preoperative ATT on one-leg standing plain radiograph showed that cutoff values of 6.9 and 4.2 mm were the optimal thresholds, respectively. Conclusion: Younger patients with a hyperextended knee, concomitant meniscectomy, small sACL and large ATT before revision ACL reconstruction are predisposed to graft failure. Level of Evidence: Level IV.

Proximal Fibulectomy for Giant Cell Tumours: What Works!

Background: Giant cell tumor of bone (GCTB) is the most common primary tumor of proximal fibula. Because of its close proximity to vascular structures, common peroneal nerve (CPN) and attachment of lateral collateral ligament (LCL), proximal fibulectomy poses unique challenges. We analyzed oncological and functional outcome of patients who underwent proximal fibulectomy for GCTB of proximal fibula. Material and methods: Between January 2006 and December 2020, 23 patients underwent proximal fibulectomy for GCTB of proximal fibula, four were recurrent tumors. Mean resection length was 9 cm (5 to 15 cm). The LCL and biceps tendon were not reconstructed in 22 cases. The common peroneal nerve was sacrificed in seven patients including three recurrent cases. Functional status was assessed using the Musculoskeletal Tumour Society (MSTS) scoring system. Results: There were two vascular complications and one infection. With 4 patients lost to follow up, mean follow up was 90 months (12 to 197). No patient had local or distant recurrence. Mean MSTS score was 26 (21 to 30). Eleven of 23 patients (48%) had loss of common peroneal nerve function with poorer functional outcome. No patient had symptoms suggestive of knee instability. Conclusion: Proximal fibulectomy is oncologically safe. Reconstruction of the LCL attachment is not mandatory and patients do not have symptomatic knee instability. Functional outcomes are compromised after sacrifice of common peroneal nerve and may be potentially improved with tendon transfers at index surgery.

Effect of posterior decompression on the spinal cord in thoracic ossification of the posterior longitudinal ligament: A Finite element analysis.

OBJECTIVE: Thoracic ossification of the posterior longitudinal ligament (T-OPLL) causes myelopathy. Although posterior decompression for T-OPLL has shown positive results, patients with kyphotic curvatures often endure poor outcomes. Posterior decompression with fusion (PDF) has demonstrated better results compared to posterior decompression alone. This study aims to evaluate the effects of the posterior procedures for T-OPLL. METHODS: A 3-dimensional finite element model of the C2-T12 spine, created from medical images, was used to develop the following T3-T4 OPLL compression models: an intact model (no surgery), 25% canal occupancy ratio (COR) OPLL (C25 OPLL), a discontinuous 25% COR OPLL (D25 OPLL), a continuous 50% COR OPLL (C50 OPLL), and a discontinuous 50% COR OPLL (D50 OPLL). These models were analyzed to evaluate the effects of posterior decompression (laminectomy: LN) with varied fixation lengths (LN T3-T4, PDF T3-T4, LN T2-T5, and PDF T2-T5) in neutral, flexion, and extension positions. RESULTS: Increased discontinuity in OPLL led to increased stress on the spinal cord. Posterior decompression reduced spinal cord stress in the neutral posture. However, in flexion and extension, spinal cord stress increased for LN T3-T4, LN T2-T5, and PDF T3-T4 compared to the neutral posture. Notably, PDF T2-T5 prevented an increase in spinal cord stress during these motions. CONCLUSIONS: Effective management of intervertebral mobility and the appropriate length of decompression are crucial for addressing the thickness and mobility of T-OPLL.

Understanding the hierarchical structure of collagen fibers of the human periodontal ligament: Implications for biomechanical characteristics.

The periodontal ligament (PDL) is a unique fibrous connective tissue that regulates periodontal homeostasis mechanisms. Its biomechanical properties primarily reside in the hierarchical and non-uniform collagenous network. This study aimed to investigate the region-specific structure and composition of collagen fibers in the PDL at various scales and to explore their relationship with mechanical properties in a split-mouth design. Fresh human cadaver transverse PDL specimens of maxillary anterior teeth were categorized into cervical, middle, and apical groups. These specimens were analyzed via Masson's trichrome staining, scanning electron microscopy, picrosirius red (PSR) staining, three-dimensional (3D) reconstruction, Raman spectroscopy, and uniaxial tensile test. Statistical analyses were performed to compare the structural, compositional, and tensile properties among the groups. Notably, the middle PDL samples exhibited superior tensile strength and higher fiber area fraction than the other two transverse sections. Despite a higher mineral-to-matrix ratio and a different collagen secondary structure, the apical PDL demonstrated a relatively weaker tensile strength, possibly associated with its discovered sparser collagen fiber areal fraction. The cervical region, characterized by a mediocre fiber areal fraction, displayed diminished tensile strength. The 3D reconstructed collagenous network model and PSR staining exposed the fiber interaction and the micropores. Microscale porosity and variations in collagen secondary structure, particularly in the apical region, suggest adaptive mechanisms for accommodating compressive forces and maintaining functional integrity. Variance in the tensile properties of samples in different force directions indicated the significant influence of fiber orientation and root level on tissue mechanics. STATEMENT OF SIGNIFICANCE: This study provides critical insights into the biomechanical and structural properties of the human periodontal ligament (PDL), particularly focusing on the underexplored anterior teeth. Through advanced techniques like SEM, histological staining, 3D reconstruction, Raman spectroscopy, and tensile testing, we reveal significant regional variations in PDL collagen organization, composition, and biomechanical properties. Our findings address a crucial knowledge gap concerning the material mechanics of the PDL, offering a foundational understanding for future periodontal tissue engineering and biomimetic material development. This multi-scale analysis underscores the importance of both mesoscale structural characteristics and nanoscale molecular structures in maintaining PDL mechanical integrity.

Bilateral absence of the common femoral artery with high-origin and superficial course of the deep femoral artery: a rare case report.

BACKGROUND: The common femoral artery is a chief source of blood supply to the lower limb. Variations in its anatomy, like its absence, high level commencement of the deep femoral artery (DFA) with a superficial course, are unusual. The knowledge of such variations may have substantial clinical applications, specifically in vascular surgical procedures, catheterizations, and diagnostic or interventional radiology. CASE REPORT: During femoral triangle dissection of a 78-years female cadaver, absence of common femoral artery, commencement of DFA at the inguinal ligament level, following a superficial path contrary to its name was observed bilaterally. The exterior diameter of superficial and DFA were 5 mm, 4 mm and 6 mm, 4 mm respectively on the right and left side. CONCLUSIONS: Awareness of such variations is essential for interventional radiologists, vascular, orthopaedic, plastic & reconstructive surgeons to plan and execute interventional and surgical procedures effectively and for Anatomist for successful embalming.

Comparison between a Novel Knee Arthrometer and Simultaneous Stress Radiography for the Diagnosis of Complete and Partial Acute Anterior Cruciate Ligament Tears.

OBJECTIVES: The type of ligamentous tear and the degree of knee laxity have important guiding significance for the diagnosis and management of anterior cruciate ligament (ACL) tears. Instrumental measurement is necessary for ACL tears since physical examination and magnetic resonance imaging (MRI) cannot provide an objective and quantitative assessment of knee laxity. This study aimed to compare the application of a novel knee arthrometer and simultaneous stress radiography in differentiating between complete and partial acute ACL tears, and further assess the correlation between the two measurements. METHODS: A total of 106 patients with complete acute ACL tears and 52 patients with partial acute ACL tears were included in the study. Preoperative arthrometry and simultaneous stress radiography were performed using the Ligs arthrometer at 90, 120, and 150 N to assess side-to-side difference (SSD) in anterior knee laxity. The optimal threshold was determined using the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was used to assess the diagnostic value of the measurement. Pearson's correlation coefficient was used to assess the correlation between the two measurements. RESULTS: The optimal differential SSD thresholds in the Ligs arthrometer were 2.7 mm at 90 N, 3.8 mm at 120 N, and 4.6 mm at 150 N. Similarly, the optimal differential SSD thresholds in simultaneous stress radiography were 3.8 mm at 90 N, 5.1 mm at 120 N, and 5.6 mm at 150 N. The AUC analysis revealed that the Ligs arthrometer was fairly informative at 90 N (AUC = 0.851), 120 N (AUC = 0.878), and 150 N (AUC = 0.884), and simultaneous stress radiography was highly informative at 90 N (AUC = 0.910), 120 N (AUC = 0.925), and 150 N (AUC = 0.948). Moreover, the AUC of the combined measurements was 0.914 at 90 N, 0.931 at 120 N, and 0.951 at 150 N. A significantly strong correlation was found between the two measurements at 90 N (r = 0.743, p < 0.001), 120 N (r = 0.802, p < 0.001), and 150 N (r = 0.823, p < 0.001). CONCLUSIONS: The Ligs arthrometer and simultaneous stress radiography proved to be valid diagnostic tools to differentiate between complete and partial acute ACL tears, with a strong correlation between the two measurements in SSD values. Compared with single instrumental measurement, the combination of the two measurements can further improve the diagnostic value in this regard.

Fortifying the foundation: assessing the role of uterine ligament integrity in uterine prolapse and beyond.

BACKGROUND: Pelvic floor stability is influenced by various biomechanical, anatomical, and physiological factors. Understanding these dynamics is crucial for improving the treatment of pelvic organ prolapse (POP) and related conditions. OBJECTIVE: To analyze the key factors affecting pelvic floor integrity and explore both non-surgical and surgical interventions to enhance stability and treatment outcomes. METHODS: This review draws from biomechanical research to assess the role of the uterosacral ligament in pelvic support, while also examining the potential of both traditional and emerging therapeutic approaches, including non-surgical interventions like vitamin C supplementation. RESULTS: - The uterosacral ligament demonstrates superior strength and stiffness, making it essential for structural support of pelvic organs. - Non-surgical interventions, such as vitamin C supplementation, show potential in improving ligament integrity and preventing pelvic floor disorders. - Emerging surgical techniques, including tendon-based procedures and injectable fibrous hydrogel composites, offer promising improvements in outcomes for patients with pelvic organ prolapse. - Additional factors such as muscle strength and neural deficiencies contribute to the complexity of pelvic floor biomechanics, indicating the need for multifaceted treatment approaches. CONCLUSION: This analysis provides a comprehensive framework for understanding and managing pelvic floor stability by integrating biomechanical, physiological, and anatomical insights. The findings highlight the potential for personalized treatment strategies to improve patient outcomes in pelvic floor disorders.

Functional and subjective outcomes after surgical management of complex elbow dislocations: a retrospective study.

INTRODUCTION: Dislocations of the elbow are the second most frequent upper-body injury after shoulder dislocations, comprising 11-28% of all elbow injuries. Complex elbow dislocations pose challenging management due to the involvement of critical stabilizing structures. This study aimed to investigate functional and subjective outcomes (MEPS, DASH, Oxford score) in 44 patients with complex elbow dislocations who underwent surgery between 2018 and 2020, with subgroup analysis focusing on gender and age differences. MATERIAL AND METHODS: A retrospective analysis was conducted on patients treated at C.T.O. Hospital, Turin, for complex elbow dislocations between January 2018 and December 2020. Surgical approaches included radial head synthesis, coronoid fixation, ligamentous repair, and ulnar nerve management. Postoperatively, patients followed a standardized or individualized program. Data analysis involved t-tests to assess score differences between subgroups. RESULTS: Among the 44 analyzed patients, the mean age was 48 years, and the mean follow-up time was 29 months. Various types of complex dislocations were identified, with radial head and coronoid fractures classified accordingly. Surgical approaches included multiple methods of reduction and synthesis. While most patients adhered to postoperative programs, subsequent reoperations were conducted in 11% of cases. Scores did not significantly differ between genders, although a trend toward better DASH scores in males was observed. Younger patients showed better, though not statistically significant, outcomes in mobility and functional measures. CONCLUSION: This study underscores the importance of pre-operative assessment for positive surgical outcomes in complex elbow dislocations. Additionally, findings suggest that younger age may correlate with slightly better functional outcomes. Despite limitations such as retrospective design and sample size, the study enhances our understanding of complex dislocation outcomes and provides valuable insights for future interventions.