Biomechanical evaluation of three patellar fixation techniques for MPFL reconstruction: Load to failure did not differ but interference screw stabilization was stiffer than suture anchor and suture-knot fixation.

PURPOSE: The purpose of this study was to compare the maximum load to failure and stiffness of three medial patella-femoral ligament (MPFL) reconstruction techniques: (i) suture anchor fixation (SA), (ii) interference screw fixation (SF), and (iii) suture knot (SK) patellar fixation. The null hypothesis was that the comparison between these three different patella fixation techniques would show no difference in the ultimate failure load and stiffness. METHODS: Reconstruction of the MPFL with gracilis tendon autograft was performed in 12 pairs of fresh-frozen cadaveric knees (24 knees total; mean age, 63.6 [Formula: see text] 8.0 years). The specimens were randomly distributed into 3 groups of 8 specimens; SA reconstruction was completed with two 3.0-mm metal suture anchors; (SF) fixation was accomplished by two 6-mm bio-composite interference screws; SK fixation at the lateral side of the patella was accomplished after drilling two semi-patellar tunnels with a diameter of 4.5 mm. The reconstructions were subjected to cyclic loading for 10 cycles to 30 N and tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). The final load of failure (N), stiffness (N / mm) and failure mode was recorded in each specimen and followed by statistical analysis. RESULTS: There was no significant difference in mean ultimate failure load among the three groups. The SK group failed at a mean ([Formula: see text] SD) ultimate load of 253.5 [Formula: see text] 38.2 N, the SA group failed at 243 [Formula: see text] 41.9 N and the SF group at 263.2 [Formula: see text] 9.06 N. The SF group had a mean stiffness of 37.8 [Formula: see text] 5.7 N/mm. This was significantly higher (p < 0.05) than the mean stiffness value achieved for the SK group 21.4 [Formula: see text] 9.5 N/mm and the SA group 18.7 [Formula: see text] 3.4 N/mm. The most common mode of failure in the SA group was anchor pullout, and in the SK group was failure at the graft-suture interface. All the reconstructions in the SF group failed due to tendon graft slippage from the tunnel. CONCLUSION: Load to failure was not significantly different between the 3 techniques. However, screw fixation was found to be significantly stronger than the anchor and the suture knot fixation in terms of rigidity of the reconstruction. From a clinical point of view, all methods of fixation can be used reliably for MPFL reconstruction, since they were found to be stronger than the native MPFL.

Age-Dependent Invasion of Pseudorabies Virus into Porcine Central Nervous System via Maxillary Nerve.

Pseudorabies virus (PRV) is the causative agent for Aujeszky's disease, a disease that mainly affects pigs and incidentally other domestic and wild animals. While PRV is almost always fatal, causing neurological disease independently of the age in non-porcine species, the development of neurological manifestation in its host species, the pig, highly depends on the age. In this study, an attempt was made to investigate the effect of nerve development on the outcome of virus infection and the effect of virus infection on the structure of nerves in piglets of various ages. For that reason, 42 pigs at the age of one (n = 14), three (n = 14) and five (n = 14) weeks were inoculated with 107 TCID50 of PRV Kaplan strain and euthanized at one- or four-days post inoculation (DPI). The tissues of the trigeminal nervous pathway were collected and examined for virus replication (titration) in cell cultures for nerve morphology by light and transmission electron microscopy, and for viral antigen visualization by immunohistochemistry. The results showed that as the age of the pig increases, virus titers and clinical manifestations reduced, while, at the same time, myelin and axon development ceased. Following infection, the nerve structure was disrupted at all ages examined, being more prominent in one-week-old pigs compared to five-week-old pigs. In conclusion, the age-dependent PRV neuroinvasion in pigs seems to correlate with the morphological changes of neurons.

Biomechanical comparison of two medial patellofemoral ligament reconstruction techniques: Quadriceps tendon fixation versus single-tunnel patella fixation with gracilis autograft did not differ in load to failure and stiffness.

BACKGROUND: The purpose of this study was to evaluate the ultimate failure load and stiffness of two patellar fixation techniques for medial patellofemoral ligament (MPFL) reconstruction: (1) quadriceps tendon fixation (QT), (2) single tunnel (STG) patella fixation with gracilis autograft. METHODS: A total of 16 fresh-frozen cadaveric knees (eight matched pairs) were randomized into two groups (QT vs. STG). The MPFL reconstructions were subjected to cyclic loading for 10 cycles to 30 N and then tested to failure at a constant displacement rate of 15 mm/min using a materials-testing machine (MTS 810 Universal Testing System). Failure mode, ultimate failure load and stiffness were recorded for each cadaveric specimen. RESULTS: There was no significant difference in mean ultimate failure load among groups (P = 0.35). The STG group failed at a mean ultimate load of 190.04 N [standard deviation (SD) 23.18] and the QT group failed at 206.24 N (SD 37.99). The STG group had a mean stiffness of 21.38 N/mm (SD 1.44). This was not significantly higher than the mean stiffness value achieved for the QT group at 20.36 N/mm (SD 1.3) (P = 0.19). In the QT group all reconstructions failed due to tendon rupture at the patella attachment. The reason for failure in the STG group was the graft-suture connection. CONCLUSIONS: This cadaver study showed no statistically significant difference in biomechanical performance of the evaluated patella fixation techniques, in terms of maximum load to failure and stiffness. Both techniques are reliable in terms of biomechanical properties and could offer additional surgical solutions.

Mast cells populations fluctuate along the spinal dura mater of the developing rat.

The present study reveals developmental changes in the number, the phenotype and the distribution pattern of mast cells (MCs) along the cervical, the thoracic and the lumbar parts of the spinal dura mater. Postnatal infiltration of spinal dura by MCs does not appear to follow a sequential developmental pattern and meningeal MCs are unevenly distributed along the various parts of the examined dura. At each spinal level, areas most densely populated by MCs are the dorsal dura and the dural sleeves of the dorsal (sensory) spinal roots The developmental time course of the total MCs number is characterized by significant fluctuations in all three parts examined, with notable increases at P1, P4, P21 and P60 (peak value) for the cervical part, at P1 (peak value), P7 and P21 for the thoracic part and at P1, P7 (peak value) and P30 for the lumbar part. At P180, MCs number declines to 56%, 33% and 13% of the peak values for the cervical, the thoracic and the lumbar part, respectively. However, a different developmental pattern is followed by each subpopulation of MCs identified on the basis of their staining characteristics, namely connective tissue type mast cells (CTMCs), mucosal type or cells with characteristics of immature mast cells (MTMCs) and mixed type MCs, in each part examined. The findings may be of importance in elucidating physiological and pathological processes in the dura mater and the vertebral column.

Developmental changes in the vascular network of the rat visual areas 17, 18 and 18a.

The present study examines quantitatively the areal and the laminar fluctuations of the vascular network in the visual areas 17, 18 and 18a of the rat cerebral cortex, from postnatal day (P) 1 to P60. For this purpose, the detailed vascular networks of the visual areas, marked after transcardial perfusion of India ink, are analyzed with the use of an image analysis system in order to measure the total vascular density (VD) and the relative density of capillaries (CD), of medium (MD)- and large (LD)-sized vessels in combination with changes in the mean diameter of all three types of vessels. Comparative quantitative microscopy showed that both VD and CD do not exhibit significant interareal differences in the adult rat brain. However, while VD reaches adult values much earlier in area 18a (P21) than in areas 17 and 18 (P60), CD obtains adult values at P31 in areas 17 and 18a, but later (P60) in area 18. Maturation process of laminar VD, CD, MD and LD was not found to follow a simple (i.e. inside-out or mediolateral) sequence, and, in each cortical area, laminar fluctuations of vessels density revealed a complicated developmental pattern, which might be attributed to their changing structural and functional status. Developmental changes in the diameter of capillaries, examined in conjunction with concomitant changes of vascular and capillary density in each area, suggest the existence of angiogenesis in all three visual areas during the third postnatal week of age.

Areal and laminar variations in the vascularity of the visual, auditory, and entorhinal cortices of the developing rat brain.

Understanding of place-specific cortical cerebrovascular changes after insult and injury depends on the detailed knowledge of the areal and laminar variations in cortical vascularity. The present study examines comparatively the developmental changes of the total vascular density and the density of capillaries and medium- and large-sized vessels in the primary visual cortex (Oc1), the primary auditory cortex (Te1), and the lateral entorhinal cortex (EntL) of the developing rat brain. Vascular networks in the three cortical areas were marked after transcardial perfusion of India ink and quantified with an image analysis system. Parameters examined exhibited (i) peculiar developmental time course within individual cortical layers and (ii) area- and age-dependent variations. Angioarchitecture in Te1 layers was stabilized earlier than that in Oc1 layers and the period of postnatal development of the vascularity of neocortical sensory areas Oc1 and Te1 appeared to be more protracted compared to that of the phylogenetically older entorhinal cortex. By the end of the first postnatal month, vascular densities in the three cortical areas established a dorsoventral gradient (Oc1 > Te1 > EntL). Finally, in all areas, layer IV was the first layer to obtain adult values of capillary density.

Noradrenergic innervation of the developing and mature visual and motor cortex of the rat brain: a light and electron microscopic immunocytochemical analysis.

The noradrenergic (NA) innervation of the developing and adult visual and motor cortex of the rat was examined with light and electron microscopic immunocytochemistry by using antibodies against dopamine-beta-hydroxylase. At birth, NA fibers were present in both cortical areas, appearing as two tangential streams, one above and the other below the cortical plate. During the subsequent weeks, these two streams arborized gradually innervating all cortical layers. The adult pattern of distribution was attained by postnatal day 14, but the density of innervation, which was higher in the motor than in the visual cortex, appeared similar to the adult by the end of the third postnatal week. Electron microscopic analysis revealed that a low proportion of NA varicosities (the highest value was 12% in the adult motor cortex in single sections) were engaged in synaptic contact, throughout development, in both areas examined. The overwhelming majority of these synapses were symmetrical, involving predominantly small or medium dendrites. This evidence suggests that transmission by diffusion is the major mode of NA action in the developing and adult cerebral cortex. Noradrenaline released in the rare synaptic junctions may act mainly to reduce the activity of its cortical targets. The results altogether provide morphologic evidence for an involvement of noradrenaline in the development of the neocortex and, along with earlier data on the serotonergic system, indicate that the monoaminergic systems are endowed with a specific anatomic organization in various areas of the brain.

Noradrenergic innervation of the developing and mature septal area of the rat.

The noradrenergic innervation of the developing and mature septal area of the rat was examined with light and electron microscopic immunocytochemistry using an antibody against dopamine-beta-hydroxylase. At birth, a small number of relatively thick noradrenergic fibers were found to innervate the lateral septum (mainly its intermediate part) and the nuclei of the vertical and horizontal limbs of the diagonal band of Broca. By postnatal day 7, a substantial increase in their density was observed. At this age some labeled fibers left the medial forebrain bundle and invaded the nucleus of the horizontal limb of the diagonal band. These fibers then ran in a ventrodorsal direction and innervated the nucleus of the vertical limb before entering the medial septum. Immunoreactive fibers were finer and more varicose than at birth. In the subsequent 2 weeks, the density of labeled fibers in the septal area was further increased. By postnatal day 21, the distribution pattern and density of the noradrenergic innervation appeared similar to the adult. In the adult, noradrenergic fibers exhibited more varicosities than in younger rats. Electron microscopic analysis revealed a low proportion (peaked at P7) of noradrenergic varicosities engaged in synaptic contacts throughout development. The overwhelming majority of these synapses were symmetrical, predominantly with small or medium-sized dendrites. The present findings provide the morphological basis for the functional interactions between noradrenergic afferents and neuronal elements in the septal area. The low proportion of synaptic contacts found in this study suggests that noradrenaline may exert its action in the septal area mainly through transmission by diffusion (volume transmission), as has been suggested for other areas of the developing and adult brain.

Postnatal development of the noradrenergic system in the dorsal lateral geniculate nucleus of the rat.

The noradrenergic innervation of the developing dorsal lateral geniculate nucleus of the rat was examined with light and electron microscopic immunocytochemistry. At birth, few, relatively thick, noradrenergic fibers innervated the nucleus. Their density was steadily increased and they became thinner, tortuous, and varicose with the progression of age. Only a minority (11-15%) of labeled varicosities made synaptic contacts. Most of these synapses were symmetrical and on dendritic shafts. The present findings demonstrate the establishment of the anatomical relationships between noradrenergic afferents and neurons of the dorsal lateral geniculate nucleus during development and may help to understand the role of noradrenaline in the processing of visual information.

Parallel development of blood vessels and mast cells in the lateral geniculate nuclei.

The present study examined quantitatively developmental changes of the vasculature in the dorsal (dLGN) and the ventral (vLGN) lateral geniculate nuclei together with concomitant changes in the number of mast cells (MCs), known for their role in angiogenesis. Vascular network, marked after transcardial perfusion of India ink, and MCs detected with conventional histochemical techniques were examined at postnatal days (P) 1, 8, 14, 21, 31, 90 and 300 of Wistar rats. Quantitative analysis by means of an image analysis system showed age-dependent changes in both vascular parameters [vascular area and relative frequency (%) of capillaries and medium- and large-diameter vessels] and mast cells number in the developing dLGN and vLGN. Despite quantitative differences in the vascularization and MC infiltration between the two nuclei at some age points, MC number, vascular area and the percentage frequency of capillaries exhibited similar developmental time courses, especially up to the end of the first postnatal month. Both MC number and the capillary frequency reached maximal levels at P31 and declined thereafter, following a massive or a partial, respectively, decrease up to P300.

Developmental changes of mast cell populations in the cerebral meninges of the rat.

It is known that both the dura and the pia mater attract and support the differentiation of mast cells. The present study shows that unevenly distributed mast cells in the cerebral meninges of the rat can be found in perivascular sites and vessel ramification points, but can also be unrelated to the meningeal vasculature. It also documents changes in the number, localization and staining preferences of the mast cells in the two meninges of the developing and mature rat brain. Quantitative examination of all types of histochemically differentiated meningeal mast cells reveals no major (although some exist) differences between right and left side subpopulations, but strongly suggests a different origin and fate of the dural and the pial mast cells. The number of dural mast cells, already high from postnatal day 0, although declining from postnatal day 21 onwards, remains conspicuous up to postnatal day 180. In contrast, pial mast cells are comparatively very few in the first day of the postnatal life, and despite a transient significant increase in the following two weeks, they reach almost zero levels from postnatal day 21.