Gracilis and semitendinosus moment arm decreased by fascial tissue release after hamstring harvesting surgery: a key parameter to understand the peak torque obtained to a shallow angle of the knee.

PURPOSE: Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, but the peak torque angle of hamstring muscles shifted to a shallow angle postoperatively. The goal was to quantify the influence of the myofascial structures on instantaneous moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations. METHODS: Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each step of the surgery. RESULTS: No significant difference was demonstrated for instantaneous moment arm of gracilis during anterior cruciate ligament surgery (84% of the maximum intact values; P ≥ 0.05). The first significant semitendinosus moment arm decrease was observed after tendon harvesting (61% of the maximum intact values; p ≤ 0.005). After hamstring harvesting, the maximum and minimum moment arm (both gracilis and semi tendinosus) shifted to a shallow angle and 90°, respectively. CONCLUSION: Moment arm modifications by paratenons and the loose connective tissue release are essential to understand the peak torque obtained to a shallow angle. LEVEL OF EVIDENCE: Basic science study, biomechanics.

Persistencia de tratamiento con antagonistas del factor de necrosis tumoral frente a antagonistas de interleucinas en psoriasis moderada-grave / Persistence of treatment with tumor necrosis factor antagonists versus interleukin antagonists in moderate-severe psoriasis

Objetivo: Evaluar y comparar el tiempo de persistencia y analizar los motivos de suspensión con fármacos antagonistas del factor de necrosis tumoral (anti-TNF) frente a antagonistas de interleucinas (anti-IL) en primera línea de tratamiento biológico en pacientes con psoriasis.Material y métodos: Estudio retrospectivo observacional realizado entre 01/2010 y 05/2019. Se incluyeron pacientes adultos diagnosticados de psoriasis moderada-grave en tratamiento con anti-TNF o anti-IL en primera línea de tratamiento biológico. Se estudiaron variables demográficas y relacionadas con el tratamiento, calculándose el tiempo de persistencia con el fármaco de estudio, así como las suspensiones de tratamiento. Resultados: Se incluyeron 94 pacientes (39 mujeres) con una media de 49 años (desviación estándar 13,0), 46 (48,9%) pacientes tratados con anti-TNF (35/46 adalimumab y 11/46 etanercept) y 48 (51,1%) pacientes tratados con anti-IL (26/48 secukinumab, 15/48 ustekinumab y 7/48 ixekizumab). El tiempo de persistencia en primera línea de tratamiento biológico fue de 18,4 (rango intercuartílico (RIQ) 22,2) meses, siendo 9,3 (RIQ 21,7) meses superior en los pacientes tratados con anti-IL (24,7 vs. 15,4 meses; p=0,002). A la finalización del seguimiento el 38,3% (36/94) de la población había interrumpido el tratamiento, debido a: falta de efectividad (34,8% (16/46) anti-TNF vs. 14,6% (7/48) anti-IL; p=0,003), eventos adversos (2,2% (1/46) anti-TNF) y otros motivos (17,4% (8/46) anti-TNF vs. 8,3% (4/48) con anti-IL; p>0,05). Conclusiones: El tiempo de persistencia en primera línea de tratamiento biológico fue de 18,4 meses, siendo significativamente superior en los pacientes tratados con anti-IL. El principal motivo de suspensión fue la falta de efectividad en ambos grupos de tratamiento. (AU)

Objective: To evaluate and compare the time of persistence and to analyse the discontinuation reasons with tumor necrosis factor antagonists (anti-TNF) vs. interleukin antagonists (anti-IL) as first line with biological treatments in patients with psoriasis. Material and methods: Retrospective observational study carried out between 01/2010 and 05/2019. Adult patients diagnosed with moderate to severe psoriasis in treatment with anti-TNF or anti-IL as first line with biological treatments were included. Demographic and treatment-related variables were studied, calculating the time of persistence with the study drug, as well as treatment discontinuations. Results: We included 94 patients (39 women) with a mean of 49 years (standard deviation 13.0), 46 (48.9%) patients treated with anti-TNF (35/46 adalimumab and 11/46 etanercept) and 48 (51.1%) patients treated with anti-IL (26/48 secukinumab, 15/48 ustekinumab and 7/48 ixekizumab). Persistence time with biological treatment in first line was 18.4 (interquartile range (IQR) 22.2) months, being 9.3 (IQR 21.7) months higher in patients treated with anti-IL (24.7 vs. 15.4 months; p=0.002). At the end of the follow-up, 38.3% (36/94) of the population had discontinued their treatments. The reasons for discontinuation were: lack of effectiveness (34.8% (16/46) anti-TNF vs. 14.6% (7/48) anti-IL; p=0.003), side effects (2.2% (1/46) anti-TNF) and other reasons (17.4% (8/46) anti-TNF vs. 8.3% (4/48) anti-IL; p>0.05). Conclusion: The persistence time with biological treatment in first line was 18.4 months, being significantly higher in the anti-IL group. The main reason of discontinuation was lack of effectiveness in both groups of treatment. (AU)

Prediction of the drilling path to surgically pin the femoral neck from the spatial location of pelvic and femoral anatomical landmarks: A cadaver validation study.

Several clinical applications rely on accurate guiding information when drilling along the femoral neck (e.g., pin insertion in case of neck fracture). Currently, applications rely on real-time X-ray imaging, which results in irradiation issues for the surgeon conducting the operation. The goal of this paper was to develop an X-ray-free method that would allow for a pathway to be drilled between the lateral aspect of the femoral diaphysis (the so-called piercing point), the femoral neck and the head centres. The method is based on on-the-fly computational predictions relying on a biomechanical database that includes morphological data related to the femoral neck and head and various palpable anatomical landmarks located on the pelvis and the femoral bone. From the spatial location of the anatomical landmarks, scalable multiple regressions allow for the prediction of the most optimal drilling pathway. The method has been entirely validated using in vitro experiments that reproduce surgical conditions. Further, a surgical ancillary prototype that integrates the method of guiding the pin drilling has been developed and used during in vitro and in situ validation using nine hip joints. Pin insertion was controlled after drilling using medical imaging and show successful result for each of the nine trials. The mean accuracy of the estimated hip joint centre and neck orientation was 6.0 ± 2.8mm and 7.1 ± 3.8°, respectively.

Tendon and fascial structure contributions to knee muscle excursions and knee joint displacement.

BACKGROUND: Semitendinosus and gracilis muscles whose tendons are used in surgical reconstruction of the anterior cruciate ligament maintain their contractile ability, and a limited decrease of hamstring muscles force is observed postoperatively despite important changes. The goal was to quantify the influence of the myofascial structures on excursions and moment arms of knee muscles to attempt explaining the above-mentioned post-surgical observations. METHODS: Hamstring harvesting procedures were performed by a senior orthopaedic surgeon on seven lower limbs from fresh-frozen specimens. Femoro-tibial kinematics and tendons excursion were simultaneously recorded at each steps of the surgery. FINDINGS: No significant difference was demonstrated for excursions and moment arms after tenotomies and gracilis tendon harvesting (P≥0.05). The first significant semitendinosus excursion (P<1.17×10(-4)) and moment arm (P<6.88×10(-5)) decrease was observed after semitendinosus tendon harvesting (46% of the initial excursion). INTERPRETATION: Gracilis and semitendinosus myofascial pathway is crucial for force transmission towards the knee joint.

Determination of the precision and accuracy of morphological measurements using the Kinect™ sensor: comparison with standard stereophotogrammetry.

The recent availability of the Kinect™ sensor, a low-cost Markerless Motion Capture (MMC) system, could give new and interesting insights into ergonomics (e.g. the creation of a morphological database). Extensive validation of this system is still missing. The aim of the study was to determine if the Kinect™ sensor can be used as an easy, cheap and fast tool to conduct morphology estimation. A total of 48 subjects were analysed using MMC. Results were compared with measurements obtained from a high-resolution stereophotogrammetric system, a marker-based system (MBS). Differences between MMC and MBS were found; however, these differences were systematically correlated and enabled regression equations to be obtained to correct MMC results. After correction, final results were in agreement with MBS data (p = 0.99). Results show that measurements were reproducible and precise after applying regression equations. Kinect™ sensors-based systems therefore seem to be suitable for use as fast and reliable tools to estimate morphology. Practitioner Summary: The Kinect™ sensor could eventually be used for fast morphology estimation as a body scanner. This paper presents an extensive validation of this device for anthropometric measurements in comparison to manual measurements and stereophotogrammetric devices. The accuracy is dependent on the segment studied but the reproducibility is excellent.

A wearable inertial system to assess the cervical spine mobility: comparison with an optoelectronic-based motion capture evaluation.

In clinical settings, the cervical range of motion (ROM) is commonly used to assess cervical spine function. This study aimed at assessing cervical spine mobility based on head and thorax kinematics measured with a wearable inertial system (WS). Sequences of imposed active head movements (lateral bending, axial rotation and flexion-extension) were recorded in ten controls and 13 patients who had undergone an arthrodesis. Orientation of the head relative to the thorax was computed in terms of 3D helical angles and compared with the values obtained using an optoelectronic reference system (RS). Movement patterns from WS and RS showed excellent concurrent validity (CMC up to 1.00), but presented slight differences of bias (mean bias<2.5°) and dispersion (mean dispersion<4.2°). ROM obtained using WS also showed some differences compared to RS (mean difference<5.7°), within the range of those reported in literature. WS enabled the observation of the same significant differences between controls and patients as RS. Moreover, ROM from WS presented good test-retest repeatability (ICC between 0.63 and 0.99 and SEM<6.2°). In conclusion, WS can provide angles and ROM comparable to those obtained with RS and relevant for the cervical assessment after treatment.

Validity and reliability of the Kinect within functional assessment activities: comparison with standard stereophotogrammetry.

The recent availability of the Kinect™ sensor, a cost-effective markerless motion capture system (MLS), offers interesting possibilities in clinical functional analysis and rehabilitation. However, neither validity nor reproducibility of this device is known yet. These two parameters were evaluated in this study. Forty-eight volunteers performed shoulder abduction, elbow flexion, hip abduction and knee flexion motions; the same protocol was repeated one week later to evaluate reproducibility. Movements were simultaneously recorded by the Kinect (with Microsoft Kinect SDK v.1.5) MLS and a traditional marker-based stereophotogrammetry system (MBS). Considering the MBS as reference, discrepancies between MLS and MBS were evaluated by comparing the range of motion (ROM) between both systems. MLS reproducibility was found to be statistically similar to MBS results for the four exercises. Measured ROMs however were found different between the systems.

Model-based approach for human kinematics reconstruction from markerless and marker-based motion analysis systems.

Modeling tools related to the musculoskeletal system have been previously developed. However, the integration of the real underlying functional joint behavior is lacking and therefore available kinematic models do not reasonably replicate individual human motion. In order to improve our understanding of the relationships between muscle behavior, i.e. excursion and motion data, modeling tools must guarantee that the model of joint kinematics is correctly validated to ensure meaningful muscle behavior interpretation. This paper presents a model-based method that allows fusing accurate joint kinematic information with motion analysis data collected using either marker-based stereophotogrammetry (MBS) (i.e. bone displacement collected from reflective markers fixed on the subject's skin) or markerless single-camera (MLS) hardware. This paper describes a model-based approach (MBA) for human motion data reconstruction by a scalable registration method for combining joint physiological kinematics with limb segment poses. The presented results and kinematics analysis show that model-based MBS and MLS methods lead to physiologically-acceptable human kinematics. The proposed method is therefore available for further exploitation of the underlying model that can then be used for further modeling, the quality of which will depend on the underlying kinematic model.

[Clinical examination of children with cerebral palsy: is there a consensus between clinicians?]. / Examen clinique de l'enfant infirme moteur cérébral: existe-t-il un consensus entre les praticiens?

Diagnosis and most of all classification of children with cerebral palsy (CP) remain a challenge for clinicians. To help them in this process, clinicians can rely on several clinical testing procedures as well as complementary investigations. The goal of this study was to determine which clinical tests found in the literature are the most frequently used in common practice in Belgium. Forty tests have been found in the literature. They have been sorted into five different categories: quantitative evaluation of motor function, spasticity evaluation, orthopaedic testing, upper limb evaluation and complementary investigations. Seven clinicians (five medical doctors and two physiotherapists) with a mean experience of sixteen years with CP children answered the questionnaire. Concerning the quantitative evaluation of motor function the most used tests are: Gross Motor Function Classification System, Manual Ability Classification System and the Pediatric Evaluation of Disability Inventory (PEDI). As regards spasticity, Ashworth scale is more frequently used than Tardieu test. No trend currently exist for the upper limb evaluation, but it was noted that these tests are rarely used in clinical practice. We observed a significant use of gait analysis at diagnosis and follow-up of CP children. We conclude that there are large differences between clinicians for clinical examination of CP children. This lack of consensus makes patient data comparison difficult between clinical centers. This seems to indicate that a homogenization effort should be organized if one wishes to better stimulate collaborations between centers.

Objective evaluation of cervical spine mobility after surgery during free-living activity.

BACKGROUND: Evaluation of cervical spine mobility after surgery is mainly based on the measurement of the range of motion during imposed movements. It can thus be questionable if this assessment represents the mobility experienced during daily life. The goal of this study was to propose a new evaluation tool based on the monitoring of cervical spine movement during daily activities. METHODS: The detection of cervical movement and the determination of primary motion component (lateral bending, axial rotation or flexion-extension), using two inertial sensors, were first validated in laboratory settings. Fifteen patients who underwent a cervical arthrodesis and nine healthy control subjects were monitored during their daily activity for half a day. The frequency of cervical movement was quantified according to posture, i.e. static and walking periods. The amplitude and velocity of cervical movement were evaluated using the median and cumulative distribution function. FINDINGS: The movement detection and classification showed an excellent performance (sensitivity and specificity>94%). For the daily monitoring, the patients presented a movement frequency similar to controls, whereas the amplitude and velocity in patients were lower than in controls (P<0.05). The differences between patients and controls were larger for the velocity parameters (effect sizes>0.37 and >0.54 for static and walking periods respectively) than for the amplitude parameters. INTERPRETATION: Body-worn inertial sensors enable the quantitative evaluation of global cervical movement. The movement amplitude and velocity during free-living conditions can be used as objective parameters to evaluate the cervical spine mobility after treatment.

In vitro biomechanical study of femoral torsion disorders: effect on moment arms of thigh muscles.

BACKGROUND: Lower limb torsion disorders have been considered as a factor inducing gonarthrosis and the three-dimensional effect of the surgical correction is not well reported yet. This paper reports an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders and moment arms of thigh muscles. METHODS: Five unembalmed lower limbs were used and fixed on an experimental jig. Muscles were loaded and 6 Linear Variable Differential Transformers were used to measure tendon excursions. Experimental osteotomies were performed to simulate torsions by steps of 6° up to 18°. Moment arms of the main thigh muscles were estimated by the tendon excursion method during knee flexion. FINDINGS: Moment arms of the tensor of fascia latae, the gracilis and the semitendinosus were significantly influenced by experimental conditions while the rectus femoris, the biceps femoris and the semimembranosus did not show modifications. Medial femoral torsion decreased the moment arm of both the gracilis and the semimembranosus. Opposite changes were observed during lateral femoral torsion. The moment arm of the tensor of fascia latae decreased significantly after 30° of knee flexion for 18° of medial femoral torsion. INTERPRETATION: Our results showed that medial and lateral femoral torsion disorders induced alterations of the moment arms of the muscles located medially to the knee joint when applied in aligned lower limbs. These results highlight a potential clinical relevance of the effect of femoral torsion alterations on moment arms of muscles of the thigh which may be related, with knee kinematics modifications, to the development of long-term knee disease.

In vitro biomechanical study of femoral torsion disorders: effect on femoro-tibial kinematics.

BACKGROUND: Gonarthrosis is a degenerative disease mainly found in elderly persons. Frontal plane deviations are known to induce lateral and medial gonarthrosis. Nevertheless, patients suffer from gonarthrosis without frontal deviations. Lower limb torsions disorders have been considered as a factor inducing lateral and medial gonarthrosis. This paper reports an in vitro study aiming at quantifying the relationships between experimental femoral torsion disorders and femoro-tibial kinematics. METHODS: Five fresh-frozen lower limbs were used. Specimens were fixed on an experimental jig and muscles were loaded. A six-degree-of-freedom Instrumented Spatial Linkage was used to measure femoro-tibial kinematics. Experimental femoral osteotomies were performed to simulate various degrees of medial and lateral torsion. Internal tibial rotation, abduction/adduction and proximo-distal, medio-lateral and antero-posterior translations were measured during knee flexion. FINDINGS: Internal tibial rotation and abduction/adduction were significantly influenced (P<0.001) by femoral torsion disorder conditions. Medial femoral torsion increased tibial adduction and decreased internal rotation during knee flexion. Opposite changes were observed during lateral femoral torsion. Concerning translations, medial femoral torsion induced a significant (P<0.05) decrease of medial translation and inversely for lateral femoral torsion. No interactions between femoral torsion disorders and range of motion were observed. INTERPRETATION: Our results showed that medial and lateral femoral torsion disorders induced alterations of femoro-tibial kinematics when applied in normally aligned lower limbs. These results highlight a potential clinical relevance of the effect of femoral torsion alterations on knee kinematics that may be related to the development of long-term knee disease.

[Organization and management of nutritional care process in hospitalized patients: the model implemented in the "Hospital Universitario de La Ribera"]. / Organización y funcionamiento de la atención nutricional hospitalaria: el modelo implantado en el Hospital Universitario de La Ribera.

INTRODUCTION: Hospital malnutrition shows a high prevalence and is an indicator of poor quality care. The intervention of different professionals involved in the nutritional care process performing uncoordinated and with different criteria is one of the reasons that contribute to perpetuate this situation. OBJECTIVE: To describe the model implemented in the "Hospital Universitario de la Ribera" for providing nutritional care to patients. METHOD: The model implemented in the "Hospital Universitario de la Ribera" is characterized by the coordinated intervention of the health professionals performing with the common goal of providing patients' nutritional care. The nutrition plan is carried out comprehensively from malnutrition identification to the establishment of the nutrition plan and monitoring as well as its adaptation to the patient's progress and discharge recommendations. The key elements to achieve this goal are described: the Nutrition Department and the Pharmacy Department, the information system available that allows to share and exchange information effectively and a dynamic and interdisciplinary Commission of Nutrition and Dietetics. CONCLUSION: At the "Hospital Universitario de la Ribera" an organization that ensures continuity of care throughout the nutritional process and its connection with primary health care has been established.

Organización y funcionamiento de la atención nutricional hospitalaria; el modelo implantado en el Hospital Universitario de La Ribera / Organization and management of nutritional care process in hospitalized patients; the model implemented in the 'Hospital Universitario de La Ribera'

Introducción: La malnutrición hospitalaria manifiesta una elevada prevalencia y es un indicador de baja calidad asistencial. Entre los motivos que perpetuán esta situación se identifican procesos asistenciales que se realizan por diferentes profesionales con criterios de actuación divergentes y a través de intervenciones fragmentadas. Objetivo: Describir el modelo implantado en el Hospital Universitario de la Ribera para proporcionar atención nutricional. Método: El modelo implementado en el Hospital Universitario de la Ribera tiene como característica diferencial la intervención coordinada de los profesionales que participan en el proceso nutricional con el objetivo de que la atención nutricional se lleve a cabo de forma integral, desde la identificación de la malnutrición, el establecimiento y monitorización del plan nutricional y su adaptación a la evolución del paciente y recomendaciones al alta. Se describen los elementos de estructura para la consecución de este objetivo: el Servicio de Nutrición y Servicio de Farmacia, el sistema de información que permite compartir e intercambiar información de forma efectiva y el funcionamiento resolutivo de la Comisión de Nutrición y Dietética interdisciplinar. Conclusión: En el Hospital Universitario de la Ribera se ha establecido una organización que garantiza la continuidad asistencial a lo largo del proceso nutricional y su conexión con atención primaria de salud (AU)

Introduction: Hospital malnutrition shows a high prevalence and is an indicator of poor quality care. The intervention of different professionals involved in the nutritional care process performing uncoordinated and with different criteria is one of the reasons that contribute to perpetuate this situation. Objective: To describe the model implemented in the ‘Hospital Universitario de la Ribera’ for providing nutritional care to patients. Method: The model implemented in the ‘Hospital Universitario de la Ribera’ is characterized by the coordinated intervention of the health professionals performing with the common goal of providing patients' nutritional care. The nutrition plan is carried out comprehensively from malnutrition identification to the establishment of the nutrition plan and monitoring as well as its adaptation to the patient's progress and discharge recommendations. The key elements to achieve this goal are described: the Nutrition Department and the Pharmacy Department, the information system available that allows to share and exchange information effectively and a dynamic and interdisciplinary Commission of Nutrition and Dietetics. Conclusion: At the ‘Hospital Universitario de la Ribera’ an organization that ensures continuity of care throughout the nutritional process and its connection with primary health care has been established (AU)

Effects of proximal row carpectomy on wrist biomechanics: a cadaveric study.

BACKGROUND: Many studies show good clinical results after proximal row carpectomy. Some biomechanical consequences are documented, but to our knowledge muscle moment arm variations have not previously been quantified. METHODS: In five fresh-frozen wrist, kinematics and tendon excursions were measured using a 3D electrogoniometer and Linear Variable Differential Transformers (SOLARTRON Inc., AMETEK Advanced Measurement Technology, Inc, 801 South Illinois Avenue, Oak Ridge, TN 37831-2011, USA), respectively, in three conditions: intact wrist, after posterior capsulotomy and after proximal row carpectomy. Mean pivot point, defined as the point whose sum of the squared distances to the helical axes is minimum, wrist range of motion and mean moment arms were measured during dorso-palmar flexion, radioulnar deviation and circumduction movements. FINDINGS: No alteration of the range of motion was observed. On the other hand, the mean pivot point shifted proximally (6.8-9.1mm) after proximal row carpectomy (p<0.05) for all motions tested and most muscle moment arms decreased significantly after proximal row carpectomy. INTERPRETATION: The results of this study allow a better understanding of the biomechanical effects of this procedure. The important moment arm reduction and pivot point displacement suggest modifications of joint biomechanical parameters which could influence the functional outcome of PRC.

Femur shape prediction by multiple regression based on quadric surface fitting.

Quadric surface fitting of joint surface areas is often performed to allow further processing of joint component size, location and orientation (pose), or even to determine soft tissue wrapping by collision detection and muscle moment arm evaluation. This study aimed to determine, for the femoral bone, if the position of its morphological joint centers and the shape morphology could be approximated using regression methods with satisfactory accuracy from a limited amount of palpable anatomical landmarks found on the femoral bone surface. The main aim of this paper is the description of the pipeline allowing on one hand the data collection and database storage of femoral bone characteristics, and on the other hand the determination of regression relationships from the available database. The femoral bone components analyzed in this study included the diaphysis, all joint surfaces (shape, location and orientation of the head, condyles and femoro-patellar surface) and their respective spatial relationships (e.g., cervico-diaphyseal angle, cervico-bicondylar angle, intercondylar angle, etc.). A total of 36 morphological characteristics are presented and can be estimated by regression method in in-vivo applications from the spatial location of 3 anatomical landmarks (lateral epicondyle, medial epicondyle and greater trochanter) located on the individual under investigation. The method does not require any a-priori knowledge on the functional aspect of the joint. In-vivo and in-vitro validations have been performed using data collected from medical imaging by virtual palpation and data collected directly on a volunteer using manual palpation through soft tissue. The prediction accuracy for most of the 36 femoral characteristics determined from virtual palpation was satisfactory, mean (SD) distance and orientation errors were 2.7(2.5)mm and 6.8(2.7)°, respectively. Manual palpation data allowed good accuracy for most femoral features, mean (SD) distance and orientation errors were 4.5(5.2)mm and 7.5(5.3)°, respectively. Only the in-vivo location estimation of the femoral head was worse (position error=23.2mm). In conclusion, results seem to show that the method allows in-vivo femoral joint shape prediction and could be used for further development (e.g., surface collision, muscle wrapping, muscle moment arm estimation, joint surface dimensions, etc.) in gait analysis-related applications.

[The first Belgian hand transplantation case. Nine years follow-up]. / Le premier cas belge de transplantation de main. Résultat à neuf ans.

The authors report the clinical result at 9 years followup of a unilateral hand transplantation performed on the dominant side after traumatic forearm amputation. The patient is back to work and sporting activities. The allograft has been fully incorporated into his self-image. The satisfaction index is 10/10, the DASH 5/100, and the 400-points score 68.1 %. The Lanzetta HTSS score is 91 (excellent). Good function of extrinsic and intrinsic muscles is observed. The grasping strength is markedly decreased (7.4 % as compared to the normal non-dominant side). The patient has experienced several rejection episodes, controlled by the immunosuppressant drugs.

[Reconstruction of the knee anterior cruciate ligament: single or double bundle?]. / Reconstruction du ligament croisé antérieur du genou: simple ou double faisceau?

Anatomical and biomechanical studies have shown that the anterior cruciate ligament (ACL) consists of two distinct bundles, the anteromedial (AM) and posterolateral. Each bundle has its specific role during the motion of the knee. ACL reconstruction techniques have focused on the restauration of the anteroposterior stability by substituting the more isometric AM bundle. Although these ligamentoplasties provide overall good results, in the last ten years double-bundle ACL reconstruction techniques have been developed, to better replicate the ligament anatomy. Despite the growing number of published studies, including randomized controlled trials comparing single bundle and double bundle reconstructions, there is still a lack of evidence of any superiority of the double-bundle technique. Furthermore, many series are criticized for their poor assessement of rotational stability, using most of the time subjective pivot shift clinical testing. Among the methods available to measure tibial rotation, 3-D optoelectronic evaluation is an attractive tool and has been used in some studies reporting rotational mesurements after ACL single-bundle reconstruction. Our Department of Orthopaedics and Traumatology has been using double-bundle techniques for a few years. We conducted a preliminary prospective randomized study, in order to compare single and double-bundle techniques by clinical and optoelectronic evaluations.

[Geldanamycin administration reduces the number of HSP86-positive germ cells in the mouse embryo: preliminary results]. / L'administration de geldanamycine réduit le nombre de gonocytes exprimant l'HSP86 chez l'embryon de souris: premiers résultats.

5 mg of Geldanamycin, an inhibitor of stress protein HSP86 which express on mammalian germ cells, were administered to E8 pregnant mice. E17 embryos were removed, and a quantitative analysis of HSP90-immunoreactive cells in the gonad was performed, in comparison to control embryos. First, we observed that the number of germ cells is lower in male than in female embryos, as well in control and experimental embryos. External features of experimental and control embryos did not display any difference. Embryos exposed to geldanamycin exhibit a significant decrease of immunoreactive germ cells. In two embryos, we observed a group of ectopic immunoreactive cells in the pelvic area. We conclude that geldanamycin inhibits germ cells migration, and suggest that this inhibition can lead to ectopic germ cell populations, similar to teratomas.

Precision of shoulder anatomical landmark calibration by two approaches: a CAST-like protocol and a new anatomical palpator method.

The objective of the study was to compare the precision of shoulder anatomical landmark palpation using a CAST-like method and a newly developed anatomical palpator device (called A-Palp) using the forefinger pulp directly. The repeated-measures experimental design included four examiners that twice repeated measurements on eleven scapula and humerus anatomical landmarks during two sessions. Inter-session and inter-examiner precision was determined on volunteers. A-Palp accuracy was obtained from in vitro measurements and using virtual palpation on 3D bone models. Error propagation on the motion representation was also analyzed for a continuous motion of abduction movement performed in the shoulder joint. Palpation results showed that CAST and A-Palp methods lead to similar precision with the Maximal A-Palp calibration error being 1.5mm. In vivo precision of the CAST and A-Palp methods varied between 4mm (inter-session) and 8mm (inter-examiner). Mean propagation of the palpation error on the motion graph representation was 2 degrees and 5 degrees for scapula and humerus, respectively. A-Palp accuracy was 3.6 and 8.1mm for scapula and humerus, respectively. The A-Palp seems promising and could probably become an additional method next to today's marker-based motion analysis systems (i.e., Helen-Hayes configuration, CAST method).