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1.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 40-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31776625

RESUMO

PURPOSE: The purpose of this study was to investigate if the calcaneofibular ligament (CFL) presents morphologic variants and measure the morphometrics of the ligament and its footprints METHODS: An anatomical study of 47 fresh-frozen below-the-knee ankle specimens was performed. Lateral ankle structures were dissected to expose the CFL. Overdissection was avoided to not modify the native morphology. The morphology (number and orientation of CFL bundles) and measurements of CFL insertions were recorded with ankle secured in neutral position. RESULTS: Four distinct morphological-oriented shapes of the CFL were observed. These included single bundle, Y-shape double bundle, V-shape double bundle, and associated with the lateral talocalcaneal ligament. The most frequent CFL morphology observed was the single bundle and the Y-shape double bundle, present in 21 (44.7%) and 13 (27.7%) ankles. The V-shape double bundle and the CFL double bundle associated with the lateral talocalcaneal ligaments were less common, appearing only in eight (17.0%) and five (10.6%) ankles. The CFL length was higher in single bundle and Y-shaped double bundle CFL variants, about 30 mm each. Footprint morphometrics were heterogenous amongst the different CFL variants. CONCLUSION: The CFL presents four distinct morphological-oriented shapes. The double bundle, V-shaped and Y-shaped CFL variants are uncommon and poorly reported in the literature. Their relation to the lateral talocalcaneal ligament and the inferior fascicle of the anterior talofibular ligament requires further research. The CFL morphology provides detailed knowledge of CFL anatomy that can improve diagnostic procedures. Furthermore, this information can fine-tune graft selection and sizing and allow a more precise anatomic placement during surgical reconstruction.

2.
J Sci Food Agric ; 100(1): 50-58, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31435937

RESUMO

BACKGROUND: Protein hydrolysate powder was prepared from non-penaeid shrimp (Acetes indicus) by enzymatic hydrolysis using Alcalase enzyme. Extraction conditions such as pH (6.5, 7.5 and 8.5), enzyme to substrate ratio (1.0, 1.5 and 2.0) and temperature (40, 50 and 60 °C) were optimized against the degree of hydrolysis using response surface methodology. RESULTS: Protein hydrolysate comprised of 740 g kg-1 protein, 150 g kg-1 ash and 90 g kg-1 fat contents. The amino acid score showed superior attributes with 56% essential amino acids. Furthermore, the functional properties of spray-dried protein hydrolysates were evaluated. Protein solubility was found to be the 90.20% at pH 2 and 96.92% at pH 12. Emulsifying properties were found to vary with the concentration of protein hydrolysates and the highest emulsifying capacity (26.67%) and emulsion stability (23.33%) were found at a concentration of 20 mg mL-1 . The highest and the lowest foaming capacity were observed at pH 6 and pH 10 with a concentration of 20 mg mL-1 . The water holding capacity of protein hydrolysate was found to increase with concentration, with a value of 5.4 mL g-1 at a concentration of 20 mg mL-1 . CONCLUSION: The results of the present study indicate that the use of A. indicus for the production of protein hydrolysate has good functional properties and nutritional value, rendering it suitable for broad industrial food applications. © 2019 Society of Chemical Industry.


Assuntos
Crustáceos/química , Proteínas de Frutos do Mar/química , Aminoácidos/análise , Animais , Biocatálise , Emulsões/química , Manipulação de Alimentos , Hidrólise , Valor Nutritivo , Hidrolisados de Proteína/química , Solubilidade , Subtilisinas/química
3.
Foot Ankle Surg ; 2019 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-31548150

RESUMO

BACKGROUND: The optimal treatment of acute Achilles tendon ruptures (AATR) is still under debate. The purpose of this study was to evaluate outcomes of open repair comparing with percutaneous procedure for AATR. METHODS: 100 patients with AATR were randomized in two groups: open "crown" type (group A) and percutaneous Bunnell type repair (group B). 87 patients were available for the mean follow up of 27months RESULTS: No statistically significant difference was observed between groups in ATRS score, leg circumference, single heel rise, Achilles resting angle, time back to work and sports and overall patient satisfaction. Percutaneous technique was much faster. Overall 13 complications occurred in both groups (5 and 8 respectively). No deep infection occurred, no revisions were needed. CONCLUSIONS: Both techniques showed to be effective and safe when using absorbable suture material with a high patient satisfaction and a low complication rate, but percutaneous repair was significantly faster.

4.
Foot Ankle Surg ; 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31084989

RESUMO

BACKGROUND: The Os Peroneum (OP) is a small sesamoid bone, which can be found in the Peroneus Longus Tendon (PLT) sheath, near the calcaneocuboid joint. Size and shape variability is quite common as well as a multipartite OP that can be found in some cases. Trying to explore and understand this variability, this study was carried out in order to provide us with answers about the presence and shape of OP in our specimens. METHODS: Twenty cadaveric lower extremities were obtained according to the body donation program of our institution. Dissections were performed to expose the OP (when present) starting proximally at the origin of the PLT and Peroneal Brevis Tendon (PBT) finalizing at the insertion of the PLT in the first metatarsal. RESULTS: In twenty feet, nine distinct OP were found, whilst six feet had a thickening of the tendon. On the remaining five foot, we did not identify an OP. CONCLUSIONS: In this study, 45% of the feet analyzed had an OP. The authors believe the variability of OP prevalence reported in the literature can be associated with differences in its definition.

5.
Foot Ankle Surg ; 2019 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-30992182

RESUMO

BACKGROUND: The lack of consensus on the relevance of the varus talar tilt test (VTTT) might be due to the divergence between the insufficiency vector of lateral ankle instability and the direction of this clinical test. Our hypothesis is that the VTTT is more accurate to diagnose lateral ankle ligaments rupture when it's applied with a pre-positioning of the foot in internal rotation (IR). METHODS: We compared, in 12 cadaver ankles, the varus opening during a classic VTTT with the same test starting in an IR pivot, using a new arthrometer. RESULTS: The classic VTTT caused a 13° tilt after ATFL section and 23,8° after ATFL and CFL section. The application of a VTTT with an IR prepositioning caused a 21,2° tilt after ATFL section (p = 0,002) and 29,5° after ATFL and CFL section (p = 0,006). CONCLUSION: The VTTT is better to identify lateral ankle ligaments' insufficiency when it's applied with a pre-positioning of the foot in internal rotation. The resulting vector is similar to the supination trauma.

6.
Knee Surg Sports Traumatol Arthrosc ; 27(9): 2852-2857, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30888450

RESUMO

PURPOSE: The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula. METHODS: Ten fresh-frozen lower extremities were dissected to expose the nerves and tendons. Having the posterior tip of the fibula as a reference, the distance between the tendons sheath and the sural nerve was measured in each point with a tachometer with three independent different observers. Two measures were taken distally at 1.5 and 2 cm from fibula tip and 3 measures were performed proximally at 2, 3, and 5 cm from fibula tip. Data were described using means, standard deviations, medians, and minimum and maximum values. RESULTS: The average distance between distance between the fibula tip and sural nerve is 16.6 ± 4.4 mm. The average distance between peroneal tendons sheath and the sural nerve at 5 cm, 3 cm, and 2 cm from the proximal fibular tip was 29.6 ± 3.2 mm, 24.2 ± 3.6 mm, and 19.7 ± 2.7 mm, respectively. The average distance between the peroneal tendons sheath and the sural nerve at 2 cm and 1.5 cm distal to fibular tip was 9.1 ± 3.5 mm and 7.8 ± 3.3 mm, respectively. CONCLUSION: The distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. As the distance between the peroneal tendons sheath and the sural nerve decreases from proximal to distal, performing the tendoscopy portal more distally would increase the risk of nerve iatrogenic injury.


Assuntos
Fíbula/anatomia & histologia , Nervo Fibular/anatomia & histologia , Nervo Sural/anatomia & histologia , Tendões/anatomia & histologia , Cadáver , Humanos , Modelos Anatômicos , Variações Dependentes do Observador , Nervo Fibular/lesões , Reprodutibilidade dos Testes , Nervo Sural/lesões
7.
Environ Sci Pollut Res Int ; 26(9): 8875-8884, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30715703

RESUMO

Fish protein hydrolysates are digested form of protein with various bioactive properties where, the cleavages of molecular bonds of proteins can be broken by the enzymatic and chemical process. In this study, antioxidant properties of spray dried protein hydrolysate prepared from Pangasius viscera by using enzymatic (papain and pepsin), and chemical methods (hydrochloric acid and sodium hydroxide) were evaluated. Among the different treatments, pepsin-derived visceral protein hydrolysate showed the maximum antioxidant activity when used at higher concentrations. Essential amino acids (EAA) and hydrophobic amino acids are higher in papain-derived visceral protein hydrolysate. In pepsin-derived visceral protein hydrolysate, major proportion was contributed by glycine (Gly), glutamine (Glu), proline (Pro), and asparagine (Asp). Higher amount of aromatic amino acids are found in alkali-derived FVPH. Scanning electron microscopy (SEM) images of pepsin fish visceral protein hydrolysate showed better globular structure than the other treatments. It can be concluded that among the different treatments, the visceral protein hydrolysate prepared with pepsin had better overall quality regarding antioxidant properties and papain in nutritional point of view.


Assuntos
Antioxidantes/farmacologia , Peixes-Gato , Hidrolisados de Proteína/farmacologia , Animais , Antioxidantes/química , Antioxidantes/isolamento & purificação , Papaína/química , Pepsina A/farmacologia , Hidrolisados de Proteína/química , Hidrolisados de Proteína/isolamento & purificação , Alimentos Marinhos/análise
8.
Foot Ankle Surg ; 25(5): 636-639, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30321932

RESUMO

BACKGROUND: Peroneal Tendon (PT) complex is formed by the Peroneus Longus Tendon (PLT) and Peroneus Brevis Tendon (PBT), their synovial sheath, the superior and inferior retinaculum, and the Os Peroneum (OP). Their insertion is associated with some anatomic variability. Knowing these variants helps to understand the PT pathology and it may support the decision-making concerning the operative approach. The purpose of this study was to assess anatomical variability in PT insertion. METHODS: Twenty fresh-frozen cadaveric feet were used. The lateral part of the ankle, foot and sole were dissected to expose PLT and PBT course and distal insertions. RESULTS: Concerning the PBT, eleven feet had a normal insertion in the base of the fifth metatarsal; the other nine had a variability. Regarding the PLT, thirteen out of twenty had the normal insertion in the first metatarsal; the remaining seven had anatomical variants. CONCLUSIONS: In this study, we found a great variability in the insertional anatomy of PBT and PLT. CLINICAL RELEVANCE: It is important that orthopedic surgeons are aware of the great variability of PT anatomical insertion when performing foot and ankle surgery, in order to avoid possible complications, for instance a PLT injury during preparation of tarso-metatarsal arthrodeses.


Assuntos
Ossos do Metatarso/anatomia & histologia , Tendões/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Masculino
9.
J Foot Ankle Surg ; 57(6): 1087-1091, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30146335

RESUMO

The clinical diagnosis of the anterior talofibular ligament (ATFL) rupture is based on the findings from the medical history and the anterior drawer test, a maneuver that allegedly pushes the talus and rearfoot anteriorly, although with great variability in its sensitivity. We consider that an ATFL rupture is best evaluated by a rotational vector (i.e., a pivot test) owing to the uncompromised medial ligaments that will block any pure anterior translation of the talus underneath the tibia. We idealized a constrained ankle cadaver model that only allows talar movements in the axial plane. Our hypothesis was that progressive sectioning of the lateral ankle ligaments in this model would cause a progressive and significant angular laxity in internal rotation. Our results showed 3.67 degrees ± 1.2 degrees of talus rotational laxity in the intact ankle, 9.6 degrees ± 3.2 degrees after ATFL sectioning, and 13.43 degrees ± 3.2 degrees after ATFL and calcaneofibular ligament sectioning, indicating almost threefold increase in internal talocrural rotation after single ATFL sectioning and an almost fourfold increase after double (ATFL and calcaneofibular ligament) sectioning. We consider this evidence of rotational ankle laxity to be a major step in defining the correct movement to diagnose an ATFL rupture and propose a new term to avoid further inconsistencies and variability, "the pivot test."


Assuntos
Articulação do Tornozelo/fisiopatologia , Instabilidade Articular/etiologia , Ligamentos Laterais do Tornozelo/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/fisiopatologia , Cadáver , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Masculino
10.
Foot Ankle Surg ; 24(2): 143-148, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29409223

RESUMO

BACKGROUND: The purpose of this anatomical study to was to determine the relationship of the structures involved in the arthroscopic repair of the anterior talofibular ligament. METHODS: Dissection of fifteen lower leg cadaveric specimens was made and distances in the anterior direction from the reference-point at the lateral malleolus origin of the anterior talofibular ligament were measured, to the talar insertion of the ligament, to the superficial peroneal nerve at 60° and 90° in relation to the lateral malleolus axis in the sagittal plane, and to the inferior extensor retinaculum. RESULTS: The mean±SD distance to superficial peroneal nerve from the reference-point was 25±6 (range 17-35) mm at 60°, and 32±9 (range 24-48) mm at 90° in relation to the lateral malleolus axis. The mean±SD distance to the inferior extensor retinaculum was 20±5 (range 14-29) mm. The mean±SD length of the anterior talofibular ligament was 21±4 (range 13-29) mm. CONCLUSIONS: The superficial peroneal nerve demonstrated the greatest variance in its anatomy. An accessory incision to include the inferior extensor retinaculum in the repair should not surpass the 22mm distance from the lateral malleolus in the anterior direction, due to the risk of damaging the nerve.


Assuntos
Articulação do Tornozelo/anatomia & histologia , Articulação do Tornozelo/cirurgia , Ligamentos Laterais do Tornozelo/anatomia & histologia , Ligamentos Laterais do Tornozelo/cirurgia , Artroscopia , Cadáver , Dissecação , Humanos , Nervo Fibular/anatomia & histologia , Nervo Fibular/cirurgia
11.
Foot Ankle Surg ; 24(1): 11-18, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29413768

RESUMO

BACKGROUND: Chronic ankle instability is defined by an instability lasting more than 6 months, in those cases where a comprehensive conservative treatment fails a surgical stabilization is required. Several surgical techniques have been proposed for the management of the chronic lateral instability of the ankle and even after 50 years, the Broström-Gould technique is still considered the gold standard for the treatment of this pathology. Recently, many authors have developed completely arthroscopic lateral ligament repair and the use of these procedures is rapidly increasing. The aim of this review is to provide an updated overview of open and new arthroscopic lateral ligament repair techniques in order to summarize and compare the effectiveness of these strategies. METHODS: A systematic literature review using PubMed/Medline databases was performed (July 1972-July 2015). Clinical results, satisfaction rate and complications of both patient populations were recorded and statistically analyzed. RESULTS: The total ankles treated with an open Broström ATFL repair in the 13 studies was 505 with a mean follow up of 73.4 months (range 9 months-27.9 years). Postoperative AOFAS score was reported in 11 studies, with a mean value of 90.1 (range, 60-100), patient's satisfaction rate was 91.7%. Surgery-related complications occurred in 40 (7.92%) out of 505 treated ankles. The total number of ankles treated within the 6 arthroscopic studies was 216 with a mean follow up of 37.2 months (range 6 months-14 years). Five studies reported a mean postoperative AOFAS score of 92.48 (range, 44-100) with a patient's satisfaction rate of 96.4%. Surgery-related complications were observed in 33 (15.27%) cases. CONCLUSIONS: The results of this review show the excellent efficacy of open and arthroscopic surgical procedures in the treatment of the chronic ankle instability. The higher complication rate of arthroscopic procedures respect to the open ones represents the major issue: however, this does not seem to affect the patient's satisfaction. Because of statistical heterogeneity observed no definitive conclusions can be statistically drawn. Finally, to definitively validate the effectiveness of arthroscopic procedures prospective and comparative studies are needed.


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Artroscopia , Doença Crônica , Humanos
12.
J Foot Ankle Surg ; 57(1): 123-130, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28870735

RESUMO

Percutaneous and minimally invasive surgery is one of the greatest advances in the operating field of orthopedic since the late 1990s. The potential advantages include a shorter operative time, quicker recovery, and reduced hospital stay compared with traditional open surgery. However, scientific validation of the safety and efficacy of hallux valgus (HV) percutaneous surgery remains inconclusive. The objective of the present study was to systematically review the published data and clinical evidence for percutaneous HV surgery, evaluate the scientific method of the reports, and clarify the indications, safety, efficacy, and potential risks of these surgical techniques. Two reviewers independently identified the studies using a PubMed search, with the keywords "hallux valgus," "osteotomy," "minimally invasive," and "percutaneous." Quality assessment was performed using the Coleman methodology scale, and each study was assigned a level of evidence and grade of recommendation. Eighteen studies were included and reported a total of 1534 procedures for percutaneous HV surgery on 1397 patients. Of the 18 studies, 14 (77.8%) were level IV, 2 (11.1%) were level III, and 2 (11.1%) were level II. Overall, the average angle correction of the HV deformity improved postoperatively. Regarding the complications, although some investigators revealed no major complications, others described deformity recurrence in 7.8%, stiffness of the first metatarsophalangeal joint in 9.8%, malunion in 4% to 8.7%, and infection rates ranging from 1.9% to 14.3%. The main indication for percutaneous HV surgery is the correction of mild deformities. The complication rate was elevated even in experienced surgeons. In conclusion, future research in percutaneous techniques should include adequately sized randomized control trials, standardization of treatment protocols, and the use of validated tools for the measurement of clinical outcomes.


Assuntos
Hallux Valgus/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Adulto , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Medição da Dor , Recidiva , Medição de Risco , Resultado do Tratamento
13.
Environ Sci Pollut Res Int ; 24(26): 21222-21232, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28735471

RESUMO

Protein hydrolysate was prepared from Acetes indicus which is a major bycatch among non-penaeid prawn landings of India. Hydrolysis conditions (enzyme to substrate ratio and time) for preparing protein hydrolysates using alcalase enzyme were optimized by response surface methodology using central composite design. The optimum conditions for enzyme-substrate ratio (mL/100 g) of 1.57, 1.69, 1.60, 1.56, and 1.50 and for hydrolysis time of 97.18, 96.5, 98.15 min, 102.48, and 88.44 min were established for attaining maximum yield, degree of hydrolysis, 2,2-diphenyl-1-picrylhydrazyl, angiotensin I-converting enzyme-inhibiting activity, and metal-chelating activity, respectively. ABTS radical scavenging activity and reducing power assay of optimized protein hydrolysate were found to be increased with the increase in concentration. The higher value of 7.04 (µM Trolox/g), 87.95, and 77.24%, respectively for DPPH, ACE, and metal-chelating activity indicated that the A. indicus protein hydrolysates have beneficial biological properties that could be well-utilized in the application of functional foods and nutraceuticals. Graphical abstract ᅟ.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/química , Antioxidantes/química , Hidrolisados de Proteína/química , Animais , Antioxidantes/farmacologia , Compostos de Bifenilo , Hidrólise , Índia
14.
Knee Surg Sports Traumatol Arthrosc ; 25(6): 1916-1924, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27351549

RESUMO

PURPOSE: The purpose of this study was to determine the clinical utility of three bony tubercles: fibular obscure tubercle, talar obscure tubercle and tuberculum ligamenti calcaneofibularis, to serve as anatomical landmarks for defining the precise location of the origins and insertions of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). METHODS: Twelve lower extremity cadaveric specimens were procured. The detectability of the tubercles was tested using palpation and fluoroscopy with subsequent confirmation after dissection. If the tubercles were present, then distances from the identified tubercles to the footprint centres and the intersection of the ATFL and CFL were measured to allow precise localization of the ATFL and CFL origin and intersection sites. Further, if the tubercles were not detectable, then an attempt to provide an alternative means of localizing ATFL and CFL origin and insertion sites was made by measuring distances between alternative landmarks and other important structures. All the measurements were performed by two researchers, and the results were averaged. RESULTS: The fibular obscure tubercle existed and was detectable in all specimens. It was located 1.3 mm proximal to the articular tip of the fibula, 2.7 mm to the intersection of the ATFL and CFL, 3.7 mm distal to the ATFL and 4.9 mm proximal to the CFL origins. The talar obscure tubercle existed 58 % of specimens and was detectable in 57 %. The talar obscure tubercle was located 1.4 mm to the ATFL. The ATFL insertion point was located 60 % of the distance from the inferolateral corner to the anterolateral corner of the of talar body along the anterior border of the talar lateral articular facet. The tuberculum ligamenti calcaneofibularis existed in 33 % of specimens and was detectable in 8 %. The CFL inserted 17 mm on a perpendicular projected line distal from the subtalar joint. CONCLUSIONS: The fibular obscure tubercle was clinically relevant and reliable bony landmark of the ATFL and CFL origin location. However, the talar obscure tubercle was less reliable and the tuberculum ligamenti calcaneofibularis was rarely available and as such alternative landmarks for the ATFL and CFL insertion location should be utilized. The present study describes the utility of clinically relevant bony landmarks that may assist in identifying the origins and insertions of the ATFL and CFL to facilitate minimally invasive ankle stabilization surgery.


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/anatomia & histologia , Procedimentos Cirúrgicos Minimamente Invasivos , Ossos do Tarso/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/diagnóstico por imagem , Cadáver , Feminino , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ossos do Tarso/diagnóstico por imagem
15.
Foot Ankle Surg ; 22(3): 205-209, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27502232

RESUMO

BACKGROUND: The objectives of the study were to evaluate the safety of hypothetical arthroscopic portals from talonavicular joint and to evaluate their reproducibility and enforceability. METHODS: 19 cadaveric feet were marked and four arthroscopic portals were made (medial, dorsomedial, dorsolateral and lateral). The specimens were dissected in layers and the distances between neurovascular structures and the trocars were measured. RESULTS: Medial and dorsomedial portals were in average 8.3 and 8.7, respectively, to the saphenous vein and nerve. Dorsolateral portal was in average 8.1mm to the deep peroneal nerve and dorsalis pedis artery, and 9.1mm to the medial dorsal cutaneous branch of the superficial peroneal nerve. Lateral portal was in average 12.3mm to the intermediate dorsal cutaneous branch of the superficial peroneal nerve. CONCLUSION: Tested portals shown to have a good safety margin for the foot neurovascular deep dorsal structures and an acceptable safety margin for the superficial neurovascular structures.


Assuntos
Pontos de Referência Anatômicos , Artroscópios , Artroscopia/métodos , Articulações Tarsianas/cirurgia , Cadáver , Dissecação , Estudos de Viabilidade , Pé/anatomia & histologia , Pé/cirurgia , Humanos , Gestão da Segurança , Articulações Tarsianas/anatomia & histologia
16.
Foot Ankle Int ; 37(1): 90-5, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26276134

RESUMO

BACKGROUND: Treatment for Freiberg disease has been largely conservative despite availability of various operative options for severe or refractory cases. The aim of this study was to evaluate the long-term results of pediatric patients with symptomatic Freiberg disease treated with intra-articular dorsal wedge osteotomy. METHODS: Pediatric patients treated for Freiberg disease with surgery between January 1982 and 1999 were identified and selected for long-term clinical evaluation. Patients were evaluated regarding operative satisfaction and clinical outcome, performed according to the American Orthopaedic Foot & Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Patients had radiographic assessment of degenerative joint status with anteroposterior and oblique foot x-ray. Twenty patients (18 female, 2 male; mean age 15.2 years; range 12-17 years) were identified. The mean follow-up period was 23.4 (range 15-32) years. RESULTS: The clinical outcomes of our patients were classified as excellent in 16 (80%) and good in 4 (20%). The AOFAS mean score was 96.8 (range 91-100) points at the last clinical appointment. A negative correlation between AOFAS score and time of follow-up (r's = -0.61, P < .001) was found. Also, a strong negative correlation was found between Smillie classification and AOFAS final score (r's = -0.88, P < .001). CONCLUSION: The patients were very satisfied with pain and quality of life at a mean follow-up time of 23.4 years. To our knowledge, this is the first long-term follow-up report supporting the procedure described by Gauthier and Elbaz as a good option for operative treatment of Freiberg disease. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Ossos do Metatarso/cirurgia , Metatarso/anormalidades , Osteocondrite/congênito , Osteotomia/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Metatarso/diagnóstico por imagem , Metatarso/cirurgia , Osteocondrite/diagnóstico por imagem , Osteocondrite/cirurgia , Satisfação do Paciente , Radiografia , Estudos Retrospectivos
17.
Eur J Orthop Surg Traumatol ; 25(3): 577-81, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25337959

RESUMO

BACKGROUND: Ankle arthroscopy is an increasingly used technique. Knowledge of the anatomical structures in relation to its portals is paramount to avoid complications. METHODS: Twenty cadaveric ankles were analysed to assess the distance between relevant neurovascular structures to the anteromedial, anterolateral, posteromedial, and posterolateral arthroscopy portals. RESULTS: The intermediate dorsal branch of the superficial peroneal nerve was the closest structure to any of the portals (4.8 mm from the anterolateral portal), followed by the posterior tibial nerve (7.3 mm from the posteromedial portal). All structures analysed but one (posterior tibial artery) were, at least in one specimen, <5 mm distant from one of the portals. DISCUSSION: This study provides information on the anatomical relations of ankle arthroscopy portals and relevant neurovascular structures, confirming previous studies identifying the superficial peroneal nerve as the structure at highest risk of injury, but also highlighting some important variations. Techniques to minimise the injury to these structures are discussed.


Assuntos
Articulação do Tornozelo/anatomia & histologia , Artroscopia , Órgãos em Risco/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos/anatomia & histologia , Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Fibular/anatomia & histologia , Veia Safena/anatomia & histologia , Artérias da Tíbia/anatomia & histologia , Nervo Tibial/anatomia & histologia
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