Superior Capsule Reconstruction Using Fascia Lata Allograft Compared With Double- and Single-Layer Dermal Allograft: A Biomechanical Study.

PURPOSE: To biomechanically characterize superior capsule reconstruction (SCR) using fascia lata allograft, double-layer dermal allograft, and single-layer dermal allograft for a clinically relevant massive irreparable rotator cuff tear involving the entire supraspinatus and 50% of the infraspinatus tendons. METHODS: Eight cadaveric specimens were tested in 0°, 30°, and 60° abduction for (1) intact, (2) massive rotator cuff tear, (3) SCR using fascia lata, (4) SCR using double-layer dermis, and (5) SCR using single-layer dermis. Superior translation and subacromial contact pressure were measured. Statistical analysis was conducted using repeated measures ANOVA or paired t test with P < .05. RESULTS: Massive rotator cuff tear significantly increased superior translation of the humeral head at all abduction angles (P < .05). At 0° abduction, all SCR conditions significantly decreased superior translation compared with the massive tear but did not restore translation (P < .05) to intact. Fascia lata and double-layer dermis SCR restored superior translation to intact at 30° and 60° of abduction, but single-layer dermis did not. Subacromial contact pressure at 0° of abduction significantly decreased with SCR with fascia lata and double-layer dermis compared with tear. At 30°, all SCR conditions significantly decreased subacromial contact pressure. Single-layer dermis graft thickness significantly decreased more than fascia lata during testing (P = .02). CONCLUSION: For SCR tensioned at 20° glenohumeral abduction, all 3 graft types may restore superior translation and subacromial contact pressure depending on the glenohumeral abduction angle; fascia lata and double-layer dermis may be more effective than single-layer dermis. CLINICAL RELEVANCE: If a dermal graft is to be used for SCR, consideration should be given to doubling the graft for increased thickness and better restorative biomechanical properties, which may improve clinical outcomes following SCR.

Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in Women with Greater Trochanteric Pain Syndrome.

Greater trochanteric pain syndrome (GTPS) is prevalent in women and severely impacts quality of life. A key muscle group demonstrating reduced strength are the hip abductors. An understanding of specific muscles affected will help guide targeted rehabilitation. Objectives of this case-control study were to compare gluteal and tensor fasciae latae (TFL) muscle size and quality (fatty infiltration) in women with symptomatic GTPS to asymptomatic age-matched female controls. Magnetic resonance imaging of 16 women with GTPS (mean age 55.75 years, range 23-69) and 15 asymptomatic controls (mean age 55.60 years, range 31-66) was undertaken. Muscle volumes of the gluteus maximus, gluteus medius, gluteus minimus, and TFL were calculated. Fatty infiltration was rated using the Goutallier classification system for all muscles in their entirety, as well as anterior and posterior segments of gluteus medius and minimus. Muscle volumes and fatty infiltration were compared between groups. Significantly smaller muscle volumes were identified in the symptomatic group for the upper (P = 0.01) and lower (P = 0.04) portions of gluteus maximus, gluteus medius (P = 0.03), and gluteus minimus (P = 0.02). There was no difference in TFL (P = 0.18). Symptomatic participants displayed significantly greater fatty infiltration in gluteus maximus upper (P = 0.021) and lower (P = 0.049) when adjusted for BMI, and gluteus minimus (P = 0.018), particularly in the posterior portion (P = 0.04). Anterior gluteus minimus demonstrated high amounts of fatty infiltration in both groups. Gluteal muscle atrophy and fatty infiltration in women with GTPS suggests gluteus maximus and minimus may be an important target for rehabilitation. Clin. Anat., 33:1082-1090, 2020. © 2019 Wiley Periodicals, Inc.

How weakness of the tensor fascia lata and gluteus maximus may contribute to ACL injury: A new theory.

Anterior cruciate ligament (ACL) injuries are common in sports including a significant failure rate following reconstruction. The iliotibial band (ITB) is an important stabilizer of the lateral portion of the knee and also an important lateral rotator of the tibia. Both the tensor fascia lata (TFL) and gluteus maximus (Gmax) muscles insert into the ITB proximally. This paper describes a theory that implicates weakened TFL and Gmax muscles as possible contributors to anterolateral rotatory instability. If the TFL and Gmax are important contributors to anterolateral rotatory instability, physical therapists can emphasize assessing for their weakness and developing a rehabilitation program to restore their strength.

Hipertrofia unilateral del músculo tensor de la fascia lata, a propósito de un caso / Tensor fascia lata unilateral hypertrophy: a case report

La hipertrofia del músculo tensor de la fascia lata es una entidad clínica poco frecuente que puede simular un tumor de partes blandas. En la mayoría de los pacientes se presenta como una masa anterior palpable en la cara proximal del muslo. La imagen característica en la TC o la RMN es diagnóstica, evitando la realización de biopsia o intervenciones quirúrgicas. En los casos donde se sospeche radiculopatía también es de utilidad el electromiograma. Presentamos un caso clínico y su evolución con tratamiento rehabilitador

Hypertrophy of the tensor fascia lata muscle is an uncommon clinical entity, which can simulate a soft tissue tumour. In most patients, it presents as a palpable proximal anterior thigh mass. The characteristic appearance on CT or MRI allows a confident diagnosis of muscle hypertrophy to be made, avoiding unnecessary diagnostic biopsy or surgical intervention. In cases with suspected radiculopathy, electromyography is also useful. We present an illustrative case of hypertrophy of the tensor fascia lata muscle and its outcome after rehabilitation treatment

Irradiation at 11 kGy conserves the biomechanical properties of fascia lata better than irradiation at 25 kGy.

The objective of this study was to determine the biomechanical properties of the fascia lata and the effects of three preservation methods: freezing, cryopreservation with dimethylsulfoxide solution and lyophilization; and to compare the effects of low-dose (11 kGy) and normal-dose (25 kGy) gamma-ray sterilization versus no irradiation. 248 samples from 14 fasciae latae were collected. Freezing samples were frozen at -80 °C. Cryopreservation with dimethylsulfoxide solution samples were frozen with 10 cl dimethylsulfoxide solution at -80 °C. Lyophilization samples were frozen at -22 °C and lyophilized. Each preservation group were then randomly divided into 3 irradiation groups. The cryopreservation with dimethylsulfoxide solution samples had significantly worse results in all 3 irradiation conditions. Young's modulus was lower for the freezing samples (p < 0.001) and lyophilization samples groups (p < 0.001). Tear deformation was lower for the freezing samples (p = 0.001) and lyophilization samples groups (p = 0.003), as was stress at break (p < 0.001 and p < 0.001). Taking all preservation methods together, samples irradiated at 25 kGy had worse results than the 0 kGy and 11 kGy groups in terms of Young's modulus (p = 0.007 and p = 0.13) and of stress at break (p = 0.006 and p = 0.06). The biomechanical properties of fascia lata allografts were significantly worse under dimethylsulfoxide cryopreservation. The deleterious effects of irradiation were dose-dependent.

Anterolateral Knee Extra-articular Stabilizers: A Robotic Sectioning Study of the Anterolateral Ligament and Distal Iliotibial Band Kaplan Fibers.

BACKGROUND: The individual kinematic roles of the anterolateral ligament (ALL) and the distal iliotibial band Kaplan fibers in the setting of anterior cruciate ligament (ACL) deficiency require further clarification. This will improve understanding of their potential contribution to residual anterolateral rotational laxity after ACL reconstruction and may influence selection of an anterolateral extra-articular reconstruction technique, which is currently a matter of debate. Hypothesis/Purpose: To compare the role of the ALL and the Kaplan fibers in stabilizing the knee against tibial internal rotation, anterior tibial translation, and the pivot shift in ACL-deficient knees. We hypothesized that the Kaplan fibers would provide greater tibial internal rotation restraint than the ALL in ACL-deficient knees and that both structures would provide restraint against internal rotation during a simulated pivot-shift test. STUDY DESIGN: Controlled laboratory study. METHODS: Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate the effect of sectioning the ALL and the Kaplan fibers in ACL-deficient knees with a 6 degrees of freedom robotic testing system. After ACL sectioning, sectioning was randomly performed for the ALL and the Kaplan fibers. An established robotic testing protocol was utilized to assess knee kinematics when the specimens were subjected to a 5-N·m internal rotation torque (0°-90° at 15° increments), a simulated pivot shift with 10-N·m valgus and 5-N·m internal rotation torque (15° and 30°), and an 88-N anterior tibial load (30° and 90°). RESULTS: Sectioning of the ACL led to significantly increased tibial internal rotation (from 0° to 90°) and anterior tibial translation (30° and 90°) as compared with the intact state. Significantly increased internal rotation occurred with further sectioning of the ALL (15°-90°) and Kaplan fibers (15°, 60°-90°). At higher flexion angles (60°-90°), sectioning the Kaplan fibers led to significantly greater internal rotation when compared with ALL sectioning. On simulated pivot-shift testing, ALL sectioning led to significantly increased internal rotation and anterior translation at 15° and 30°; sectioning of the Kaplan fibers led to significantly increased tibial internal rotation at 15° and 30° and anterior translation at 15°. No significant difference was found when anterior tibial translation was compared between the ACL/ALL- and ACL/Kaplan fiber-deficient states on simulated pivot-shift testing or isolated anterior tibial load. CONCLUSION: The ALL and Kaplan fibers restrain internal rotation in the ACL-deficient knee. Sectioning the Kaplan fibers led to greater tibial internal rotation at higher flexion angles (60°-90°) as compared with ALL sectioning. Additionally, the ALL and Kaplan fibers contribute to restraint of the pivot shift and anterior tibial translation in the ACL-deficient knee. CLINICAL RELEVANCE: This study reports that the ALL and distal iliotibial band Kaplan fibers restrain anterior tibial translation, internal rotation, and pivot shift in the ACL-deficient knee. Furthermore, sectioning the Kaplan fibers led to significantly greater tibial internal rotation when compared with ALL sectioning at high flexion angles. These results demonstrate increased rotational knee laxity with combined ACL and anterolateral extra-articular knee injuries and may allow surgeons to optimize the care of patients with this injury pattern.

Retraso de la latencia de activación de los músculos de cadera y rodilla en individuos con acortamiento de la banda iliotibial / Latency delay of hip and knee muscles in individuals with iliotibial band tightness

Objetivo: Determinar la latencia de activación de los músculos de cadera y rodilla en participantes con acortamiento de la banda iliotibial (BIT). Material y método: Estudio de casos y controles. Doce participantes masculinos con acortamiento de la BIT y 12 participantes masculinos sin acortamiento de la BIT realizaron una prueba de alteración repentina de los miembros inferiores en dirección anterior, posterior, ipsolateral y contralateral. Se midió la latencia de activación electromiográfica del vasto medial (VM), vasto lateral (VL), tensor de la fascia lata (TFL) y glúteo mayor (GM) durante esta prueba. Se utilizó la prueba t de Student para comparar la latencia muscular entre los grupos. Se consideró un nivel alfa de 0,05. Resultados: Durante una desestabilización anterior se observó un aumento significativo de la latencia del VM (p = 0,0001), VL (p = 0,0163), GM (p = 0,0036) y TFL (p < 0,0001) en los participantes con acortamiento de la BIT. En una desestabilización posterior, se observó un aumento significativo de las latencias de activación de GM (p = 0,0001) y TFL (p < 0,0001) en individuos con acortamiento de la BIT. Durante una desestabilización contralateral a la extremidad evaluada, se observó un aumento de la latencia solo en el TFL (p < 0,0001) en participantes con acortamiento de la BIT. Conclusiones: Los individuos con acortamiento de la BIT presentan un retraso de la latencia de activación de los músculos de cadera y rodilla, principalmente del músculo TFL

Objective: To determinate the onset latency of the hip and knee muscles in participants with iliotibial band (ITB) tightness. Material and methods: A case-control study. Twelve male participants whit ITB tightness and 12 male participants without ITB tightness performed a sudden lower limbs perturbation in anterior, posterior, ipsolateral and contralateral direction. The electromyographic onset latencies of the medial vastus (VM), vastus lateralis (VL), tensor fascia lata (TFL) and gluteus maximus (GM) were measured during this test. The statistical analysis was performed with t-student test. Significance level was established a priori at P < .05. Results: A significant increase of the VM (P = .0001), VL (P = .0163), GM (P = .0036) and TFL (P < .0001) latency was observed in participants with ITB tightness during a sudden anterior perturbation. In a posterior perturbation, a significant increase in the GM (P = .0001) and TFL (P < .0001) latency was observed in participants with ITB tightness. A significant increase of the TFL (P < .0001) latency was observed in participants with ITB tightness during a contralateral limb evaluated perturbation. Conclusions: Individuals with ITB tightness present a delay of knee and hip muscles latencies, mainly the TFL muscle

Biomechanical Effect of Thickness and Tension of Fascia Lata Graft on Glenohumeral Stability for Superior Capsule Reconstruction in Irreparable Supraspinatus Tears.

PURPOSE: To investigate the effects of graft length and thickness on shoulder biomechanics after superior capsule reconstruction. METHODS: Subacromial peak contact pressure and glenohumeral superior translation were measured at 0°, 30°, and 60° of glenohumeral abduction in 8 fresh-frozen cadaveric shoulders under 5 conditions: (1) intact shoulder; (2) irreparable supraspinatus tendon tear, (3) superior capsule reconstruction with a fascia lata allograft 4-mm thick and 15 mm longer than the distance from the superior glenoid to the lateral edge of the greater tuberosity, as determined during placement at 30° of glenohumeral abduction; (4) superior capsule reconstruction with a fascia lata allograft 8-mm thick and with the same 15 mm relative length determined at 10° of glenohumeral abduction, and (5) superior capsule reconstruction with a fascia lata allograft 8-mm thick and with the 15-mm relative length determined at 30° of glenohumeral abduction. To investigate the effect of graft thickness, we compared the data from conditions 1, 2, 3, and 5. To assess the effect of graft length, we compared conditions 1, 2, 4, and 5. RESULTS: With superior capsule reconstruction using a 4-mm graft, subacromial peak contact pressure (but not superior translation) was significantly lower than with irreparable supraspinatus tears (at 0° abduction: 259% decrease; P = .0002; at 30° abduction: 113% decrease; P = .01). The superior capsule reconstruction using an 8-mm graft significantly decreased both subacromial peak contact pressure (at 0° abduction: 246% decrease, P = .0002; at 30° abduction: 158% decrease; P = .0008; at 60° abduction: 57% decrease; P = .04) and superior translation (at 0° abduction: 135% decrease; P = .02; at 30° abduction; 130% decrease; P = .004). Graft length with placement at 10° glenohumeral abduction was 5 mm greater than that at 30° abduction. The 8-mm superior capsule reconstruction performed at 10° or 30° of glenohumeral abduction significantly decreased subacromial peak contact pressure (placement at 10° and 30°: 0° abduction, P = .0002 and .0002, respectively; 30° abduction, P = .0004 and .0005, respectively; 60° abduction, P = .04 and .04, respectively) and superior translation (placement at 10° and 30°; 0° abduction, P =.04 and .02, respectively; 30° abduction, P = .02 and .004, respectively) compared with irreparable supraspinatus tears. CONCLUSIONS: Superior capsule reconstruction normalized the superior stability of the shoulder joint when the graft was attached at 10° or 30° of glenohumeral abduction. An 8-mm-thick graft of fascia lata had greater stability than did a 4-mm-thick graft. CLINICAL RELEVANCE: Grafts 8-mm thick and attached at 15° to 45° of shoulder abduction (equal to 10° to 30° of glenohumeral abduction) biomechanically restore shoulder stability during superior capsule reconstruction using fascia lata.

Surgical technique: Gluteus maximus and tensor fascia lata transfer for primary deficiency of the abductors of the hip.

BACKGROUND: Avulsion of the abductor muscles of the hip may cause severe limp and pain. Limited literature is available on treatment approaches for this problem, and each has shortcomings. This study describes a muscle transfer technique to treat complete irreparable avulsion of the hip abductor muscles and tendons. DESCRIPTION OF TECHNIQUE: Ten adult cadaver specimens were dissected to determine nerve and blood supply point of entry in the gluteus maximus and tensor fascia lata (TFL) and evaluate the feasibility and safety of transferring these muscles to substitute for the gluteus medius and minimus. In this technique, the anterior portion of the gluteus maximus and the entire TFL are mobilized and transferred to the greater trochanter such that the muscle fiber direction of the transferred muscles closely matches that of the gluteus medius and minimus. METHODS: Five patients (five hips) were treated for primary irreparable disruption of the hip abductor muscles using this technique between January 2008 and April 2011. All patients had severe or moderate pain, severe abductor limp, and positive Trendelenburg sign. Patients were evaluated for pain and function at a mean of 28 months (range, 18-60 months) after surgery. RESULTS: All patients could actively abduct 3 months postoperatively. At 1 year postoperatively, three patients had no hip pain, two had mild pain that did not limit their activity, three had no limp, and one had mild limp. One patient fell, fractured his greater trochanter, and has persistent limp and abduction weakness. CONCLUSIONS: The anterior portion of the gluteus maximus and the TFL can be transferred to the greater trochanter to substitute for abductor deficiency. In this small series, the surgical procedure was reproducible and effective; further studies with more patients and longer followup are needed to confirm this.

The electrodiagnostic sensitivity of proximal lower extremity muscles in the diagnosis of L5 radiculopathy.

The aim of this study was to assess the electrodiagnostic (EDx) sensitivity of proximal lower extremity muscles, including tensor fascia lata (TFL) and gluteus medius (GMED), in the diagnosis of L5 radiculopathy.Eleven EDx recordings with L5 radiculopathy were collected. The motor unit action potentials were assessed for morphology, stability, and firing characteristics. A descriptive analysis was performed. In proximal L5-supplied muscles, 4 of 11 recordings were abnormal in TFL only, with normal GMED; 4 of 11 recordings had similar findings in both muscles; 2 of 11 had abnormal findings in both muscles, but TFL had more noticeable findings; and 1 had abnormal findings in both muscles, but GMED findings were more noticeable. No patient had abnormalities limited to GMED. TFL was more sensitive than GMED in detecting L5 radiculopathy. Knowing which muscles are more likely to show abnormalities can improve the efficiency of EMG and reduce patient discomfort. Muscle Nerve 45: 891-893, 2012.

Effect of gamma sterilisation and deep-freezing on length and strength of fascia latae.

PURPOSE: To compare the length and strength of fascia latae after gamma sterilisation and different durations of deep-freezing. METHODS: 50 pieces of fresh porcine fascia latae were randomly divided into 5 groups. Group 1 acted as controls, which were not gamma irradiated and deep-frozen. In groups 2 to 4, fascia latae were incubated in phosphate buffer solution for 4 hours, and then gamma irradiated at 25 kGy. They were preserved at -70 degrees Celcius for one to 3 months, respectively. In group 5, fascia latae were preserved for 3 months, and during the whole process they were fixed on a wooden board to maintain their original length. The maximum tensile strength of each fascia lata was tested at a displacement rate of 1 cm per minute until failure. RESULTS: The maximum tensile strength was not significantly different among groups 1 to 4, but was significantly higher in group 5. CONCLUSION: Gamma sterilisation and deep-freezing had no effect on the strength of fascia latae, but fixation on a board could increase strength.

Iliotibial band syndrome: an examination of the evidence behind a number of treatment options.

Iliotibial band (ITB) syndrome (ITBS) is a common cause of distal lateral thigh pain in athletes. Treatment often focuses on stretching the ITB and treating local inflammation at the lateral femoral condyle (LFC). We examine the area's anatomical and biomechanical properties. Anatomical studies of the ITB of 20 embalmed cadavers. The strain generated in the ITB by three typical stretching maneuvers (Ober test; Hip flexion, adduction and external rotation, with added knee flexion and straight leg raise to 30 degrees ) was measured in five unembalmed cadavers using strain gauges. Displacement of the Tensae Fasciae Latae (TFL)/ITB junction was measured on 20 subjects during isometric hip abduction. The ITB was uniformly a lateral thickening of the circumferential fascia lata, firmly attached along the linea aspera (femur) from greater trochanter up to and including the LFC. The microstrain values [median (IQR)] for the OBER [15.4(5.1-23.3)me], HIP [21.1(15.6-44.6)me] and SLR [9.4(5.1-10.7)me] showed marked disparity in the optimal inter-limb stretching protocol. HIP stretch invoked significantly (Z=2.10, P=0.036) greater strain than the SLR. TFL/ITB junction displacement was 2.0+/-1.6 mm and mean ITB lengthening was <0.5% (effect size=0.04). Our results challenge the reasoning behind a number of accepted means of treating ITBS. Future research must focus on stretching and lengthening the muscular component of the ITB/TFL complex.

Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve.

BACKGROUND: Meralgia paresthetica is a rarely encountered sensory mononeuropathy characterized by paresthesia, pain or sensory impairment along the distribution of the lateral femoral cutaneous nerve caused by entrapment or compression of the nerve as it crosses the anterior superior iliac spine and runs beneath the inguinal ligament. OBJECTIVE: We describe the first reported use of pulsed radiofrequency neuromodulation to relieve the intractable pain associated with meralgia paresthetica. CASE REPORT: A 33-year-old morbidly obese female with a history of lower back pain and previous spinal fusion presented with sensory dysesthesias and paresthesias in the right anterolateral thigh, consistent with meralgia paresthetica. Temporary relief occurred with multiple lateral femoral cutaneous nerve and fascia lata blocks at 2 different institutions. The patient expressed dissatisfaction with her previous treatments and requested "any" therapeutic intervention that might lead to long-lasting pain relief. At this time, we located the anterior superior iliac spine and reproduced concordant dysesthesia. Pulsed radiofrequency was then undertaken at 42 degrees C for 120 seconds followed by dexamethasone and bupivicaine. The patient reported exceptional and prolonged pain relief at 6-month follow-up. LIMITATIONS: Since this case report is not a prospective, randomized, controlled or blinded study, no conclusions may be drawn from the results attained on behalf of this single individual. Additional, larger group analyses studying this technique while eliminating bias from patient variables would be essential prior to assuming any validity to using pulsed radiofrequency techniques of neuromodulation for managing peripheral neuropathic pain processes. CONCLUSION: The patient had experienced long-standing pain that was recalcitrant to conservative/pharmacologic therapy and multiple nerve blocks with local steroid instillations. A single treatment with pulsed radiofrequency resulted in complete and sustained cessation of pain. No side effects were evident. Pulsed radiofrequency of the LFCN may offer an effective, low risk treatment in patients with meralgia paresthetica who are refractory to conservative medical management or are unwilling or unfit to undergo surgery.

Iliotibial band syndrome in runners: innovations in treatment.

Iliotibial band syndrome (ITBS) is the most common cause of lateral knee pain in runners. It is an overuse injury that results from repetitive friction of the iliotibial band (ITB) over the lateral femoral epicondyle, with biomechanical studies demonstrating a maximal zone of impingement at approximately 30 degrees of knee flexion. Training factors related to this injury include excessive running in the same direction on a track, greater-than-normal weekly mileage and downhill running. Studies have also demonstrated that weakness or inhibition of the lateral gluteal muscles is a causative factor in this injury. When these muscles do not fire properly throughout the support phase of the running cycle, there is a decreased ability to stabilise the pelvis and eccentrically control femoral abduction. As a result, other muscles must compensate, often leading to excessive soft tissue tightness and myofascial restrictions. Initial treatment should focus on activity modification, therapeutic modalities to decrease local inflammation, nonsteroidal anti-inflammatory medication, and in severe cases, a corticosteroid injection. Stretching exercises can be started once acute inflammation is under control. Identifying and eliminating myofascial restrictions complement the therapy programme and should precede strengthening and muscle re-education. Strengthening exercises should emphasise eccentric muscle contractions, triplanar motions and integrated movement patterns. With this comprehensive treatment approach, most patients will fully recover by 6 weeks. Interestingly, biomechanical studies have shown that faster-paced running is less likely to aggravate ITBS and faster strides are initially recommended over a slower jogging pace. Over time, gradual increases in distance and frequency are permitted. In the rare refractory case, surgery may be required. The most common procedure is releasing or lengthening the posterior aspect of the ITB at the location of peak tension over the lateral femoral condyle.

The role of epimysium in suturing skeletal muscle lacerations.

BACKGROUND: Direct muscle trauma is a common and disabling clinical problem. Surgical muscle repair is difficult to evaluate because reliable repair techniques have not been established scientifically. The purpose of this study was to assess the biomechanical properties of epimysium, the collagenous tissue sheath that surrounds muscles in the body. STUDY DESIGN: We surgically repaired transected porcine muscle bellies with and without epimysium. For both groups, 25 figure-eight stitches in lacerated quadriceps bellies from a euthanatized pig were loaded under tension on a biomechanical machine (model 8521S, Instron Company). Maximum loads and strains were measured and mechanisms of failure recorded. RESULTS: The mean load for repairs with epimysium (25.1 N) was significantly higher (p = 0.034) than that for repairs without epimysium (21.2 N). The mean strain for repairs with epimysium (10.4%) was significantly higher (p < 0.001) than that for repairs without epimysium (7.3%). The mechanisms of failure were also different. Among epimysium repairs, 15 stitches avulsed muscle transversely, and 10 stitches tore out longitudinally from the muscle. In the nonepimysium group, 1 suture avulsed muscle and 24 sutures tore out. Muscle was the weakest element in each test. CONCLUSIONS: These data showed that epimysium incorporation into suturing improves the capacity of repairs to bear force. These findings fill a knowledge gap and may improve outcomes of muscle suturing. By focusing the experiment on biomechanical properties of muscle stitching, this study showed the key role epimysium plays in muscle suturing.

Neurolysis for meralgia paresthetica: an operative series of 45 cases.

BACKGROUND: Failure of symptom relief after neurolysis for meralgia paresthetica (MP) is reported frequently, yet systematic outcome analysis is limited in the modern literature. The present operative series of 45 cases aims to address this issue. METHODS: From 1996 to 2000, all patients who had neurolysis for MP by our senior author were enrolled in the study. Nerve entrapment was confirmed preoperatively by electrophysiological studies or a positive response to local anesthetic and steroid injection. Attention to the anatomical variability of the lateral femoral cutaneous nerve was made during nerve exploration. Decompression of the nerve was performed at the level of the iliac fascia, the inguinal ligament, and the fascia of the thigh distally. The outcome of surgery was assessed 6 weeks after the procedure followed by 3 monthly intervals if symptoms persisted. Telephone interviews were conducted to assess long-term results. RESULTS: Forty-five decompressive procedures were performed in 42 patients over the 5-year period. The average duration of symptoms was 31 (2.5-180) months. All patients were followed for an average of 4.1 years. Complete and partial symptom improvements were noted in 33 (73%) and 9 (20%) cases, respectively. No recurrence was reported. Analysis of clinical variables demonstrated that the duration of symptoms preoperatively did not affect the rate of complete symptom relief, but obese patients (body mass index > 30) was 6 times more likely to have (odds ratio 6.16, P = 0.04) incomplete relief after surgery at long-term follow-up. CONCLUSION: High success rate was recorded in our series of 45 cases. Prolonged duration of symptoms did not preclude favorable outcome but obesity had a negative association with good outcome.

Force and repetition in cycling: possible implications for iliotibial band friction syndrome.

This study examined force and repetition during simulated distance cycling with regard to how they may possibly influence the on-set of the overuse injury at the knee called iliotibial band friction syndrome (ITBFS). A 3D motion analysis system was used to track lower limb kinematics during cycling. Forces between the pedal and foot were collected using a pressure-instrumented insole that slipped into the shoe. Ten recreational athletes (30.6+/-5.5 years) with no known history of ITBFS participated in the study. Foot-pedal force, knee flexion angle and crank angle were examined as they relate to the causes of ITBFS. Specifically, foot-pedal force, repetition and impingement time were calculated and compared with the same during running. A minimum knee flexion angle of approximately 33 degrees occurred at a crank angle of 170 degrees. The foot-pedal force at this point was 231 N. This minimum knee flexion angle falls near the edge of the impingement zone of the iliotibial band (ITB) and the femoral epicondyle, and is the point at which ITBFS is aggravated causing pain at the knee. The foot-pedal forces during cycling are only 18% of those occurring during running while the ITB is in the impingement zone. Thus, repetition of the knee in the impingement zone during cycling appears to play a more prominent role than force in the on-set of ITBFS. The results also suggest that ITBFS may be further aggravated by improper seat position (seat too high), anatomical differences, and training errors while cycling.

Spigelion hernia: fascia lata repair is an alternative option in absence of prolene mesh.

Spigelian hernia is rare. Seven cases of Spigelian hernia are presented. These include two recurrent Spigelian hernias. Incisional hernias through Spigelian aponeurosis after Pfannensteil incision are not included. Clinical examination is the mainstay of diagnosis. The true incidence is possibly higher, as a low Spigelian hernia is not recognised and often diagnosed as a direct inguinal hernia. Ultrasound scanning is recommended, as it is non-invasive and easily available and can detect the hernial orifice in the Spigelian fascia at an early stage. Recurrence of Spigelian hernia took place in two cases through the site of prolene stitch of a previous repair. Hernioplasty with tension free fascia lata graft/prolene mesh was carried out in all cases. The cost of fascia lata graft is only a scar in the thigh. In a mean follow-up of 3.1 -year no patient has reported back with recurrence This is the ideal substitute for the patients in developing countries where synthetic meshes are still not freely available.