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Blank JL, Thelen DG, Roth JD. Regional shear wave speeds track regional axial stress in nonuniformly loaded fibrous soft tissues. J Biomech 2024; 167:112071. [PMID: 38593721 DOI: 10.1016/j.jbiomech.2024.112071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/19/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
Ligaments and tendons undergo nonuniform deformation during movement. While deformations can be imaged, it remains challenging to use such information to infer regional tissue loading. Shear wave tensiometry is a promising noninvasive technique to gauge axial stress and is premised on a tensioned beam model. However, it is unknown whether tensiometry can predict regional stress in a nonuniformly loaded structure. The objectives of this study were to (1) determine whether regional shear wave speed tracks regional axial stress in nonuniformly loaded fibrous soft tissues, and (2) determine the sensitivity of regional axial stress and shear wave speed to nonuniform load distribution and fiber alignment. We created a representative set of 12,000 dynamic finite element models of a fibrous soft tissue with probabilistic variations in fiber alignment, stiffness, and aspect ratio. In each model, we applied a randomly selected nonuniform load distribution, and then excited a shear wave and tracked its regional propagation. We found that regional shear wave speed was an excellent predictor of the regional axial stress (RMSE = 0.57 MPa) and that the nature of the regional shear wave speed-stress relationship was consistent with a tensioned beam model (R2 = 0.99). Variations in nonuniform load distribution and fiber alignment did not substantially alter the wave speed-stress relationship, particularly at higher loads. Thus, these findings suggests that shear wave tensiometry could provide a quantitative estimate of regional tissue stress in ligaments and tendons.
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Affiliation(s)
- Jonathon L Blank
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Joshua D Roth
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA.
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Aoki A, Makihara Y, Tamura A, Ishii T, Kawagishi K. Anatomical analysis of ligaments surrounding calcaneocuboid joint; implications for role in foot stability. Surg Radiol Anat 2024; 46:425-431. [PMID: 38376525 DOI: 10.1007/s00276-024-03303-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE The calcaneocuboid joint is located in the lateral part of the foot and acts as a major stabilizer for the foot. Injuries to this joint often occur in association with ankle or foot injuries and are frequently overlooked, subsequently causing chronic pain or osteoarthritis. However, the relationship between ligaments surrounding the joint and joint instability remains unclear. Therefore, this study aimed to clarify the morphology and position of the ligaments surrounding the calcaneocuboid joint, and to reveal the relationship between the ligament structure. METHODS The position and morphology of the bifurcate ligament (subdivided into calcaneonavicular and calcaneocuboid ligaments), dorsal calcaneocuboid ligament, lateral calcaneocuboid ligament, long plantar ligament, and short plantar ligament were measured (N = 11 feet in 6 Japanese cadavers). The circumference of the joint was quartered, while the ligament-uncovered area and the estimated cross-sectional area of each ligament were compared between the four sides. Furthermore, the estimated cross-sectional area of each ligament was calculated as an index for the ligament strength. RESULTS The inferolateral side of the calcaneocuboid joint had the most uncovered area (54.63%) by the ligaments. In addition, the cross-sectional area of the ligaments on the lateral side was considerably smaller than that on the medial side. CONCLUSION Our results suggest that ligament weakness on the inferolateral side may cause instability of the calcaneocuboid joint, especially after an inversion sprain injury, and may decrease the lateral longitudinal arch function, which results in chronic foot pain.
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Affiliation(s)
- Akino Aoki
- Department of Physical Therapy, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan.
| | - Yukiko Makihara
- Department of Physical Therapy, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Akihiro Tamura
- Department of Physical Therapy, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Takaya Ishii
- Department of Anatomy, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
| | - Kyutaro Kawagishi
- Department of Anatomy, International University of Health and Welfare School of Medicine, Narita, Chiba, Japan
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Hafiz H, Yousefsani SA, Moradi A, Akbarzadeh A, Jirofti N. Contribution of Soft Tissue Passive Forces in Thumb Carpometacarpal Joint Distraction. Ann Biomed Eng 2024:10.1007/s10439-024-03492-2. [PMID: 38503946 DOI: 10.1007/s10439-024-03492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/10/2024] [Indexed: 03/21/2024]
Abstract
Thumb carpometacarpal joint space changes when the surrounding soft tissues including the capsule, ligaments, and tendons are stretched or pulled away. When at rest, joint forces originate from passive contraction of muscles and the involvement of joint capsule and ligaments. Previous biomechanical models of hand and finger joints have mostly focused on the assessment of joint properties when muscles were active. This study aims to present an experimental-numerical biomechanical model of thumb carpometacarpal joint to explore the contribution of tendons, ligaments, and other soft tissues in the passive forces during distraction. Five fresh cadaveric specimens were tested using a distractor device to measure the applied forces upon gradual distraction of the intact joint. The subsequent step involved inserting a minuscule sensor into the joint capsule through a small incision, while preserving the integrity of tendons and ligaments, in order to accurately measure the fundamental intra-articular forces. A numerical model was also used to calculate the passive forces of tendons and ligaments. Before the separation of bones, the forces exerted by tendons and ligaments were relatively small compared to the capsule force, which accounted for approximately 92% of the total applied force. Contribution of tendons and ligaments, however, increased by further distraction. The passive force contribution by tendons at 2-mm distraction was determined less than 11%, whereas it reached up to 74% for the ligaments. The present study demonstrated that the ligament-capsule complex plays significant contribution in passive forces of thumb carpometacarpal joint during distraction.
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Affiliation(s)
- Hamed Hafiz
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, P.O. Box: 9177948974, Mashhad, Iran
| | | | - Ali Moradi
- Orthopedics Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Akbarzadeh
- Department of Mechanical Engineering, FUM Center of Advanced Rehabilitation and Robotics Research (FUM CARE), Ferdowsi University of Mashhad, Mashhad, Iran
| | - Nafiseh Jirofti
- Orthopedics Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran
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Cruz EP, Sanhudo JAV, Iserhard WB, Eggers EKM, Camargo LM, de Freitas Spinelli L. Midfoot width changes after first metatarsal osteotomy in hallux valgus surgery: A biomechanical effect? Foot (Edinb) 2024; 58:102070. [PMID: 38382165 DOI: 10.1016/j.foot.2024.102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Abstract
Hallux valgus is a challenging pathology characterized by a valgus deformity in the metatarsophalangeal area of the first ray. The aim of this study was to analyze the influence of first metatarsal osteotomy on the relationship between midfoot bones in patients with hallux valgus. The sample consisted of patients from the orthopedics and traumatology outpatient clinic who underwent surgical treatment for hallux valgus. Preoperative and postoperative X-rays were compared regarding the width of the midfoot and the tarsometatarsal joint. The sample consisted of 17 women, with 22 feet assessed in each group. The distance from the medial cuneiform to the cuboid, the distance from the intermediate cuneiform to the cuboid, the distance between the first and fifth metatarsals, and the distance between the second and fifth metatarsals reduced significantly between pre- and postoperative assessments. Hallux valgus correction through osteotomy of the first metatarsal leads to a structural change in the midfoot. Further studies should determine whether these changes persist over time.
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Affiliation(s)
- Eduardo Pedrini Cruz
- Department of Orthopedics, Department of Orthopedics and Trauma, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil.
| | - José Antônio Veiga Sanhudo
- Department of Orthopedics, Department of Orthopedics and Trauma, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910, 90035000 Porto Alegre, RS, Brazil
| | - Walter Brand Iserhard
- Department of Orthopedics, Santa Casa de Misericordia de Porto Alegre, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil
| | - Esthefani Katherina Mendes Eggers
- Department of Orthopedics, Santa Casa de Misericordia de Porto Alegre, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil
| | - Leandro Marcantônio Camargo
- Department of Orthopedics, Department of Orthopedics and Trauma, Hospital Santa Casa de Misericórdia de Porto Alegre, Rua Professor Annes Dias, 295, Centro Histórico, 90020-090 Porto Alegre, RS, Brazil
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Zandee van Rilland ED, Payne SR, Gorbachova T, Shea KG, Sherman SL, Boutin RD. MRI of patellar stabilizers: Anatomic visibility, inter-reader reliability, and intra-reader reproducibility of primary and secondary ligament anatomy. Skeletal Radiol 2024; 53:555-566. [PMID: 37704830 DOI: 10.1007/s00256-023-04432-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/12/2023] [Accepted: 08/13/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To compare MRI features of medial and lateral patellar stabilizers in patients with and without patellar instability. METHODS Retrospective study of 196 patients (mean age, 33.1 ± 18.5 years; 119 women) after diagnosis of patellar instability (cohort-1, acute patellar dislocation; cohort-2, chronic patellar maltracking) or no patellar instability (cohort-3, acute ACL rupture; cohort-4, chronic medial meniscus tear). On MRI, four medial and four lateral stabilizers were evaluated for visibility and injury by three readers independently. Inter- and intra-reader agreement was determined. RESULTS Medial and lateral patellofemoral ligaments (MPFL and LPFL) were mostly or fully visualized in all cases (100%). Of the secondary patellar stabilizers, the medial patellotibial ligament was mostly or fully visualized in 166 cases (84.7%). Other secondary stabilizers were mostly or fully visualized in only a minority of cases (range, 0.5-32.1%). Injury scores for all four medial stabilizers were higher in patients with acute patellar dislocation than the other 3 cohorts (p < .05). Visibility inter- and intra-reader agreement was good for medial stabilizers (κ 0.61-0.78) and moderate-to-good for lateral stabilizers (κ 0.40-0.72). Injury inter- and intra-reader agreement was moderate-to-excellent for medial stabilizers (κ 0.43-0.90) and poor-to-moderate for lateral stabilizers (κ 0-0.50). CONCLUSION The MPFL and LPFL were well visualized on MRI while the secondary stabilizers were less frequently visualized. The secondary stabilizers were more frequently visualized medially than laterally, and patellotibial ligaments were more frequently visualized compared to the other secondary stabilizers. Injury to the medial stabilizers was more common with acute patellar dislocation than with chronic patellar maltracking or other knee injuries.
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Affiliation(s)
- Eddy D Zandee van Rilland
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Shelby R Payne
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Tetyana Gorbachova
- Department of Radiology, Einstein Medical Center, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA
| | - Kevin G Shea
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA
| | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA.
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Hong JJ, Kim S, Lee GY, Chung BM. Demonstration of transverse ligament on 3D SPACE MRI in whiplash-associated disorder and nontraumatic conditions. Eur Spine J 2024; 33:1171-1178. [PMID: 38141107 DOI: 10.1007/s00586-023-08079-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE This study aims to delineate the three-dimensional (3D) SPACE MRI findings of the transverse ligament (TL) in whiplash-associated disorder (WAD) patients, and to compare them with those from a nontraumatic group. METHODS A retrospective analysis was performed on cervical spine MRI scans obtained from 46 patients with WAD and 62 nontraumatic individuals. Clinical features, including the WAD grade and stage, were recorded. The TL's morphological grade and the symmetricity of the lateral atlantodental interval was assessed using axial 3D T2-SPACE images. The morphological grading was evaluated using a four-point scale: 0 = homogeneously low signal intensity with normal thickness, 1 = high signal intensity with normal thickness, 2 = reduced thickness, 3 = full-thickness rupture or indistinguishable from surrounding structures. Additionally, the number of cervical levels exhibiting degeneration was documented. RESULTS When comparing the WAD and nontraumatic groups, a significant difference was observed in the proportion of high-grade TL changes (grade 2 or 3) and the number of degenerated cervical levels. Logistic regression analysis revealed that high-grade TL changes and a lower number of degenerative levels independently predicted the presence of WAD. Within the WAD group, the subset of patients with high-grade TL changes demonstrated a significantly higher mean age than the low-grade group (grade 0 or 1). CONCLUSION High-grade morphological changes in the TL can be detected in patients with WAD through the use of 3D SPACE sequences. Clinical relevance statement 3D SPACE MRI could serve as an instrumental tool in the assessment of TL among patients with WAD. Integrating MRI findings with patient history and symptomology could facilitate the identification of potential ligament damage, and may help treatment and follow-up planning.
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Affiliation(s)
- Jung Joo Hong
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea
| | - Guen Young Lee
- Department of Radiology, Chung-Ang University Gwangmyeong Hospital, 110, Deokan‑ro, Gwangmyeong‑si, Gyeonggi‑do, Republic of Korea
| | - Bo Mi Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 156-755, Republic of Korea.
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Mukasheva F, Zhanbassynova A, Erisken C. Biomimetic grafts from ultrafine fibers for collagenous tissues. Biomed Mater Eng 2024:BME230193. [PMID: 38393888 DOI: 10.3233/bme-230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND The ligament is the soft tissue that connects bone to bone and, in case of severe injury or rupture, it cannot heal itself mainly because of its poor vascularity and dynamic nature. Tissue engineering carries the potential to restore the injured tissue functions by utilization of scaffolds mimicking the structure of native ligament. Collagen fibrils in the anterior cruciate ligament (ACL) have a diameter ranging from 20 to 300 nm, which defines the physical and mechanical properties of the tissue. Also, the ACL tissue exhibited a bimodal distribution of collagen fibrils. Currently, the ability to fabricate scaffolds replicating this structure is a significant challenge. OBJECTIVE This work aims at i) measuring the diameter of collagens of bovine ACL tissue, ii) investigating the fabrication of sub-100 nm fibers, and iii) fabricating aligned scaffolds with bimodal diameter distribution (with two peaks) resembling the healthy ACL structure. It is hypothesized that such scaffolds can be produced by electrospinning polycaprolactone (PCL) solutions. METHODS To test the hypothesis, various PCL solutions were formulated in acetone and formic acid in combination with pyridine, and electrospun to generate sub-100 nm fibers. Next, this formulation was adjusted to produce nanofibers with a diameter between 100 nm and 200 nm. Finally, these solutions were combined in the co-electrospinning process, i.e., two-spinneret electrospinning, to fabricate biomimetic scaffolds with a bimodal distribution. RESULTS Electrospinning of 8% and 15% PCL solutions, respectively, resulted in the production of fibers with diameters below and above 100 nm. The combined scaffold exhibited a bimodal distribution of aligned fibers with peaks around 80 and 180 nm, thus mimicking the collagen fibrils of healthy ACL tissue. CONCLUSION This research is expected to have a society-wide impact because it aims to enhance the health condition and life quality of a wide range of patients.
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Affiliation(s)
- Fariza Mukasheva
- Department of Chemical and Materials Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Ainur Zhanbassynova
- Department of Chemical and Materials Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
| | - Cevat Erisken
- Department of Chemical and Materials Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
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Wu WT, Onishi K, Mezian K, Naňka O, Wang B, Su DCJ, Ricci V, Chang KV, Özçakar L. Ultrasound imaging of the posterior lateral corner of the knee: a pictorial review of anatomy and pathologies. Insights Imaging 2024; 15:39. [PMID: 38334861 PMCID: PMC10857999 DOI: 10.1186/s13244-024-01606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024] Open
Abstract
Assessment of the posterior lateral knee pain poses diagnostic challenges, requiring accurate evaluation of various structures in light of the medical history and physical examination. Despite substantial progress in the ultrasonographic diagnosis of musculoskeletal disorders, the current protocol (EURO-MUSCULUS/USPRM. Basic scanning protocols for knee) fails to conduct a comprehensive investigation into the intricate, tendons, and ligaments of the posterior lateral knee. This pictorial review aims to bridge this gap by offering a systematic approach to utilize ultrasound examination of the less-discussed structures in this specific region. Providing cadaveric and magnetic resonance images, this essay demonstrates the efficacy of ultrasound in diagnosing posterior lateral knee pain. Notably, pathologies such as ligamentous sprains and tears are clearly discernible. Moreover, the integration of ultrasound guidance plays a vital role in reducing the risk of inadvertent neurovascular injury during injection, such as the common peroneal nerve and lateral genicular artery. This comprehensive approach will enhance clinicians' understanding and equip them with effective management strategies for posterior lateral knee pain.Critical relevance statement In this visual exposition, we delve into the intricacies of the posterior lateral corner of the knee. Offering a methodical approach to employ ultrasound for visualization of the less-explored structures within this region, the authors aim to enhance the diagnosis in posterior lateral knee pain.Key points1. Ultrasound excels at revealing intricate structures in the posterior lateral knee.2. Due to proximity of vital structures, extreme caution is crucial during injections.3. Employing dynamic scan and understanding ligaments enables a comprehensive exploration of pathologies.
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Affiliation(s)
- Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kamal Mezian
- Department of Rehabilitation Medicine, First Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Ondřej Naňka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Daniel Chiung-Jui Su
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan
| | - Vincenzo Ricci
- Physical and Rehabilitation Medicine Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, No. 87, Nei-Jiang Rd., Wan-Hwa District, Taipei, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei, Taiwan.
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Sun YM, Xin W, Liu YF, Guan ZM, Du HW, Sun NN, Liu YD. Appendicitis combined with Meckel's diverticulum obstruction, perforation, and inflammation in children: Three case reports. World J Clin Cases 2024; 12:865-871. [PMID: 38322683 PMCID: PMC10841135 DOI: 10.12998/wjcc.v12.i4.865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Meckel's diverticulum is a common congenital malformation of the small intestine, with the three most common complications being obstruction, perforation, and inflammation. To date, only a few cases have been reported worldwide. In children, the clinical symptoms are similar to appendicitis. As most of the imaging features are nonspecific, the preoperative diagnosis is not precise. In addition, the clinical characteristics are highly similar to pediatric acute appendicitis, thus special attention is necessary to distinguish Meckel's diverticulum from pediatric appendicitis. Patients with poor disease control should undergo laparoscopic exploration to avoid serious complications, including intestinal necrosis, intestinal perforation and gastrointestinal bleeding. CASE SUMMARY This report presents three cases of appendicitis in children combined with intestinal obstruction, which was caused by fibrous bands (ligaments) arising from the top part of Meckel's diverticulum, diverticular perforation, and diverticular inflammation. All three patients, aged 11-12 years, had acute appendicitis as their initial clinical presentation. All were treated by laparoscopic surgery with a favorable outcome. A complete dataset including clinical presentation, diagnostic imaging, surgical information, and histopathologic findings was also provided. CONCLUSION Preoperative diagnosis of Meckel's diverticulum and its complications is challenging because its clinical signs and complications are similar to those of appendicitis in children. Laparoscopy combined with laparotomy is useful for diagnosis and treatment.
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Affiliation(s)
- Yi-Meng Sun
- School of Clinical Medicine, Weifang Medical University, Weifang 261000, Shandong Province, China
| | - Wang Xin
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yu-Fang Liu
- Department of Burn Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Zhe-Ming Guan
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Hao-Wen Du
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Ning-Ning Sun
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
| | - Yong-Dong Liu
- Department of Pediatric Surgery, Weifang People’s Hospital, Weifang 261000, Shandong Province, China
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Al'Khafaji I, Olszewski Y, Clarnette G, Settle E, Ernstbrunner L, O'Donnell J, Ackland D. The contribution of the ligamentum teres to the hip fluid seal: A biomechanics study. Clin Biomech (Bristol, Avon) 2024; 112:106186. [PMID: 38301536 DOI: 10.1016/j.clinbiomech.2024.106186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/19/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND The suction seal of the hip plays an important role in maintaining hip stability; however, the function of the ligamentum teres in maintaining this seal remains poorly understood. This study aimed to evaluate the effectiveness of the hip suction seal in ligamentum teres deficient hips for joint positions occurring during gait. METHODS Six fresh-frozen human cadaveric hips were dissected and mounted to an Instron materials test system. Each specimen was analyzed for average peak distraction force, stiffness, and total energy during hip displacement. Testing was performed in the native intact ligamentum teres state and the deficient ligamentum teres state. Specimens were examined in 20° of flexion, neutral, and 10° of extension. FINDINGS In the neutral position, the ligamentum teres deficient state displayed a significant decrease in peak distraction force (mean difference: 33.2 N, p < 0.001), average stiffness (mean difference: 63.7 N/mm, p = 0.016), and total energy (mean difference: 82.3 mJ, p = 0.022) compared to the intact controls. In extension, the deficient state exhibited a significant decrease in peak distraction force (mean difference: 42.8 N, p < 0.001) and total energy (mean difference: 72.9 mJ, p = 0.007). In flexion, the deficient state displayed a significant decrease in peak distraction force relative to contols (mean difference: 7.1 N, p = 0.003). INTERPRETATION The ligamentum teres plays a significant role in maintaining the suction seal of the hip, with its effect being most prominent when the hip is in neural alignment or in extension. The findings suggest that ligamentum teres deficiency may be a relevant treatment target in the clinical setting.
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Affiliation(s)
- Ian Al'Khafaji
- Department of Orthopaedics, Epworth Healthcare, Richmond, Victoria, Australia
| | - Yvonne Olszewski
- Department of Biomedical Engineering, University of Melbourne, Australia
| | - Georgina Clarnette
- Department of Biomedical Engineering, University of Melbourne, Australia
| | - Edward Settle
- Department of Biomedical Engineering, University of Melbourne, Australia
| | - Lukas Ernstbrunner
- Department of Biomedical Engineering, University of Melbourne, Australia; Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - John O'Donnell
- Hip Arthroscopy Australia, Richmond, Victoria, Australia
| | - David Ackland
- Department of Biomedical Engineering, University of Melbourne, Australia.
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Li Y, Deng T, Aili D, Chen Y, Zhu W, Liu Q. Cell Sheet Technology: An Emerging Approach for Tendon and Ligament Tissue Engineering. Ann Biomed Eng 2024; 52:141-152. [PMID: 37731091 DOI: 10.1007/s10439-023-03370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023]
Abstract
Tendon and ligament injuries account for a substantial proportion of disorders in the musculoskeletal system. While non-operative and operative treatment strategies have advanced, the restoration of native tendon and ligament structures after injury is still challenging due to its innate limited regenerative ability. Cell sheet technology is an innovative tool for tissue fabrication and cell transplantation in regenerative medicine. In this review, we first summarize different harvesting procedures and advantages of cell sheet technology, which preserves intact cell-to-cell connections and extracellular matrix. We then describe the recent progress of cell sheet technology from preclinical studies, focusing on the application of stem cell-derived sheets in treating tendon and ligament injuries, as well as highlighting its effects on mitigating inflammation and promoting tendon/graft-bone interface healing. Finally, we discuss several prerequisites for future clinical translation including the selection of appropriate cell source, optimization of preparation process, establishment of suitable animal model, and the fabrication of vascularized complex tissue. We believe this review could potentially provoke new ideas and drive the development of more functional biomimetic tissues using cell sheet technology to meet the needs of clinical patients.
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Affiliation(s)
- Yexin Li
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ting Deng
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Dilihumaer Aili
- Department of Orthopedic Surgery, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University, Ürümqi, People's Republic of China
| | - Yang Chen
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Weihong Zhu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Qian Liu
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, People's Republic of China.
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the anterior talo-fibular and calcaneo-fibular ligaments using shear wave elastography in young healthy adults. Orthop Traumatol Surg Res 2024; 110:103647. [PMID: 37356798 DOI: 10.1016/j.otsr.2023.103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the stiffness of the anterior talo-fibular ligament (ATFL) and calcaneo-fibular ligament (CFL) using shear wave elastography (SWE) with the ankle in the neutral position and in varus, in young healthy adult volunteers. We also evaluated the reliability and reproducibility of the SWE measurements. HYPOTHESIS The stiffness of both ligaments increases with increasing ankle varus. SWE may be a reliable tool for evaluating the lateral collateral ligament complex of the ankle. MATERIAL AND METHODS We used SWE to evaluate both ankles of each of 20 healthy volunteers (10 females and 10 males). For each test, the foot was placed on a hinged plate and tested in the neutral position and in 15° and 30° of varus. Stiffness was evaluated based on shear wave velocity (SWV). RESULTS Stiffness of both the ATFL and CFL was minimal in the neutral position (2.06m/s and 3.43m/s, respectively). Stiffness increased significantly for both ligaments in 15° of varus (2.48m/s and 4.11m/s, respectively; p<0.0001) and was greatest in 30° of varus (3.15m/s and 4.57m/s, respectively; p<0.0001). ATFL stiffness was greater in males than in females in 15° (p=0.04) and 30° (p=0.02) of varus. For the CFL, in contrast, stiffness was not different between males and females. Stiffness of the ATFL and CFL was not associated with age, dominant side, height, or foot morphology. No correlations were found between stiffness of the two ligaments in any of the positions. Repeating each measurement three times produced excellent concordance for both ligaments in all three positions. CONCLUSION The ATFL and CFL are the main lateral stabilisers of the ankle, and each exerts a specific function. Their stiffness increases with the degree of varus. This study describes a protocol for evaluating ATFL and CFL density by SWE, which is a reliable and reproducible technique that provides a normal range. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique adulte, hôpital de la Pitié-Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France.
| | - Thibault Marty-Diloy
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Marie Vigan
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Unité de recherche clinique, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphaël Vialle
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculosquelettiques, université de la Sorbonne, Paris, France
| | - Tristan Langlais
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique pédiatrique, hôpital des enfants, université de Toulouse, Purpan, Toulouse, France
| | - Alexandre Hardy
- Département de chirurgie orthopédique, clinique du sport, 75005 Paris, France
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Lau B, Kothari V, Trowbridge S, Lewis TL, Ray R. Tourniquet use in ankle arthroscopy: A systematic review. Foot Ankle Surg 2024; 30:50-56. [PMID: 37866989 DOI: 10.1016/j.fas.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/23/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Ankle arthroscopy is commonly performed using a thigh tourniquet and is thought to improve visibility and reduce operative time. However, the current evidence is unclear as to whether the use of a tourniquet provides these benefits. The aim of this study was to investigate whether there is any clinical benefit of using a tourniquet in ankle arthroscopy. METHODS A systematic review following PRISMA guidelines was undertaken. All clinical studies published in Medline, Embase, PubMed and the Cochrane Library Database from inception until January 2023 reporting on the use of a tourniquet in ankle arthroscopy were included. RESULTS 180 studies were identified of which 3 (164 patients) met the inclusion criteria. All studies showed no statistically significant difference in mean surgical time and complication rate between the tourniquet and non-tourniquet groups. Overall, the quality of the evidence was moderate to poor without data in favour or against the routine use of tourniquets in ankle arthroscopy. CONCLUSION The current literature suggests that there are no significant differences in mean surgical time and complication rate between the tourniquet and non-tourniquet groups.
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Affiliation(s)
- B Lau
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK.
| | - V Kothari
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - S Trowbridge
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - T L Lewis
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
| | - R Ray
- King's Foot and Ankle Unit, King's College NHS Foundation Trust, UK
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15
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Papineni VRK, Mariathas M, Sidhu SS, Chari B. Imaging modalities for non-acute pathologies of the foot and ankle. J Clin Orthop Trauma 2024; 48:102329. [PMID: 38299021 PMCID: PMC10826320 DOI: 10.1016/j.jcot.2023.102329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/30/2023] [Indexed: 02/02/2024] Open
Abstract
Chronic foot and ankle pain, in contrast to acute traumatic injuries, presents a diagnostic challenge due to its diverse underlying causes. Accurate diagnosis often necessitates the utilization of various imaging modalities, emphasizing the importance of selecting the most appropriate one. The intricate structure of the foot, composed of multiple bones and supported by soft tissues like ligaments and plantar fascia, gives rise to a spectrum of mechanical disorders, including stress fractures, plantar fasciitis, Morton's neuroma, and more. In addition to mechanical issues, non-acute abnormalities encompass inflammatory diseases affecting tendons and joints, benign tumors, tumor-like lesions, vascular abnormalities, and others. This article reviews the indispensable role of imaging in the assessment of these conditions, with a focus on plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine studies, tailored to the specific clinical presentation. By providing insights into the selection and interpretation of imaging modalities, this article aims to assist clinicians in achieving accurate diagnoses and optimizing patient care for nonacute foot and ankle pathologies.
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Affiliation(s)
- Vijay Ram Kumar Papineni
- Consultant Musculoskeletal Radiologist, Sheikh Shakhbout Medical City (Mayo Clinic), Abu Dhabi, United Arab Emirates
| | - Matthew Mariathas
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Sandeep Singh Sidhu
- Consultant Musculoskeletal Radiologist, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Basavaraj Chari
- Consultant Musculoskeletal Radiologist, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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von Witzleben M, Hahn J, Richter RF, de Freitas B, Steyer E, Schütz K, Vater C, Bernhardt A, Elschner C, Gelinsky M. Tailoring the pore design of embroidered structures by melt electrowriting to enhance the cell alignment in scaffold-based tendon reconstruction. Biomater Adv 2024; 156:213708. [PMID: 38029698 DOI: 10.1016/j.bioadv.2023.213708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
Tissue engineering of ligaments and tendons aims to reproduce the complex and hierarchical tissue structure while meeting the biomechanical and biological requirements. For the first time, the additive manufacturing methods of embroidery technology and melt electrowriting (MEW) were combined to mimic these properties closely. The mechanical benefits of embroidered structures were paired with a superficial micro-scale structure to provide a guide pattern for directional cell growth. An evaluation of several previously reported MEW fiber architectures was performed. The designs with the highest cell orientation of primary dermal fibroblasts were then applied to embroidery structures and subsequently evaluated using human adipose-derived stem cells (AT-MSC). The addition of MEW fibers resulted in the formation of a mechanically robust layer on the embroidered scaffolds, leading to composite structures with mechanical properties comparable to those of the anterior cruciate ligament. Furthermore, the combination of embroidered and MEW structures supports a higher cell orientation of AT-MSC compared to embroidered structures alone. Collagen coating further promoted cell attachment. Thus, these investigations provide a sound basis for the fabrication of heterogeneous and hierarchical synthetic tendon and ligament substitutes.
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Affiliation(s)
- Max von Witzleben
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Judith Hahn
- Leibniz-Institut für Polymerforschung Dresden e. V. (IPF), Institute of Polymer Materials, Hohe Str. 6, 01069 Dresden, Germany
| | - Ron F Richter
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Bianca de Freitas
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Emily Steyer
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Kathleen Schütz
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Corina Vater
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Anne Bernhardt
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany
| | - Cindy Elschner
- Leibniz-Institut für Polymerforschung Dresden e. V. (IPF), Institute of Polymer Materials, Hohe Str. 6, 01069 Dresden, Germany
| | - Michael Gelinsky
- Technische Universität Dresden, University Hospital Carl Gustav Carus and Faculty of Medicine, Centre for Translational Bone, Joint and Soft Tissue Research, Fetscherstr. 74, 01307 Dresden, Germany.
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Brown ME, Puetzer JL. Enthesis maturation in engineered ligaments is differentially driven by loads that mimic slow growth elongation and rapid cyclic muscle movement. Acta Biomater 2023; 172:106-122. [PMID: 37839633 DOI: 10.1016/j.actbio.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/17/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
Entheses are complex attachments that translate load between elastic-ligaments and stiff-bone via organizational and compositional gradients. Neither natural healing, repair, nor engineered replacements restore these gradients, contributing to high re-tear rates. Previously, we developed a culture system which guides ligament fibroblasts in high-density collagen gels to develop early postnatal-like entheses, however further maturation is needed. Mechanical cues, including slow growth elongation and cyclic muscle activity, are critical to enthesis development in vivo but these cues have not been widely explored in engineered entheses and their individual contribution to maturation is largely unknown. Our objective here was to investigate how slow stretch, mimicking ACL growth rates, and intermittent cyclic loading, mimicking muscle activity, individually drive enthesis maturation in our system so to shed light on the cues governing enthesis development, while further developing our tissue engineered replacements. Interestingly, we found these loads differentially drive organizational maturation, with slow stretch driving improvements in the interface/enthesis region, and cyclic load improving the ligament region. However, despite differentially affecting organization, both loads produced improvements to interface mechanics and zonal composition. This study provides insight into how mechanical cues differentially affect enthesis development, while producing some of the most organized engineered enthesis to date. STATEMENT OF SIGNIFICANCE: Entheses attach ligaments to bone and are critical to load transfer; however, entheses do not regenerate with repair or replacement, contributing to high re-tear rates. Mechanical cues are critical to enthesis development in vivo but their individual contribution to maturation is largely unknown and they have not been widely explored in engineered replacements. Here, using a novel culture system, we provide new insight into how slow stretch, mimicking ACL growth rates, and intermittent cyclic loading, mimicking muscle activity, differentially affect enthesis maturation in engineered ligament-to-bone tissues, ultimately producing some of the most organized entheses to date. This system is a promising platform to explore cues regulating enthesis formation so to produce functional engineered replacements and better drive regeneration following repair.
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Affiliation(s)
- M Ethan Brown
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23284, United States
| | - Jennifer L Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, 23284, United States; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, 23284, United States.
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Spriet M, Vaughan B, Barrett M, Galuppo LD. Advances in Regional Vascular Injection Techniques for the Delivery of Stem Cells to Musculoskeletal Injury Sites. Vet Clin North Am Equine Pract 2023; 39:503-514. [PMID: 37550127 DOI: 10.1016/j.cveq.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Vascular injections of stem cells are a pertinent alternative to direct intralesional injections when treating multiple or extensive lesions or with lesions impossible to reach directly. Extensive research using stem cell tracking has shown that intra-arterial injections without the use of a tourniquet should be preferred over venous or arterial regional limb perfusion techniques using a tourniquet. The median artery is used for the front limbs and the cranial tibial artery for the hind limbs. Proper efficacy studies are still lacking but early clinical work seems promising.
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Affiliation(s)
- Mathieu Spriet
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, 2112 Tupper Hall, One Shields Avenue, Davis, CA 95616, USA.
| | - Betsy Vaughan
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, 2112 Tupper Hall, One Shields Avenue, Davis, CA 95616, USA
| | - Myra Barrett
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine, Colorado State University, 300 West Drake Road, Fort Collins, CO 80523, USA
| | - Larry D Galuppo
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, 2112 Tupper Hall, One Shields Avenue, Davis, CA 95616, USA
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McCarrel TM. Equine Platelet-Rich Plasma. Vet Clin North Am Equine Pract 2023; 39:429-442. [PMID: 37550126 DOI: 10.1016/j.cveq.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
Platelet-rich plasma (PRP) is an orthobiologic therapy composed of platelets, leukocytes, red blood cells, and plasma proteins. PRP has been used for 20 years, but progress determining efficacy has been slow. The definitions and classification of PRP are reviewed, and the use of PRP for tendon, ligament, and joint disease is discussed with a focus on findings of basic science and clinical studies, platelet activation, concurrent administration of nonsteroidal anti-inflammatory drugs, and treatment complications. Finally, the advantages of platelet lysates and freeze-dried platelets are discussed. The promising results of a PRP lysate optimized for antibiofilm and antimicrobial properties are introduced.
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Affiliation(s)
- Taralyn M McCarrel
- Department of Large Animal Clinical Sciences, University of Florida College of Veterinary Medicine, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA.
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20
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Yin H, Mao K, Huang Y, Guo A, Shi L. Tendon stem/progenitor cells are promising reparative cell sources for multiple musculoskeletal injuries of concomitant articular cartilage lesions associated with ligament injuries. J Orthop Surg Res 2023; 18:869. [PMID: 37968672 PMCID: PMC10647040 DOI: 10.1186/s13018-023-04313-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Trauma-related articular cartilage lesions usually occur in conjunction with ligament injuries. Torn ligaments are frequently reconstructed with tendon autograft and has been proven to achieve satisfactory clinical outcomes. However, treatments for the concomitant articular cartilage lesions are still very insufficient. The current study was aimed to evaluate whether stem cells derived from tendon tissue can be considered as an alternative reparative cell source for cartilage repair. METHODS Primary human tendon stem/progenitor cells (hTSPCs) were isolated from 4 male patients (32 ± 8 years) who underwent ACL reconstruction surgery with autologous semitendinosus and gracilis tendons. The excessive tendon tissue after graft preparation was processed for primary cell isolation with an enzyme digestion protocol. Decellularization cartilage matrix (DCM) was used to provide a chondrogenic microenvironment for hTSPCs. Cell viability, cell morphology on the DCM, as well as their chondrogenic differentiation were evaluated. RESULTS DAPI staining and DNA quantitative analysis (61.47 μg per mg dry weight before and 2.64 μg/mg after decellularization) showed that most of the cells in the cartilage lacuna were removed after decellularization process. Whilst, the basic structure of the cartilage tissue was preserved and the main ECM components, collagen type II and sGAG were retained after decellularization, which were revealed by DMMB assay and histology. Live/dead staining and proliferative assay demonstrated that DCM supported attachment, survival and proliferation of hTSPCs with an excellent biocompatibility. Furthermore, gene expression analysis indicated that chondrogenic differentiation of hTSPC was induced by the DCM microenvironment, with upregulation of chondrogenesis-related marker genes, COL 2 and SOX9, without the use of exogenous growth factors. CONCLUSION DCM supported hTSPCs attachment and proliferation with high biocompatibility. Moreover, TSPCs underwent a distinct chondrogenesis after the induction of a chondrogenic microenvironment provided by DCM. These results indicated that TSPCs are promising reparative cell sources for promoting cartilage repair. Particularly, in the cohort that articular cartilage lesions occur in conjunction with ligament injuries, autologous TSPCs can be isolated from a portion of the tendon autograph harvested for ligaments reconstruction. In future clinical practice, combined ligament reconstruction with TSPCs- based therapy for articular cartilage repair can to be considered to achieve superior repair of these associated injuries, in which autologous TSPCs can be isolated from a portion of the tendon autograph harvested for ligaments reconstruction.
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Affiliation(s)
- Heyong Yin
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Kelei Mao
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Yufu Huang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China
| | - Ai Guo
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
| | - Lin Shi
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100053, China.
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Piagkou M, Fiska A, Tsakotos G, Triantafyllou G, Politis C, Koutserimpas C, Skrzat J, Olewnik L, Zielinska N, Tousia A, Kostares M, Totlis T, Triantafyllou A, Al Nasraoui K, Karampelias V, Tsiouris C, Natsis K. A morphological study on the sphenoid bone ligaments' ossification pattern. Surg Radiol Anat 2023; 45:1405-1417. [PMID: 37550483 PMCID: PMC10587028 DOI: 10.1007/s00276-023-03226-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE The sphenoid bone (SB) extracranial ligaments (ECRLs) are the pterygoalar and pterygospinous ligaments (PTAL and PTSL) that are located at the SB lateral pterygoid plate, and inferior to the foramen ovale (FO). Their ossification may affect the mandibular nerve's distribution. The intracranial ligaments' (ICRLs) ossification (the caroticoclinoid ligament-CCLL, the anterior and posterior interclinoid ligaments-AICLL and PICLL) may impede the approaches to the sella. This study highlights the incidence of the ossified ECRLs and ICRLs location, their type (partial, or complete), considering laterality, gender, age, and ligaments' simultaneous presence. METHODS The sample consisted of 156 Greek adult dried skulls of both genders and variable age. RESULTS Ossified ligaments were identified in 57.05%, predominantly extracranially (42.31%, P = 0.003). ECRLs were predominantly identified unilaterally (30.13%, P < 0.001). The majority of the ossified ICRLs were predominantly identified in male skulls (31.1%, P = 0.048) and the majority of the ECRLs (52.8%, P = 0.028) were predominantly identified at the age of 60 years and above. The PTAL was the most ossified (32.69%), followed by the CCLL (24.36%), the PTSL (16.03%), the PICLL (6.41%), and the AICLL (4.49%). CONCLUSIONS Detailed knowledge of the SB morphology and ligaments' ossification extent is essential to improve the technique of the FO percutaneous approach, and sellar approaches, to minimize complications.
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Affiliation(s)
- Maria Piagkou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Aliki Fiska
- Laboratory of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - George Tsakotos
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - George Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Constantinus Politis
- Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Christos Koutserimpas
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Athens, Greece
| | - Janusz Skrzat
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Olewnik
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Nicole Zielinska
- Department of Anatomical Dissection and Donation, Medical University of Lodz, Lodz, Poland
| | - Athina Tousia
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Michael Kostares
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Trifon Totlis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Triantafyllou
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Katerina Al Nasraoui
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Vasilios Karampelias
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Christos Tsiouris
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Estébanez-de-Miguel E, Bueno-Gracia E, González-Rueda V, Pérez-Bellmunt A, Caudevilla-Polo S, López-de-Celis C. Changes Over Time in the Strain on the Inferior Iliofemoral Ligament During a Sustained 5-Minute High-Force Long-Axis Distraction Mobilization: A Cadaveric Study. Arch Phys Med Rehabil 2023; 104:1796-1801. [PMID: 37040862 DOI: 10.1016/j.apmr.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes. DESIGN A cross-sectional laboratory cadaveric study. SETTING Anatomy laboratory. PARTICIPANTS Thirteen hip joints from 9 fresh-frozen cadavers (mean age, 75.6±7.8 years; N=13). INTERVENTIONS High-force LADM in open-packed position was sustained for a period of 5 minutes. MAIN OUTCOME MEASURE(S) Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15 seconds for the first 3 minutes and every 30 seconds for the next 2 minutes. RESULTS Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15 seconds (7.3±7.2%). At 30 seconds, the increase in strain was 10.1±9.6%, the half of the total increase at the end of the 5-minute high-force LADM (20.2±8.5%). Significant changes in strain measures were shown to occur at 45 seconds of high-force LADM (F=18.11; P<.001). CONCLUSIONS When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45 seconds to produce a significant change in the strain of capsular-ligament tissue.
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Affiliation(s)
| | - Elena Bueno-Gracia
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza
| | - Vanessa González-Rueda
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona
| | - Santos Caudevilla-Polo
- Department of Physiatrist and Nursery, Faculty of Heath Sciences, University of Zaragoza, Zaragoza
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat International de Catalunya, Barcelona; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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23
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Hou X, Tian Y, Xu N, Li H, Yan M, Wang S, Li W. Overstrain on the longitudinal band of the cruciform ligament during flexion in the setting of sandwich deformity at the craniovertebral junction: a finite element analysis. Spine J 2023; 23:1721-1729. [PMID: 37385409 DOI: 10.1016/j.spinee.2023.06.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/31/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CONTEXT In the setting of "sandwich deformity" (concomitant C1 occipitalization and C2-3 nonsegmentation), the C1-2 joint becomes the only mobile joint in the craniovertebral junction. Atlantoaxial dislocation develops earlier with severer symptoms in sandwich deformity, which has been hypothesized to be due to the repetitive excessive tension in the ligaments between C1 and C2. PURPOSE To elucidate whether and how the major ligaments of the C1-2 joint are affected in sandwich deformity, and to find out the ligament most responsible for the earlier development and severer symptoms of atlantoaxial dislocation in sandwich deformity. STUDY DESIGN A finite element (FE) analysis study. METHODS A three-dimensional FE model from occiput to C5 was established using anatomical data from a thin-slice CT scan of a healthy volunteer. Sandwich deformity was simulated by eliminating any C0-1 and C2-3 segmental motion respectively. Flexion torque was applied, and the range of motion of each segment and the tension sustained by the major ligaments of C1-2 (including the transverse and longitudinal bands of the cruciform ligament, the alar ligaments, and the apical ligament) were analyzed. RESULTS Tension sustained by the longitudinal band of the cruciform ligament and the apical ligament during flexion is significantly larger in the FE model of sandwich deformity. In contrast, tension in the other ligaments is not significantly changed in the sandwich deformity model compared with the normal model. CONCLUSIONS Considering the importance of the longitudinal band of the cruciform ligament to the stability of the C1-2 joint, our findings implicate that the early onset, severe dislocation, and unique clinical manifestations of atlantoaxial dislocation in patients with sandwich deformity are mainly due to the enlarged force loaded on the longitudinal band of the cruciform ligament. CLINICAL SIGNIFICANCE The enlarged force loaded on the longitudinal band of the cruciform ligament can add to its laxity and thus reducing its ability to restrict the cranial migration of the odontoid process. This is in accordance with our clinical experience that dislocation of the atlantoaxial joint in patients with sandwich deformity is mainly craniocaudal, which means severer cranial neuropathy, Chiari deformity, and syringomyelia, and more difficult surgical treatment.
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Affiliation(s)
- Xiangyu Hou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Yinglun Tian
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Hui Li
- Beijing Engineering and Technology Research Center for Medical Endoplants, Building 1, Yard 9, Chengwan Street, Haidian District, Beijing, China
| | - Ming Yan
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
| | - Shenglin Wang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China.
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing, China; Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Rd, Haidian District, Beijing, China; Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Rd, Haidian District, Beijing, China
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24
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Cain EL, Parker D. Open Anatomic Coracoclavicular Ligament Reconstruction for Acromioclavicular Joint Injuries. Clin Sports Med 2023; 42:589-598. [PMID: 37716723 DOI: 10.1016/j.csm.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Open reconstruction of the coracoclavicular (CC) and acromioclavicular (AC) ligaments results in excellent reduction of severely displaced AC dislocations, most commonly Grades III and V. Anatomic CC reconstruction through clavicular bone tunnels can prevent vertical instability, whereas the addition of an acromial limb of the graft can increase horizontal stability. Autograft tendon is preferred in the young athletic group of collision sports participants, although allograft has had acceptable results. Accessory fixation may be placed to protect the graft during healing, or for severe instability, especially for athletes involved in contact sports.
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Affiliation(s)
- E Lyle Cain
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA.
| | - David Parker
- American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, 805 Saint, Vincents Drive, Suite 100, Birmingham, AL, 35205, USA
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25
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Meyer Zu Reckendorf G, Artuso M, Kientzi M, Rouzaud JC. Collateral ligament sprains of the metacarpophalangeal joint of the long fingers: Results of a surgical series of 15 patients. Orthop Traumatol Surg Res 2023; 109:102952. [PMID: 33951542 DOI: 10.1016/j.otsr.2021.102952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Collateral ligament sprains of the metacarpophalangeal joint (MP) of the long fingers are rare and mostly treated conservatively. Clinical examination to diagnose the severity of these injuries is mandatory. The purpose of our study is to report the results of 15 patients treated surgically. METHODS Twenty-three patients, mean age 48, underwent surgery for Stage 3 radial collateral ligament (RCL) injuries of the middle finger (12), the ring finger (4) and the little finger (7). The mean time from trauma to surgery was 53 days. The clinical evaluation consisted of measuring active joint motion, performing laxity tests at 0°, 30° and 90° of MP flexion, testing for laxity and rotation, looking for a spontaneous overlapping finger (or hyperabducted little finger) in relaxed position and measuring the strength (Jamar). RESULTS Among the 23 operated patients, RCL lesions were distal in 8 cases, proximal in 9, and mid-substance in 6. There were 2 Stener-like lesions. Preoperatively, 16 patients presented an overlapping finger over the next one and 7 had spontaneous hyperabduction of the fifth finger. Mean follow-up of the 15 patients reviewed was 24 months (8-56). Mean MP flexion-extension range of motion was 86°/11° (71-99/0-29). Mean MP ulnar laxity of the injured finger was 18°, 14° and 11° respectively at 0°, 30° and 90° and 19°, 16°and 13°on comparison to the same digit on the opposite side. Mean MP radial laxity of the injured finger was 28°, 22° and 10° respectively at 0°, 30°, 90°, same digit on opposite side was 29°, 21°, 11°. There were no postoperative overlapped or hyperabducted fingers concerning spontaneous lateral laxity in extension. The postoperative rotational laxity test showed differences of arc in supination and pronation between operated finger and healthy side of respectively -12% and +8%. CONCLUSION The postoperative results of RCL repair of the MP in the long fingers are good in spite of some residual ligamentous distension, revealed by the laxity tests. The lateral laxity sign as a simple painless clinical sign for diagnosing complete RCL tears requiring surgery needs a validating study in order to spread its use. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Gero Meyer Zu Reckendorf
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Mickaël Artuso
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France.
| | - Mylène Kientzi
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
| | - Jean-Claude Rouzaud
- Institut Montpelliérain de la main et du membre supérieur, clinique Saint-Roch, 560, avenue du Colonel Pavelet, 34070 Montpellier, France
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26
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Xie T, Brouwer RW, van den Akker-Scheek I, van der Veen HC. Clinical relevance of joint line obliquity after high tibial osteotomy for medial knee osteoarthritis remains controversial: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:4355-4367. [PMID: 37340220 PMCID: PMC10471655 DOI: 10.1007/s00167-023-07486-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE To systematically review the literature on the association between knee joint line obliquity (KJLO) and clinical outcome after high tibial osteotomy (HTO) for medial knee osteoarthritis and summarize the KJLO cut-off value used when studying this association. METHODS A systematic search was conducted in three databases (PubMed, Embase, and Web of Science) on September 2022, updated on February 2023. Eligible studies describing postoperative KJLO in relation to clinical outcome after HTO for medial knee osteoarthritis were included. Nonpatient studies and conference abstracts without full-text were excluded. Two independent reviewers assessed title, abstract and full-text based on the inclusion and exclusion criteria. The modified Downs and Black checklist was used to assess the methodological quality of each included study. RESULTS Of the seventeen studies included, three had good methodological quality, thirteen fair quality, and one had poor quality. Conflicting findings were shown on the associations between postoperative KJLO and patient-reported outcome, medial knee cartilage regeneration, and 10-year surgical survival in sixteen studies. Three good-quality studies found no significant differences in lateral knee cartilage degeneration between postoperative medial proximal tibial angle > 95° and < 95°. Joint line orientation angles by the tibial plateau of 4° and 6°, joint line orientation angle by the middle knee joint space of 5°, medial proximal tibial angles of 95° and 98°, and Mikulicz joint line angle of 94° were KJLO cut-off values used in the included studies. CONCLUSION Based on current evidence, the actual association between postoperative KJLO and clinical consequences after HTO for medial knee osteoarthritis cannot be ascertained. The clinical relevance of KJLO after HTO remains controversial. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tianshun Xie
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopaedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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27
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Patel A, Baudoin J, Chaiyamoon A, Cardona JJ, Carrera A, Reina F, Iwanaga J, Dumont AS, Tubbs RS. An unusual arrangement between the highest denticulate ligament and posterior inferior cerebellar artery. Anat Cell Biol 2023; 56:394-397. [PMID: 37013378 PMCID: PMC10520863 DOI: 10.5115/acb.23.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
The posterior inferior cerebellar artery (PICA) is often involved in pathologies of the posterior cranial fossa. Therefore, a good understanding of the vessel's normal and variant courses is important to the neurosurgeon or neurointerventionalist. During the routine microdissection of the craniocervical junction, an unusual arrangement between the highest denticulate ligament and PICA was observed. On the right side, the PICA was given rise to by the V4 segment of the vertebral artery 9 mm after the artery entered the dura mater of the posterior cranial fossa. The artery made an acute turn around the lateral edge of the highest denticulate ligament to then recur 180 degrees and travel medially toward the brainstem. Invasive procedures that target the PICA should be aware of the variant as described herein.
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Affiliation(s)
- Aditi Patel
- Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, USA
| | - Johnathan Baudoin
- Tulane School of Public Health & Tropical Medicine, Tulane School of Medicine, New Orleans, LA, USA
| | - Arada Chaiyamoon
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Thailand
| | - Juan J. Cardona
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ana Carrera
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group, University of Girona, Girona, Spain
| | - Francisco Reina
- Department of Medical Sciences, Clinical Anatomy, Embryology and Neurosciences Research Group, University of Girona, Girona, Spain
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Aaron S. Dumont
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - R. Shane Tubbs
- Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada, USA
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- University of Queensland, Brisbane, Australia
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28
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Mandalia V, Bayley M, Bhamber N, Middleton S, Houston J. Posterior Tibial Slope in Anterior Cruciate Ligament Surgery: A Systematic Review. Indian J Orthop 2023; 57:1376-1386. [PMID: 37609016 PMCID: PMC10441937 DOI: 10.1007/s43465-023-00947-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/23/2023] [Indexed: 08/24/2023]
Abstract
Background While the literature suggests a correlation between posterior tibial slope and sagittal stability of the knee, there is a lack of consensus relating to how to measure the slope, what a normal slope value would be, and which critical values should guide extra surgical treatment. We performed a systematic literature review looking at the posterior tibial slope and cruciate ligament surgery. Our aims were to define a gold standard measurement technique of posterior tibial slope, as well as determining its normal range and the important values for consideration of adjuncts during cruciate ligament surgery. Methods Electronic searches of MEDLINE (PubMed), CINAHL, Cochrane, Embase, ScienceDirect, and NICE in June 2020 were completed. Inclusion criteria were original studies in peer-reviewed English language journals. A quality assessment of included studies was completed using the Methodological Index for Non-Randomized Studies (MINORS) Criteria. Results Two-hundred and twenty-one papers were identified; following exclusions 34 papers were included for data collection. The mean MINORS score was 13.8 for non-comparative studies and 20.4 for comparative studies, both indicating fair to good quality studies. A large variation in the posterior tibial slope measurement technique was identified, resulting in a wide range of values reported. A significant variation in slope value also existed between different races, ages and genders. Conclusion Cautiously, the authors suggest a normal range of 6-12º, using the proximal tibial axis at 5 and 15 cms below the joint. We suggest 12º as a cut-off value for slope-reducing osteotomy as an adjunct to revision ligament reconstruction.
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Affiliation(s)
- Vipul Mandalia
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, EX2 5DW Devon UK
| | - Morgan Bayley
- Department of Trauma and Orthopaedics, Swansea Bay University Health Board, Swansea, SA6 6NL UK
| | - Nivraj Bhamber
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, EX2 5DW Devon UK
| | - Simon Middleton
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, EX2 5DW Devon UK
| | - James Houston
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Exeter, EX2 5DW Devon UK
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Bordalo M, Felippe de Paula Correa M, Yamashiro E. High-resolution Ultrasound of the Foot and Ankle. Foot Ankle Clin 2023; 28:697-708. [PMID: 37536826 DOI: 10.1016/j.fcl.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
High-resolution ultrasound (US) can be used to assess soft tissue abnormalities in the foot and ankle. Compared to MRI, it has lower cost, is widely available, allows portability and dynamic assessment. US is an excellent method to evaluate foot and ankle tendon injuries, ligament tears, plantar fascia, peripheral nerves, and the different causes of metatarsalgia.
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Affiliation(s)
- Marcelo Bordalo
- Radiology Department, Aspetar Orthopedic and Sports Medicine Hospital, Al Waab Street, Zone 54, PO Box 29222, Doha, Qatar.
| | | | - Eduardo Yamashiro
- Radiology Department, Aspetar Orthopedic and Sports Medicine Hospital, Al Waab Street, Zone 54, PO Box 29222, Doha, Qatar
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30
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Alexeev SO, Buckley SE, Hewitt MA, Hunt KJ. Publication trends in ligament augmentation techniques: current concepts. J ISAKOS 2023; 8:232-238. [PMID: 37105381 DOI: 10.1016/j.jisako.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
IMPORTANCE Ligament augmentation techniques (LATs) are surgical procedures, in which an anatomical ligament repair or reconstruction is strengthened with a synthetic material. During the last decade, LATs have increased in prevalence in clinical practice and academic literature. Observing the trends in LAT publications can be used to identify clusters of strong evidence for clinical practice and to highlight areas of the literature which need further development. OBJECTIVE This article aims to define ligament augmentation as a technique category, observe anatomical, procedural, and temporal trends in LAT publication, and report on the state of current research in this field. EVIDENCE REVIEW Primary literature in the English language, which describes ligament augmentation and reports on human, cadaveric, or biomechanical models, and published prior to May 24th, 2022, was targeted for analysis. PubMed, Embase, and Cochrane CENTRAL databases were explored using a focused keyword search strategy, and the resulting publications were reviewed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were collected and analysed using descriptive statistics. FINDINGS Two hundred eighty-three publications reporting ligament augmentation techniques, published from May 1989 to May 2022, were included for final analysis. A wide technical and anatomical variety of procedures are reported. 36.8% of LAT publications describe knee ligaments, among which the anterior cruciate ligamenthas the highest focus in ligament augmentation publications (31.8% of articles). LAT literature has recently expanded in anatomical scope, with many contemporary articles describing the usage of a LAT in the ankle syndesmosis and coracoclavicular ligaments. 60.4% of LAT literature has been published since 2017. There has been an 11% average increase in the rate of LAT publication reports since 2015. Novel fixation devices-suture buttons and suture anchors-have gained wide popularity in the literature. CONCLUSIONS AND RELEVANCE In this review, we define LATs and quantitatively describe the expansion of LAT use reported in the literature. This data will provide physicians an overview of the history of these methods, as well as illustrate the broad range of applications available for the use of LATs. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Sergei O Alexeev
- University of South Carolina School of Medicine, Columbia, SC 29209, USA
| | - Sara E Buckley
- University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Michael A Hewitt
- University of Colorado School of Medicine, Denver, CO 80045, USA
| | - Kenneth J Hunt
- University of Colorado School of Medicine, Denver, CO 80045, USA.
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Means O, Fahrenkopf M. Volar Scapholunate Interosseous Ligament Reconstruction in Acute Traumatic Wrist: A Review of Volar-Based Repairs/Reconstructions. J Hand Surg Glob Online 2023; 5:467-470. [PMID: 37521544 PMCID: PMC10382873 DOI: 10.1016/j.jhsg.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 08/01/2023] Open
Abstract
The volar scapholunate interosseous ligament is an important stabilizer of the wrist. In 2015, van Kampen et al described the technique for reconstruction of an isolated palmar injury using a long radiolunate ligament in the subacute or chronic setting; however, its use has not been described in the acute, traumatic setting. We describe the use of their technique in a 22-year-old man who presented with a traumatic right open transradiocarpal disarticulation with underlying bony, tendinous, ligamentous, and neurovascular injuries secondary to a motor vehicle accident. At 3 months after surgery, the patient had improved range of motion, no pain, normal scapholunate angle at 59.6°, and no scapholunate gap.
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Affiliation(s)
- Olivia Means
- Integrated Plastic Surgery Residency, Corewell Health/Michigan State University (formerly Spectrum Health), Grand Rapids, MI
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32
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Zbojniewicz AM. MRI anatomy and injuries of the fingers. Pediatr Radiol 2023; 53:1562-1575. [PMID: 36808525 DOI: 10.1007/s00247-023-05624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/20/2023]
Abstract
Magnetic resonance imaging (MRI) diagnosis of underlying finger pathology can be intimidating due to the presence of unique anatomy. The small size of the fingers and the unique orientation of the thumb compared to the fingers also introduce unique demands on the MRI system and the technologists performing the study. This article will review the anatomy pertinent to injuries at the fingers, provide protocol guidance, and discuss pathology encountered at the fingers. Although much of the encountered pathology in the fingers overlaps with adults, unique pathology to children will be highlighted when applicable.
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Affiliation(s)
- Andrew M Zbojniewicz
- Advanced Radiology Services, Michigan State University, Grand Rapids, MI, 49525, USA.
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Chen H, Fang JH, Yin GY. [Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation]. Zhongguo Gu Shang 2023; 36:543-9. [PMID: 37366096 DOI: 10.12200/j.issn.1003-0034.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction. METHODS One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared. RESULTS The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction. CONCLUSION The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.
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Affiliation(s)
- Hao Chen
- Nanjing Medical University, Nanjing 211166, Jiangsu, China; Department of Orthopaedics, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu, China
| | - Jia-Hu Fang
- Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
| | - Guo-Yong Yin
- Department of Orthopaedics, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
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Bleakley C, Netterström-Wedin F. Does mechanical loading restore ligament biomechanics after injury? A systematic review of studies using animal models. BMC Musculoskelet Disord 2023; 24:511. [PMID: 37349749 DOI: 10.1186/s12891-023-06653-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mechanical loading is purported to restore ligament biomechanics post-injury. But this is difficult to corroborate in clinical research when key ligament tissue properties (e.g. strength, stiffness), cannot be accurately measured. We reviewed experimental animal models, to evaluate if post-injury loading restores tissue biomechanics more favourably than immobilisation or unloading. Our second objective was to explore if outcomes are moderated by loading parameters (e.g. nature, magnitude, duration, frequency of loading). METHODS Electronic and supplemental searches were performed in April 2021 and updated in May 2023. We included controlled trials using injured animal ligament models, where at least one group was subjected to a mechanical loading intervention postinjury. There were no restrictions on the dose, time of initiation, intensity, or nature of the load. Animals with concomitant fractures or tendon injuries were excluded. Prespecified primary and secondary outcomes were force/stress at ligament failure, stiffness, laxity/deformation. The Systematic Review Center for Laboratory animal Experimentation tool was used to assess the risk of bias. RESULTS There were seven eligible studies; all had a high risk of bias. All studies used surgically induced injury to the medial collateral ligament of the rat or rabbit knee. Three studies recorded large effects in favour of ad libitum loading postinjury (vs. unloading), for force at failure and stiffness at 12-week follow up. However, loaded ligaments had greater laxity at initial recruitment (vs. unloaded) at 6 and 12 weeks postinjury. There were trends from two studies that adding structured exercise intervention (short bouts of daily swimming) to ad libitum activity further enhances ligament behaviour under high loads (force at failure, stiffness). Only one study compared different loading parameters (e.g. type, frequency); reporting that an increase in loading duration (from 5 to 15 min/day) had minimal effect on biomechanical outcomes. CONCLUSION There is preliminary evidence that post-injury loading results in stronger, stiffer ligament tissue, but has a negative effect on low load extensibility. Findings are preliminary due to high risk of bias in animal models, and the optimal loading dose for healing ligaments remains unclear.
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Affiliation(s)
- Chris Bleakley
- School of Health Sciences, Faculty of Life and Health Sciences, Ulster University, Jordanstown campus, Newtownabbey, UK
| | - Fredh Netterström-Wedin
- Division of Public Health Science, School of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
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Amer KM, Thomson JE, Elsamna ST, Congiusta DV, Gantz O, DalCortivo RL, Vosbikian MM, Ahmed IH. Comparison of Treatment Options for Chronic Scapholunate Interosseous Ligament (SLIL): A Systematic Literature Review and Meta-Analysis. Eplasty 2023; 23:e33. [PMID: 37465482 PMCID: PMC10350884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background The scapholunate interosseous ligament (SLIL) is an important contributor to wrist stability and functionality. SLIL injury is debilitating and therefore many surgical techniques have been proposed, but the optimal treatment modality remains debated.This meta-analysis reviews the available literature comparing surgical techniques used in the treatment of chronic SLIL to determine the best approach. Methods An electronic search of the literature was conducted to identify all randomized controlled trials and cohort studies published before January 2019 that evaluated clinical outcomes of capsulodesis reconstruction, the modified Brunelli technique, and the reduction and association of the scaphoid and lunate (RASL) procedure for treatment of chronic SLIL. A chi-square analysis was performed to identify possible differences between each technique for several outcome measures. Results A total 20 studies encompassing 409 patients met inclusion criteria. Average age among patients was 36.7 years, and 68.2% of patients were male. Reductions in visual analog scale pain scale; Disabilities of Arm, Shoulder, and Hand (DASH) scores; and increases in grip strength and range of motion were observed for all techniques. Capsulodesis was superior to the modified Brunelli technique regarding preserved range of motion. Conclusions No significant differences were observed among any of the techniques for pain, DASH score, and grip strength outcomes. Capsulodesis, modified Brunelli, and RASL surgical techniques for the treatment of chronic SLIL injuries may all be seen as reliable methods of treatment of chronic SLIL injuries. While future trials directly comparing these methods are needed, this study suggests there is no superiority of one technique over another.
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Affiliation(s)
- Kamil M Amer
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Jennifer E Thomson
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Samer T Elsamna
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Dominick V Congiusta
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Owen Gantz
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Robert L DalCortivo
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Michael M Vosbikian
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
| | - Irfan H Ahmed
- Rutgers Health - New Jersey Medical School Department of Orthopaedics, Newark, New Jersey
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36
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Stewart ZE, Lee K. Lower extremity ultrasound-guided interventions: tendon, ligament, and plantar fascia. Skeletal Radiol 2023; 52:991-1003. [PMID: 36326878 DOI: 10.1007/s00256-022-04212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Lower extremity tendinopathy and soft tissue injury are common clinical problems that can cause significant disability. Ultrasound-guided minimally invasive treatments using orthobiologics and image-guided percutaneous treatments continue to gain relevance with an ever-growing body of literature. We review the indications, technique, risks, and benefits according to the literature of common ultrasound-guided interventions utilized in the lower extremities.
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Affiliation(s)
- Zachary E Stewart
- Department of Radiology - Musculoskeletal Imaging and Intervention, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey Bldg Room 6033, Boston, MA, 02114, USA.
| | - Kenneth Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Naya Y, Takanari H. Elastin is responsible for the rigidity of the ligament under shear and rotational stress: a mathematical simulation study. J Orthop Surg Res 2023; 18:310. [PMID: 37072855 PMCID: PMC10114388 DOI: 10.1186/s13018-023-03794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/11/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND An accurate understanding of the mechanical response of ligaments is important for preventing their damage and rupture. To date, ligament mechanical responses are being primarily evaluated using simulations. However, many mathematical simulations construct models of uniform fibre bundles or sheets using merely collagen fibres and ignore the mechanical properties of other components such as elastin and crosslinkers. Here, we evaluated the effect of elastin-specific mechanical properties and content on the mechanical response of ligaments to stress using a simple mathematical model. METHODS Based on multiphoton microscopic images of porcine knee collateral ligaments, we constructed a simple mathematical simulation model that individually includes the mechanical properties of collagen fibres and elastin (fibre model) and compared with another model that considers the ligament as a single sheet (sheet model). We also evaluated the mechanical response of the fibre model as a function of the elastin content, from 0 to 33.5%. Both ends of the ligament were fixed to a bone, and tensile, shear, and rotational stresses were applied to one of the bones to evaluate the magnitude and distribution of the stress applied to the collagen and elastin at each load. RESULTS Uniform stress was applied to the entire ligament in the sheet model, whereas in the fibre model, strong stress was applied at the junction between collagen fibres and elastin. Even in the same fibre model, as the elastin content increased from 0 to 14.4%, the maximum stress and displacement applied to the collagen fibres during shear stress decreased by 65% and 89%, respectively. The slope of the stress-strain relationship at 14.4% elastin was 6.5 times greater under shear stress than that of the model with 0% elastin. A positive correlation was found between the stress required to rotate the bones at both ends of the ligament at the same angle and elastin content. CONCLUSIONS The fibre model, which includes the mechanical properties of elastin, can provide a more precise evaluation of the stress distribution and mechanical response. Elastin is responsible for ligament rigidity during shear and rotational stress.
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Affiliation(s)
- Yuki Naya
- Division of Interdisciplinary Research for Medicine and Photonics, Institute of Post-LED Photonics, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
- Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Hiroki Takanari
- Division of Interdisciplinary Research for Medicine and Photonics, Institute of Post-LED Photonics, Tokushima University, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan.
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Isvilanonda V, Li EY, Iaquinto JM, Ledoux WR. Regional differences in the mechanical properties of the plantar aponeurosis. J Biomech 2023; 151:111531. [PMID: 36924529 DOI: 10.1016/j.jbiomech.2023.111531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
The plantar aponeurosis functions to support the foot arch during weight bearing. Accurate anatomy and material properties are critical in developing analytical and computational models of this tissue. We determined the cross-sectional areas and material properties of four regions of the plantar aponeurosis: the proximal middle and distal middle portions of the tissue and the medial (to the first ray) and lateral (to the fifth ray) regions. Bone-plantar aponeurosis-bone specimens were harvested from fifteen cadaveric feet. Cross-sectional areas were measured using molding, casting, and sectioning methods. Mechanical testing was performed using displacement control triangle waves (0.5, 1, 2, 5, and 10 Hz) loaded to physiologic tension by estimating from body weight and area ratio of the region. Five specimens were tested for each region. Regional deformations were recorded by a high-speed video camera. There were overall differences in cross-sectional areas and biomechanical behavior across regions. The stress-strain responses are non-linear and mainly elastic (energy loss 3.6% to 7.2%). Moduli at the proximal middle and distal middle regions (400 and 522 MPa) were significantly higher than the medial and lateral regions (225 and 242 MPa). The effect of frequency on biomechanical outcomes was small (e.g., 3.5% change in modulus), except for energy loss (107% increase as frequency increased from 0.5 to 10 Hz). These results indicate that the plantar aponeurosis tensile response is non-linear, nearly elastic, and frequency independent. The cross-sectional area and material properties differ by region, and we suggest that such differences be included to accurately model this structure.
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Beltran LS, Zuluaga N, Verbitskiy A, Bencardino JT. Imaging of Acute Ankle and Foot Sprains. Radiol Clin North Am 2023; 61:319-344. [PMID: 36739148 DOI: 10.1016/j.rcl.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ankle and foot injuries are very common injuries in the general population, and more so in athletes. MR imaging is the optimal modality to evaluate for ligamentous injuries of the ankle and associated conditions after ankle sprain. In this article, the authors discuss the epidemiology, biomechanics, normal anatomy, and pathology of the ankle as well as injuries of the hindfoot and midfoot that are often associated with ankle injuries.
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Affiliation(s)
- Luis S Beltran
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Nicolas Zuluaga
- Department of Radiology, University of Pennsylvania Health System, 3737 Market Street, Philadelphia, PA 19104, USA
| | - Anna Verbitskiy
- Department of Radiology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Jenny T Bencardino
- Department of Radiology, University of Pennsylvania Health System, 3737 Market Street, Philadelphia, PA 19104, USA
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Nichols JA, Baratta C, Reb CW. Biomechanical Sequelae of Syndesmosis Injury and Repair. Foot Ankle Clin 2023; 28:77-98. [PMID: 36822690 DOI: 10.1016/j.fcl.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This review characterizes fibula mechanics in the context of syndesmosis injury and repair. Through detailed understanding of fibula kinematics (the study of motion) and kinetics (the study of forces that cause motion), the full complexity of fibula motion can be appreciated. Although the magnitudes of fibula rotation and translation are inherently small, even slight alterations of fibula position or movement can substantially impact force propagation through the ankle and hindfoot joints. Accordingly, implications for clinical care are discussed.
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Affiliation(s)
- Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA; Department of Orthopaedic Surgery & Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32607, USA.
| | - Chloe Baratta
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, 1275 Center Drive, Gainesville, FL 32611, USA
| | - Christopher W Reb
- Orthopaedics, Veterans Health Administration North Florida / South Georgia Health System, Malcolm Randall VA Medical Center, 1601 SW Archer Road, Gainesville, FL, 32608, USA
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Phua SKA, Lim JY, Li T, Ho SWL. The segond fracture: A narrative review of the anatomy, biomechanics and clinical implications. J Clin Orthop Trauma 2023; 38:102127. [PMID: 36860993 PMCID: PMC9969264 DOI: 10.1016/j.jcot.2023.102127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 03/03/2023] Open
Abstract
The Segond fracture is commonly regarded as pathognomonic for significant intra-articular pathology such as an anterior cruciate ligament (ACL) tear. There is worsened rotatory instability in patients with concomitant ACL tear and Segond fracture. Current evidence does not suggest that a concomitant and unrepaired Segond fracture leads to worst clinical outcomes after ACL reconstruction. However, there remains a lack of consensus on several aspects of the Segond fracture such as its exact anatomical attachments, ideal imaging modality for detection and indication for surgical treatment. There is currently no comparative study evaluating the outcomes of combined ACL reconstruction and Segond fracture fixation. More research is necessary to deepen our understanding and establish consensus on the role of surgical intervention.
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Affiliation(s)
| | - Jia Ying Lim
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Tianpei Li
- Department of Radiation Oncology, National Cancer Centre, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Reynolds AW, Jordan D, Schimoler PJ, DeMeo PJ, Casagranda B, Peterson WM, Miller MC. Shear wave elastography ultrasound does not quantify mechanical properties of the ulnar collateral ligament of the elbow. J Ultrasound 2023:10.1007/s40477-022-00768-y. [PMID: 36790657 DOI: 10.1007/s40477-022-00768-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/19/2022] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE To validate shear wave elastography (SWE) stiffness measurements for the ulnar collateral ligament (UCL) of the elbow compared to mechanical measurements. MATERIALS AND METHODS Eleven fresh frozen human cadaveric upper extremities were evaluated by a musculoskeletal-specialized radiologist to provide SWE measurements used to calculate stiffness at 4 points along the anterior band of the UCL at various load states and flexion angles. Specimens were then dissected and optical markers were placed on the UCL to track displacement during applied force by a load frame, thereby providing measurements to calculate the mechanical stiffness. These two stiffness values were compared by ANOVA for all load states and flexion angles. RESULTS Measurements of stiffness by SWE for the UCL were three orders of magnitude smaller than the true mechanical testing stiffness and no correlations between SWE and mechanical measurements of stiffness were found at 30, 60 or 90 degrees of elbow flexion (R2 = 0.004, p = 0.85; R2 = 0.001, p = 0.92; R2 = 0.15, p = 0.24 respectively). SWE stiffness was greatest near the insertion of the ligament and lowest in the mid-substance of the ligament (p = 0.0002). CONCLUSIONS SWE stiffness did not correlate with mechanical measurements. Clinical utility of musculoskeletal SWE may be better defined when biomechanical properties or clinical outcomes can be correlated with SWE measurements. The ultimate clinical utility of SWE in musculoskeletal tissues may be qualitative, as demonstrated by differences throughout the length of the UCL in this study.
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Affiliation(s)
- Alan W Reynolds
- Department of Orthopaedics, Allegheny Health Network, 1307 Federal St., Pittsburgh, PA, 15212, USA.
| | - David Jordan
- Department of Orthopaedics, Allegheny Health Network, 1307 Federal St., Pittsburgh, PA, 15212, USA
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J Schimoler
- Department of Orthopaedics, Allegheny Health Network, 1307 Federal St., Pittsburgh, PA, 15212, USA
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J DeMeo
- Department of Orthopaedics, Allegheny Health Network, 1307 Federal St., Pittsburgh, PA, 15212, USA
| | | | | | - Mark C Miller
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
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Migliorini F. Patellofemoral instability: Current status and future perspectives. J Orthop 2023; 36:49-50. [PMID: 36594079 PMCID: PMC9804008 DOI: 10.1016/j.jor.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The patellofemoral joint is complex, and the management of the first patellar dislocation is not well decoded. The progression to recurrent instability is common. Bony anatomy, muscle tone, and soft tissues are essential stabilizers to preserve the physiological patellar tracking, and they should be carefully evaluated when facing patients with instability.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
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44
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Wilson MS. Diagnosis and Management of Lunotriquetral Ligament Injuries. Curr Rev Musculoskelet Med 2023; 16:55-59. [PMID: 36689137 PMCID: PMC9889576 DOI: 10.1007/s12178-022-09819-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW The standard of care for lunotriquetral ligament injuries is evolving. An understanding of the mechanics of the lunotriquetral ligament and its role in carpal kinematics is critical when deciding how to treat these injuries. Treatment for these injuries varies from nonoperative to wrist arthroscopy with thermal capsulodesis and/or repair to reconstruction or limited arthrodesis. This article provides a review of the anatomy, pathomechanics, evaluation, and ultimately treatment of lunotriquetral ligament injuries. RECENT FINDINGS Although lunotriquetral ligament injuries can occur in isolation, injuries to the lunotriquetral ligament are often viewed as a component of other injury patterns to the intrinsic and extrinsic ligaments of the wrist. Static volar intercalated segment instability typically occurs when the dorsal radiocarpal ligament is also compromised. If nonoperative treatment fails, arthroscopy is the gold standard for diagnosis even with improving imaging modalities. Recently, authors have proposed employing the technique of ulnar-shortening osteotomy in those with ulnar negative variance and the absence of an impaction lesion. Other newer techniques included bone-ligament-bone reconstruction for chronic, static instability. LT injuries rarely occur in isolation. Most injuries involving the lunotriquetral ligament can be treated nonoperatively. Those individuals with persistent pain should be treated with a diagnostic wrist arthroscopy. Primary repairs are indicated in those with an acute, complete tear. In chronic, static instability, ligament reconstruction has been shown to improve wrist function and decrease pain.
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Affiliation(s)
- Matthew S Wilson
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut St., Suite G-114, Philadelphia, PA, 19107, USA.
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Tokumoto M, Nakasa T, Shirakawa Y, Nekomoto A, Ikuta Y, Ishikawa M, Miyaki S, Adachi N. The role of substance P on maintaining ligament homeostasis by inhibiting endochondral ossification during osteoarthritis progression. Connect Tissue Res 2023; 64:82-92. [PMID: 35856812 DOI: 10.1080/03008207.2022.2099847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Osteoarthritis (OA) is characterized by the degeneration of various tissues, including ligaments. However, pathological changes such as chondrogenesis and ossification in ligaments during OA are still unclear. Substance P (SP), a neuropeptide, has various functions including bone metabolism. This study aimed to analyze the expression and function of SP in OA ligaments, and the therapeutic potential of SP agonists in OA mice. MATERIALS AND METHODS Expressions of SP, SOX9, and MMP13 were histologically analyzed in the posterior cruciate ligament (PCL) in humans with OA and Senescence-accelerated mouse-prone 8 (SAMP8) mice as a spontaneous OA model. The effect of SP agonists on chondrogenesis was evaluated using human ligament cells. Finally, SP agonists were administered intraperitoneally to destabilized medial meniscus (DMM) mice, and the PCL was histologically evaluated. RESULTS In PCL of humans and mice, the expression of SP, SOX9, and MMP13 was upregulated as OA progressed, but their expression was downregulated in severe degeneration. SP and SOX9 were co-expressed in chondrocyte-like cells. In ligament cells, SP agonists downregulated SOX9, RUNX2, and COL10A1. On evaluating chondrogenesis in ligament cells, pellet diameter was reduced in those treated with the SP agonists compared to those untreated. Administration of SP agonists ameliorated PCL degeneration in DMM mice. The Osteoarthritis Research Society and ligament scores in mice with SP agonists were significantly lower than those without SP agonists. CONCLUSIONS SP plays an important role in maintaining ligament homeostasis by inhibiting endochondral ossification during OA progression. Targeting SP has therapeutic potential for preventing ligament degeneration.
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Affiliation(s)
- Maya Tokumoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshiko Shirakawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shigeru Miyaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Hajiahmadi S, Rezvani M, Fahimitabar S, Rasti S. Thoracolumbar Injury: The Thoracolumbar Injury Classification and Severity Scoring System or Modified Thoracolumbar Injury Classification and Severity? World Neurosurg 2023; 169:e73-e82. [PMID: 36272726 DOI: 10.1016/j.wneu.2022.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the Thoracolumbar Injury Classification and Severity (TLICS) scoring system with its modified (mTLICS) version based on their agreement with the surgeon's opinion regarding treatment for patients with thoracolumbar injuries. Moreover, the Posterior Ligamentous Complex health was compared between intraoperative examinations and magnetic resonance imaging (MRI) reports. METHODS MRI was obtained from 114 patients suffering thoracolumbar spinal trauma; the TLICS and mTLICS scores were measured. Approaches 1 and 2 were designed in both scoring systems based on assuming a total score of 4 as surgery and conservative management indication, respectively. Kappa was used to estimate the agreements between each approach and the surgeon's opinion on treatment. The receiver operating curve calculated the appropriate cut-off scores for the above systems over which surgical management was preferred. A P < 0.05 was considered significant. RESULTS All the approaches showed moderate agreements with the surgeon's opinion on therapeutic management (TLICS: κapproach1 = 0.557, κapproach2 =0.508; mTLICS: κapproach1 = 0.557, κapproach2 = 0.551; P < 0.001 for each κ). A score >3.5 best illustrated the indication for surgery in both systems. The radiology report agreed stronger with intraoperatively observed ligamentous health when suspicious cases on MRI were reported as injured (κTLICS = 0.830, κmTLICS = 0.704) rather than healthy (κTLICS = 0.620, κmTLICS = 0.620). CONCLUSIONS The surgeon's treatment plan agreed moderately with suggestions of the TLICS and mTLICS systems; surgery was the preferred management for the patients with a score of 4. Moreover, radiologic suspicion of Posterior Ligamentous Complex injury seemed to indicate a damaged ligament rather than a healthy one.
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Affiliation(s)
- Somayeh Hajiahmadi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeid Fahimitabar
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Rasti
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Rodrigues BS, Bortolozzo DO, Ito MH, Gastaldi TND, Duarte ML, Duarte ÉR. Torsion of the Falciform Ligament Diagnosed by Imaging Tests - Case Report of an Unusual Disease. Prague Med Rep 2023; 124:177-180. [PMID: 37212136 DOI: 10.14712/23362936.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
The falciform ligament is a peritoneal double layer that anatomically divides the right and left hepatic lobes. Abnormality of the falciform ligament is rare - less than 20 cases of torsion of the falciform ligament have been reported to date in adults. The pathophysiology of these entities is similar to intra-abdominal focal fat infarction. The clinical of the patient with torsion of the falciform ligament is abdominal pain of sudden onset and focal location. Laboratory tests can lead to diagnostic confusion with cholecystitis. Ultrasonography is usually the initial evaluation test, but the gold standard diagnosis is computed tomography. We report the case of a 30-year-old female patient reporting sudden abdominal pain that radiates to the dorsal region associated with nausea and vomiting diagnosed with torsion of the falciform ligament with ultrasonography and confirmed with computed tomography. She was treated conservatively without the need for surgical treatment, being discharged after one week hospitalization.
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Affiliation(s)
- Bruna Suda Rodrigues
- Department of Ultrasonography, Irmandade da Santa Casa de Misericórdia de Santos, Santos (SP), Brazil
| | | | - Maura Harumi Ito
- Department of Ultrasonography, Irmandade da Santa Casa de Misericórdia de Santos, Santos (SP), Brazil
| | | | - Márcio Luís Duarte
- Department of Radiology, Centro Radiológico e Especialidades Médicas São Gabriel, Praia Grande (SP), Brazil.
- Universidade de Ribeirão Preto - Campus Guarujá, Guarujá (SP), Brazil.
| | - Élcio Roberto Duarte
- Department of Ultrasonography, Irmandade da Santa Casa de Misericórdia de Santos, Santos (SP), Brazil
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Patra A, Asghar A, Chaudhary P, Ravi KS. Identification of valid anatomical landmarks to locate and protect recurrent laryngeal nerve during thyroid surgery: a cadaveric study. Surg Radiol Anat 2023; 45:73-80. [PMID: 36459179 DOI: 10.1007/s00276-022-03054-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Recurrent laryngeal nerve (RLN) is the most critical structure in terms of intricacy. Anatomic variations of the nerve may further make thyroid surgery cumbersome. The present study was undertaken to provide comprehensive knowledge about the soundness of commonly used anatomical landmarks such as Berry's ligament (BL), tracheo-esophageal groove (TEG), inferior thyroid artery (ITA), and the midpoint of the posterior border of the thyroid gland in the identification of the nerve intraoperatively. METHODS Thirty adult cadavers were dissected to identify the RLN in the neck and to locate it in relation to the aforementioned anatomical landmarks. RESULTS The RLN/BL relationship: RLN was most often located superficial to the BL (88.3%), followed by deep to the BL in 8.4%, and piercing the BL in 3.3% of cases, respectively. The RLN/TEG relationship: the RLN was located inside the TEG in most cases (71.7%), followed by RLN lying outside the TEG in 28.3%. Outside the groove, it was most commonly found lateral to the TEG (64.7%). RLN/ITA relationship: the nerve was passing deep to the artery in most of the cases (65%), followed by superficial (30%) and rarely (5%) in-between the branches. RLN/ midpoint posterior border of thyroid relationship: In 57 (95%) cases, RLN was coursing in the area posterior to the midpoint of the posterior border of the gland with an average distance of 4.95 ± 2.23 mm ranging between 2.21 and 12.1 mm. CONCLUSIONS Both the BL and TEG are potentially crucial for safeguarding RLN. Although in results, BL turns out to be more consistent than TEG, we propose the utilization of both these anatomical landmarks together for complication-free neck surgeries. Furthermore, the midpoint of the posterior border of the thyroid turns out to be the single most consistent landmark for identifying RLN during partial thyroidectomy.
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Affiliation(s)
- Apurba Patra
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Adil Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Priti Chaudhary
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Kumar Satish Ravi
- Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, India.
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Moen P, Hill B, Teytelbaum D, Kim C, Kaar S. Radiographic Description of Soft Tissue Attachments around the Elbow. Arch Bone Jt Surg 2023; 11:556-564. [PMID: 37868134 PMCID: PMC10585480 DOI: 10.22038/abjs.2023.49879.2491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/19/2023] [Indexed: 10/24/2023]
Abstract
Objectives Quantitatively define the radiographic locations of the major soft-tissue attachments about the elbow. Methods In 10 cadaveric elbows, the attachments of the medial ulnar collateral ligament, lateral ulnar collateral ligament, annular ligament, triceps, and biceps were marked with radiopaque spheres. Measurements were made on calibrated AP and lateral fluoroscopic images from known osseous landmarks. Results On AP radiographs; the anterior bundle of the MUCL (aMUCL) measured 28.6mm (95% CI, 27. 5-29.8mm) from the humeral attachment to the midpoint of the MUCL ridge on the ulna and 14.3mm, (95% CI 13.0-15.5) to the olecranon. The LUCL was 39.9mm (95% CI, 38.6 - 41.1mm) from the humeral attachment to the supinator crest attachment and 8.9mm (95% CI, 8.1-9.8mm) to the lateral epicondyle. On the lateral radiographs, the humeral attachment of the aMUCL to the medial coronoid was 27.1mm (95% CI, 25.9-28.2mm) and 9.3mm (95%CI, 17.5 -21.2mm) to the tip. The LUCL humeral attachment to the supinator crest was 45.4mm (95%CI, 44.1-46.8mm). The LUCL humeral attachment was located 8.9mm (95%CI, 8.0-9.7mm) posterior from the anterior humeral line. Conclusion The soft-tissue attachments about the elbow were reproducibly demonstrated on radiographs in relation to osseous landmarks and radiographic lines. The radiographic relationships will allow for improved identification of the ligament and tendon attachment sites of the elbow for intraoperative assessment and postoperative evaluation following reconstruction.
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Affiliation(s)
- Patrick Moen
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Brian Hill
- Palm Beach Orthopaedic Institute, Palm Beach Gardens, FL, USA
| | - David Teytelbaum
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Christopher Kim
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
| | - Scott Kaar
- Department of Orthopaedic Surgery, Saint Louis University, St. Louis, MO, USA
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Dąbrowski K, Ciszek B. Anatomy and morphology of iliolumbar ligament. Surg Radiol Anat 2023; 45:169-173. [PMID: 36592184 PMCID: PMC9899183 DOI: 10.1007/s00276-022-03070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE To address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe their insertions and morphology. METHODS The ligaments were removed during the standard autopsy procedures with a use of an oscillating saw, a chisel and a scalpel. The specimens were photographed before the extraction and measured alongside their anterior margin. Next, they were preserved in formaldehyde, stripped of other soft tissues and then examined, photographed and described. RESULTS The mean length of the ligaments was 31.7 mm. 44 specimens were described as single-banded, 13 as double-banded and 3 as other. In 24 cases costal process of LV has been fixed to the iliac plate by short ligamentous bands. In 38 cases there was a thick fibrous membrane connected to the ligament. No legitimate insertions on LIV vertebra were observed. CONCLUSIONS Typical iliolumbar ligament consists of a single ligamentous band. Most common variability of the ligament consist of two bands. In approximately 40% of cases the costal process of LV can be additionally stabilized to the iliac plate by short, strong ligamentous bands. In 63% of cases a connection between the iliolumbar ligament and a fibrous membrane placed in the frontal plane, superiorly to the ligament, has been observed. There seems to be no convincing proof of existence of the insertion of the iliolumbar ligament on the LIV vertebra.
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Affiliation(s)
- K. Dąbrowski
- grid.13339.3b0000000113287408Department of Descriptive and Clinical Anatomy, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland
| | - B. Ciszek
- grid.13339.3b0000000113287408Department of Descriptive and Clinical Anatomy, Center for Biostructure Research, Medical University of Warsaw, Warsaw, Poland ,Department of Neurosurgery in Bogdanowicz Children’s Hospital, Warsaw, Poland
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