Journal articles on the topic 'Anatomical tibia length'
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Miles, James E. "Approximations to the Tibial Distal Anatomical Axis in the Sagittal Plane." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 01 (September 2, 2019): 022–27. http://dx.doi.org/10.1055/s-0039-1695728.
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Objective The aim of this study was to compare approximations to the tibial distal anatomical axis (DAA) with regression lines for the symmetric axis of the tibia, and to identify an optimal approximation for surgical planning of osteotomies for the management of canine cruciate ligament deficiency. Study Design Prospective radiographic study of 20 canine tibiae. Using curve-fitting and the symmetric axis technique, the true anatomical axis was identified for each tibia. Regression lines were calculated for the distal 67% and distal 50% subsections of this axis. Angular deviations between these lines and DAA approximations were calculated and compared with to find the closest approximations. Results The DAA approximations based on the distal 50% rather than the distal 67% of the tibia had smaller maximal deviations from the true axis. Landmarks at 50% and 75% of tibial length exhibited greater deviations than those at 50% and 95% or 100%. Conclusion The DAA landmarks should be restricted to the distal half of the tibia. Use of a distal landmark either just proximal to the distal metaphyseal flare of the tibia or at the mid-point of the distal articular surface is to be preferred. In this way, the DAA will better reflect the true anatomical axis of the distal tibia.
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Heming, James F., Jason Rand, and Mark E. Steiner. "Anatomical Limitations of Transtibial Drilling in Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 35, no. 10 (October 2007): 1708–15. http://dx.doi.org/10.1177/0363546507304137.
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Background Recommended techniques for transtibial drilling in anterior cruciate ligament reconstruction are based on strategies to prevent graft impingement and preserve tibial tunnel length. The limitations of this drilling technique may restrict the ability to centralize tunnels in the anterior cruciate ligament footprints. Hypothesis A transtibial drilling starting point to centralize the tibial and femoral tunnels in their respective footprints can be identified, but it will result in a short tibial tunnel. Study Design Descriptive laboratory study. Methods The femoral and tibial attachments of the anterior cruciate ligament were characterized in 12 fresh-frozen cadaveric knees. Knees were secured in 70° and 90° of flexion. A guide pin was drilled antegrade through the central femoral and proximal anterior cruciate ligament attachment sites through the central tibial anterior cruciate ligament attachment site to exit on the anterior tibia. Results In 90° of flexion using the central femoral and tibial attachment sites, the exit point of the pin on the anterior tibia was 14.1 mm from the tibial joint line and 20.9 mm anterior to the superficial medial collateral ligament. The length of the pin in the tibia was 30.6 mm. Extending the knee to 70° or directing the pin through the proximal femoral anterior cruciate ligament attachment moved the starting point less than 4 mm from this point. Conclusion The transtibial technique can produce tunnels centered in the anterior cruciate ligament footprints, but a starting point close to the tibial joint line is required. This will result in a relatively short tibial tunnel. Clinical Relevance If tunnels centered in the anterior cruciate ligament attachment sites are desired with the transtibial drilling technique, then a short tibial tunnel is necessary. A short tibial tunnel may compromise graft fixation and graft incorporation, or it may result in a tunnel length—graft length mismatch. An alternative drilling strategy might be employed.
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Iyaji, Paul Inalegwu, and Roger Williams Soames. "ANATOMICAL STUDY OF THE MORPHOMETRY OF THE TIBIAL AND FEMORAL ATTACHMENT SITES OF THE POSTERIOR CRUCIATE LIGAMENT; Estudio anatómico de la morfometría de los sitios de inserción tibial y femoral del ligamento cruzado posterior." Revista Argentina de Anatomía Clínica 8, no. 3 (November 23, 2016): 142–50. http://dx.doi.org/10.31051/1852.8023.v8.n3.15240.
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, Although later isolated injuries cruciate of the ligament (PCL) are managed through non-operative rehabilitation, reconstruction is becoming ITS anatomic increasingly important. This study Provides Information Regarding the position and variability of Its tibial attachment sites, dimensions of the femoral insertions, Between These Comparing males and females, and Between right and left knees. Thirty one cadaveric knees (15 right, 16 left) from nine female and seven male cadavers ( mean age 77 years) Were Examined. The PCL footprint Which was Identified from the mean length and width of the tibial anterolateral (AL) and posteromedial (PM) 8.7 and 10.9 mm Were bundles, and 7.3 and 13.44mm respectively. The mean length and width of the tibial footprint in males and females 10.2 and 10.3 mm Were, and 7.7 and 11.4 mm for the AL bundle and 8.2 and 14.2 mm and 12.9 mm and 6.7 for the PM bundle respectively. The mean anatomical position of the AL and 51.0% Were PM bundles and 50.0% of the mediolateral diameter of the tibial plateau. The mean lengths and widths of the PCL femoral attachment Were 9.4 mm and 12.8 for the AL bundle and 7.5 and 11.4 mm for the PM bundle, with the AL bundle attachment being Significantly larger (P = 0.034) in evils. No Difference between right and left knees Were Observed . The data presented here will aid in making decisions to Achieve Appropriate anatomic PCL reconstruction., Although isolated lesions of the posterior cruciate ligament (PCL) are Treated by non-operative rehabilitation, anatomical reconstruction've Become increasingly important. This study Provides information on the position and variability of the binding sites of the tibia, the dimensions of the femoral insertions, Comparing them Between the sexes, and Between the right and left knee. They Were Examined thirty-one (15 right and 16 left knees) of 9 women and 7 dead bodies of males (mean age 77 years). Brand LCP was Identified from the length and width anterolateral and posteromedial (PM) of the tibia (AL) Were the results 8.7 and 10.9 mm, and 7.3 and 13.44mm respectively. The average length and width of the mark of the tibia in the male and female Were 10.2 and 10.3 mm and 7.7 mm and 11.4 for fiber AL, 8.2 and 14.2 mm and 6.7 mm and 12.9 for PM, respectively fiber. The average anatomical position of the tendons AL and PM Were 51.0% and 50.0% of the mediolateral diameter of the tibial plateau. Half lengths and widths of the PCL femoral insertion Were 9.4 and 12.8 mm for the tendon AL and 7.5 and 11.4 mm for the PM tendon, tendon insertion site AL was Significantly higher (P = 0.034) in men. no Difference Between the right and left Knees Were Observed. The data presented here will help in the decision-PCL suitable for anatomical reconstruction decisions.
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Poudel, Abhishek, and Biswas Satyal. "Percutaneous Tibial Length Measurement for Estimation and Correlation of Stature in Nepalese Males." Journal of Nepalgunj Medical College 15, no. 2 (June 1, 2017): 33–36. http://dx.doi.org/10.3126/jngmc.v15i2.22841.
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Introduction: Estimation of stature is an important step in identification of an individual, which often is required in medio-legal practice. It provides a valuable indicator for unknown individual in a population. Through the remains of human skeletal or body parts stature of an individual can be estimated.
Methods and Materials: Percutaneous tibial length (PCTL) is measured in present study to estimate the stature by formulating simple regression equation. The PCTL was measured by the surface anatomical landmarks that is between most prominent part of medial condyle of tibia and tip of medial malleolus.
Result: Positive correlation was found between the length of tibia and estimated height. A linear regression formula was derived for estimation of height from the length of right and left tibia.
Conclusion: Estimated height and observed height were closely related within the range of error. Differences in length of right and left tibia showed statistically non-significant.
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Yasukawa, Shinji, Koji Tanegashima, Mamiko Seki, Kenji Teshima, Kazushi Asano, Tomohiro Nakayama, Kei Hayashi, and Kazuya Edamura. "Evaluation of bone deformities of the femur, tibia, and patella in Toy Poodles with medial patellar luxation using computed tomography." Veterinary and Comparative Orthopaedics and Traumatology 29, no. 01 (January 2016): 29–38. http://dx.doi.org/10.3415/vcot-15-05-0089.
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SummaryObjectives: To evaluate morphological parameters of the femur, tibia, and patella in Toy Poodles with medial patellar luxation (MPL) using three-dimensional (3D) computed tomography (CT) and to compare these parameters between radiography and CT.Methods: Thirty-five hindlimbs of Toy Poodles were divided into normal and grade 2 and 4 MPL groups. The anatomical and mechanical lateral proximal femoral angle, anatomical and mechanical lateral distal femoral angle (aLDFA, mLDFA), femoral varus angle (FVA), inclination of the femoral head angle, procurvation angle, anteversion angle (AA), frontal angle of the femoral neck, mechanical medial proximal or distal tibial angle, mechanical cranial proximal or distal tibial angle, tibial plateau angle, tibial torsion angle (TTA), Z angle, relative tibial tuberosity width, ratio of the medial distance of tibial tuberosity to the proximal tibial width (MDTT/PTW), patella size, and the patellar ligament length: patellar length (L:P) ratio were evaluated on radiography and 3D CT.Results: The aLDFA, mLDFA, FVA, and TTA were significantly larger and the AA, MDTT/ PTW, and patella were significantly smaller in the grade 4 MPL group. There were significant differences in many parameters between imaging tools, and CT was considered less susceptible to potential artefacts and rotational deformities.Clinical significance: Toy Poodles with grade 4 MPL had significant femoral varus deformity, medial displacement of the tibial tuberosity, internal torsion of the proximal tibia, and hypoplasia of the patella.
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Minh, Do Van, Tran Trung Dung, Ngo Van Toan, Nguyen Huy Phuong, Vo Sy Quyen Nang, and Thien Chu Dinh. "The Anatomical Numerical Measurement of Posterior Cruciate Ligament: A Vietnamese Cadaveric Study." Open Access Macedonian Journal of Medical Sciences 7, no. 24 (December 20, 2019): 4357–61. http://dx.doi.org/10.3889/oamjms.2019.835.
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BACKGROUND: The posterior cruciate ligament (PCL) is crucial to restrain the posterior translation of the tibia. Its anatomical structure is complex. A proper understanding of PCL anatomy may assist surgeon in reconstructing anatomically native PCL.
AIM: To describe the anatomical numerical measurement of the PCL in Vietnamese adults.
METHODS: Twenty-one fresh cadaveric knees were examined. The macroscopic details of the intra-articular PCL, the attachment of the anterolateral bundle (ALB), posteromedial bundles (PMB) to the femur and tibia were analysed. We used a digital camera to photograph the cadaveric specimens and used the ImageJ software to analyse the collected images.
RESULTS: The ALB and PMB length were 35.5 ± 2.78 and 32.6 ± 2.28 mm, respectively. The smallest and the biggest diameter of middle third of the PCL were 5.9 ± 0.71 and 10.0 ± 1.39 mm, respectively. The area of cross section of middle third of the PCL was 53.6 ± 12.37 mm2. The femoral insertion area of ALB and PMB were 88.4 ± 16.89 and 43.5 ± 8.83 mm2, respectively. The distance from the central point of femoral ALB, PMB, and total PCL insertion to the Blumensaat line were 5.5 ± 0.91, 11.5 ± 1.98, and 7.6 ± 1.42 mm, respectively. The shortest distance from medial femoral cartilage rim to the central point of femoral ALB, PMB, and total PCL insertion were 7.0 ± 0.79, 7.3 ± 0.95, and 7.8 ± 1.73 mm, respectively. The tibial insertion area of ALB and PMB were 84.5 ± 12.52 and 47.8 ± 6.20 mm2 respectively. The shortest distance from the posterior cartilage corner of the medial tibial plateau to the central point of ALB, PMB, and total PCL insertion to tibia were 8.5 ± 1.02, 9.4 ± 1.11, and 8.3 ± 1.1 mm, respectively. The central point of tibial PCL insertion was 9.7±1.08 mm below cartilage plane of the medial tibial plateau.
CONCLUSION: This study describes the detailed anatomical measurement of the PCL and its bundles in adults.
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Mehta, Suresh. "Gross anatomical studies on the femur, tibio-tarsus and fibula of emu (Dromaius novaehollandiae)." INTERNATIONAL JOURNAL OF AGRICULTURAL SCIENCES 17, no. 2 (June 15, 2021): 627–29. http://dx.doi.org/10.15740/has/ijas/17.2/627-629.
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The study was conducted on three adult emu birds of 2-3 years of age. The femur was a relatively short, but thickbone, measuring about 23±0.43 cm in length.The fovea capitiswas absent.The large trochanter major was at the same level as the head.A large pneumatic foramen was present on the caudal surface of the femur, medioventrally to the trochanter major. Distal extremity of femur showed a trochlea anteriorly and two condyles posteriorly.The tibio-tarsus waslongest and formed by the fusion of the tibia and proximal row of tarsalbones.The average length was 43±0.68 cm, was almost twice as long as the femur.The cranial part of the proximal end was greatly expanded which formed a large ridge, the proximal end of which was divided to form lateraland medial cranial ridges.The distal end showed lateral and medial condyles cranially and a trochlea with symmetrical ridges caudally. The fibula was shorter than the tibia, measuring about 29±0.23 cm in length with a prominent head.
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Almansour, Haidara, Eleftherios Armoutsis, Marie K. Reumann, Konstantin Nikolaou, and Fabian Springer. "The Anatomy of the Tibial Nutrient Artery Canal—An Investigation of 106 Patients Using Multi-Detector Computed Tomography." Journal of Clinical Medicine 9, no. 4 (April 15, 2020): 1135. http://dx.doi.org/10.3390/jcm9041135.
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Radiologic evaluation of the tibial nutrient artery is clinically important as disruption of tibial blood supply is a risk factor for delayed or non-union of tibial fractures. Damage to the tibial nutrient artery canal (TNAC) may occur by a traversing fracture or iatrogenic cause in the context of pin/screw placement. Furthermore, TNAC could be misdiagnosed as a stress fracture. The aim of this study was to characterize the normal anatomy of TNAC and to delineate its gender and side-specific differences. Patients who underwent contrast-enhanced computed-tomography encompassing the pelvis and lower extremities were included. TNAC was identified with an external and internal foramen and a traversing intercortical canal. Various anatomical morphometrics were evaluated: total number of nutrient canals, angular position of the outer and inner nutrient foramina, absolute and relative position of the nutrient foramina, as well as the intercortical canal length with respect to tibial length. The majority of patients of both genders had only one tibial nutrient canal, multiple canals or complete absence were rare. In most cases, the outer nutrient foramen was found on the posterolateral aspect of the upper-third of tibia at about 32% of tibial length; the inner foramen was found at the middle third of the tibia (41% of tibial length). The course of nutrient canal was mostly cranio-caudal with a small, but significant difference in relative canal length: 8.5% vs. 10% of tibial length for females and males, respectively. The angular location of the outer and inner foramen was between 20–30° and did not reveal a statistically significant difference between genders. No statistically significant side specific differences were found for all analyzed parameters and both genders. The clinical relevance of this anatomical study pertains to establishing “safe corridors” of pin/screw insertion in the context of surgical management of tibial fractures in order to avoid iatrogenic disruption of tibial blood supply.
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Cai, Wenquan, Yuxi Su, and Guoxin Nan. "Novel method for the treatment of congenital pseudarthrosis of the tibia using the gastrocnemius flap: A preliminary study." Journal of Children's Orthopaedics 16, no. 3 (June 2022): 167–73. http://dx.doi.org/10.1177/18632521221097525.
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Purpose: Congenital pseudarthrosis of the tibia is a rare disease that is particularly difficult to treat; the most difficult complications include nonunion of the tibia, refracture, and failed surgery. This study aimed to evaluate the efficiency of transposing gastrocnemius flaps for the treatment of congenital pseudarthrosis of the tibia. Methods: Nine patients (aged 6.2 ± 3.6 years) diagnosed with congenital pseudarthrosis of the tibia in our hospital between March 2013 and March 2018 were enrolled. The tibial pseudarthrosis and thickened periosteum were completely removed, and intramedullary nails were used to fix the tibia. Bone harvest from the iliac, mixed with allogenic bone, was filled in the gap created by excision of the pseudarthrosis site and the surrounding periosteum; the gastrocnemius flap was then used to wrap the pseudoarthrosis site. The plaster cast was fixed postoperatively. The tibial union was evaluated via radiograph, and the plaster cast was removed after 12–24 weeks. Patients began walking approximately 12–14 weeks postoperatively. Results: Anatomical reduction was achieved in all the patients; the mean bone healing time was 10.1 ± 2.1 months. Bone nonunion was observed in one patient, and no neurovascular injury or wound infection occurred. Limb length discrepancy was in the range 3.2 ± 1.8 cm at 1 year and 4.7 ± 2.7 cm at 2 years after surgery. Two patients underwent replacement of the intramedullary nail, and eight patients exhibited good functional and radiographic outcomes. Conclusion: This preliminary study proved that using the gastrocnemius muscle flap to cover the pseudarthrosis site was an effective method to promote the tibial union and treat congenital pseudarthrosis of the tibia.
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B, Abdulrahman. "Anatomical Study of Some Selected Bones of the Hind Limb of Local Domestic Dog ( Canis lupus familiaris )." Cytology & Histology International Journal 5, no. 1 (2021): 1–9. http://dx.doi.org/10.23880/chij-16000127.
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This study was aimed at investigating the age related changes in the morphometry and biometry of some selected bones of the hind limb of Nigerian local dog ( canis lupus familiaris ). In this study a total of fifteen dogs were used as sample and were grouped into five age categories (group A-E). The dogs were aged by estimation using dentition eruption and wearing. The segment of the hind limb was identified and separated from the rest from other parts. The gross study of the hind limb revealed that the hind limb was composed of: ossa coxarum, femur, patella, tibia, fibula, tarsal and metatarsal bones. The biometric study revealed that the weight, length, width and circumference were found to be increasing with advancement in age. The result revealed that mean weight, length and circumference of various segments of the ossa coxarum, femur and the tibia tends to increase with age across the group that is from group A to group E. However, there is variation in the length of the fibula, width of the obturator foramen and length of the obturator foramen. Base on the above results, it was concluded that base line data was established with the aim of enhancing learning.
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Ahmad, Nadia, Deepa Singh, Aksh Dubey, and S. L. Jethani. "Morphometric Analysis of Proximal End of the Tibia." National Journal of Clinical Anatomy 08, no. 02 (April 2019): 082–86. http://dx.doi.org/10.1055/s-0039-1688529.
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Abstract Background Total knee arthroplasty and unicompartmental knee arthroplasty are frequently done procedures for the treatment of various forms of arthritis and knee injuries. The knee prosthesis, which is used for these procedures, requires adequate sizing specific to the population. Morphometric parameters of upper end of the tibia can be used to guide treatment and monitor outcome of total knee replacement surgeries. Information regarding morphometry of upper end of the tibia is important as it provides reliable method of assessing knee deformity. This article assesses different morphometric parameters of condylar and intercondylar surface of the tibia and to compile the results, analyze, and formulate a baseline data for future studies with relevance to Indian population. Materials and Methods The study group comprised of 60 adult human dry and processed tibia of both sides which are grossly normal and complete, obtained from the Department of Anatomy, Himalayan Institute of Medical Sciences. Morphometric measurements of the medial condyle, lateral condyle, and intercondylar area of tibia were recorded with vernier calipers with a least count of 0.01 mm. The dimensions were summarized as mean ± standard deviation. A p-value of < 0.05 was considered significant. Result Mediolateral and anteroposterior length were 66.33 and 42.52 mm, respectively. Conclusion Anatomical profile of tibial condyle for Indians is smaller, hence highlighting the need for sizing of prosthesis specific to the population in question.
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G., Sreedevi, and Muralidhar Reddy Sangam. "Morphometric study of human fibular incisura in dry bones." National Journal of Clinical Anatomy 7, no. 02 (April 2018): 069–73. http://dx.doi.org/10.1055/s-0040-1701712.
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Abstract Aims & Objectives : Interosseous border of tibia splits distally into anterior and posterior edges. These edges project into anterior and posterior tubercles enclosing a notch called fibular incisura that articulates with the distal fibula forming distal tibio fibular syndesmosis. The aim of the present study was to obtain the morphometric data of fibular incisura that may be helpful for the orthopedic surgeons in ankle reconstructive surgeries and ankle joint replacement. Materials & Method: To describe the morphometry of the fibular incisura, a total of 100 tibia [right 55 and left 45] were obtained from the Department of Anatomy, NRI Medical College, Chinakakani. The width of tibia, width, depth, height of fibular incisura and the length of anterior, posterior incisural tubercles were measured in both right and left tibia using digital vernier calipers. Right and left side para meters were compared using Karl Pearson Coefficient [r value]. Results: Average values for the width, depth and height of the fibular incisura were 16.83mm on the right side and 17.42mm on the left side, 2.85±1.38mm on the right and 2.9±1.57mm on the left side, 38.82±5.8mm on the right side and 38.72±7.68 mm on the left side respectively. While average lengths of anterior and posterior tubercles of the fibular incisura were 13.19±1.96mm, 15.71±2.03mm on the right side and 12.6±1.49mm, 15.66±1.41mm on left side. Thirty-three tibia presented deeply concave [depth>4cm], and sixty-seven had shallow fibular incisura [depth<4cm]. Conclusion: The morphometry and anatomical variability of fibular incisura should be taken to account in assessing radiographs, CT and MRI of talocrural joint.
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Boss, Andreas Peter, and Beat Hintermann. "Anatomical Study of the Medial Ankle Ligament Complex." Foot & Ankle International 23, no. 6 (June 2002): 547–53. http://dx.doi.org/10.1177/107110070202300612.
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The purpose of this in vitro study was to determine insertion area, length and thickness of the various bundles and their anatomical relationship with inter-individual differences. Twelve ankles from human cadavers (ages 56 to 95 years, from nine men and three women) were dissected to the capsuloligamentous structures. Marked inter-individual differences were found for the five main ligaments (tibiospring, tibiocalcaneal, posterior and anterior deep tibiotalar and superficial posterior tibiotalar). The tibionavicular ligament is a thickened fibrous layer of the ankle capsule. The tibiocalcaneal and tibiospring ligaments are the longest, and the tibiocalcaneal and posterior deep tibiotalar ligaments are the thickest of these ligaments. Fibrils run in the direction of the tibia or dorsally. Knowledge of the deltoid ligament complex is necessary for anatomically and biomechanically correct reconstruction that provides stability without hazard to biomechanics of function.
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Cabassu, Julien. "Minimally Invasive Plate Osteosynthesis Using Fracture Reduction Under the Plate without Intraoperative Fluoroscopy to Stabilize Diaphyseal Fractures of the Tibia and Femur in Dogs and Cats." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 06 (July 29, 2019): 475–82. http://dx.doi.org/10.1055/s-0039-1693413.
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Objective The aim of this study was to prospectively evaluate postoperative alignment when using fracture reduction under the plate (FRUP) during a minimally invasive plate osteosynthesis in tibial and femoral fractures, without intraoperative imaging, and report immediate postoperative complications. Materials and Methods After precise plate contouring and preoperative planning, FRUP was obtained with one cortical screw per fragment. Fractures were stabilized with a plate or plate rod. Tibial/femoral lengths, tibial plateau angles, mechanical medial proximal and distal tibial angles, anatomical lateral distal femoral angles, femoral curvatum and neck anteversion were evaluated on postoperative radiographs and contralateral bone. Tibial torsion was evaluated visually. Paired t-test were used to compare data. Immediate postoperative complications were recorded. Results Twenty-one tibial and 20 femoral fractures were stabilized (14 plate rod cases). Mean postoperative operated tibial length was 1.4% shorter (p = 0.001). Mean postoperative operated femoral length was 2% shorter (p = 0.04). Mean operated tibial plateau angle was 1.1° lower (p = 0.02). No difference in tibial torsion was noticed. No significant difference in mechanical medial proximal tibial angle, mechanical medial distal tibial angle, anatomical lateral distal femoral angle and femoral neck anteversion was observed. Mean operated femoral curvatum angle was 5.6° less (p = 0.01). Five cases (3 plate rod cases) required an immediate revision. Clinical Significance Minimally invasive plate osteosynthesis with FRUP leads to acceptable postoperative alignment. Correct pin placement should be evaluated.
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Gogáin, Aodhán Ó., and Patrick N. Wyse Jackson. "Microcomputed tomography of the holotype of the early tetrapod Ichthyerpeton bradleyae (Huxley in Wright and Huxley, 1866) from the Pennsylvanian of Ireland." Journal of Paleontology 95, no. 5 (May 7, 2021): 1048–60. http://dx.doi.org/10.1017/jpa.2021.31.
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AbstractIchthyerpeton bradleyae (Huxley in Wright and Huxley, 1866) is one of the seven tetrapods originally described by Huxley from the Jarrow Assemblage (Pennsylvanian, Langsettian Regional Substage equated with the Bashkirian International Stage) in south-eastern Ireland. The holotype, one of only two specimens considered to represent the taxon, consists of the postcranial skeleton, which has been highly compressed and has undergone extensive replacement of bone by carbonaceous material. The holotype is studied using microcomputed tomography, which reveals that the vertebral column has at least 25 diplospondylous vertebrae with cylindrical centra. Neural arches and a haemal arch are described for the first time. Neural arches in the caudal region are paired and neural spines only contact one another dorsally. The hemal arch is fused and wraps around the ventral margin of the centrum. A stout femur and tibia are described. The morphology of the femur is unique for early tetrapods, with fibular and tibial condyles of similar length and lacking an adductor crest. The morphology of the femur, and its length relative to the tibia, suggests that the holotype of I. bradleyae preserves an immature individual. The tibia is a flat bone characteristic of stem tetrapods. Phalanges from the right and left pes are present. Because the phalanges are disarticulated, a phalangeal count cannot be determined. Despite the new anatomical information, the systematic position of I. bradleyae is still difficult to establish; however, it does not belong within the colosteids, temnospondyls, or embolomeres, to which it has previously been assigned.
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Najefi, Ali-Asgar, and Andrew Goldberg. "Mechanical and Anatomical Axis in Total Ankle Arthroplasty." Foot & Ankle Orthopaedics 3, no. 3 (July 1, 2018): 2473011418S0008. http://dx.doi.org/10.1177/2473011418s00089.
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Category: Ankle Arthritis Introduction/Purpose: Inadequate correction of alignment in the coronal, sagittal or axial planes will inevitably lead to failure of the Total Ankle Arthroplasty (TAA). The mechanical axis of the lower limb (MAL), the mechanical axis of the tibia (MAT) and the anatomical axis of the tibia (AAT) are three recognized coronal plane measurements using plain radiography. The relationship between anatomical and mechanical axes depends on the presence of femoral or tibial deformities from trauma or inherited conditions, or previous corrective or replacement surgery. Ankle arthroplasty relies heavily on preoperative radiographs or CT scans and the purpose of this study was to assess whether MAL, MAT and AAT are the same in a cohort of patients upon which placement of TAA is considered. Methods: We analysed 75 patients operated on between 2015 and 2016 at a specialist tertiary centre for elective orthopaedic surgery. All patients had a pre-operative long leg radiograph. They were split into 2 groups. The first group had known deformity proximal to the ankle (such as previous tibial or femoral fracture, severe arthritis, or previous reconstructive surgery) and the second group had no clinically detectable deformity. The MAL, MAT and AAT were assessed and the difference between these values was calculated. Results: There were 54 patients in the normal group, and 21 patients in the deformity group. Overall, 25 patients(33%) had a difference between all three axes of less than 1 degree. In 33 patients(44%), there was a difference in one of the axes of ≥2 degrees. There was no significant difference between MAT and AAT in patients in the normal group(p=0.6). 95% of patients had a difference of <1 degree. There was a significant difference between the MAT and AAT in patients in the deformity group(p<0.01). In the normal group, 39 patients(73%) had a difference of <2 degrees between the AAT and MAL. In the deformity group, only 10 patients (48%) had a difference of <2 degrees.In fact, 24% of patients had a difference ≥3 degrees. Conclusion: Malalignment in the coronal plane in TAA may be an issue that we have not properly addressed. Up to 66% of patients without known deformity may have a TAA that is placed at least 1 degree incorrectly relative to the MAL. We recommend the use of full-length lower limb radiographs when planning a TAA in order to plan the placement of implants. The decision to perform extramedullary referencing, intramedullary referencing, or patient specific Instrumentation must be part of the pre-operative planning process.
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Roy, Rajarshi, Prerana Aggarwal, and Shyamalendu Medda. "Variations in nutrient foramen in the long bones of lower limb." Indian Journal of Clinical Anatomy and Physiology 9, no. 1 (March 15, 2022): 35–41. http://dx.doi.org/10.18231/j.ijcap.2022.009.
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Morphology and morphometry of nutrient foramen of bones vary from country to country and from place to place. Objective was to study the number, position, location, directions, distance of nutrient foramen from the proximal end of femur, tibia and fibula in eastern Indian region. In a descriptive study, 393 bilateral lower limb long bones (138 femur, 132 tibia & 123 fibulae) were studied. Total nutrient foramen calculated; 178 in femur, 137 in tibia, 121 in fibula. Most had single foramen; femur (66%), tibia (96%) and fibula (94%). Number of foramina ranged from 0-3 in femur, 1-2 in tibia and 0-2 in fibula. Foramina were present mainly on the posterior surface of the bones [linea aspera in femur (96), below soleal line and lateral to the vertical line in tibia (90) and peroneal crest in fibula (74)]. The mean length, mean distance of nutrient foramen from the proximal end of the bones measured. Most foramina found on the middle third, with foraminal index ranging from 33% to 66%; though on tibia it’s not a common finding. The 't' test value of foraminal index was significant for tibia. Mean foraminal index was measured for femur 42.28%, tibia 35.91%, fibula 41.54%. The knowledge of anatomical variations of nutrient foramen is very important as preservation of vascularization of long bones is essential in fracture repair, tumor resection, bone grafting.
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Mandri, Arjun, Nuthan Jagadeesh, Sunil Nanjareddy, and Vishwanath Muttagaduru Shivalingappa. "The prospective analysis of functional outcome of osteosynthesis of extra-articular distal tibia fractures using minimally invasive percutaneous plate osteosynthesis technique." International Journal of Research in Orthopaedics 6, no. 3 (April 22, 2020): 536. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20201555.
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<p class="abstract"><strong>Background:</strong> Extra-articular distal tibial fractures are one of the most complicated ones to treat, specially comminuted fractures. Its subcutaneous nature and lack of adequate musculature makes it more prone for soft tissue damage and bone loss. The key to handle these troubling fractures is to skilfully preserve and reconstruct the soft tissues, early mobilisation and functional use of the extremity with the maintenance of satisfactory length and alignment of the fracture.</p><p class="abstract"><strong>Methods:</strong> This prospective longitudinal study involved 30 patients with extraarticular distal tibia fracture, who are admitted in Vydehi Institute of Medical Sciences and Research Centre between January 2017 to 2019. All were treated with closed reduction and internal fixation using pre-contoured anatomical distal tibia locking plate using minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. Functional and radiological outcome along with associated complications are evaluated in serial follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> 30 patients with minimal follow up criteria of 6 months was evaluated with AOFAS score for functional outcome. At the end of 1 year, 21 cases (70%) of the cases had excellent results, 5 cases (16.7%) had good results, 3 cases had fair results and only 1 case had poor result.</p><p class="abstract"><strong>Conclusions:</strong> With the use of pre-contoured anatomical locking plates used, MIPPO technique is effective in extra articular distal tibia fractures where it not only helps in decreasing operating time but also in achieving excellent functional outcome with radiological union the fractures by preserving osseous vascularity and minimal soft tissue insult due to surgery.</p>
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Vulcano, Ettore, Lorenzo Bettella, Rohoman Tasarib, Tania Tondolo, Francesco Sala, and Giovanni Lovisetti. "Treatment with Circular External Fixation of Bicondylar Tibial Fractures: Potential in Accurate Reduction and Efficacy on Functional Results." Journal of Knee Surgery 31, no. 05 (July 18, 2017): 459–66. http://dx.doi.org/10.1055/s-0037-1604139.
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AbstractSurgical reconstruction of bicondylar tibial fractures with external fixation relies on indirect fracture reduction that could affect anatomical restoration. The aim of the present study is to evaluate the radiographic and clinical outcomes of tibial bicondylar fractures treated with circular external fixation. A total of 20 bicondylar fractures of the proximal tibia in 20 patients treated with circular external fixation were included in the study. Two fractures were open. Mean clinical and radiographic follow-up was 37.3 months after frame removal. Angular, translation, and length deformities were assessed on nonweight-bearing anteroposterior, lateral, and two 45 degrees oblique views. The medial proximal tibia (MPTA) and posterior proximal tibia angles (PPTA) were calculated in all cases. The condylar widening was calculated in relation to the width of the femoral condyles. Joint depressions or gaps of the articular surface were identified on the four views of the knee. The modified Hospital for Special Surgery (HSS) knee scoring system was used for clinical evaluation. The MPTA was good in 18 (90%) and fair in 2 patients (10%). The PPTA was good in 13 (65%), fair in 6 (30%), and poor in 1 patient (5%). The articular reduction was good in 12 (60%) and fair in 8 patients (40%). The condylar widening was good in 15 (75%) and fair in 5 patients (25%). Mechanical axis deviation was within the normal range in 11/12 patients (91.7%). All fractures consolidated. One deep infection was successfully treated with local debridement, the mean modified HSS knee score at the latest follow-up was 90.5 (range: 67–100). Articular reconstruction and tibia alignment based on radiographic evaluation in the present study, along with functional results compare favorably with those of external and internal fixation presented in the literature.
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Cho, Ho-Jung, and Dai-Soon Kwak. "Anatomical Consideration of the Anterolateral Ligament of the Knee." BioMed Research International 2019 (April 11, 2019): 1–6. http://dx.doi.org/10.1155/2019/5740473.
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Many researchers have studied the structures of the anterolateral part of the knee. Several researchers have investigated the existence of the anterolateral ligament (ALL) and its frequency has been inconsistently reported. Therefore, we assessed whether the ALL is the anatomical true ligament and studied the morphological variations of this structure. Sixty-four Korean adult cadavers (120 knees, mean age: 79.1 years) were used for this study. The lateral part of the knee joint was carefully dissected with internal rotation of the tibia. We checked the existence and morphological features and measured the dimensions (length, width, and thickness) of the ALL. The ALL was clearly distinguished from the capsulo-osseous layer of the iliotibial tract and runs obliquely from the lateral femoral epicondyle to the tibial plateau. The ALL was found in 42.5% of the samples, and 15 cadavers had ALLs in both knees. There was no prevalence difference between females and males. Most of the anterior border of the ALL was blended with the knee capsule. Therefore, we concluded that this structure is a local thickening of the capsule in the anterolateral region of the knee, where it possibly developed against some external physical stress. Therefore, the ALLs in this present study can be defined as a capsular ligament of the knee and, as per the nomenclature of the capsular ligament, can be also called the ‘anterolateral (capsular) ligament’.
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Mahat, Samyog, Shamsher Shrestha, and Prabhakar Yadav. "Anatomical study of nutrient foramen in lower limb dry long bones." International Journal of Research in Medical Sciences 9, no. 8 (July 28, 2021): 2246. http://dx.doi.org/10.18203/2320-6012.ijrms20213068.
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Background: Nutrient artery gain access through nutrient foramen and provide vascular supply to bone. Number, size and location of nutrient foramen has significant medical as well as surgical importance. Any insult to nutrient artery during surgical procedure or during trauma may lead to devascualarization or poor prognosis.Methods: The present study consist of 50 femurs, 50 tibia and 50 fibula, collected from department of anatomy, BPKIHS. Mean length of bone, number, position and size and foraminal index of nutrient foramen was observed and recorded accordingly.Results: In femur 62% bone shows single nutrient foramen. Nutrient foramen was commonly located in medial lip of linea aspera and in upper third of bone which was noted in 80% of bone. In tibia 82% of total bone shows single foramen with absent of foramen in 6% bone. Foramen was commonly located above the soleal line and middle third of bone which was noted in 56% of bone. In fibula 6% of total bone shows absent of nutrient foramen and majority of bone shows single nutrient foramen (82%). Foramen was commonly located in lower part of posterior surface (60%) and in middle third of bone.Conclusions: This study provides details topographic knowledge about nutrient foramen which is important clinically for proper planning of surgery and its outcome.
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João, Leite Maria, Relvas Miguel, Almeida Joana, Martins João, Pinho André, and Sousa António PhD. "Does Patient Specific Factors or Alignment Influence Total Knee Arthroplasty Clinical and Functional Outcomes?" Orthopaedic Journal of Sports Medicine 9, no. 6_suppl2 (June 1, 2021): 2325967121S0018. http://dx.doi.org/10.1177/2325967121s00186.
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Objectives: Knee alignment following total knee arthroplasty (TKA) may be the most important factor determining the long-term survival of the prosthesis. Despite proper alignment of implants being strongly associated with greater stability and a lower rate of loosening, literature still finds conflicting results regarding the influence of TKA alignment in patients clinical scores. The present study sought to address what is the optimal postoperative TKA alignment. Methods: We retrospectively selected 100 consecutive primary knee replacements performed for primary knee osteoarthritis. Pre-operative full length weight bearing x-rays were used to evaluate native knee anatomic alignment, as well as proximal tibial and distal femoral coronal alignment. Pos-operative full length weight bearing x-rays were also used to evaluate TKA alignment, tibial and femoral components coronal alignment, tibial position, tibial slope and femoral flexion angle. Extension anteroposterior (AP) and profile at 30º of flexion x-rays were used. Functional assessment was conducted including the VAS, the Oxford Knee and the Kujala scores, as well as range of motion (ROM). Results: Regarding ROM, only 8 patients didn’t presented full range of motion. Regarding the native knee, the average anatomical angle was 174 ± 4º. The average femoral distal coronal angle was 88±4º and the average tibial proximal coronal angle was 89±6º. The average post-operative angles were: 175±3º for the TKA tibia-femoral coronal angle, 88±6º for the coronal femoral angle and 89±3º for the coronal tibial angle. Regarding tibial tray position, when referring to the medial cortex of the proximal tibia, our sample had a tray in average 1±1mm more lateral than the medial cortex, with the worst positioned tibial components being 3,2mm medial or lateral to the medial cortex. When considering the proximal tibia lateral cortex, our patients had in average a tibial tray 1±2mm more medial than the lateral cortex, with the worst positioned tibial components being 4,2mm medial or 2,2mm lateral to the lateral cortex. Regarding the TKA sagittal alignment, the average TKA tibial slope was of 3±4º, and the average femoral flexion angle was 10±3º. Gender, IMC or age didn’t seem to influence TKA clinical results, either regarding pain (VAS) or function (Kujala or Osxford Scores). Comparing patients with post-operative alignment within of 5º of the native knee anatomical alignment, with patients with greater differences, no significant differences were obtained regarding pain or function. Also comparing patients with pos-operative coronal femoral or tibial angle within 85-95º, with patients with greater differences, no significant differences were reached regarding clinical outcomes. Besides that, tibial tray coronal position also didn’t seem to influence patient results. In regard to sagittal alignment, neither the femoral flexion angle or the tibial slope showed and correlation to post-operative outcomes. Regarding TKA size, the tibial tray or polytene size didn’t seem to influence clinical outcomes, however the femoral component size showed correlation with the functional scores, with smaller femoral sizes associated with greater Oxford scores (p=0,0029). Conclusion: Most patients of our sample seem to have well aligned TKA, with an difference of only 1º between the native knee anatomic angle and the TKA alignment. Regarding tibial tray position, most surgeons opted for a tibial tray smaller than the tibial plateau, however these differences were of 1 millimeter medially and laterally, which probably is not clinically significant. The tibial slope is also within the desired values of 0-7º. We verified that most errors in tibial tray regard positioning it more medially than laterally, however we can assume that the tibial tray is, in most patients, correctly sized and positioned. Regarding femoral sagittal alignment, our sample showed a greater femoral flexion than previously described, however the clinical relevance of this measurement is sill controverse. Despite some papers describing an association between greater femoral flexion angle and patellofemoral instability, in our sample this angle didn’t seem to influence the Kujala score. No differences in pain or functional results were obtain in regard to TKA alignment, however this can be explained by the fact that most patients presented well aligned TKAs.
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Komar, T. V. "Fetal Topography of Cutaneous Nerves of Lower Leg Region." Ukraïnsʹkij žurnal medicini, bìologìï ta sportu 7, no. 2 (May 6, 2022): 54–58. http://dx.doi.org/10.26693/jmbs07.02.054.
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The purpose of the study was to determine the topographic and anatomical relationships of the cutaneous nerves of the lower leg in human fetuses of 4-6 months. Materials and methods. The study was performed on 27 preparations of human fetuses of 81.0-230.0 mm parietal-coccygeal length, using the methods of macromicroscopic preparation and morphometry. Results and discussion. In most of the studied fetuses, there was a classic variant of innervation of the skin of the lower leg region, both on the right and left. In other fetuses, variability in the number and length of cutaneous nerves in the lower leg region was found. The most interesting, from our point of view, were the anatomical variants of innervation of the skin of the lower leg region in the fetuses of 90.0, 158.0, 182.0, and 190.0 mm parietal-coccygeal length. Taking into account the individual and age anatomy of the cutaneous nerves of the leg in human fetuses provides not only the scientific value of the results, but also the rational use of knowledge in the practice of traumatologists, anesthesiologists and surgeons. The study of variants of innervation of the skin of the lower leg region in human fetuses from the standpoint of modern macroscopic anatomy is considered relevant and promising. The need to clarify the topographic and anatomical features of the innervation of the skin of the lower leg region in human fetuses of different ages is due to the search for ways to prevent iatrogenic damage to the cutaneous nerves of the shin when performing surgical and anesthetic manipulations on the structures of this area, since the establishment of the anatomical variability of the skin nerves and branches allows to choose the optimal tactics of surgical intervention. In the literature, there are fragmentary data on the fetal topography of the cutaneous nerves of the lower leg region. Conclusion. In fetuses of 90.0 mm and 158.0 mm parietal-coccygeal length, the innervation of the skin of the anterior-upper surface of the lower leg region was provided by two cutaneous branches from the tibial nerve. In the fetus of 190.0 mm parietal-coccygeal length lateral sural cutaneous nerve was not involved in the formation of the sural nerve, the area of its innervation was limited to the proximal two-thirds of the tibia. Innervation of the lateral border of the foot and lateral bone, in this case, provided only the medial sural cutaneous nerve from the tibial nerve. In the fetus of 182.0 mm parietal-coccygeal length medial sural cutaneous branches are represented by a single independent nerve trunk, from which at different angles short sensitive branches began
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H.P., Shobha, Karthik S., Akshay Dhanda, Lingaraju K., and Giridhar Kumar. "Functional and radiological outcome of surgical treatment of distal tibial fracture by minimally invasive percutaneous plate osteosynthesis technique." International Journal of Research in Orthopaedics 6, no. 2 (February 25, 2020): 340. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20200736.
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<p class="abstract"><strong>Background:</strong> Minimally invasive percutaneous plate osteosynthesis (MIPPO) is an established technique for fixation of fractures of the distal third tibia. Aim of our study was to manage extraarticular fractures of the distal third tibia by the minimally invasive plate osteosynthesis technique and follow them prospectively. Clinical and radiological outcomes were studied and clinical indications & efficacy of the procedure reviewed.</p><p class="abstract"><strong>Methods:</strong> From June 2018 to June 2019,25 patients of closed distal tibial fractures were operated by MIPPO technique with a distal tibial anatomical locking plate having 4.5 out of 5 proximal and 3.5 out of 4 distal screw holes. The follow up duration was for 1 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean fracture healing time was 17 weeks (range 16 to 32 weeks) and average The American orthopedic foot and ankle score was 88.2 out of a total possible 100 points. At last follow up, superficial infection occurred in 3 patients, deep infection in 1 patient, ankle stiffness in 1 patient, limb length discrepancy <1 cm in 1 patient and malunion in 2 patients.</p><p class="abstract"><strong>Conclusions:</strong> MIPPO technique provides good bone healing and decreases incidence of non-union and need for bone grafting. This technique should be used in distal tibia fractures where locked nailing cannot be done like fractures with small distal metaphyseal fragments, vertical splits, markedly comminute fractures.</p>
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Ilyas, Muhammad Saad, Uruj Zehra, Nimra Ijaz, and Amer Aziz. "Malunited and malrotated Salter-Harris type I fracture of distal femur managed with circular ring external Ilizarov fixator." BMJ Case Reports 14, no. 6 (June 2021): e240195. http://dx.doi.org/10.1136/bcr-2020-240195.
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A 9-year-old girl presented with malunited Salter-Harris type I fracture of distal femur treated by bone-setter (unreliable-practitioner). Assessment revealed 3 cm limb-length-discrepancy and affected leg was unable to bear weight, knee was stiff with no active-range of motion; radiographs showed displaced sagittally malunited femoral condyle with 163° posterior distal femoral angle (PDFA). Correction planned with circular-ring-external Ilizarov fixator using distraction-osteogenesis through supracondylar osteotomy and gradual anterior opening. Partial weight bearing allowed from first postoperative day on walker. Eight weeks follow-up showed restored anatomical position of femoral condyle and PDFA. During anterior-distraction and angulation correction, tibia subluxated posteriorly, for that assembly extended to tibia which gradually translated tibia anteriorly and reduced knee. Twenty weeks after removal of assembly patient was advised knee-ankle-foot-orthosis. At 40 weeks of frame removal, patient was walking without support and pain. Managing such rare injuries with distraction-osteogenesis technique allows gradual correction and monitoring, till desirable degree of correction is achieved.
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S. V., Akshay Kumar, and Venkatesh Babu S. "Safe leg surgery: the anatomic principles and techniques." International Surgery Journal 7, no. 10 (September 23, 2020): 3523. http://dx.doi.org/10.18203/2349-2902.isj20204174.
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The goals of surgical treatment of leg injury are to achieve soft tissue healing, good osseous union and to restore the length of the limb, correct alignment of both bones with their respective joints and normal range of movements of the entire limb at the earliest. Presently, the surgical treatment has been standardised for the tibia fractures for adults and children. Though the surgical progress made in the implants, instruments and techniques, there are considerable surgical complications happening. This article highlights the need of anatomical expertise and safe operative ability for the surgeon.
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Sacchetti, Federico, Will Aston, Rob Pollock, Panos Gikas, Pierluigi Cuomo, and Craig Gerrand. "Endoprosthetic replacement of the proximal tibia for oncological conditions." Bone & Joint Open 3, no. 9 (September 1, 2022): 733–40. http://dx.doi.org/10.1302/2633-1462.39.bjo-2022-0069.r1.
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Aims The proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs). Methods This was a retrospective analysis of clinical data relating to patients who underwent proximal tibial arthroplasty in our regional bone tumour centre from 2010 to 2018. Results A total of 76 patients fulfilled the inclusion criteria and were included in the study. Mean age at surgery was 43.2 years (12 to 86 (SD 21)). The mean follow-up period was 60.1 months (5.4 to 353). In total 21 failures were identified, giving an overall failure rate of 27.6%. Prosthesis survival at five years was 75.5%, and at ten years was 59%. At last follow-up, mean knee flexion was 89.8° (SD 36°) with a mean extensor lag of 18.1° (SD 24°). In univariate analysis, factors associated with better survival of the prosthesis were a malignant or metastatic cancer diagnosis (versus benign), with a five- and ten-year survival of 78.9% and 65.7% versus 37.5% (p = 0.045), while in-hospital length of stay longer than nine days was also associated with better prognosis with five- and ten-year survival rates at 84% and 84% versus 60% and 16% (p < 0.001). In multivariate analysis, only in-hospital length of stay was associated with longer survival (hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.08 to 0.66). Conclusion We have shown that proximal tibial arthroplasty with endoprosthesis is a safe and reliable method for reconstruction in patients treated for orthopaedic oncological conditions. Either modular or custom implants in this series performed well. Cite this article: Bone Jt Open 2022;3(9):733–740.
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Greatrex, Frederick, Erica Montefiori, Thomas Grupp, Josef Kozak, and Claudia Mazzà. "Reliability of an Integrated Ultrasound and Stereophotogrammetric System for Lower Limb Anatomical Characterisation." Applied Bionics and Biomechanics 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/4370649.
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Background. Lower extremity analysis for preoperative total knee and hip arthroplasty routines can increase surgery success rate and hence reduce associated costs. Current tools are limited by being invasive, limited to supine analysis, or too expensive. This study aimed to propose and validate a device, OrthoPilot®, based on the combined use of a stereophotogrammetric and ultrasound system which can in vivo and noninvasively measure varus/valgus, flexion/extension, femur and tibia torsion, and femur and tibia lengths.Methods. A phantom was measured by four operators to determine the resolution of the system. Interoperator variability was measured on three operators who measured the above six variables on both legs of three subjects in standing and supine positions. Intraoperator variability was assessed on data from three repeats from 9 subjects (18 legs).Results. All 6 variables were reliably detected on a phantom, with a resolution of 1 mm and 0.5°. Inter- and intraoperator consistency was observed for varus/valgus, flexion/extension, and length measurements on the healthy subjects in standing and supine positions (all ICC > 0.93). For torsion measurements, there was a considerable variation.Conclusion. The proposed system, when used on healthy subjects, allowed reliable measurements of key parameters for preoperative procedures in both supine and standing positions. Accuracy testing and further validation on patient populations will be the next step toward its clinical adoption.
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Keremu, Ajimu, Nuersimanguli Mijiti, Sirejiding Mijiti, Aikebaier Tuxun, and Abulikemu Abudurexiti. "Evaluation of the application value of a three-dimensional digital model of the knee in clinical practice." Journal of International Medical Research 48, no. 5 (May 2020): 030006051988974. http://dx.doi.org/10.1177/0300060519889742.
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Objective To compare the knee shape and bone parameters between knee prosthesis products from overseas companies and a Chinese patient’s knee, and to apply the anatomical basis for Chinese knee prosthesis design. Methods Three-dimensional digital models were built, including prosthesis products for a normal adult. The relevant anatomy index was measured, and physical parameter, radiographic, geometric, knee kinematic, and distal geometry data were collected on the femur and tibia. Results The width of the femoral condyle (WFC), width of the medial femoral condyle (WMFC), width of the lateral femoral condyle (WLFC), depth of the intercondylar fossa (DICF), sagittal length of the medial femoral condyle (SLMFC), sagittal length of the lateral femoral condyle (SLLFC), angle of the medial femoral condyle (AMFC), and angle of the lateral femoral condyle (ALFC) in the femur and the transverse diameter (ML) and anteroposterior diameter (AP) of the tibial bone were measured. These parameters were significantly lower in the normal group compared with the prosthesis product model group. Conclusion When using an imported knee prosthesis, the osteotomy angle may not fit perfectly. Use of an imported prosthesis may be an important factor in the increasing failure of knee arthroplasty in China.
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Nabholz, Katrin, Antonio Pozzi, Philipp A. Schmierer, Lucas A. Smolders, and Sebastian C. Knell. "Safety and Accuracy of Minimally Invasive Long Bone Fracture Repair Using a 2.5-mm Interlocking Nail: A Cadaveric Feline Study." Veterinary and Comparative Orthopaedics and Traumatology 32, no. 05 (July 6, 2019): 351–61. http://dx.doi.org/10.1055/s-0039-1691828.
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Abstract Objectives The Targon Vet System (TVS) is a 2.5-mm interlocking nail that can be applied minimally invasively. The purpose of this study was to test if the TVS could be safely applied percutaneously to different feline long bones without fluoroscopic guidance. Methods A gap fracture was created in 96 feline humeri, femora and tibiae (n = 32/group). Paired bones were randomly assigned to two treatment groups: (1) TVS inserted percutaneously with fluoroscopy and (2) TVS inserted percutaneously without fluoroscopy. Intraoperative evaluation (complications, procedure time, attempts), radiographs (pre-/postoperative alignment, length) and anatomical dissection (neurovascular injury, rotational alignment) were compared between treatment groups. Results The use of fluoroscopy did not lead to significant differences in any of the outcome measures. Intraoperative complications predominantly occurred in the distal humerus (12/32) and the proximal femur (7/32). In total, 20/96 complications occurred with no complications for the tibia. Neurovascular structures were only damaged at the medial side of the distal humerus (10/32). Clinical Significance We conclude that the TVS can be safely applied percutaneously to the tibia and with limitations to the femur in normal cadaveric cats without fluoroscopy. Despite the limitations of a cadaveric study, the high number of complications is leading us to consider the humerus not safe for the TVS. A learning curve has to be expected and technical recommendations should be respected to decrease complications.
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Gundavda, Manit K., Manish G. Agarwal, Rajeev Reddy, and Ashik Bary. "Reconstructive Challenges of Distal Tibia Bone Tumors: Extracorporeally Irradiated Autograft Combined with a Nonvascularized Autograft Fibula for Superior Reconstruction and Functional Outcomes When Compared to Ipsilateral Pedicled Fibula Transfer Alone." Sarcoma 2021 (March 23, 2021): 1–6. http://dx.doi.org/10.1155/2021/6624550.
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Introduction. Traditionally, centralization of the fibula with fusion across the tibiotalar joint has been used to reconstruct distal tibial defects. Although effective, it requires long periods of protected weight-bearing. The fibula or the fixation often fails before fibular hypertrophy necessitating multiple additional surgeries. A method of using ECRT with the available ipsilateral fibula (nonvascularized) to reconstruct the distal tibia defect with the aim of early return to weight-bearing was evolved. This paper documents our early experience. Patients and Methods. Four patients; with the diagnosis of osteosarcoma in 3 patients and recurrent giant cell tumor of the bone in 1 patient, underwent resection of the distal tibia for tumors between 2017 and 2019. Extracorporeally irradiated (50 Gy) distal tibia along with ipsilateral nonvascularized fibula was used to bridge the defect and fuse the tibiotalar joint. A plate was used to rigidly hold the construct. The final outcome was compared to the historical control group that underwent only pedicled ipsilateral fibula transposition and ankle arthrodesis without recycled autograft or allograft between 2009 and 2017. Oncological reconstruction and functional outcomes were compared for each group. Patient reported outcomes on the acceptability of ankle fusion; cosmesis and function were analyzed and compared between the two groups. Results. The mean resection length in the study group (4 patients) was 7.75 cm (7 to 8.5 cm). As compared to the historical cohort of 7 patients, the study population showed statistically superior results in all reconstruction, functional, and patient-reported outcomes except time to proximal junction union ( p = 0.068 ). There were no reconstruction failures, infection, or nonunions in the study group, whereas the control comparative group had 2 proximal junction nonunions and a mean time to fibular hypertrophy of 143 weeks (82 to 430 weeks) with fibula centralization. Earlier weight-bearing was allowed (mean 26.75 weeks; median 27 weeks) compared to (mean 80.75 weeks; median 80 weeks) in the control group. Conclusion. We think that ECRT with ipsilateral vascularized fibula is a promising method of reconstructing the distal tibia. The recycled autograft tibia added strength to the distal tibia construct in our study and aided the anatomical reconstruction of the distal tibia. The patient-reported outcomes for cosmesis and acceptability add to the benefits of performing this procedure. Consistent early union across the proximal junction and earlier weight-bearing were clear advantages of this method.
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Jeon, Anna, Ye-Gyung Kim, Youngjoo Sohn, and Je-Hun Lee. "Nerve and Arterial Supply Pattern of the Popliteus Muscle and Clinical Implications." BioMed Research International 2022 (January 10, 2022): 1–6. http://dx.doi.org/10.1155/2022/6980471.
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Introduction. The aim of this study was to investigate the nerve and artery supply and the tibial attachment of the popliteus muscle using anatomical methods. Methods. Forty-four nonembalmed and embalmed extremities were dissected for this study. To measure the attachment area of the popliteus, the most prominent points of the medial epicondyle of the femur and the medial malleolus of the tibia were identified before dissection. A line connecting these two prominent points was used as the reference line, with the most prominent point of the medial epicondyle of the femur as the starting point. This study also investigated the area where the popliteus attaches to the bone and the points where nerves and arteries enter the popliteus muscle when it is divided into three equal parts in the coronal plane. Results. The mean length of the reference line was 34.6 ± 2.1 cm . The origin of the popliteus was found to be at a distance of 16.6% to 35.2% on the tibial bone from the proximal region. The popliteus was innervated by only the tibial nerve in 90% of the cases and by the tibial and the sciatic nerves in the remaining 10% of the cases. The inferior medial genicular artery and the posterior tibial artery supplied blood to the popliteus in 90% and 65% of the cases, respectively. When the popliteus muscle was divided into three equal parts in the coronal plane, the nerve and the artery were found to enter the muscle belly in zones II and III and zones I and II in 92% and 98% of the specimens, respectively. Discussion. The anatomical investigation of the popliteus in this study will help identify patients with clinically relevant syndromes.
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Jensen, Janni, Bo R. Mussmann, John Hjarbæk, Zaid Al-Aubaidi, Niels W. Pedersen, Oke Gerke, and Trine Torfing. "Microdose acquisition in adolescent leg length discrepancy using a low-dose biplane imaging system." Acta Radiologica 58, no. 9 (January 9, 2017): 1108–14. http://dx.doi.org/10.1177/0284185116682381.
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Background Children with leg length discrepancy often undergo repeat imaging. Therefore, every effort to reduce radiation dose is important. Using low dose preview images and noise reduction software rather than diagnostic images for length measurements might contribute to reducing dose. Purpose To compare leg length measurements performed on diagnostic images and low dose preview images both acquired using a low-dose bi-planar imaging system. Material and Methods Preview and diagnostic images from 22 patients were retrospectively collected (14 girls, 8 boys; mean age, 12.8 years; age range, 10–15 years). All images were anonymized and measured independently by two musculoskeletal radiologists. Three sets of measurements were performed on all images; the mechanical axis lines of the femur and the tibia as well as the anatomical line of the entire extremity. Statistical significance was tested with a paired t-test. Results No statistically significant difference was found between measurements performed on the preview and on the diagnostic image. The mean tibial length difference between the observers was −0.06 cm (95% confidence interval [CI], −0.12 to 0.01) and −0.08 cm (95% CI, −0.21 to 0.05), respectively; 0.10 cm (95% CI, 0.02–0.17) and 0.06 cm (95% CI, −0.02 to 0.14) for the femoral measurements and 0.12 cm (95% CI, −0.05 to 0.26) and 0.08 cm (95% CI, −0.02 to 0.19) for total leg length discrepancy. ICCs were >0.99 indicating excellent inter- and intra-rater reliability. Conclusion The data strongly imply that leg length measurements performed on preview images from a low-dose bi-planar imaging system are comparable to measurements performed on diagnostic images.
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Stern-Perry, Michal, Amit Gefen, Nogah Shabshin, and Yoram Epstein. "Experimentally tested computer modeling of stress fractures in rats." Journal of Applied Physiology 110, no. 4 (April 2011): 909–16. http://dx.doi.org/10.1152/japplphysiol.01468.2010.
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The objective of this study was to develop a finite-element (FE) modeling methodology for studying the etiology of a stress fracture (SF). Several variants of three-dimensional FE models of a rat hindlimb, which differed in length or stiffness of tissues, enabling the analyses of mechanical strains and stress in the tibia, were created. We compared the occurrence of SFs in an animal model to validate locations of peak strains/stresses in the FE models. Four Sprague-Dawley male rats, age ∼7 wk, were subjected to mechanical cyclic loads of 1.2 Hz and ∼6 N, which were delivered to their hindlimb for 30 min, 3 times/wk, up to 12 wk, by using a specially designed apparatus. The results showed that 1) FE modeling predicted the maximal strains/stresses (∼220,0 με and ∼29 MPa, respectively) between the mid- and proximal thirds of the tibia; 2) in a longer shin, greater and more inhomogeneous tensile strains/stresses were evident, at the same location; 3) anatomical variants in shin length influenced the strain/stress distributions to a greater extent with respect to changes in mechanical properties of tissues; and 4) bone stiffness was more dominant than muscle stiffness in affecting the strain/stress distributions. In the animal study, 35,000 loading cycles were associated with the formation of a SF. The location of the identified SF in the rat limb verified the FE model. We find the suggested model a valuable tool in studying various aspects of SFs.
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Woo, Savio L. Y., J. A. Weiss, M. A. Gomez, and D. A. Hawkins. "Measurement of Changes in Ligament Tension with Knee Motion and Skeletal Maturation." Journal of Biomechanical Engineering 112, no. 1 (February 1, 1990): 46–51. http://dx.doi.org/10.1115/1.2891125.
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This study was designed to determine the in situ strains, stresses, and loads in the medial collateral ligament (MCL) of skeletally immature and mature rabbits. Using a noncontact method, the magnitudes of the in situ strains were first determined as a function of knee flexion angle. The MCL was divided into three anatomical regions (anterior, middle, and posterior) across its width. For strain measurements, the variation of a gauge length in these regions was obtained in the intact knee at 60, 90, and 120 deg of flexion. Subsequently, all soft tissues around the knee were dissected away, leaving the femur-MCL-tibia (FMT) complex. The MCL was allowed to retract freely and the new length, called the zero length, was measured. From this, the in situ strains were determined. To obtain the stress-strain relationship of the FMT complex, the specimens were subjected to tensile testing. Knowing the in situ strains and the stress-strain relationship, the in situ stresses in the three anatomical regions of the MCL were determined as a function of knee flexion angle. Multiplying these stresses by 1/3 of the cross-sectional area and summing the loads thus calculated, the in situ loads of the MCL were obtained. Our data suggest that the in situ load in the MCL is not large within the range of knee flexion angles studied, i.e., 1.4 to 2.7 N for the skeletally immature animals and 3.0 to 5.8 N for the skeletally mature animals. An increase in the in situ load with skeletal maturation was demonstrated.
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Micicoi, Grégoire, Pierre Martz, Christophe Jacquet, Levi Reina Fernandes, Raghbir Khakha, and Matthieu Ollivier. "High Tibial Osteotomy With Miniaci Planning Using Manual and Semiautomated Digital Measures." Video Journal of Sports Medicine 1, no. 6 (November 2021): 263502542110329. http://dx.doi.org/10.1177/26350254211032968.
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Background: Inadequate deformity analysis and planning before high tibial osteotomy (HTO) may result in correction errors with unsatisfactory clinical results. Indications: The purpose of this article is to describe the deformity analysis and preoperative planning before HTO. This surgery is effective for young patients with compartmental mild knee osteoarthritis. A partial deformity analysis without considering the femoral or intra-articular deformity may lead to overcorrection or excessive joint line obliquity. Preoperative planning using the Miniaci method with manual or semiautomated digital measures may help to prevent these types of errors. Technique Description: Landmarks are used at the proximal femoral side, distal condyles, proximal tibial plateau, and talus borders to define angles automatically on PeekMed software. Fujisawa point is determined to be 50% of the length of the proximal tibia, and Miniaci method is performed after defining the weightbearing line. The method can be performed manually or semiautomatically with the software. In this last case, the optimal procedure to be done to correct the malalignment is proposed by the software which automatically does the opening of the osteotomy to match the desired weightbearing axis and displays the size of the wedge in millimeters. Results: The intraobserver and interobserver reproducibility were performed by 2 different analyses and 2 different observers. The precision of the measures was confirmed based on computed tomographic (CT) scan 3-dimensional measures defined as the gold standard. All the intraobserver and interobserver reproducibility correlation coefficients and precision were satisfactory compared with the gold standard. Hip-knee-ankle angle may vary because of weightbearing situations between CT and long-axis x-rays. Discussion/Conclusion: The interest of semiautomated software for angular value measurements is now well recognized, and the inclusion of anatomical landmarks allows accurate and reproducible angular value measurements. Automatic knee osteotomy planning analyzes the metaphyseal deformity of both the tibia and the femur, and the software suggests the optimal procedure with the degree of openness to obtain the desired mechanical axis without creating excessive joint line obliquity
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Ataoğlu, Muhammet Baybars, Mehmet Ali Tokgöz, Anıl Köktürk, Yılmaz Ergişi, Mustafa Yasin Hatipoğlu, and Ulunay Kanatlı. "Radiologic Evaluation of the Effect of Distal Tibiofibular Joint Anatomy on Arthroscopically Proven Ankle Instability." Foot & Ankle International 41, no. 2 (October 31, 2019): 223–28. http://dx.doi.org/10.1177/1071100719884555.
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Background: Ankle sprains occur frequently in both athletes and the general population. The social and economic consequences can be significant. In an effort to understand the injury, dynamic and static structures around the ankle have been investigated in detail, but anatomical factors predisposing to lateral ankle instability have not been fully clarified. The aim of this study was to radiologically investigate the relationship between bony variations of the distal tibiofibular joint and arthroscopically proven ankle instability. Methods: Fifty patients with arthroscopically proven ankle instability and 50 patients without instability were included in this study. Measurements were obtained from a magnetic resonance imaging (MRI) section 1 cm proximal to the tibiotalar joint; distal tibiofibular joint anterior facet length ( a), posterior facet length ( b), angle between the anterior and posterior facets ( c), fibular notch depth ( d), tibia thickness ( e), and fibula thickness ( f) was measured. Results: It was found that instability was more frequent when the length of a ( P < .001) and e ( P < .001) were shorter. In addition, when value of a/ b and e/f were evaluated, it was observed that the number of individuals who had instability increased as the ratio became smaller ( P < .016-.020, respectively). Pearson correlation analysis indicated strong negative correlation between the values of a- e and instability ( r = −0.348, P < .001, and r = −0.328, P = .001; respectively). Conclusion: Lateral ankle sprains are common, and a clear understanding of the relevant structures and clinical function of the ankle complex should extend beyond the talocrural joint. This study demonstrated that the presence of narrow anterior facet ( a) and thinner tibia ( e) were strongly correlated with lateral ankle instability. Level of Evidence: Level III, retrospective case control study.
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Iyaji, Paul I., Abduelmenem Alashkham, Abdulrahman Alraddadi, and Roger Soames. "ANATOMICAL STUDY OF THE MORPHOMETRY OF THE ANTERIOR CRUCIATE LIGAMENT ATTACHMENT SITES. Estudio anatómico de la morfometría de los sitios de fijación del ligamento cruzado anterior." Revista Argentina de Anatomía Clínica 8, no. 1 (March 28, 2016): 29–37. http://dx.doi.org/10.31051/1852.8023.v8.n1.14205.
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Incidence of anterior cruciate ligament (ACL) rupture and its consequent reconstruction is on the rise. In contributing to the achievement of anatomic reconstruction this study seek to provide information regarding the position and variability of the tibial attachment sites, dimensions of femoral insertions and compare these measurements in males and females, and in right and left knees. Thirty one cadaveric knees (15 right and 16 left from 9 females and 7 males, mean age 77 years) were dissected. Various ACL footprint dimensions were taken. The mean length and width of the tibial anteromedial (AM) bundle footprint were 8.9 and 9.8 mm while that of the posterolateral (PL) bundle were 9.3 and 8.0 mm respectively. The mean length and width of the tibial AM and PL bundles in males were 8.5 and 9.8 mm, and 9.1 and 8.3 mm while corresponding values in females were and 9.2 and 9.7 mm, and 9.4 and 7.8 mm respectively. Males had larger femoral footprints (P=0.020) and tibial plateau (P<0.001). No significant difference between the right and left knees were observed. The mean anatomical positions of the AM and PL bundles were 46.0% and 50.0% of the mediolateral diameter of the tibial plateau. The mean length and width of the ACL femoral insertion sites were 8.3 and 7.7 mm for the AM bundle and 7.8 and 6.9 mm for the PL bundle respectively. The smaller ACL attachment parameters in females could be a contributing factor to the higher incidence of ACL rupture in female athletes. La incidencia de la rotura del ligamento cruzado anterior (LCA) y su consiguiente reconstrucción está en aumento. Para contribuir a la actualización de la reconstrucción anatómica del ligamento cruzado anterior, este estudio proporciona información sobre la posición y la variabilidad de los sitios de fijación en la tibia, las dimensiones de las inserciones femorales, así como las relaciones de estas mediciones en hombres y mujeres y en las rodillas derecha e izquierda. Se disecaron treinta y un (15 rodillas de cadáver derecha, 16 izquierda, de 9 mujeres y 7 hombres, con una edad media de 77 años). Se tomaron diversas dimensiones de la huella del LCA. La longitud media y la anchura de la huella del haz tibial anteromedial (AM) eran 8,9 mm y 9,8 mm mientras que la del haz posterolateral (PL) eran 9,3 mm y 8 mm respectivamente. La longitud media y la anchura de la AM tibial y paquetes PL en los varones eran 8,5 y 9,8 mm, y 9,1 y 8,3 mm, mientras que los valores correspondientes en las mujeres eran 9,2 y 9,7 mm, y 9,4 y 7,8 mm, respectivamente. Los varones tenían huellas femorales (P = 0,045 para AM, P = 0,043 para PL) y la meseta tibial (P <0,001) más grandes. No se observó ninguna diferencia significativa entre la rodilla derecha e izquierda. Las posiciones anatómicas medias de los haces de AM y PL fueron 46% y 50% del diámetro mediolateral de la meseta tibial. La longitud media y la anchura de los sitios de inserción femoral del LCA fueron 8,3 y 7,7 mm para el paquete de AM y 7,8 y 6,9 mm para el paquete PL respectivamente. Los parámetros más pequeños de fijación del LCA en las mujeres podría ser un factor que contribuye a la mayor incidencia de rotura del LCA en mujeres atletas.
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Taşdemir, Zeki, Safiye Tokgöz Özal, Nurzat Elmalı, and Fevzi Sağlam. "Radiologic and Clinical Evaluation of Anatomic and Transtibial ACL Reconstruction in a Population Excluding Professional Athletes." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (November 1, 2014): 2325967114S0012. http://dx.doi.org/10.1177/2325967114s00122.
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Objectives: Two different approaches for drilling the femoral tunnel are commonly used in single-bundle anterior cruciate ligament (ACL) reconstruction: creating the femoral tunnel through the tibial tunnel or drilling the tunnel through a low anteromedial portal. The purpose of this retrospective study was to compare the radiological and clinical outcomes of hamstring ACL reconstruction using the transtibial (TT) versus the anteromedial portal (AM) technique for drilling the femoral tunnel by two different surgeons in non-professional athletes. Methods: Using the elevator system with hamstring tendons, single-bundle ACL reconstruction was applied to 24 patients with the TT technique and to 15 patients with the AM technique. Radiological outcome was evaluated by the postoperative X-rays and MRI images at the 6-9 month and clinical outcomes by the modified Cincinnati Knee Score. The angle made by the tunnel with the anatomic axis of the femur (FTA) and the angle made by the tunnel with the anatomic axis of the tibia (TTA) were examined on direct radiographs and the angular difference between the tunnels was evaluated. On MRI, evaluation was made of the anterior length in the sagittal plane of the exit point of the tibial tunnel in the joint (TAS) in ratio to the whole plateau (TSR) and the posterior length in the sagittal plane of the entrance point of the femoral tunnel in the femoral lateral condyle (FPS) in ratio to the anterior posterior diameter of the whole condyle (FCR) and the height of the lateral condyle location in the sagittal plane (FH). Results: The FH height ratio of the TT group was statistically significant when compared to the AM group (p<0.01). No statistically significant difference was found between the groups in respect of FPS (p>0.05). The mean femoral tunnel angle of the AM group was statistically significant compared to that of the TT group (p<0.01). The mean tibial tunnel angle of the TT group was statistically significant compared to that of the AM group (p<0.01). The angular difference of the AM group was statistically significant compared to that of the TT group (p<0.01). In both the AM and TT groups, the increase seen in the postoperative clinical scores compared to the preoperative scores was determined to be statistically significant (p<0.01). No statistically significant relationship was determined in either the AM group or the TT group between the postoperative clinical scores and the femoral tunnel angle, the tibial tunnel angle and the angular difference (p>0.05). Conclusion: When using a transtibial drilling technique, the location of the femoral tunnel is restricted by the angulation of the tibial tunnel in the coronal plane and may lead to a high placement of the femoral tunnel in a non-anatomical position. The use of the anteromedial portal (AMP) for the femoral drilling provides the surgeon with more freedom to anatomically place the tunnel in the natural femoral ACL footprint, thus improving rotational stability. In this early stage study of individuals not participating in professional sports, although a significant difference was seen in favour of the anatomic group, in the radiological measurements between the anatomic and transtibial groups, no significant difference was determined in respect of clinical results. This can be considered to be due to a low requirement for rotational stability in individuals who do not participate sports.
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Uzun, Metin, Adnan Kara, Müjdat Adaş, Bülent Karslioğlu, Murat Bülbül, and Burak Beksaç. "Hindfoot Valgus following Interlocking Nail Treatment for Tibial Diaphysis Fractures: Can the Fibula Be Neglected?" Advances in Orthopedics 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/806363.
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Purpose. We evaluated whether intramedullary nail fixation for tibial diaphysis fractures with concomitant fibula fractures (except at the distal one-third level) managed conservatively with an associated fibula fracture resulted in ankle deformity and assessed the impact of the ankle deformity on lower extremity function.Methods. Sixty middle one-third tibial shaft fractures with associated fibular fractures, except the distal one-third level, were included in this study. All tibial shaft fractures were anatomically reduced and fixed with interlocking intramedullary nails. Fibular fractures were managed conservatively. Hindfoot alignment was assessed clinically. Tibia and fibular lengths were compared to contralateral measurements using radiographs. Functional results were evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Foot and Ankle Disability Index Score (FADI).Results. Anatomic union, defined as equal length in operative and contralateral tibias, was achieved in 60 fractures (100%). Fibular shortening was identified in 42 fractures (68%). Mean fibular shortening was 1.2 cm (range, 0.5–2 cm). Clinical exams showed increased hindfoot valgus in 42 fractures (68%). The mean KOOS was 88.4, and the mean FADI score was 90.Conclusion. Fibular fractures in the middle or proximal one-third may need to be stabilized at the time of tibial intramedullary nail fixation to prevent development of hindfoot valgus due to fibular shortening.
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Sandberg, Maxwell L., Seyed Alireza Mirghasemi, Zachary Troiani, Zachary M. Vaupel, and Paul T. Fortin. "Location of the Ankle Osteochondral Lesion of the Talus (OLT) Corresponding to the Anatomical Axis of the Tibia (Loading Axis) Crosses the Ankle Joint." Foot & Ankle Orthopaedics 7, no. 1 (January 2022): 2473011421S0043. http://dx.doi.org/10.1177/2473011421s00432.
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Category: Ankle; Sports Introduction/Purpose: studies demonstrated that mechanical axis alignment affects the clinical outcome of the chondral repair surgery in the knee. Reduction in stress concentration around chondral defects with HTO has been found to favor cartilage repair in knee surgery. this study aimed to determine the relationship between the tibia mechanical axis alignment and OLT size and location. Methods: 57 patients that underwent OLT repair between 2016-2020 were included. X-rays and MRIs of the ankle were used to collect data on OLT in the study group. X-ray measurements included (a)-measured as distance from where vertical line through center of tibia crosses to center the talar joint in AP view (medial, lateral), (b)- measured as distance from where vertical line through center of tibia crosses to the center talar body in lateral view (ant, post). The coverage angle, TLS, TAS, MA, TI, TTI angles were measured. MRI measurements included distance of the edge of the OLT lesion from the center of the talar surface, in three plans, and for location of the OLT lesion based on the 9-zone grid system. Results: 37.3% of these patients had the mechanical axis of the joint cross posterolaterally, 15.6% anteromedially, 5.9% anterolaterally, and 3.9% posteromedially. 33.3% had the mechanical axis cross posteriorly along the midline of the lateral axis. Using the 9-zone grid to localize lesion location, lesions were most often seen in location 6 (37.3%), location 7 (21.6%), location 9 (21.6%), and location 4 (19.6%). Of note, 36.8% of patients with a posterolateral axis had lesions at location 6 and 26.3% at location 9. For patients with poster joint axis along the midline of the lateral axis, 47.1% had lesions at location 6 and 23.5% at location 7. There is a correlation between Lesion Surface Area and axis location in the AP view (Correlation coefficient: 0.301, P Value: 0.023). we found a significant difference for coverage angle (P<0.001), TLS (P<0.001), and TTI (P<0.001) for different groups. Conclusion: The significant correlation shows that the farther medial the location of the axis crosses the joint, the larger the surface area of the lesion. there is no significant difference between lesion length or area and location.
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Anous, M. R. "A comparative study of muscle-bone relationships in the hind limb of goats and sheep." Animal Science 53, no. 1 (August 1991): 81–87. http://dx.doi.org/10.1017/s0003356100006000.
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ABSTRACTMuscle to bone weight relationships within anatomical regions (proximal-distal division into pelvic, thigh and lower leg groups) and subregions (division within regions into gluteal, intrinsic pelvic, cranial, caudal and medial thigh, and cranial and caudal lower leg groups) of the hind limb and also of its most important muscles (no. = 11) were compared between goats and sheep using the method of multivariate analysis of the centred data. In this comparison, a total of 39 animals was considered: 13 male kids of the Alpine breed (K) and a sample of 26 male lambs derived from different breeds or crossbreeds representing, in equal numbers, lambs having good conformation (LGC) and poor conformation (LPC). Lambs were chosen on the basis of the hindlimb length the means of which were 22·9 (s.e. 1·5), 29·3 (s.e. 1·8) and 29·1 (s.e. 2·5) cm for LGC, LPC, and K, respectively. Corresponding cold carcass weights were 19·71 (s.e. 347), 17·28 (s.e. 1·77) and 10·84 (s.e. 0·56) kg.In both comparisons (K-LGC and K-LPC) the two species were systematically distinguished by the size of the following ratios: (pelvic muscles/os coxae + leg muscles /tibia) relative to thigh muscles/femur (for regions), which was lower in lambs than in kids; intrinsic pelvic muscles/os coxae relative to caudal thigh muscles/femur (for subregions), which was higher in kids than in lambs. For individual muscles, they were distinguished by the size of the following ratios: rectus (emoris/femur relative to semimembranosus/femur (or gluteus medius/os coxae) in the comparison K-LGC, which was higher in lambs than in kids, and vastus lateralis/femur relative to sum of pectineus + gracilis/femur (or gastrocemius/tibia) in the comparison K-LPC, which was lower in kids than in lambs. The results show that the muscle-bone ratios of the anatomical regions, subregions and the most commercially important muscles in the hindlimb can be used as discriminant characteristics of species.
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Stupina, T. A., O. V. Diuriagina, D. S. Mokhovikov, Yu А. Stupina, and D. Yu Borzunov. "Histomorphometric changes in the synovial membrane of the knee joint in combined use of the Ilizarov non-free bone plasty and the Masquelet technique (experimental study)." Genij Ortopedii 27, no. 2 (April 2021): 249–53. http://dx.doi.org/10.18019/1028-4427-2021-27-2-249-253.
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Relevance Defects of long bones result in anatomical and functional complex of pathologies in the entire limb. There are few fundamental studies of tissues adjacent to bone defects by using different technologies for management of long bone defects. Purpose To study the structural changes in the synovial membrane of the knee joint by modelling the conditions for tibial defect management using the Ilizarov method of non-free bone plasty in combination with the Masquelet technique. Materials and methods The conditions of post-resection defect of the tibia (from 15 % of the segment length) by lengthening the distal fragment were modeled in ten mongrel dogs. Temporarily, for 30 days, a cement spacer was implanted into the post-resection defect gap. Upon its removal, the intermediate fragment in the lower third of the leg was transported at a rate of 1 mm in 4 steps until complete contact of the bone fragments. Histomorphometric studies of the synovium were carried out at the observation stages at the end of the fixation period (60 days) and after removing the apparatus (30 days). Results Two types of changes were revealed in the synovium: changes of a destructive nature without synovitis (30 % of cases) and with signs of synovitis (70 % of cases, 3 dogs had mild synovitis and 4 dogs had severe synovitis). Changes in the microvessels of the synovial membrane in synovitis indicated impaired microcirculation, high activity of angiogenesis and the development of hypervascularization. Conclusion Experimental management of the tibial bone defect by Ilizarov method in combination with the Masquelet technique revealed signs of synovitis of the knee joint in 70 % of cases using histophorphometry methods.
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Li, Jiantao, Hao Zhang, Peng Yin, Xiuyun Su, Zhe Zhao, Jianfeng Zhou, Chen Li, Zhirui Li, Lihai Zhang, and Peifu Tang. "A New Measurement Technique of the Characteristics of Nutrient Artery Canals in Tibias Using Materialise’s Interactive Medical Image Control System Software." BioMed Research International 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/171672.
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We established a novel measurement technique to evaluate the anatomic information of nutrient artery canals using Mimics (Materialise’s Interactive Medical Image Control System) software, which will provide full knowledge of nutrient artery canals to assist in the diagnosis of longitudinal fractures of tibia and choosing an optimal therapy. Here we collected Digital Imaging and Communications in Medicine (DICOM) format of 199 patients hospitalized in our hospital. All three-dimensional models of tibia in Mimics were reconstructed. In 3-matic software, we marked five points in tibia which located at intercondylar eminence, tibia tuberosity, outer ostium, inner ostium, and bottom of medial malleolus. We then recorded Z-coordinates values of the five points and performed statistical analysis. Our results indicate that foramen was found to be absent in 9 (2.3%) tibias, and 379 (95.2%) tibias had single nutrient foramen. The double foramina was observed in 10 (2.5%) tibias. The mean of tibia length was 358 ± 22 mm. The mean foraminal index was 31.8% ± 3%. The mean distance between tibial tuberosity and foramen (TFD) is 66 ± 12 mm. Foraminal index has significant positive correlation with TFD (r = 0.721, P < 0.01). Length of nutrient artery canals has significant negative correlation with TFD (r = −0.340, P < 0.01) and has significant negative correlation with foraminal index (r=-0.541, P<0.01).
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Palma, Joaquin, Jorge Filippi Nussbaum, Pablo Mery Ponce, Jorge Briceño, Andres Villa, and Mario Abarca. "Proximal Tibiofibular Joint Dislocation as a Maissoneuve Equivalent Fracture." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0003. http://dx.doi.org/10.1177/2473011417s000312.
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Category: Ankle, Trauma Introduction/Purpose: Dislocation of the proximal tibiofibular joint (PTFJ) in association with ankle fracture is an infrequent injury. The mechanism involves a pronation-external rotation injury in which the energy exits through the PTFJ instead of the proximal fibula, like in a Maissoneuve fracture. Early diagnosis and treatment is of paramount importance to avoid complications such as pain, posterolateral knee instability and peroneal nerve injury due to chronic traction by the dislocated fibular head. In addition, an anatomical reduction of the PTFJ is mandatory to restore the fibular length in order to obtain anatomic reduction at the ankle. The objective is to report 3 cases with PTFJ dislocation in association with ankle fracture and to provide a treatment guide based on the management of these patients. Methods: Three cases of PTFJ dislocation in association with ankle fracture, surgically treated in our institution between 2009 and 2016, were retrospectively analyzed. For each case, clinical history at admission, pre and post operative radiographs and computed tomography (CT) were obtained. Clinical follow up time was between 1 and 6 years. Results: Diagnosis of the PTFJ dislocation required a high degree of suspicion. All the patients had subtle radiographic abnormalities at the PTFJ, thus requiring a CT of the knee to confirm the diagnosis. The first surgical step was to perform an open reduction of the PTFJ. Common peroneal nerve was identified and retracted. Reduction was performed with a clamp and for fixation we used one cortical positioning screw from the fibula to the tibia. After the achievement of an anatomic reduction, the second step was to approach the ankle according the specific fracture pattern. Anatomical reduction was obtained in all the patients checked by ankle and knee CT. At final follow up none of the patients had knee pain, and all returned to their activities. Conclusion: The PTFJ dislocation in association with ankle fracture is an infrequent injury and should be considered as a Maissoneuve equivalent fracture in terms of mechanism and diagnosis. A high index of suspicion is needed and the diagnosis is confirmed with a knee CT. As the Essex Lopresti injury of the upper extremity, this type of lesion requires proximal and distal stabilization. Our recommended treatment, based on the good clinical results of our 3 patient, is open reduction and screw fixation of the PTFJ as the first step in order to allow anatomical reduction of the distal injury at the ankle.
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Turgut, Ali, Emre Bilgin, Mert Filibeli, İbrahim Kuşak, Mert Kumbaracı, and Önder Kalenderer. "A New Reference to Evaluate Syndesmosis in Sagittal Plane Radiographs of the Ankle: The Lateral Posterior Ankle Ratio." Journal of the American Podiatric Medical Association 109, no. 6 (November 1, 2019): 426–30. http://dx.doi.org/10.7547/17-134.
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Background: Confirmation of anatomical reduction of ankle syndesmosis is mandatory because improper reduction leads to poor functional results. Coronal plane evaluation of syndesmosis is well described in the literature, but there is little information about sagittal plane evaluation. We sought to evaluate the relationship of fibula and tibia in the sagittal plane and create a new reference that can be applied easily and reliably. Methods: Lateral ankle radiographs of 337 individuals with no history of ankle fracture were evaluated. A line was drawn between the anterior and posterior cortices of the distal lateral tibia, and the length of this line was measured (line 1). The distance between the anterior and posterior cortices of the fibula on this line was measured, and the center of this second distance was identified and marked. The posterior half of the fibular width was divided by line 1 and was named the lateral posterior ankle ratio (LPAR). Statistical analysis was performed by side and sex. Results: Mean patient age was 38.6 years; mean LPAR was 0.48. There was a significant difference between men and women by age (P < .001) and LPAR (P = .01). There was no significant difference between right and left ankles by age (P = .63) and LPAR (P = .64). The LPAR was less than 0.40 in 6.8% of the radiographs, 0.40 to 0.50 in 57.9%, and greater than 0.50 to 0.60 in 32.9%. Conclusions: The LPAR should approximate 50% in normal lateral ankle images and, by extrapolation, after syndesmotic reduction.
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Tsibidakis, Haridimos, Artemisia Panou, Antonios Angoules, Vassilios I. Sakellariou, Nicola Marcello Portinaro, Julian Krumov, and Anastasios D. Kanellopoulos. "The Role of Taylor Spatial Frame in the Treatment of Blount Disease." Folia Medica 60, no. 2 (June 1, 2018): 208–15. http://dx.doi.org/10.1515/folmed-2017-0082.
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Abstract Background: Alteration of the posteromedial part of the proximal tibia is the main characteristic of Blount’s disease and if left untreated, leg alignment and normal development of the lower limbs may be compromised. Aim: To report treatment outcomes in children with Blount’s disease using the Taylor Spatial Frame (TSF). Materials and methods: From January 2007 to December 2014, 16 young children (24 tibia) with a mean age of 7.5 years (range of 3-14 yrs) and severe Blount’s disease were treated using TSF. Preoperative long standing radiographs were performed and anatomic medial proximal tibial angle (MPTA), diaphyseal-metaphyseal tibial angle (Drennan), femoro-tibial angle and leg length discrepancy (LLD) were measured. Results: Post-operative improvement of all measurements was observed. MPTA increased from a mean of 71.8° (58° - 79°) to 92.5° (90° - 95°), the Drennan decreased from 16.6° (14° - 18°) to 3.6° (0° - 6°), the F-T angle changed from 15.4° (10° - 25°) of varus to 5.9° (2° - 10°) of valgus and the LLD decreased from 208 mm (150-320) to 69 mm (0- +120). Mean follow-up was 45.6 months. According to Paley’s criteria pin track infection was present in 6 tibiae, while in 5 patients software changes were necessary. Recurrence was observed in 3 patients (triplets). Complete restoration of the mechanical axis was obtained at the end of the treatment. Conclusions: In the last decades, different surgical treatments have been proposed for Blount’s disease (tension band plate, staples, osteotomies using external or internal fixation). External fixation using the TSF allows gradual safe correction of multiplanar deformities and is a well-tolerated technique by patients with Blount’s disease.
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Helito, Camilo Partezani, Tales Mollica Guimarães, and Marcel Faraco Sobrado. "Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel." Video Journal of Sports Medicine 1, no. 3 (May 2021): 263502542110045. http://dx.doi.org/10.1177/26350254211004597.
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Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (<20 years), ACL revision, generalized hyperlaxity, and Lachman >7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.
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Benton, Michael J., and Alick D. Walker. "Saltopus, a dinosauriform from the Upper Triassic of Scotland." Earth and Environmental Science Transactions of the Royal Society of Edinburgh 101, no. 3-4 (September 2010): 285–99. http://dx.doi.org/10.1017/s1755691011020081.
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ABSTRACTSaltopus elginensis, reported in 1910 from the yellow sandstones of the Lossiemouth Sandstone Formation (Late Triassic) of Morayshire, NE Scotland, has long been controversial. It was described first as a theropod dinosaur, but others disagreed. Reanalysis of the type, and only, specimen using casts from the natural rock moulds, as well as X-rays and CT scans, has revealed new anatomical data not available to previous researchers. Saltopus was a small, 800–1000 mm-long biped, whose tail made up more than half its length. It is an avemetatarsalian because it has elongated and tightly bunched metatarsals, the tibia is longer than the femur, the calcaneal tuber is rudimentary or absent, and metatarsal II is equal to or longer than metatarsal IV; a unique assemblage of characters diagnosing this clade. Saltopus is a dinosauromorph on the basis of the reduced fingers IV and V, the saddle-shaped dorsal margin of the iliac blade, and the articulation of sacral rib 1 close to the front of the iliac blade. Saltopus is a dinosauriform on the basis of the trochanteric shelf and lesser trochanter on the proximal end of the femur, the waisted sacral ribs, and perhaps the rod-like and straight pubis. However, it lacks all apomorphies of Dinosauria, retaining for example the primitive condition of two sacral vertebrae. Cladistic analyses place Saltopus within Dinosauromorpha and Dinosauriformes, and between the basal dinosauriform Pseudolagosuchus and the derived clade consisting of Silesauridae and Dinosauria, so making it one of a radiation of small pre-dinosaurian bipedal archosaurs in the Triassic found so far in North and South America and in Europe.
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Guth, Jared, Sam Akhavan, Patrick Schimoler, Mark Miller, and Jon Hammarstedt. "Biomechanical analysis of ideal knee flexion angle for ACL graft tensioning utilizing multiple femoral and tibial tunnel locations." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl4 (July 1, 2021): 2325967121S0022. http://dx.doi.org/10.1177/2325967121s00225.
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Objectives: Despite more anatomic reconstruction of the ACL, graft failure rate has been reported to be greater than 5% at 5 years. There is concern that anatomic reconstructions may not result in an isometric graft and may predispose the graft to stretching. The current biomechanical study evaluated excursion of the ACL with different drill points for both femoral and tibial tunnels. The purpose was to evaluate the excursion of the ACL with both anatomic and non-anatomic tunnel combinations and determine the optimal flexion angle to tension the ACL to minimize stretching of the graft during motion. Methods: Ten cadaveric knee specimens, mid-femur to mid-tibia, were dissected of skin and subcutaneous tissue. The ACL was sectioned and the femoral and tibial attachments were marked prior to excision. A 1/16 inch drill was used to create a tunnel in the center of the ACL footprint on the tibia and femur and additional tunnels were made 5mm from the original tunnel (Figure 1). A suture was passed through each tunnel combination (Femur A-F; Tibia A-E) and was attached to a string potentiometer. The knee was ranged from full extension to 120 degrees of flexion for 10 cycles while mounted in a custom fixture that measured angle of flexion in the sagittal plane. The change in length (excursion) of the suture during movement was recorded for each combination of femoral and tibial tunnels. Results: Anatomic reconstruction of the ACL with tunnel placement in the center of the femoral (femoral tunnel A) and tibial (tibial tunnel A) footprint did not result in an isometric graft, with excursion of the ACL during knee motion of 7.46mm (SD 2.7mm). The tunnel combination that resulted in the least amount of excursion during knee motion was a reconstruction with a femoral footprint 5mm anterior to the femoral (femoral tunnel D) and 5mm posterior to the tibial footprint (tibial tunnel D) (4.2mm, SD 1.37mm). The tunnel combination that resulted in the most amount of excursion during knee motion was utilized femoral footprint 5mm proximal to the femoral (femoral tunnel F) and 5mm posterior to the tibial footprint (tibial tunnel D) (9.81mm, SD 2.68mm). In an anatomic tunnel placement, we found the angle with the most excursion of the ACL to occur at 2.84 degrees of flexion (SD 4.22). Conclusions: Anatomic ACL reconstruction results in significant excursion of the ACL during range of motion. If not tensioned properly, the ACL can stretch during range of motion, potentially leading to re-rupture. In order to prevent stretching of the graft, the current biomechanical study recommends tensioning an anatomic ACL reconstruction at its point of maximal exertion, or about 10 degrees of flexion. We also determined optimal flexion angles for tensioning the ACL for tunnel combinations that may be non-anatomic. [Table: see text][Table: see text][Table: see text]