Plane Alignment Research Articles

The Relationships between Coronal Plane Alignments and Patient-Reported Outcomes Following High Tibial Osteotomy: A Systematic Review

ObjectiveThis systematic review aimed to determine whether coronal angular corrections correlate with patient reported outcomes following valgus-producing high tibial osteotomy (HTO).DesignOvid MEDLINE, Embase, and Web of Science were systematically searched. Studies that reported hip-knee-ankle angles (HKA) or femorotibial angles (FTA), and the Oxford Knee Score (OKS), visual analogue scale (VAS) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), or EQ-5D before and after valgus-producing HTO were eligible. Correlation analyses were performed where appropriate to investigate the relationships between variables. PROSPERO ID: CRD42019135467.ResultsThis study included 39 articles including 50 cohorts. VAS was reported in 22 studies, OKS in 9, KOOS in 12 and EQ-5D in 2. The HKA angle was corrected from 7.1° ± 1.7° varus to 2.3° ± 1.7° valgus at final follow-up. The FTA changed from 3.0° ± 2.0° varus to 7.7° ± 1.3° valgus. Outcome scores improved with clinical and statistical significance postoperatively. Spearman correlations for nonparametric data revealed greater changes in knee alignment were moderately associated with larger improvements in VAS scores (r = 0.50). Furthermore, those who experienced greater changes in alignment showed larger improvements in the KOOS Activity and Quality of Life domains (r = 0.72 and r = 0.51, respectively).ConclusionOn average, patients did not achieve the “ideal correction” of 3° to 6° valgus postoperatively. Nevertheless, statistical and clinical improvements in patient-reported outcome measure scores were consistently reported. This suggests that the “ideal correction” may be more flexible than 3° to 6°.

Geometric Calibration Updates to Landsat 7 ETM+ Instrument for Landsat Collection 2 Products

The Landsat 7 (L7) spacecraft and its instrument, the enhanced thematic mapper plus (ETM+), have been consistently characterized and calibrated since its launch in April of 1999. These performance metrics and calibration updates are determined through the U. S. Geological Survey (USGS) Landsat image assessment system (IAS), which has been performing this function since launch. Starting in 2016, the USGS adopted a tiered collection management structure for its Landsat data products that ensures a consistent method of processing for the Landsat archive within a given collection while allowing a set of calibration updates to be performed between any two given collections. The time frame between 2016 and the end of 2020 was part of the Landsat data Collection 1, in the middle of 2020 was the start of the Landsat Collection 2 data products. The start of a given collection initiates the reprocessing of the Landsat archive, which may involve one or more of a set of updated calibration parameters, improvements in the support data needed for product generation, and improved algorithms used in both the processing flow of products along with the characterization and calibration of the Landsat instruments and spacecraft. This paper discusses only the ETM+ geometric spacecraft and instrument calibration improvements for Collection 2. Three ETM+ calibration updates were made for the ETM+; updates to the thermal band odd-to-even detector alignment, sensor to attitude control system (ACS) alignment, and a cold-to-warm focal plane alignment adjustment. The sensor alignment updates impact only the accuracy of the systematic terrain products (L1GT), which are the products generated before applying any corrections based on the ground control used in registration. The band alignment changes impacted only bands 5, 6, and 7 within the focal plane. Other geometric calibration updates, such as scan mirror alignment, are done on a routine basis and are not part of the Collection 2 updates due to their more dynamic characteristics.

Knee loading in OA subjects is correlated to flexion and adduction moments and to contact point locations

This study evaluated the association of contact point locations with the knee medial and lateral contact force (Fmed, Flat) alterations in OA and healthy subjects. A musculoskeletal model of the lower limb with subject-specific tibiofemoral contact point trajectories was used to estimate the Fmed and Flat in ten healthy and twelve OA subjects during treadmill gait. Regression analyses were performed to evaluate the correlation of the contact point locations, knee adduction moment (KAM), knee flexion moment (KFM), frontal plane alignment, and gait speed with the Fmed and Flat. Medial contact point locations in the medial–lateral direction showed a poor correlation with the Fmed in OA (R2 = 0.13, p = 0.01) and healthy (R2 = 0.24, p = 0.001) subjects. Anterior–posterior location of the contact points also showed a poor correlation with the Fmed of OA subjects (R2 = 0.32, p < 0.001). Across all subjects, KAM and KFM remained the best predictors of the Fmed and Flat, respectively (R2 between 0.62 and 0.69). Results suggest different mechanisms of contact force distribution in OA joints. The variations in the location of the contact points participate partially to explains the Fmed variations in OA subjects together with the KFM and KAM.

Dynamic Knee Alignment and Pelvic Balance: Comparison Regarding Gender in Young Soccer Athletes.

Objective To evaluate knee alignment in the frontal plane and pelvic balance during the step-down test in female and male soccer players. Methods Cross-sectional study carried out with male and female soccer players from under-15 and under-17 teams of a professional club in Southern Brazil. The step-down test was performed, filmed with a video camera, and evaluated according to the angular measurements obtained during movement using the Kinovea software (open source), version 0.8.24. Results The sample consisted of 38 individuals, 19 males and 19 females. Female athletes had a greater varus angle (9.42° ± 1.65°) compared to male athletes (3.91° ± 2.0°; p = 0.04). There was no difference regarding the unilateral pelvic drop between the groups. In addition, the association between the hip-related pelvic drop and the projection angle on the frontal plane of the knee was weak in both genders. Conclusion Even though the pelvic drop was observed in both genders, young female athletes had greater varus knee angles on the step-down test, which require greater attention to minimize the risk of injury.

Can we use shorter constructs while maintaining satisfactory sagittal plane alignment for adult spinal deformity?

Issues with spinopelvic fixation for adult spinal deformity (ASD) include loss of the physiological mobility of the entire lumbar spine, perioperative complications, and medical costs. Little is known about the factors associated with successful short fusion for ASD. The authors evaluated radiographic and clinical outcomes after shorter fusion for different subtypes of ASD at 2 years postoperatively and examined factors associated with successful short fusion. This was a single-center study of 37 patients who underwent short fusion and a minimum 2 years of follow-up for ASD in which lumbar kyphosis was the main deformity. The exclusion criteria were 1) age < 40 years, 2) previous lumbar vertebral fracture, 3) severe osteoporosis, 4) T10-L2 kyphosis > 20°, 5) scoliotic deformity with an upper end vertebra (UEV) above T12, and 6) concomitant Parkinson's disease or neurological disease. The surgical procedures, radiographic course, and Oswestry Disability Index (ODI) were assessed, and correlations between radiographic parameters and postoperative ODI at 2 years were analyzed. A mean of 3.5 levels were fused. The mean radiographic parameters preoperatively, at 2 weeks, and at 2 years, respectively, were as follows: coronal Cobb angle: 22.9°, 11.5°, and 12.6°; lumbar lordosis (LL): 12.9°, 35.8°, and 32.2°; pelvic incidence (PI) minus LL: 35.5°, 14.7°, and 19.2°; pelvic tilt: 29.4°, 23.1°, and 25.0°; and sagittal vertical axis 85.3, 36.7, and 59.2 mm. Abnormal proximal junctional kyphosis occurred in 8 cases. Revision surgery was performed to extend the length of fusion from a lower thoracic vertebra to the pelvis in 2 cases. The mean ODI scores preoperatively and at 2 years were 50.7% and 24.1%, respectively. Patient age, number of fused intervertebral segments, and radiographic parameters were analyzed by the stepwise method to identify factors contributing to the ODI score at 2 years, preoperative PI, and sagittal vertical axis at 2 years. On receiver operating characteristic curve analysis of the minimal clinically important difference of ODI (15%) and preoperative PI, the cutoff value of the preoperative PI was 47° (area under the curve 0.75). In terms of subtypes of ASD in which lumbar kyphosis is the main deformity, if the PI is < 47°, then the use of short fusion preserving mobile intervertebral segments can produce adequate LL for the PI, improving both postoperative global spinal alignment and quality of life.

Calcaneal Sliding Osteotomy Versus Calcaneal Lengthening Osteotomy for Valgus Foot Deformity Correction in Children With Cerebral Palsy.

Medial calcaneal sliding (CS) osteotomy and lateral column lengthening (LCL) are often performed to relieve pain and improve transverse plane alignment and gait stability for children with cerebral palsy (CP) and valgus foot deformities. The purpose of this study was to examine the effectiveness of these procedures in this population. Retrospective medical record review (including 3D gait analysis data) of patients with CP who underwent LCL (26 subjects, 46 limbs) or CS (46 subjects, 73 limbs). Data extraction included complications (modified Clavien-Dindo system), change in standing foot position (modified Yoo system), and change in gait kinematics and kinetics preoperatively to postoperatively. Groups were compared using paired t tests, Fisher exact test, and survivorship analysis using Cox proportional hazard models. Subjects were 57% male, average age at surgery 11.1 (SD 2.5) years. Average length of follow-up was 3.2 (SD 2.8) years, and was longer in the LCL group (P=0.0004). Complications were minor with similar rates between groups (P=0.14). Prolonged pain and plantar hypersensitivity occurred only in the CS group. Successful maintenance of deformity correction was achieved in 52/73 limbs (71%) in the CS group and 16/44 limbs (36%) in the LCL group (P<0.001). Recurrent pes valgus and need for repeat foot surgery were more common after LCL (P=0.003 and 0.001, respectively). Recurrent pes valgus never occurred when talonavicular fusion was done concomitantly with CS. After accounting for the between group difference in length of follow-up, there was no difference in the rates of recurrent valgus or repeat foot surgery between LCL and CS. None of the variables predicted development of pes varus (P>0.20). Ankle kinematics and kinetics during gait were unchanged in both groups. CS and LCL have similar effectiveness in providing long-lasting correction of valgus foot deformities. Concomitant talonavicular fusion is key to success of CS for lower functioning patients with severe deformities, and obligate brace wearers. Level III, retrospective comparative study.

Predicting Postoperative Sagittal Plane Alignment of the Foot Using Intraoperative Simulated Weightbearing Lateral Imaging During Flatfoot Reconstructive Surgery: A Short-Term Retrospective Analysis

The sagittal plane relationship of the hindfoot and midfoot joints is a primary determinant of proper alignment in flatfoot reconstructive surgery as assessed both clinically and on postoperative weightbearing (WB) lateral radiographs. The traditional approach to intraoperative radiographic imaging allows for accurate assessment of fixation placement but only a crude evaluation of final sagittal plane alignment. Surgeons employ various methods in an attempt to load the foot during lateral imaging. Skepticism exists regarding the ability of simulated WB fluoroscopy to predict the final outcome, and evidence is lacking to support this practice. A retrospective investigation was performed assessing the correlation of Meary's angle, calcaneal inclination angle, and calcaneal-1st metatarsal angle as demonstrated on intraoperative simulated WB lateral foot imaging to 10- week postoperative full WB lateral radiographs. A consistent simulated WB imaging protocol was used with 46 consecutive cases of flatfoot reconstruction in this analysis of secular trends. The average change in Meary's angle between intraoperative simulated WB and postoperative full WB was -1.09° with 89% of cases within ±5°. The average change in calcaneal-1st metatarsal angle between intraoperative simulated WB and full WB was -2.61° with 85% of cases within ±5°. The average change in calcaneal inclination angle between intraoperative simulated WB and full WB was -2.62° with 88% of cases within ±5°. These findings confirm the clinical utility of intraoperative simulated WB lateral imaging as a useful tool in predicting the postoperative sagittal plane alignment of the midfoot and rearfoot in patients undergoing flatfoot reconstructive surgery.

Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study.

Objectives:To assess the impact of various reduction techniques on postoperative alignment following intramedullary nail (IMN) fixation of tibial shaft fractures.Design:Retrospective comparative study.Setting:Level I trauma center.Patients:Four hundred twenty-eight adult patients who underwent IMN fixation of a tibial shaft fracture between 2008 and 2017.Intervention:IMN fixation with use of one or more of the following reduction techniques: manual reduction, traveling traction, percutaneous clamps, provisional plating, or blocking screws.Main outcome measures:Immediate postoperative coronal and sagittal plane alignment, measured as deviation from anatomic axis (DFAA); coronal and sagittal plane malalignment (defined as DFAA >5° in either plane).Results:Four hundred twenty-eight patients met inclusion criteria. Manual reduction (MR) alone was used in 11% of fractures, and adjunctive reduction aids were used for the remaining 89%. After controlling for age, BMI, and fracture location, the use of traveling traction (TT) with or without percutaneous clamping (PC) resulted in significantly improved coronal plane alignment compared to MR alone (TT: 3.4°, TT+PC: 3.2°, MR: 4.5°, P = .007 and P = .01, respectively). Using TT+PC resulted in the lowest rate of coronal plane malalignment (13% vs 39% with MR alone, P = .01), and using any adjunctive reduction technique resulted in decreased malalignment rates compared to MR (24% vs 39%, P = .02). No difference was observed in sagittal plane alignment between reduction techniques. Intraclass correlation coefficient (ICC) results indicated excellent intraobserver reliability on both planes (both ICC>0.85), good inter-observer reliability in the coronal plane (ICC = 0.7), and poor inter-observer reliability in the sagittal plane (ICC = 0.05).Conclusions:The use of adjunctive reduction techniques during IMN fixation of tibia fractures is associated with a lower incidence of coronal plane malalignment when compared to manual reduction alone.Level of evidence:Therapeutic Level III.

Opportunistic use of dual-energy X-ray absorptiometry to evaluate lumbar scoliosis.

Osteoporosis and scoliosis are interrelated disease processes. Dual-energy X-ray absorptiometry (DXA), used to assess bone density, can also be used to evaluate spinal deformity since it captures a posteroanterior (PA) image of the lumbar spine. We assessed the use of DXA to evaluate lumbar spine alignment. A lumbar spine DXA phantom was used to assess the effects of axial and sagittal plane rotation on lumbar bone mineral content (BMC), density (BMD), and L1-L4 Cobb angle measurements. Using two subject cohorts, intra- and inter-observer reliability and validity of using DXA for L1-L4 Cobb angle measurements in the coronal and sagittal planes were assessed. Axial and sagittal plane rotation greater than 15° and 10°, respectively, significantly reduced measured BMD and BMC; there was minimal effect on Cobb angle measurement reliability. In human subjects, excellent intra- and inter-observer reliability was observed using lumbar PA DXA images for Cobb angle measurements. Agreement between Cobb angles derived from lumbar PA DXA images and AP lumbar radiographs ranged from good to excellent. The mean difference in Cobb angles between supine lumbar PA DXA images and upright AP lumbar radiographs was 2.8° in all subjects and 5.8° in those with scoliosis. Lumbar spine rotation does not significantly affect BMD and BMC within 15° and 10° of axial and sagittal plane rotation, respectively, and minimally affects Cobb angle measurement. Spine alignment in the coronal plane can be reliably assessed using lumbar PA DXA images.

Effects of Surgical Positioning on L4-L5 Accessibility and Lumbar Lordosis in Lateral Transpsoas Lumbar Interbody Fusion: A Comparison of Prone and Lateral Decubitus in Asymptomatic Adults

Lateral interbody fusion (LIF) is traditionally performed in lateral decubitus on a breaking surgical table to improve L4-L5 access. Prone transpsoas (PTP) LIF may improve sagittal alignment and facilitate single-position circumferential procedures; but may require manipulation of the iliac crest for L4-L5 accessibility. Healthy adult volunteers (n= 41) were positioned as if for surgery in right-lateral decubitus on a radiolucent breaking table, and also prone on a Jackson-style surgical frame atop a custom PTP bolster. Iliac crest distance from the L5 superior endplate, and coronal and sagittal plane alignments were measured from fluororadiographs obtained in each of 5 positions: standard lateral decubitus (LD), prone-hips and spine neutral (PR-NN), prone-hips neutral and spine coronally bent (PR-NCB), prone-hips extended and spine neutral (PR-EN), and prone-hips extended and spine coronally bent (PR-ECB). L4-L5 accessibility was lowest in prone-neutral and improved in all augmented positional configurations: PR-NN<>PR-EN<LD<PR-ECB<PR-NCB. Coronal bending with the PTP positioner created greater accessibility than that achieved by lateral decubitus breaking (PR-NCB>LD, P= 0.0480). Coronal angulations were greatest in LD, and statistically different from both prone neutral (LD>PR-NN, P < 0.0001) and prone coronally bent (LD>PR-NCB, P < 0.0001). Lordosis was greatest in extended prone positions and lowest in lateral decubitus: PR-EN>PR-ECB>PR-NCB<>PR-NN>LD. All prone positions showed significantly greater lordosis than lateral decubitus (P < 0.001). Compared with lateral decubitus, prone positioning provides equivalent or better L4-L5 LIF access around the iliac crest when a positioner is used that enables coronal bending, and improved positional lordosis, which may facilitate segmental correction and achievement of surgical alignment goals.

Coronal Plane Alignment of the Knee (CPAK) classification.

AimsA comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA).MethodsA radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10° of flexion within each type. Secondary outcomes assessed balance at 45° and 90° and bone recuts required to achieve final knee balance within each CPAK type.ResultsThere was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p < 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p < 0.001).ConclusionCPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies.Cite this article: Bone Joint J 2021;103-B(2):329–337.

Microscopic and Macroscopic Characterization of Grain Boundary Energy and Strength in Silicon Carbide via Machine-Learning Techniques.

Predicting the properties of grain boundaries poses a challenge because of the complex relationships between structural and chemical attributes both at the atomic and continuum scales. Grain boundary systems are typically characterized by parameters used to classify local atomic arrangements in order to extract features such as grain boundary energy or grain boundary strength. The present work utilizes a combination of high-throughput atomistic simulations, macroscopic and microscopic descriptors, and machine-learning techniques to characterize the energy and strength of silicon carbide grain boundaries. A diverse data set of symmetric tilt and twist grain boundaries are described using macroscopic metrics such as misorientation, the alignment of critical low-index planes, and the Schmid factor, but also in terms of microscopic metrics, by quantifying the local atomic structure and chemistry at the interface. These descriptors are used to create random-forest regression models, allowing for their relative importance to the grain boundary energy and decohesion stress to be better understood. Results show that while the energetics of the grain boundary were best described using the microscopic descriptors, the ability of the macroscopic descriptors to reasonably predict grain boundaries with low energy suggests a link between the crystallographic orientation and the resultant atomic structure that forms at the grain boundary within this regime. For grain boundary strength, neither microscopic nor macroscopic descriptors were able to fully capture the response individually. However, when both descriptor sets were utilized, the decohesion stress of the grain boundary could be accurately predicted. These results highlight the importance of considering both macroscopic and microscopic factors when constructing constitutive models for grain boundary systems, which has significant implications for both understanding the fundamental mechanisms at work and the ability to bridge length scales.

The Variability of Pelvic Obliquity Measurements in Patients with Neuromuscular Scoliosis.

Background:Pelvic obliquity (PO), or pelvic alignment in the coronal plane, is an important radiographic parameter to indicate fusion levels and judge success of scoliosis correction in patients with neuromuscular scoliosis. There are multiple commonly used techniques to measure PO that have good to excellent interrater and intrarater reliability, but these different methods yield inconsistent values when used on the same radiograph. This study evaluates the inconsistency in the magnitude of PO measurements for patients with neuromuscular scoliosis among 5 common measurement techniques.Methods:Radiographs of 63 patients with neuromuscular scoliosis were evaluated by 5 raters. Each rater measured PO on each radiograph using the Osebold, O’Brien, Allen and Ferguson, Lindseth, and Maloney techniques. Patients were divided into 2 cohorts based on coronal balance or imbalance. Interrater and intrarater analyses were performed using a 2-way random effects model to calculate absolute agreement. The mean difference in PO between all possible pairs of the techniques was compared using a 2-tailed t test.Results:The Maloney and Osebold techniques demonstrated excellent interrater reliability, and the Maloney, Osebold, and O’Brien techniques demonstrated excellent intrarater reliability. Significant differences in PO measurement were found in 6 of the 10 comparisons for the balanced spines and 8 of the 10 comparisons for the unbalanced spines. Variability in measurement was captured by best-fit lines, which demonstrated greater dispersion between the means for the Osebold and Maloney techniques in the unbalanced spines than in the balanced spines.Conclusions:To our knowledge, this study is the first to evaluate mean differences in magnitude of PO among common measurement techniques while accounting for coronal imbalance. Although there is no gold standard for measuring PO, the Maloney and Osebold techniques are the most consistent. This study suggests that those 2 techniques can be used interchangeably when the spine is coronally balanced, but the Osebold technique becomes more inconsistent than the Maloney technique when coronal imbalance exceeds 2 cm.Clinical Relevance:This information is relevant to surgeons using PO to plan fusion levels and striving for objective ways to judge correction intraoperatively as well as for researchers compiling PO data from multiple centers or studies.

Aged layered double hydroxide nanosheet-polyvinyl alcohol dispersions for enhanced gas barrier coating performance.

Whilst applying a coating layer to a polymer film is a routine approach to enhance the gas barrier properties of the film, it is counter-intuitive to consider that the gas barrier performance of the film would improve by ageing the coating dispersion for weeks before application. Herein, we report that the oxygen barrier performance of a 12 μm PET film coated with a dispersion of inorganic nanosheets in polyvinyl alcohol can be significantly enhanced by ageing this coating dispersion for up to 8 weeks before application. We found up to a 37-fold decrease in the oxygen transmission rate (OTR) of the PET coated film using aged dispersions of [Mg0.66Al0.33(OH)2](NO3)0.33 layered double hydroxide nanosheets (Mg2Al-LDH NS) in polyvinyl alcohol (PVA) compared to the film coated with an equivalent freshly prepared LDH/PVA dispersion. A limiting OTR value of 0.31 cc m-2 day-1 was achieved using the PET film coated with a 3 week aged LDH NS/PVA dispersion. X-ray diffraction experiments show that the degree of in plane alignment of LDH NS on the PET film surface increased significantly from 70.6 ± 0.6 to 86.7 ± 0.6 (%) (100% represents complete alignment of LDH NS platelets on the film surface) for the 4 week aged dispersion compared to the freshly prepared layer. We postulate that when the Mg2Al-LDH NS are aged in PVA the coiled PVA aggregates start to unwrap and attach onto the Mg2Al-LDH NS through hydrogen bonding and eventually form a hydrogen bonded ordered network that facilitates the alignment of nanosheet dispersions during the coating process. Our results suggest that the ageing of inorganic nanosheet dispersions in PVA or other potential hydrogen bonding adhesive systems could be a general approach to improve the alignment of the nanosheets on the polymer film surface once applied and thus improve their performance characteristics for barrier coating applications.

大视场间隔双焦面成像遥感相机焦面装调

大视场间隔双焦面成像遥感相机焦面装调

大视场间隔双焦面成像遥感相机焦面装调

大视场间隔双焦面成像遥感相机焦面装调

Core Strength Training Can Alter Neuromuscular and Biomechanical Risk Factors for Anterior Cruciate Ligament Injury

Background: Core stability is influential in the incidence of lower extremity injuries, including anterior cruciate ligament (ACL) injuries, but the effects of core strength training on the risk for ACL injury remain unclear. Hypothesis: Core muscle strength training increases the knee flexion angle, hamstring to quadriceps (H:Q) coactivation ratio, and vastus medialis to vastus lateralis (VM:VL) muscle activation ratio, as well as decreases the hip adduction, knee valgus, and tibial internal rotation angles. Study Design: Controlled laboratory study. Methods: A total of 48 male participants were recruited and randomly assigned to either the intervention group (n = 32) or the control group (n = 16). Three-dimensional trunk, hip, knee, and ankle kinematic data and muscle activations of selected trunk and lower extremity muscles were obtained while the participants performed side-step cutting. The core endurance scores were measured before and after training. Two-way analyses of variance were conducted for each dependent variable to determine the effects of 10 weeks of core strength training. Results: The trunk endurance scores in the intervention group significantly increased after training (P < .05 for all comparisons). The intervention group showed decreased knee valgus (P = .038) and hip adduction angles (P = .032) but increased trunk flexion angle (P = .018), rectus abdominis to erector spinae coactivation ratio (P = .047), H:Q coactivation ratio (P = .021), and VM:VL activation ratio (P = .016). In addition, the knee valgus angle at initial contact was negatively correlated with the VM:VL activation ratio in the precontact phase (R2 = 0.188; P < .001) but was positively correlated with the hip adduction angle (R2 = 0.120; P < .005). No statistically significant differences were observed in the trunk endurance scores, kinematics, and muscle activations for the control group. Conclusion: Core strength training altered the motor control strategies and joint kinematics for the trunk and the lower extremity by increasing the trunk flexion angle, VM:VL activation ratio, and H:Q activation ratio and reducing the knee valgus and hip adduction angles. Clinical Relevance: Training core muscles can modify the biomechanics associated with ACL injuries in a side-step cutting task; thus, core strength training might be considered in ACL injury prevention programs to alter the lower extremity alignment in the frontal plane and muscle activations during sports-related tasks.

Adolesanlarda Omurganın Sagital Düzlem Dizilimi

Giriş ve Amaç: Omurganın fizyolojik sagital düzlem eğriliklerinden olan torakal kifoz ve lumbal lordozdaki değişiklikler adolesanlarda ilerleyen dönemlerde bir çok soruna yol açabilir. Bu çalışmada amacımız; sedanter, sporcu ve skolyoz tanısı olan adolesanların omurgalarındaki sagital düzlem parametrelerini değerlendirerek birbirleriyle karşılaştırmak ve saptanan anormal eğrilik varlığında bu eğriliklerdeki değişikliklerden kaynaklanabilecek olası yaralanmaları önlemektir.&#x0D; Gereç ve Yöntemler: Çalışmaya 15-18 yaş aralığında olan 27 sedanter, 28 sporcu ve 18 adolesan idiopatik skolyoz (AİS) tanısı alan genç birey olmak üzere toplam 73 kişi (46 kız, 27 erkek) katılmıştır. Sagital düzlem parametrelerinin ölçümü için yerçekimine bağlı inklinometre (Baseline® Bubble® Inclinometer) kullanılmıştır. Bunlara ek olarak skolyoz tanısı alan katılımcıların gövde rotasyon açısı (Angle of Trunk Rotation, ATR) ve Cobb açısı değerleri de ölçülmüştür&#x0D; Bulgular: Skolyoz grubunda kifoz açısı her iki gruptan da anlamlı olarak daha az bulunmuştur(p

Comparison of Preoperative Bone Density in Patients With and Without Periprosthetic Osteolysis Following Total Ankle Arthroplasty.

Modern total ankle arthroplasty (TAA) prostheses are uncemented press-fit designs whose stability is dependent on bone ingrowth. Preoperative insufficient bone density reduces initial local stability at the bone-implant interface, and we hypothesized that this may play a role in periprosthetic osteolysis. We aimed to investigate the preoperative bone density of the distal tibia and talus and compare these in patients with and without osteolysis. We enrolled 209 patients (218 ankles) who underwent primary TAA using the HINTEGRA prosthesis. The overall mean follow-up duration was 66 (range, 24-161) months. The patients were allocated into 2 groups according to the presence of periprosthetic osteolysis: the osteolysis group (64 patients, 65 ankles) and nonosteolysis group (145 patients, 153 ankles). Between the 2 groups, we investigated and compared the radiographic outcomes, including the Hounsfield unit (HU) value around the ankle joint and the coronal plane alignment. HU values of the tibia and talus measured at 5 mm from the reference points were higher than those at 10 mm in each group. However, comparing the osteolysis and nonosteolysis groups, we found no significant intergroup difference in HU value at every measured level in the tibia and talus (P > .05). Concerning the coronal plane alignment, there were no significant between-group differences in the tibiotalar and talar tilt angles (P > .05). Patients with osteolysis showed similar preoperative bone density of the distal tibia and talus compared with patients without osteolysis. Our results suggest that low bone density around the ankle joint may not be associated with increased development of osteolysis. Level III, retrospective cohort study.

Range of motion following percutaneous fixation of pediatric supracondylar humerus fracture is independent of anterior osseous fragment resorption.

The objective of this study was to understand postoperative resorption of the anterior osseous fragment following closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures and its effect on final range of motion (ROM). Eighty-six patients that underwent CRPP had sagittal and or axial plane deformities resulting in an anterior fragment. Humerocapitellar angle (HCA), anterior humeral line (AHL) and angle of rotation (AoR) were measured. A total of 11 (12.8%) patients failed to resorb the anterior fragment, 10 (90.9%) had satisfactory ROM. HCA initially was acceptable in 40 (46.5%) patients, and 37 (92.5%) demonstrated acceptable ROM. Final HCA was acceptable in 44 (51.2%) patients and 42 (95.4%) had acceptable final ROM. AHL was in the anterior third of the capitellum in 35 (40.6%) patients and 33 (94.3%) had acceptable ROM. Final AHL was in the anterior third of the capitellum in 43 (50.0%) patients and 41 (95.3%) had acceptable final ROM. No difference was found between acceptable ROM and HCA or AHL at either follow-up. Sixty-five and 21 patients had an AoR of 0° and between 23 and 36°, respectively. A total of 59 (90.7%) patients with an AoR of 0°, and 18 (85.7%) patients with an AoR of 23-36° displayed acceptable ROM. A total of 57 (87.7%) patients with an AoR of 0° and 18 (85.7%) with an AoR of 23-36° resorbed the anterior fragment. No association was found between rotational deformity and postoperative ROM or fragment resorption. Postoperative sagittal and axial plane alignment, HCA, AHL, AoR and resorption of the anterior osseous fragment does not correlate with final ROM.