Anatomical Techniques Research Articles

Anatomic Posterolateral Corner Reconstruction With Single Graft Tibial Socket Fixation

Introduction: The posterolateral corner (PLC) is comprised of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Injuries to the PLC are associated with significant morbidity and functional limitation, most frequently manifested through a varus thrust gait. In the previous 2 decades, advances have been made in understanding the importance of the PLC and as a result, many techniques have been developed to address its reconstruction. Material and Methods: The Laprade technique is a previously described anatomic reconstruction of the PLC. We propose some modifications to this technique, which involve dissection of the posterolateral tibia to allow direct protection of the popliteal neurovascular bundle while establishing tibial fixation. A single hamstring graft is utilized for the reconstruction, is routed through the fibular tunnel and subsequently secured with the use of a dual-expanding tenodesis anchor, placed in a tibial socket removing the need for a tibial tunnel. Conclusion: The present study describes a novel anatomic technique that allows for improved protection of neurovascular structures, better control of graft tensioning and tunnel management, and the judicious use of a single tendon autograft while maintaining the described benefits of the anatomic Laprade technique.

Extensor Carpi Ulnaris Instability: A Comprehensive Review of Pathology and Operative Techniques.

The extensor carpi ulnaris (ECU) is primarily responsible for extension and ulnar deviation at the wrist. Secondary to repetitive loading of, or acute trauma to the flexed, supinated and ulnarly deviated wrist, the ECU tendon can be a common source of ulnar-sided wrist pain. Common pathology includes ECU tendinopathy, tenosynovitis, tendon instability, and tendon rupture. Extensor carpi ulnaris pathology commonly occurs in athletes and patients with inflammatory arthritis. Given the multitude of available methods to treat ECU tendon pathology, the aim of our study was to outline operative management of ECU tendon pathology, with emphasis on reviewing techniques for addressing ECU instability. We acknowledge a continuing debate between anatomical and nonanatomical techniques for ECU subsheath reconstruction. However, use of a portion of the extensor retinaculum for nonanatomical reconstruction is commonly used and demonstrates successful outcomes. Future comparative studies on ECU fixation are required to increase data on patient outcomes, to further define and standardize these techniques.

Biomechanical Comparison of Distal Biceps Tendon Repair Techniques: Extracortical Single-Button Inlay Fixation Versus Intracortical Double-Button Onlay Anatomic Footprint Fixation

Background: Extracortical single-button (SB) inlay repair is a commonly used distal biceps tendon technique. However, complications (eg, neurovascular injury) and nonanatomic repairs have led to the development of intracortical fixation techniques. Purpose: To compare the biomechanical stability of extracortical SB repair with an anatomic intracortical double-button (DB) repair technique. Study Design: Controlled laboratory study. Methods: The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SB or anatomic DB group. Both groups were cyclically loaded with 60 N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap formation and construct stiffness during cyclic loading and ultimate load to failure were analyzed. Results: When compared with the extracortical SB technique after 1000 cycles, the anatomic DB technique showed significantly less gap formation (mean ± SD, 2.7 ± 0.8 vs 1.5 ± 0.9 mm; P = .017) and significantly more construct stiffness (87.4 ± 32.7 vs 119.9 ± 31.6 N/mm; P = .023). Ultimate load to failure was not significantly different between the groups (277 ± 93 vs 285 ± 135 N; P = .859). The failure mode in the anatomic DB group was significantly different from that of the extracortical SB technique (P = .002) and was due to fracture avulsion of the cortical button in 7 of 9 specimens (vs none in the SB group). Conclusion: Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to that of the SB technique. The DB technique may offer a clinically viable alternative to the SB repair technique. Clinical Relevance: This study suggests, at worst, an equivalent and, at best, a superior biomechanical performance of intracortical anatomic DB footprint repair at the time of surgery. However, the mode of failure suggests that this technique should not be used in patients with poor bone quality.

Thoracoscopic Anatomical Sublobar Resection Including Subsegmentectomy for Non-Small Cell Lung Cancer.

Among anatomical sublobar resection techniques for non-small cell lung cancer (NSCLC), the clinical benefit of subsegmentectomy remains unclear. We investigated whether anatomical sublobar resection including subsegmentectomy-segmental resection with subsegmental additional resection or subsegmental resection alone-is an effective and feasible surgical procedure for NSCLC. We retrospectively reviewed data of 285 patients with clinical stage I NSCLC who underwent anatomical sublobar resection at our institution from January 2013 to March 2021 and compared surgical outcomes between patients who underwent anatomical sublobar resection including (IS; n = 50) and excluding (ES; n = 235) subsegmentectomy. No significant intergroup differences were noted in terms of age, sex, smoking, comorbidities, tumor size or location, consolidation tumor ratio, and preoperative pulmonary function. The IS group had more preoperative computed tomography-guided markings (34 vs. 15%; p = .004) and smaller resected lung volumes converted to the total subsegment number [3 (2-4) vs. 3 (3-6); p = .02] than the ES group. No significant differences in margin distance [mm, 20 (15-20) vs. 20 (20-20); p = .93], readmission rate (2% vs. 3%; p > .99), and intraoperative (8% vs. 7%; p = .77) or postoperative (8% vs. 10%; p = .80) complication rates were observed, and the 5-year local recurrence-free survival (91% vs. 90%; p = .92) or postoperative pulmonary function change were comparable between both groups. Although further investigations are required, anatomical sublobar resection including subsegmentectomy for clinical stage I NSCLC could be an acceptable therapeutic option.

Clinical and radiological outcomes of a modified anatomic posterolateral corner reconstruction technique using a single semitendinosus autograft

PurposeWe aimed to assess the clinical and radiological outcomes of a modified anatomical posterolateral corner (PLC) reconstruction technique using a single autograft.MethodsThis prospective case series included 19 patients with a posterolateral corner injury. The posterolateral corner was reconstructed using a modified anatomical technique that utilized adjustable suspensory fixation on the tibial side. Patients were evaluated subjectively using the international knee documentation form (IKDC), Lysholm, and Tegner activity scales and objectively by measuring the tibial external rotation angle, knee hyperextension, and lateral joint line opening on stress varus radiographs before and after surgery. The patients were followed-up for a minimum of 2 years.ResultsBoth IKDC and Lysholm knee scores significantly improved from 49 and 53 preoperatively to 77 and 81 postoperatively, respectively. The tibial external rotation angle and knee hyperextension showed significant reduction to normal values at the final follow-up. However, the lateral joint line opening measured on the varus stress radiograph remained larger than the contralateral normal knee.ConclusionPosterolateral corner reconstruction with a hamstring autograft using a modified anatomical reconstruction technique significantly improved both the subjective patient scores and objective knee stability. However, the varus stability was not completely restored compared with the uninjured knee.Level of evidenceProspective case series (Level of evidence IV).

Osteology of the pelvic limb of nine-banded-armadillo, dasypus novemcinctus linnaeus, 1758 applied to radiographic interpretation

At South Brazil, where the Pampa biome is predominant, dead nine-banded armadillo is frequentely found injuried or even dead at margins of roads and highways what has contributed to the increasing of number of specimens in admission to wildlife rehabilitation centers. Osteological studies are limited and normal skeleton morphology informations is need to radiographic recognition in wildlife medicine. The objective of this work was to present the morphology of the bones from the pelvic limbs of Dasypus novemcinctus, pointing out their topographical characterization and how their can be seen in radiographic images. Pelvic limbs of twelve dead nine-banded armadillo specimens from different age categories were used. The carcass were underwent radiological examinations using digital processing and practical plans for the clinical routine of small animals. From each radiographed individual osteological preparation was carrying out using conventional anatomical techniques. Photographic records of bones were made considering views of anatomical importance to the study. All bone components of the pelvic limb showed characteristics favorable to the species' lifestyle and habits reforcing evolutive morphoplasticity. Some bone accidents were unable to be clearly recorded through radiographic images because peculiar anatomical characteristics and limited mobility in some joints which not allowed executing positioning as done in the dog or cat. Presence of a sinsacre, a great third trochanter, a well structured leg with tibia and fibula similar in size and thickness and the complex sesamoid elements on feet suggests the specialization in shifting body weight to the pelvic limb while using the forelimbs to dig. The study provided a radiographic protocol includyind suitable positionings from practical execution by wildlife veterinarians that work in rehabilitation centers.

Development of a Departmental Resident Educational Program to Increase Knowledge and Confidence Related to Obstetric Anal Sphincter Injuries [ID: 1375536

INTRODUCTION: Obstetric anal sphincter injuries (OASIS) have been reported in up to 35% of vaginal deliveries; thus, understanding these injuries is a critical part of obstetrics and gynecology training. Formal educational programs with incorporated simulation training can have an advantageous effect, particularly when provided as part of residency education. This project seeks to evaluate the positive effect of departmental resident education related to OASIS, on confidence and knowledge of obstetrics and gynecology residents at Wake Forest University. METHODS: A structured OASIS curriculum was developed by the urogynecology program, including 2 hours of didactic lecture followed by stepwise simulation with swine models to demonstrate and practice anatomic repair techniques. Participants completed pre- and post-class surveys including skill confidence assessments via Likert scale (range 1–10), and standardized knowledge assessments adapted from ACOG Obstetric Laceration Repair Module, along with educational experience reports. These items were scored and analyzed. RESULTS: In August 2022, 16 residents (4 per residency year) participated. Prior to education, mean confidence level with techniques was 4.2 among all areas (range 1.6–7.4), with mean knowledge assessment score 64% (range 33–100%). Post-education, confidence improved across several domains including effectively applying perineal support (7.3–7.9), identifying lacerations and performing rectal examinations (6.1–8.0), and OASIS repair (1.9–5.4) (P<.05). Knowledge assessment scores remained similar, at 70% (P>.05). In qualitative analysis, all individuals reported beneficial aspects of the program. CONCLUSION: Introduction of an OASIS curriculum including repair simulation utilizing an animal model, increased resident skill confidence. Future research will investigate longitudinal data to improve outcomes.

Structural and histochemical approach to the fruit and seed diversity of Cyperaceae in an evolutionary context.

The Cyperaceae fruit consistency depends on the mesocarp. Seed structure is diverse and related to the evolutionary history of their species. A new storage tissue is described for Cyperaceae. Anatomy and histochemistry of Cyperaceae fruits (including seeds) are poorly known due to their hard, isolating tissues that prevent anatomical techniques. We performed the first, most comprehensive structural diversity characterisation of fruit and seed in Cyperaceae, accompanied by an unprecedented histochemical characterisation of seeds for this family. We analysed fruits of 29 species, included in 19 genera and 12 tribes within the subfamilies Cyperoideae and Mapanioideae, using light microscopy. Cyperaceae fruits have a pericarp with a one-cell-layered exocarp and endocarp, and a multi-cell-layered mesocarp. The mesocarp of the Mapanioideae has a spongy-fleshy outer region and a hard inner region. The mesocarp of the Cyperoideae has only a hard region. The pericarp is free from the seed coat. Cyperaceae seeds have a three-layered seed coat, an embryo with haustorial function of its scutellum, and two storage tissues: the endosperm and a putative perisperm. Nine seed morphotypes and four seed subtypes were observed among the studied species. Our results suggested that the fruit consistency is determined by the mesocarp. Both the terms "nut" and "achene" should be accepted to refer to the dry fruit of the Cyperaceae until a widely accepted fruit classification for angiosperms is proposed. The Cyperaceae seed structural diversity is high and related to the evolutionary history of the species. The "perisperm" is a new tissue proposed for sedge seeds, and is here characterized for the first time. The seed coat has a different structure than the one described so far for the family.

Recent growth increase in endemic Juglans boliviana from the tropical Andes

The spatial coverage of tree-ring chronologies in tropical South America is low compared to the extratropics, particularly in remote regions. Tree-ring dating from such tropical sites is limited by the generally weak temperature seasonality, complex coloration, and indistinct anatomical morphology in some tree species. As a result, there is a need to complement traditional methods of dendrochronology with innovative and independent approaches. Here, we supplement traditional tree-ring methods via the use of radiocarbon analyses to detect partial missing rings and/or false rings, and wood anatomical techniques to precisely delineate tree-ring boundaries. In so doing we present and confirm the annual periodicity of the first tree-ring width (TRW) chronology spanning from 1814 to 2017 for Juglans boliviana (‘nogal’), a tree species growing in a mid-elevation tropical moist forest in northern Bolivia. We collected 25 core samples and 4 cross-sections from living and recently harvested canopy-dominant trees, respectively. The sampled trees were growing in the Madidi National Park and had a mean age of 115 years old, with certain trees growing for over 200 years. Comparison of (residual and standard) TRW chronologies to monthly climate variables shows significant negative relationships to prior year May-August maximum temperatures (r = −0.54, p < 0.05) and positive relationships to dry season May-October precipitation (r = 0.60, p < 0.05) before the current year growing season. Additionally, the radial growth of Juglans boliviana shows a significant positive trend since 1979. Our findings describe a new and promising tree species for dendrochronology due to its longevity and highlight interdisciplinary techniques that can be used to expand the current tree-ring network in Bolivia and the greater South American tropics.

Vestibular physiology and function in zebrafish.

The vestibular system of the inner ear provides information about head motion and spatial orientation relative to gravity to ensure gaze stability, balance, and postural control. Zebrafish, like humans, have five sensory patches per ear that serve as peripheral vestibular organs, with the addition of the lagena and macula neglecta. The zebrafish inner ear can be easily studied due to its accessible location, the transparent tissue of larval fish, and the early development of vestibular behaviors. Thus, zebrafish are an excellent model for studying the development, physiology, and function of the vestibular system. Recent work has made great strides to elucidate vestibular neural circuitry in fish, tracing sensory transmission from receptors in the periphery to central computational circuits driving vestibular reflexes. Here we highlight recent work that illuminates the functional organization of vestibular sensory epithelia, innervating first-order afferent neurons, and second-order neuronal targets in the hindbrain. Using a combination of genetic, anatomical, electrophysiological, and optical techniques, these studies have probed the roles of vestibular sensory signals in fish gaze, postural, and swimming behaviors. We discuss remaining questions in vestibular development and organization that are tractable in the zebrafish model.

18F]FDG/PET: a non-invasive technique for the study of stroke in murine and rat models

The use of mouse and rat models in conjunction with anatomic functional imaging techniques has directly contributed to expanding knowledge about the complex pathophysiology of stroke. Therefore, this study aims to identify the most relevant mouse and rat models of stroke and how [18F]FDG/PET can contribute to this pathology study. A narrative review of the literature was performed to describe applications of positron emission tomography in conjunction with the radiopharmaceutical [18F]FDG in stroke models. PubMed, Scopus, and Web of Science were searched for relevant articles published between 2015 and 2022. In this study, we describe applications of positron emission tomography in combination with the radiopharmaceutical [18F]FDG in mouse and rat stroke models. The most commonly used model was middle cerebral artery occlusion (MCAO) in rats. This study demonstrates that using murine and rat models in conjunction with anatomic functional imaging techniques has directly contributed to expanding knowledge about the complex pathophysiology of stroke. In addition, they have been essential for studies aimed at discovering and developing therapeutic and prophylactic strategies for the disease.

Comparison the treatment of anterior inferior tibiofibular ligament anatomical repair and syndesmosis screw fixation for syndesmotic injuries in ankle fracture

BackgroundThe fixation method of syndesmotic injuries in ankle fractures remains controversial. The goal of the study was to compare radiographic and clinical outcomes between anterior inferior tibiofibular ligament (AITFL) anatomical repair with syndesmosis screw fixation in syndesmotic injuries.MethodsWe analyzed 62 patients who were treated with AITFL anatomical repair or syndesmosis screw fixation for syndesmotic injuries in an advanced teaching hospital between March 2016 and March 2019. Fixation was performed with AITFL anatomical repair in 30 patients (AAR group) and syndesmosis screw in 32 patients (SS group). Radiographic evaluations were the differences in mean anterior and posterior (A difference and P difference) tibiofibular distance between injured and uninjured ankle computed tomography (CT) scan at 6 months postoperatively. Clinical evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, the Olerud-Molander Ankle (OMA) score and visual analogue scale (VAS) score at 1, 3, 6 months and 1, 2 years postoperatively.ResultsThe A difference and P difference on CT was no differences (1.6 ± 0.8 mm, 1.3 ± 0.7 mm vs. 1.5 ± 0.7 mm, 1.2 ± 0.7 mm) between the two groups (All of P > 0.05). The AAR group had higher mean AOFAS score (65.6 ± 5.9, 82.3 ± 4.2, 87.6 ± 5.6 vs. 61.8 ± 5.2, 79.1 ± 4.0, 83.8 ± 4.9; P = 0.008, 0.003, 0.007) and higher mean OMA score (45.7 ± 8.7, 79.2 ± 6.5, 84.1 ± 5.3 vs. 40.4 ± 7.3, 74.8 ± 6.3, 80.3 ± 5.8; P = 0.012, 0.009, 0.010)) at 1, 3 and 6 months postoperatively. The AAR group had lower mean VAS scores (2.6 ± 1.2, 1.7 ± 0.7 vs. 3.4 ± 1.2, 2.2 ± 1.1; P = 0.018, 0.038) at 1 and 3 months postoperatively.ConclusionsThe results of this study suggest that the AITFL anatomical repair technique could effectively improve ankle function during daily activity. Therefore, AITFL anatomical repair technique is expected to become a better fixation method for syndesmotic injuries.

Nanoparticle-Based Activatable MRI Probes for Disease Imaging and Monitoring.

Traditional diagnosis relies on identifying anatomical abnormality, which offers a stage for various anatomical imaging techniques, such as X-ray computed tomography (CT), ultrasonic imaging, and magnetic resonance imaging (MRI). The good capacity of providing anatomical details, especially for soft tissues, popularizes the clinical use of MRI. However, as the understanding of various diseases reaches the molecular level, it is gradually accepted that molecular anomaly often precedes anatomical abnormality. Therefore, molecular imaging, which is aimed at gathering various molecular information in organisms via imaging, starts to gain momentum. Unfortunately, traditional MRI is not capable of molecular imaging. As a result, there is an urgent demand for probes that enable MRI to "see" molecules. A promising design strategy for these probes is to elicit a signal change triggered by the presence of molecular targets, i.e. activation. Benefiting from the rapid development of nanotechnology, a number of nanoparticle-based activatable MRI probes have been developed for molecular imaging. This review summarizes recent advances of activatable MRI nanoprobes for imaging pathological characteristics of cancer, inflammation, and neurodegenerative diseases, with a focus on the design strategies and applications of these probes. In addition, the prospects and challenges of activatable MRI nanoprobes are also discussed.

Comparative Study Between Conventional Landmark Versus Ultrasound-Guided Paravertebral Block in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Study.

Thoracic paravertebral block (TPVB) has emerged as an effective and safe regional technique for providing postoperative analgesia. We aimed to compare the ease and efficacy of conventional landmark and ultrasound-guided (USG) paravertebral blocks for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. This was a randomized controlled study. Seventy-six patients of either sex, age 18-40 years, body mass index (BMI) 18-29 kg/m2, American Society of Anesthesiologists physical status classifications I and II posted for elective laparoscopic cholecystectomy under general anesthesia were randomly allocated into two groups of 38 each. Patients in group A were administered a paravertebral block using the anatomical landmark technique (ALT), and group B using an ultrasound-guided paravertebral block in the sitting position. In both groups, 20 ml of 0.5% bupivacaine injection was administered at the T7 vertebral level on the right side. The primary outcome was the first-pass success rate. Secondary outcomes were the number of passes and attempts, duration of analgesia, visual analog scale (VAS) score for pain during 24 h postoperatively and complications if any, were recorded. No patients were excluded in the study. Demographic characteristics were comparable in both groups. The number of passes was less in group B (1.45±0.5) compared to group A (2.42±0.95) and was reported to be statistically significant (p = 0.001). The number of attempts was less in group B (1.00±0) as compared to group A (1.29±0.46) and was statistically significant (p = 0.001). The duration of analgesia was longer in group B (530.00±326.33 minutes) compared to group A (345.60±252.95 minutes) and was observed to be statistically significant (p<0.05). The VAS score was significantly lower in group B (1.87±0.78, 2.24 ±0.82) compared to group A (2.42±0.72, 3.13±1.07) at the secondand fourth hours, respectively (p = 0.001). Conclusion: We concluded that paravertebral block using an ultrasound-guided technique is more efficacious than the conventional landmark technique for postoperative analgesia in patients undergoing laparoscopic cholecystectomy.

Wood and bark anatomy of the charismatic Wisteria vines (Leguminosae)

Summary Wisteria is a legume genus composed of lianas with a disjunct distribution, occurring in temperate zones of eastern Asia and the eastern United States, being also introduced in numerous countries as an ornamental. The anatomy of the wood has been previously studied for W. sinensis and only some characteristics of the phloem have been reported for this species. Here we describe the overall wood and bark anatomy of four Wisteria species and identify diagnostic, informative anatomical features to sort them for identification purposes among the species of the genus. Samples were collected from natural, naturalized, and introduced populations and processed using traditional anatomical techniques, while a few samples were analyzed from photos available online. Wisteria species show conserved wood anatomy, even if species occur as far apart as Asia and North America. The presence of a cambial variant, vessel dimorphism, G-fibers, non-lignified axial, and ray parenchyma is common and is here interpreted as part of the lianescent syndrome. The subepidermal origin of the periderm is taxonomically informative within the subfamily. The few variable features that vary among species are the arrangement of narrow vessels: radial to dendritic pattern in the specie W. frutescens and arranged in clusters in the species distributed in Eastern Asia. Also, the ray cell composition: procumbent, square, and upright cells mixed through the body in the specie W. sinensis and procumbent to square cells in the body and upright in the margins in the species W. brachybotrys and W. frutescens.

The suprascapular nerve block (SScNB) is easily administered using a landmark-based technique: A cadaveric study to assess nerve staining post-injection.

The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. To widen availability of this treatment, we investigate whether an anatomical landmark technique can be adopted by novice injectors to provide efficacious blockade. Five injectors were recruited with varying experience. 10 shoulders of Thiel embalmed cadavers were injected with blue dye. Written instructions and an illustration of the Dangoisse landmark technique were provided prior to injection. Cadavers were dissected and the presence or absence of dye staining reported by three observers and a consensus agreement reached. Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders had adequate staining of the suprascapular nerve directly, or distal branches, which would provide adequate anaesthesia. Inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k = 0.87) for staining distally. The technique was performed by novice injectors with a good success rate. This technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider group of patients.

Laser ablation tomography (LATscan) as a new tool for anatomical studies of woody plants.

Traditionally, botanists study plant anatomy by carefully sectioning samples, histological staining to highlight tissues of interests, then imaging slides under light microscopy. This approach generates significant details; however, this workflow is laborious, particularly in woody vines (lianas) with heterogeneous anatomies, and ultimately yields two-dimensional (2D) images. Laser ablation tomography (LATscan) is a high-throughput imaging system that yields hundreds of images per minute. This method has proven useful for studying the structure of delicate plant tissues; however, its utility in understanding the structure of woody tissues is underexplored. We report LATscan-derived anatomical data from several stems of lianas (c. 20 mm) of seven species and compare these results with those obtained through traditional anatomical techniques. LATscan successfully allows the description of tissue composition by differentiating cell type, size, and shape, but also permits the recognition of distinct cell wall composition (e.g. lignin, suberin, cellulose) based on differential fluorescent signals on unstained samples. LATscan generate high-quality 2D images and 3D reconstructions of woody plant samples; therefore, this new technology is useful for both qualitative and quantitative analyses. This high-throughput imaging technology has the potential to bolster phenotyping of vegetative and reproductive anatomy, wood anatomy, and other biological systems.

Posterolateral Rotational Knee Instability: Evolution and Current Trends in Surgical Treatment

Background. Diagnostics and treatment of patients with chronic posterior and posterolateral instability of the knee is one of the most understudied problems of modern orthopedics. This is due to rather low frequency of this pathology, as well as to complex anatomy of tendoligamentous structures of the posterolateral part of the knee joint. Steadily increasing number of foreign publications dedicated to this topic say that there is no common approach to the tactics of surgical treatment of patients of this category at the moment.&#x0D; Aim of review to evaluate the main trends of surgical treatment of this pathology according to the stage of involvement of various anatomical structures responsible for posterolateral rotational instability in the pathologic process.&#x0D; Results. Despite a large number of methods of surgical treatment of posterolateral corner injuries, when analyzing modern publications, several main trends concerning posterolateral instability of the knee joint can be identified. In case of type 1 posterolateral instability, an isolated arthroscopic posterior cruciate ligament plasty is the most optimal. As for types 3 and 4, today such anatomical techniques as Larson and LaPrade have completely replaced the methods of non-anatomical reconstruction of the posterolateral corner. In addition, a large number of publications have recently appeared concerning arthroscopic techniques of these surgeries. The most important problem concerns the extent and the methods of surgical intervention in case of type 2 instability. Authors of the article consider that an arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty is the most optimal for such category of patients.&#x0D; Conclusion. The actual problem is the question of the method of surgical treatment in case of type 2 instability. The optimal technique for such patients is arthroscopic posterior cruciate ligament plasty combined with popliteal tendon plasty.

THE SUPRASCAPULAR NERVE BLOCK (SSCNB) IS EASILY ADMINISTERED USING A LANDMARK-BASED TECHNIQUE: A CADAVERIC STUDY TO ASSESS NERVE STAINING POST-INJECTION

The suprascapular nerve is an ideal target for nerve blockade to alleviate shoulder pain given its widespread innervation to the shoulder girdle. Many techniques have been described. To widen the availability of this treatment we investigate whether an anatomical landmark technique can be easily learned by novice injectors to provide efficacious blockade.Five injectors were recruited with varying experience; from the novice medical student to an orthopaedic consultant. Five torsos (10 shoulders) were used. A single page of written instruction and illustration of the Dangoisse landmark technique was provided prior to injection of a Thiel embalmed cadaver bilaterally. A pre-mixed injectate with blue dye was used. Cadavers were dissected and the presence or absence of dye staining reported by 3 observers and a consensus agreement reached.Dissection demonstrated diffuse staining in the suprascapular fossa. 90% of shoulders were found to have adequate staining of the suprascapular nerve directly, or its distal branches, in a manner which would provide adequate anaesthesia. The inter-observer agreement was good (k = 0.73) for staining at the supraspinous fossa and excellent (k=0.87) for staining distally. The technique was easily performed by novice injectors with a 100% success rate.We demonstrate that this technique is reproducible by a range of clinicians to effectively provide anaesthesia of the SScN. The main risks are ineffective block (10% in this series) and of intravascular injection. Within a resource strained healthcare environment greater uptake of this technique is likely to be of benefit to a wider array of patients.

Medial-Sided Ligamentous Injuries of the Athlete's Knee: Evaluation and Management.

The superficial medial collateral ligament (sMCL) is the most commonly injured ligamentous structure in the knee. The other medial knee stabilizers include the deep medial collateral ligament, the posterior oblique ligament, and the medial meniscus. Medial collateral ligament injuries frequently occur in young athletes. As a result of the good healing capacity of the sMCL, the majority of acute medial-sided knee injuries can be treated nonoperatively with good outcomes. However, missed concomitant injuries can lead to residual laxity and instability of the knee when treated conservatively. When surgical management is warranted, numerous techniques exist, including repair, augmentation, and reconstruction. Recent anatomic and biomechanical studies defining the attachment sites and functional roles of the individual medial knee structures have led to advancements in diagnosis, treatment, and rehabilitation. These studies have allowed for the development of an anatomic reconstruction technique that restores the native stability and load-sharing relationships among the medial knee structures. The purpose of this narrative review is to summarize the recent updates in the anatomy, biomechanics, evaluation, and treatment of ligamentous injuries on the medial side of the athlete's knee.