Anterior Compartment Research Articles

Trends in Urogynecology-Transvaginal Mesh Surgery in Germany.

Pelvic organ prolapse constitutes a prevalent condition associated with a considerable impact on the quality of life. The utilization of transvaginal mesh surgery for managing POP has been a subject of extensive debate. Globally, trends in TVM surgery experienced significant shifts subsequent to warnings issued by the FDA. This study aims to explore temporal patterns in transvaginal mesh surgery in the German healthcare system. A comprehensive analysis was conducted on in-patient data from the German Federal Statistical Office spanning 2006 to 2021. A total of 1,150,811 operations, each associated with specific codes, were incorporated into the study. Linear regression analysis was employed to delineate discernible trends. The trends in transvaginal mesh surgery within the anterior compartment exhibited relative stability (p = 0.147); however, a significant decline was noted in all other compartments (posterior: p < 0.001, enterocele surgery: p < 0.001). A subtle increasing trend was observed for uterine-preserving transvaginal mesh surgery (p = 0.045). Surgical trends over the specified timeframe demonstrate how POP management has evolved globally. Notably, despite observed fluctuations, transvaginal mesh surgery remains a viable option, particularly for specific cases with a high risk of relapse and contraindications to alternative surgical approaches.

Objective and subjective results of native tissue repair (plication of pubo-cervical facia) in isolated anterior compartment defects

Objective and subjective results of native tissue repair (plication of pubo-cervical facia) in isolated anterior compartment defects

Penile reconstruction after complete bladder exstrophy repair

The decreased penile length in patients born with bladder exstrophy (BE) results partly from pubic symphysis diastasis and the separation of the corporal bodies. Also, intrinsic shortening of anterior corporal compartment, residual penile dorsal curvature, and postsurgical scarred skin share in creation of short penile length. The goal of this study was to look at whether adult men who had bladder exstrophy (BE) surgery as babies needed and benefited from penile reconstruction, which included penile lengthening and repair of any redo penile pathology that was present at the same time. We reviewed the records of 31 repaired BE patients with mean age of 21.4±3.7 years. The patients complained of their dissatisfaction with short penile length, residual dorsal penile curvature, distal dorsal or hypospadiac urethral opening and scared penopubic skin. The penile lengthening was performed by sub-periosteal detachment of the corporal bodies from the pubic rami in all cases. In 8 patients full thickness dermal grafts were used to penile resurfacing after its lengthening. Twelve patients underwent coronal or glanular urethroplasty. Phalloplasty was performed in one patient using forearm free graft. Subjective evaluation by the patient reported satisfactory results in 25/31 (80.6%). The degree of penile lengthening measured at 6 months and one year postoperatively showed increased length which varied between 50% and 150% of the preoperative penile length. We hypothesize that congenital causes, such as short anterior corporeal compartment, wide pubic rami diastasis, and short penile urethra, as well as iatrogenic causes, such as post-surgical peno-pubic scars, could account for the coexisting multifactorial causes of penile shortening in male adults with BE. Penile lengthening is permitted, in our opinion, provided that the crura from the pubic rami is carefully and partially mobilized. The short phallus, residual dorsal chordee and distal urethroplasty can be corrected successfully in the majority of patients. Adult males with BE may have short penis that requires another reconstructive stage. The short phallus, residual chordee and distal urethroplasty can be corrected` successfully in the majority of patients.

Experimental characterization of motion resistance of the sacroiliac joint.

The human sacroiliac joint (SIJ) in vivo is exposed to compressive and shearing stress environment, given the joint lines are almost parallel to the direction of gravity. The SIJ supports efficient bipedal walking. Unexpected or unphysiological, repeated impacts are believed to cause joint misalignment and result in SIJ pain. In the anterior compartment of the SIJ being synovial, the articular surface presents fine irregularities, potentially restricting the motion of the joints. To clarify how the SIJ articular surface affects the resistance of the motion under physiological loading. SIJ surface models were created based on computed tomography data of three patients and subsequently 3D printed. Shear resistance was measured in four directions and three combined positions using a customized setup. In addition, repositionability of SIJs was investigated by unloading a shear force. Shear resistance of the SIJ was the highest in the inferior direction. It changed depending on the direction of the shear and the alignment position of the articular surface. SIJ articular surface morphology is likely designed to accommodate upright bipedal walking. Joint misalignment may in consequence increase the risk of subluxation.

Is hip capsule morphology associated with hip pain in patients without another structural correlate?

The goals of this study were (i) to assess the association between hip capsule morphology and pain in patients without any other MRI abnormalities that would correlate with pain and (ii) to investigate whether hip capsule morphology in hip pain patients is different from that of controls. In this study, 76 adults with hip pain who did not show any structural abnormalities on MRI and 46 asymptomatic volunteers were included. Manual segmentation of the anterior and posterior hip capsules was performed. Total and mean anterior hip capsule area, posterior capsule area, anterior-to-posterior capsule area ratio, and medial-to-lateral area ratio in the anterior capsule were quantified. Differences between the pain and control groups were evaluated using logistic regression models. Patients with hip pain showed a significantly lower anterior-to-posterior area ratio as compared with the control group (p = 0.002). The pain group's posterior hip capsule area was significantly larger than that of controls (p = 0.001). Additionally, the ratio between the medial and lateral sections of the anterior capsule was significantly lower in the pain group (p = 0.004). Patients with hip pain are more likely to have thicker posterior capsules and a lower ratio of the anterior-to-posterior capsule area and thinner medial anterior capsules with a lower ratio of the medial-to-lateral anterior hip capsule compartment, compared with controls. During MRI evaluations of patients with hip pain, morphology of the hip capsule should be assessed. This study aims to be a foundation for future analyses to identify thresholds distinguishing normal from abnormal hip capsule measurements. • Even with modern image modalities such as MRI, one of the biggest challenges in handling hip pain patients is finding a structural link for their pain. • Hip capsule morphologies that correlated with hip pain showed a larger posterior hip capsule area and a lower anterior-to-posterior capsule area ratio, as well as a smaller medial anterior capsule area with a lower medial-to-lateral anterior hip capsule ratio. • The hip capsule morphology is correlated with hip pain in patients who do not show other morphology abnormalities in MRI and should get more attention in clinical practice.

Variation in the Branching Pattern of the Radial Nerve Observed during Fixation of the Humerus Shaft: A Case Report

The posterior cord of the brachial plexus typically maintains a consistent branching pattern, and deviations from this norm are exceedingly rare. Even more infrequently encountered are variations in the branching pattern of the radial nerve. The current case report of a 45-year-old male patient presents a unique clinical scenario involving a middle third and distal third humerus shaft fracture, manifesting as the chief complaint of pain during movement, coupled with localised swelling. A posterior approach was employed for surgical intervention due to the expansile nature of the fracture within the middle and distal thirds. During the surgical exploration, an anomalous branching pattern of the radial nerve was observed when transitioning from the posterior to the anterior compartment. This atypical radial nerve branching consisted of a branch extending into the anterior compartment and an accompanying posteroinferior branch, which notably supplied the medial and long heads of the triceps muscle. The present case underscores the imperative role of the orthopaedic surgeon in considering the radial nerve's intricate anatomy while exposing and stabilising segmental humerus fractures. It is of paramount importance to exercise vigilance, as the conventional practice of splitting the triceps muscle should be abstained from until an unusual branching or splitting of the radial nerve is definitively ruled out. The present case report elucidates the significance of meticulous anatomical awareness and surgical technique when addressing such complex humeral fractures, offering insights into the management of these uncommon clinical presentations.

Outcomes of Abdominal Apical Suspension Using Mesh in a Tertiary Training Hospital: A Seven-year Retrospective Review.

Pelvic organ prolapse (POP) is an inconvenience that can affect a woman's well-being. Reconstructive pelvic floor surgery involves repairing defects in the endopelvic fascia and pelvic floor musculature as close to the physiologic and anatomic norm. The cornerstone of successful prolapse repair is a strong apical support. The aim of the study is to determine the outcomes of abdominal sacrocolpopexy (ASC) and abdominal sacrohysteropexy (ASH) in the Philippines. The study utilized a descriptive study design to compare the pre-operative and post-operative Pelvic Organ Prolapse Quantification Score (POP-Q Score), presence of mesh complications, and urinary/bowel symptoms in patients operated within 2010-2016 in a Philippine tertiary training hospital. Based on recovered charts and inclusion/exclusion criteria, this study sampled 34 of 50 patient records. Statistical measures of median and range were used to describe pre-operative and post-operative POP-Q scores in any two follow-ups within 6-, 12-, 18-, and 24-month interval. The objective success rate and incidence of urinary/bowel symptoms were described using frequencies and percentages. Presence of any mesh erosion was noted for each follow-up. McNemar's test was applied to assess the comparative occurrence of each symptom comparing between the pre-operative and first follow-up periods. ASC had a success rate of 73.7% at six months and 56.3% at 12 months post-surgery. ASH showed an 84.6% success rate at six months and 71.4% at 12 months. Apical support has a 97% success rate without affecting the anterior or posterior compartments. Out of 20 ASC patients, 5 (25%) exhibited anterior compartment descent, whereas two out of 14 ASH patients (14.2%) had the same condition. It is observed that the anterior vaginal wall has the higher tendency to descend after reconstructive surgery, independent of route or technique. In addition, not all patients with surgical prolapse beyond -1 experienced symptomatic vaginal bulges. Overall, a notable decrease in the occurrence of urine symptoms was seen after the surgery. No mesh erosion was seen within the initial two years of follow-up but there was a single reported instance of abdominal hernia, an uncommon consequence. This study demonstrated that ASC and ASH have good success rate in apical support; however, descent of the anterior or posterior compartment diminishes the overall success rate in terms of over-all objective POP-Q score. Both resulted to improvement in symptoms with minimal complications.

Intraoperative patellar tracking assessment during image-based robotic-assisted total knee arthroplasty: technical note and reliability study.

Restoration of the anterior knee compartment is increasingly studied with the development of personalized surgery. However, evaluating the patellar tracking during the surgery is still subjective and at the surgeon's discretion. This study aimed 1) to describe the assessment of the patellar tracking during robotic-assisted total knee arthroplasty (TKA), 2) to describe a new measurement technique for evaluating the evolution of this patellar tracking, and 3) to assess its reliability and repeatability. This monocentric study assessed the evolution of patellar tracking for 20 robotic-assisted TKA. The sharp probe was used to perform patellar tracking in all the arcs of knee flexion before and after the bone cuts. The patella positioning was recorded every 10° of flexion between the full extension and 90° knee flexion and was assessed in the coronal and sagittal planes. For the measurements of the patellar tracking, we used a sagittal view and a coronal view of the knee on the MAKO software. From these two views, the difference between the patellar tracking before and after the bone cuts with the definitive implants was measured. Two independent reviewers performed the measurements to assess their reliability. To determine intraobserver variability, the first observer performed the measurements twice. The mean age was 68.7years old±5.2 [61;75], the mean body mass index was 28.8kg/m2±4.2 [21.4; 36.2], the mean HKA angle was 176.3°±3.7° [174.1.4;179.7]. The radiographic measurements showed very good to excellent intra-observer and inter-observer agreements (0.60 to 1.0). This new measurement technique assessed the evolution of patellar tracking after TKA with good inter and intra-observer reliability.

A Variant Dorsalis Pedis Artery and Its Relationship with the Deep Fibular Nerve

During a cadaveric dissection session, a distinctive neurovascular pattern was identified in the left leg of a 66-year-old female cadaver. The Anterior Tibial Artery (ATA), while maintaining a normal origin and luminal diameter, exhibited a shortened course, terminating in the upper third of the leg. In the lower third of the leg, the Fibular Artery (FA), known as the peroneal artery, traversed through the interosseous membrane to the anterior compartment, persisting as the Dorsalis Pedis Artery (DPA). The Deep Fibular Nerve (DFN), displaying a usual course in the upper two-thirds of the leg, crossed the variant DPA posteriorly and divided into two terminal branches on its posterolateral side. The medial terminal branch proceeded to cross the artery anteriorly within the anterior tarsal tunnel. This distinctive relationship between the DFN and the variant DPA renders the nerve susceptible to compression and may result in “anterior tarsal tunnel syndrome”.

A Case of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Mimicking Hashimoto’s Thyroiditis

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma (DSV-PTC) is a rare and aggressive subtype of Papillary Thyroid Carcinoma (PTC) The prognosis of this variant is as good as classic PTC, but close follow-up is necessary because of frequent tumour recurrence. The authors report a case of a 30-year-old female who presented with a 6-month history of gradually progressive midline neck swelling. Antithyroid antibodies were elevated, and radiology was suggestive of a colloid goitre. Total thyroidectomy was done along with anterior compartment lymph node removal for confirmation. Interestingly, histopathology showed a picture reminiscent of Hashimoto’s Thyroiditis (HT), but the lymph node showed tumour metastasis. Thereafter, additional sections were taken to establish the diagnosis of DSV-PTC in the thyroid. The present case highlights the importance of extensive sampling in histopathology for a suspected case of malignancy, as it can be misdiagnosed as a benign aetiology.

Normative Extensor Hallucis Brevis Muscle Activity During Locomotion Following the Development of a Novel Ultrasound-Guided Fine-Wire Electromyography Protocol.

Fine-wire electromyography (EMG) is a traditional laboratory technique to estimate muscle activity of the small foot muscles, however, recordings have not been reported from extensor hallucis brevis (EHB). As an extensor of the great toe, EHB is an important muscle when studying physiological changes associated with foot pathologies such as hallux valgus. The purpose of this study was to develop an ultrasound-guided fine-wire EMG protocol to record EHB muscle activity and report normative EMG profiles of healthy young adults during locomotion. Sixteen asymptomatic young adults completed 20 walking trials at a self-selected velocity. Ensemble averages were calculated from the time normalized linear envelopes and represented from 0% to 100% of the single stance phase of gait. EHB muscle bursts were observed between 0% and 20% of the stance phase of gait in all participants. A second burst of EMG was observed between 80% and 100% of stance in 50% of the participants. This study introduces a novel ultrasound-guided EMG protocol and normative data from EHB recordings suggest a synergistic role to anterior compartment musculature at contact. These results provide preliminary insights into understanding the functional role of EHB and may help elucidate the biomechanical factors exacerbating the progression of hallux pathologies.

Morphometric description of the subfascial intermuscular adipose tissue of anterior compartment of the leg

Objectives: To describe the morphological characteristics of subfascial intermuscular adipose tissue (IMATS) in the anterior compartment of the leg, considering its developmental and functional relationship with the crural fascia. Methods: In twenty formalin-fixed cadaveric legs (13 males, 7 females), after removal of the skin and crural fascia, the IMATS was exposed and classified into four types according to its shape. Leg length was divided into eight regions. The length, width at the widest point, closest distances of the upper and lower ends to the intermalleolar line and the anterior margin of the tibia, as well as the thickness of the skin-subcutaneous tissue complex, limb and leg lengths were measured for IMATS. Results: The most common type of IMATS was the short-large type. The largest point of IMATS was located in zone 3 or 4, and this point was located in the two zones closest to the lower end of IMATS in 75% of cases. In all cases, one to three connecting vessels piercing the crural fascia (80% were in zones 2, 3 or 4) connected to the IMATS in a slightly lateral to medial oblique course of the IMATS from top to bottom. The IMATS was superficially located in the tendinous and muscular parts of the extensor digitorum longus and/or tibialis anterior muscles, loosely attached to the muscles and crural fascia, but not between the muscle fibers. Although the largest point (p=0.041) and the distance from the distal end to the anterior margin of the tibia were found to be greater in males (p=0.049), the gender difference disappeared when normalized for limb length. Conclusion: No data on IMATS morphometry could be found in the literature. A remarkable finding of the study, which is open to interpretation in terms of the function of the IMATS, is that the location of the IMATS overlaps with the crural fascia region, which is reported to be biomechanically stiffer in the transverse direction. Our data that a connecting vessel is always connected to the IMATS by a fixed spatial relationship strengthens the argument that the developmental history of both structures may intersect.

What Are the Recurrence Rates, Complications, and Functional Outcomes After Multiportal Arthroscopic Synovectomy for Patients With Knee Diffuse-type Tenosynovial Giant-cell Tumors?

What Are the Recurrence Rates, Complications, and Functional Outcomes After Multiportal Arthroscopic Synovectomy for Patients With Knee Diffuse-type Tenosynovial Giant-cell Tumors?

Anterior Thigh Myxofibrosarcoma with Management of Wide Excision and Modified Anterior Thigh Compartment Resection : A Case Report

Introduction: Myxofibrosarcoma (MFS) is a type of malignancy from the group of malignant fibrous histiocytoma. Myfxofibrosarcoma is a type of soft tissue neoplasm that is aggressive. The clinical symptoms are not pathognomonic and the histological picture is very heterogeneous, often receiving delayed treatment and causing misdiagnosis. Complementary histochemical and immunohistochemical staining is mandatory to confirm the diagnosis of MFS. Extensive surgical treatment and followed by radiotherapy is the first choice of myxofibrosarcoma treatment.&#x0D; Case Presentation: A 54-years old woman complained of a lump on her left thigh that had been getting bigger for the past 2 years. The lump initially looked the size of a marble, then grew to the size of a tennis ball in the last 7 months. On physical examination, a mass was found in the left thigh area, a hard, fixed mass, the size of a tennis ball. Fine needle aspiration examination showed suspicious results for myxofibrosarcoma. The patient underwent a Magnetic Resonance Imaging examination in the left lower extremity area and underwent wide excision and anterior thigh compartment resection surgery.&#x0D; Discussion: Wide resection is the standard treatment for MFS [4]. The choice of procedure for each patient is different and should be based on tumor size, location, stage, surrounding neurovascular and bony elements, as well as functional and cosmetic considerations [4]. The minimum resection margin in MFS is at least 1 cm which aims to minimize the risk of local recurrence [4]. The recommended resection margin is at least 2 cm for MFS resection [4]. We had plan a 2 cm margin of the entire preoperative MRI enhancement area. It should be noted that the local recurrence rate for MFS in margin-negative resections is relatively high compared with other STS subtypes.&#x0D; Conclusion: We recommend Wide Excison and Modified Anterior Thigh compartment Resection is recommended procedure for anterior thigh myxofibrosarcoma. This procedure involves preserving uncontaminated thigh neurovascular, and only resecting one of the sarcoma-infiltrated muscle heads and preserving the other quadriceps muscle head of the thigh to maintain knee extension function. This paper is the first report on the successful treatment of anterior thigh myxofibrosarcoma without weakness of knee extension complication.

A national survey of UK practice for day-case vaginal prolapse surgery: Unrealistic expectations?

ObjectiveThe UK NHS Getting It Right First Time report (2021) recommended that a significant proportion of native tissue vaginal prolapse operations should be undertaken as day-case procedures (target: 80% anterior compartment, 70% posterior compartment, 60% combined anterior/posterior compartment). The evidence for perioperative care, options for anaesthesia and outcomes of day-case vaginal prolapse surgery is limited. This study aimed to establish current practice amongst UK gynaecologists and explore perceived barriers to implementing day-case surgery for pelvic organ prolapse.Study designA pre-tested 16-item survey was emailed to British Society of Urogynaecology members in July 2022. This survey recorded rates of day-case prolapse surgeries, barriers to implementation and practices for managing urethral catheters, vaginal packs, intraoperative anaesthetics and perioperative care. Responses to free-text questions were independently analysed by two of the authors and underwent thematic analysis. Results121 eligible responses were received (28 % response-rate): 41 % never undertook day-case prolapse repair, 16 % undertook < 5 per year and 26 % undertook > 20 cases per year. There was no significant difference in training level or hospital setting between those groups. Reasons cited for not undertaking day-case prolapse surgery included concerns about vaginal packs and urinary catheters (92 %) postoperative complications (67 %), early discharge of elderly patients (60 %) and a lack of published evidence (39 %) or national guidance (35 %). For those currently undertaking day-case prolapse surgery; 67 % used general anaesthesia, 15 % spinal with short-acting local anaesthetic, 14 % spinal with long-acting local anaesthetic and 3 % local anaesthetic alone. Vaginal packs and self-retaining urethral catheters were used by 68 % and 70 % respectively. Concerns regarding the management of vaginal packs and urinary catheters were the most frequently cited barrier to implementing day-case surgery for pelvic organ prolapse amongst free-text responses. There were wide variations in managing catheters and packs, and in managing readmissions. ConclusionsThere is significant variation in uptake and practice for day-case prolapse surgery in the UK, with legitimate clinical concerns a barrier to its implementation. Further evaluation and development of robust, evidence-based management pathways are required to make day-case prolapse surgery consistent, feasible and defensible in clinical practice.

Italian multicenter mid-term analysis of laparoscopic lateral suspension in women with pelvic organ prolapse: clinical, sexual and Quality of Life assessment after surgical intervention.

The aim of this study was to evaluate effectiveness and safety of laparoscopic lateral suspension in women affected by high grade uterine prolapse associated to anterior defect. The secondary endpoint is to evaluate mid-term impact on Quality of Life and sexual function. A multicenter retrospective study on women undergoing laparoscopic lateral suspension for uterine prolapse ≥III stage was performed. We included 174 women, but due to exclusion criteria, 134 patients were enrolled for this study. Preoperative evaluation consisted of an urogynecological interview, clinical exam, 3-day voiding diary and urodynamic testing; the prolapse Quality of Life Questionnaire was used to quantify the impact of prolapse symptoms on Quality of Life and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form, the Female Sexual Function Index and the Female Sexual Distress Scale were administered to evaluate sexual function before surgical intervention and at median follow-up of 3.8 years. We included 134 women with uterine prolapse ≥III stage. All patients underwent laparoscopic lateral suspension, 8 also posterior colporrhaphy and 5 also transobturator tape insertion. POP-Q classification score for anterior and apical compartment showed a significant average decrease. The surveys administered to patients showed an improvement in Quality of Life, an increase in the number of monthly intercourses and a significant improvement in sexual life after surgery. Laparoscopic lateral suspension for pelvic organ prolapse correction is a safe and effective technique for uterine and anterior associated defect. Quality of Life and sexual function significantly improved after surgery.

Correlation between the female pelvic floor biomechanical parameters and the severity of stress urinary incontinence

BackgroundStress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor.MethodsWomen with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score.ResultsThirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22–24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22–24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044).ConclusionsFemale pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.

Which method for femoral component sizing when performing kinematic alignment TKA? An in silico study

IntroductionThe kinematically alignment (KA) technique for TKA aims to reproduce the pre-arthritic knee anatomy, including both the femoro-tibial and femoro-patellar joints. An in silico study was conducted to compare 3 different femoral component sizing techniques to identify the anatomical landmark which allows closest restoration of the native trochlear anatomy. Our study's question was: what was the best method for sizing the femoral component when performing KA-TKA? It was hypothesized that sizing the femoral component by aiming to restore the groove height would be the best method to restore the native trochlear anatomy. MethodsGMK sphere® (Medacta) femoral component 3D models were virtually kinematically aligned on 30 tri-dimensional (3D) bony osteoarthritis knee models. The femoral component was mediolaterally positioned to match distal native and prosthetic grooves. Three methods were used to size the femoral component: a conventional method with the anterior femoral cut flush to the femoral cortex (C-KATKA) and two alternative personalized methods aiming to recreate either the medial facet's height (ATM-KATKA) or the groove's height (ATG-KATKA). In-house analysis software was used to compare native and prosthetic trochlear articular surfaces and mediolateral implant overhangs. ResultsCompared with the C-KATKA, ATG-KATKA and ATM-KATKA techniques increased the component size by a mean of 0.90 (SD 0.31, min 0.5 to max 1.5) (p<0.001) and 1.02 (SD 0.31, min 0.5 to max 1.5) (p<0.001), respectively. C-KATKA technique substantially proximally understuffed the trochleae with maximum values of 7.11mm (SD 1.39, min 3.93mm to max 10.57mm) in the medial facet, 4.72mm (SD 1.27, min 1.46mm to max 6.86mm) in the lateral facet and 4.51mm (SD 1.40, min 1.92mm to max 7.30mm) in the groove, respectively. Alternative techniques understuffed medial facet with maximum values of 5.07mm (SD 1.29, min 2.83mm to max 8.34mm) and 4.70mm (SD 1.52, min 0.83mm to max 8.04mm) for ATG-KATKA and ATM-KATKA techniques, respectively. There was no significant understuffing of the groove or lateral facet for alternative techniques (ATM and ATG). The ATM-KATKA and ATG-KATKA techniques generated mediolateral implant overhang, mainly postero-lateral, with a rate of 90.0% and 86.7%, respectively. In this study, no mediolateral implant overhang was found for C-KATKA. Discussion/conclusionThe C-KATKA technique substantially understuffs the native trochlear articular surfaces in medial, lateral and groove parts. Alternative techniques (ATM-KATKA and ATG-KATKA) for sizing the femoral component better restore the native trochlear anatomy but also generate a high rate of postero-lateral implant overhangs. Would this postero-lateral implant overhang be clinically deleterious remains unknown? The aspect ratio of contemporary femoral TKA implants can probably be optimized to allow a better anatomical restoration of the anterior femoral compartment. Level of evidenceII, in silico study.

Increased Grades of Rectal Intussusception: Role of Decline in Pelvic Floor Integrity and Association With Dyssynergic Defecation.

The natural history of rectal intussusception (RI) is poorly understood. We hypothesized that decline in pelvic floor integrity and function leads to increasing RI grades. Retrospective analysis of a registry of patients with defecatory disorders with high-resolution anorectal manometry and magnetic resonance defecography was performed. Association of risk factors on increasing RI grades was assessed using logistic regression. Analysis included a total of 238 women: 90 had no RI, 43 Oxford 1-2, 49 Oxford 3, and 56 Oxford 4-5. Age ( P = 0.017), vaginal delivery ( P = 0.008), and prior pelvic surgery ( P = 0.032) were associated with increased Oxford grades. Obstructive defecation symptoms and dyssynergic defecation were observed at relatively high rates across groups. Increased RI grades were associated with less anal relaxation at simulated defecation yet, higher rates of normal balloon expulsion ( P < 0.05), linked to diminished anal sphincter. Indeed, increased RI grades were associated with worsening fecal incontinence severity, attributed to higher rates of anal hypotension. Levator ani laxity, defined by increased levator hiatus length and its excessive descent at straining, was associated with increasing RI grades, independent of age, history of vaginal delivery, and pelvic surgeries and could independently predict increased RI grades. Concurrent anterior and posterior compartments, and visceral prolapse were associated with higher Oxford grades. Our data suggest that decline in pelvic floor integrity with abnormal levator ani laxity is associated with increased RI grades, a process that is independent of age, history of vaginal deliveries, and/or pelvic surgeries, and perhaps related to dyssynergic defecation.

Muscle Architecture of Leg Muscles: Functional and Clinical Significance.

Architectural properties of the muscles are the prime predictors of functional attributes and force-generating capacity of the muscles. This data is vital for musculoskeletal modelling and selecting the appropriate muscle-tendon units for tendon transfers.Cadaveric data for architectural properties is the gold standard and primary input for musculoskeletal modelling. There is a paucity of these datasets, especially in the leg muscles. Sixty muscles of the anterior and lateral compartments from twelve formalin-fixed lower limbs were studied for gross architecture, including the peculiar fibre arrangements and architectural properties of muscles. Muscle weight, muscle length, fibre length, pennation angle and sarcomere length were measured. Normalised fibre length, fibre length to muscle length ratio (FL/ML ratio), and the physiological cross-sectional area (PCSA) were calculated from the obtained data. Muscles displayed a combination of architectural strategies and were partly fusiform and partly pennate. The tibialis anterior and peroneus longus were the heaviest muscles in their respective compartments and showed more extensive origin from the nearby deep facial sheets.Long fibre length and less pennation angle were seen in muscles of the extensor compartment. Potential muscle power was highest in the tibialis anterior and peroneus longus and least in the extensor hallucis longus. Arching of the foot and eversion are peculiar to humans and recent in evolution. Due to the functional demand of maintaining the medial longitudinal arch and eversion, the tibialis anterior and peroneus longus have more muscle weight and larger physiological cross-sectional area and are potentially more powerful.Extensor compartment muscles were architecturally more suited for excursions because of the long fibre length and less pennation angle.This study contributes baseline normative data for musculoskeletal modelling platforms and simulation tools - an emerging area in biomechanics and tendon transfers.