Anterior Edge Research Articles

Closing-opening wedge osteotomy for the treatment of congenital kyphosis in children

To evaluate the safety and effectiveness of posterior closed-open wedge osteotomy for treatment of congenital kyphosis in children. Imaging and clinical data from January 2010 to December 2019 of posterior closed-open wedge osteotomy of congenital kyphosis with at least 2-year follow up was analyzed retrospectively. Perioperative indicators such as operation time, osteotomy site, osteotomy method and occurrence of complications, and imaging indicators were observed. The 3D printed models were used to measure the expanded distance of anterior edge vertebra and closed length of spinal canal line. The clinical effect was evaluated through SRS-22 questionnaires. There were 15 CK patients in this study. The osteotomy segments and details are as follows: 1 case each for T6-9 and L2, 2 cases at T11, 3 cases at T12, and 6 cases at L1. The average operation time was 314 min, the average blood loss was 970mL, the average fusion range was 6.3 segments, and the average time of follow up was 70.5 months. The Cobb angle of local kyphosis was corrected from 65.6 ± 18.8° to 11.3 ± 7.1°(p < .001). The range of kyphosis correction was 40-90°, and average correction rate was 83.2% (67.7-95.7%). The correction was stable in follow-up, and the kyphotic angle was 11.0 ± 7.6 (p = .68). The preoperative SVA was 31.5 ± 21.8mm, and the postoperative recovery was 18.0 ± 15.5, while the last follow-up was 9.1 ± 7.9. The p values were 0.02 and 0.07 respectively. By using 3D printed models, the expanded distance of anterior edge vertebra and closed length of spinal canal line were 14.5 ± 7.5mm and 24.5 ± 8.0mm respectively. Self-image and satisfaction in SRS-22 improved significantly. There was no recurrence of deformity and junctional kyphosis. The posterior closing-opening wedge osteotom for treatment of congenital kyphosis in children is satisfactory, if selected appropriately. During the longitudinal follow-up, the patients could achieve solid fusion and the correction could be well maintained.Evidence of Confidence: IVa.

What Changes in Pelvic Sagittal Tilt Occur 20 Years After THA?

Cup orientation in THA in the supine, standing, and sitting positions is affected by pelvic sagittal tilt (PT). Patterns of PT shift between these positions may increase the risk of dislocation and edge loading. The PT has also been reported to change during the aging process; however, there is limited research regarding long-term changes in PT and PT shifts after THA. (1) What changes occur in PT in the supine, standing, and sitting positions during 20 years of follow-up after THA in patients who have not had revision or dislocation? (2) What factors are associated with the differences between preoperative supine PT and postoperative sitting or standing PT (Δ sitting and Δ standing, respectively) 20 years postoperatively? Between January 1998 and December 1999, 101 consecutive patients underwent THA for appropriate indications. AP radiographs of the pelvis in the supine, standing, and sitting positions preoperatively and at 1, 10, and 20 years after THA were longitudinally performed to evaluate changes in PT. Fifty-nine percent (60 of 101) of patients were lost before 20 years of follow-up or had incomplete sets of imaging tests, leaving 41% (41 of 101) eligible for analysis here. There were no patients who had recurrent dislocation or underwent revision arthroplasty in the cohort; therefore, this analysis regarding postoperative changes in PT indicates the natural course of the change in PT during follow-up of THA. PT was measured based on the anterior pelvic plane. PT shifts with positional changes, Δ standing, and Δ sitting during the follow-up period were calculated. Posterior changes and shifts are represented by negative values. To analyze the factors associated with Δ standing and Δ sitting after 20 years, the correlations between these parameters and preoperative factors (including sex, age, pelvic incidence [PI], lumbar lordosis [LL], preoperative PT, and preoperative PT shift) and postoperative factors (including the occurrence of new lumbar vertebral fractures, lumbar spondylolisthesis, contralateral THA performed during follow-up, and PI-LL 20 years after THA) were determined. Median (IQR) supine and standing PTs changed (moved posteriorly) by -5° (-11° to -2°; p < 0.01) and -10° (-15° to -7°; p < 0.01), respectively. Sitting PT did not change during the 20-year follow-up period. Median (IQR) PT shift from standing to sitting changed from -34° preoperatively (-40° to -28°) to -23° after 20 years (-28° to -20°). There were posterior changes in median (range) Δ standing (median -12° at 20 years [-19° to -7°]); Δ sitting did not change during the follow-up period (median -36° at 20 years [-40° to -29°]). Patients with a large preoperative posterior PT shift from supine to standing demonstrated larger posterior tilt of Δ standing at 20 years. Patients with lumbar vertebral fractures during follow-up demonstrated larger posterior tilt of Δ standing at 20 years. Patients who demonstrate a large preoperative posterior shift from supine to standing deserve special consideration when undergoing THA. In such circumstances, we recommend that the anteversion of the cup not be excessive, given that there is a relatively high risk of further posterior tilt in PT, which may lead to anterior dislocation and edge loading. Further longitudinal study in a larger cohort of patients with complications including postoperative dislocation and revision, as well as older patients, is needed to verify these assumptions on the potential risk for dislocation and edge loading after THA. Level III, therapeutic study.

Risk factors of adjacent vertebral refracture after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in super-old patients

To analyze the risk factors for refracture of adjacent vertebrae after percutaneous vertebroplasty (PVP) in super-old patients with osteoporotic vertebral compression fractures(OVCFs). A retrospective analysis was performed on 40 patients(age≥90 years) with OVCFs who underwent PVP between June 2012 and June 2019. There were 7 males and 33 females, age from 90 to 101 years old with an average of (94.6±1.6) years. Patients were divided into two groups according to whether adjacent vertebral refracture occurred after PVP. Among them, 20 patients occurred refracture after PVP (refracture group) and 20 patients did not occur it(control group). The general information, radiological data and pelvic parameters of the two groups were collected. The items included age, gender, body mass index (BMI), fracture site and bone mineral density(BMD) T-value, fracture to operation time, compression degree of injured vertebra, recovery degree of anterior edge of injured vertebra, bone cement injection amount, bone cement leakage, pelvic index(PI), pelvic tilt angle (PT), sacral angle(SS), et al. Factors that may be related to refracture were included in the single-factor study, and multivariate Logistic regression analysis was performed on the risk factors with statistical significance in the single-factor analysis to further clarify the independent risk factors for refracture of adjacent vertebral bodies after PVP. There were no significant differences in age, gender, fracture site, fracture to operation time, compression degree of injured vertebra and recovery degree of anterior edge of injured vertebra between two groups (P>0.05). There were significant differences in BMI, BMD T-value, bone cement injection amount and bone cement leakage rate between two groups(P<0.05). The PI and PT values of the refracture group were higher than those of the control group(P<0.05). There was no significant difference in SS between two groups (P>0.05). Multivariate Logistic regression analysis showed that decreased BMD T-value, bone cement leakage, increased PT and PI values increased the risk of recurrence of adjacent vertebral fractures in OVCFs (P<0.05). There are many risk factors for the recurrence of adjacent vertebral fractures in super-old patients with OVCFs. Patients with high PI and PT values may be one of the risk factors.

Cervical Anatomical Landmarks Indicate the Amount of Vertebra Resection during ACAF Surgery: A Semi-Quantitative Anatomical Parameter Study on Imaging Data.

ObjectiveWith the innovation and development of cervical spine surgical procedures, there is currently a lack of new and reliable data on cervical anatomical landmarks. The purpose of this study is to measure the CT data of the cervical vertebrae of healthy volunteers, so as to make up for the missing part of the measured value of cervical vertebra bone markers, and provide data support for the safety and accuracy of anterior controllable antedisplacement and fusion (ACAF) surgery.MethodsFrom January 2019 to January 2020, the cervical computed tomography (CT) scan image data of volunteers in Changhai Hospital and Zhabei Hospital were randomly selected. The radiological parameters included three parameters were measured in the upper lamina plane. a: the distance from the anterior edge of the vertebral body to the anterior edge of the bilateral uncinate joint; c1: the sagittal diameter of the vertebral body; and d: the distance between the anterior edge of the uncinate joint. Three parameters were measured in the pedicle plane. b: the vertical distance from the anterior edge of the vertebral body to the junction line between the two lateral processes; c2: the sagittal diameter of the vertebral body; e: the transverse diameter of the vertebral body; and f: the sagittal diameter of the vertebral canal. The correlation ratios were calculated: a/c1, b/c2, a/f, b/f, d/e. The data between the two groups were compared by independent sample t‐test.ResultsFinally, 51 patients were included in this study, 18 males and 33 females, with an average age of 47.9 years (21–72 years). The maximum values of seven parameters measured were all at C7. The minimum b value was at C5, and the minimum f value was at C4. The minimum values of the other five parameters were all at C3, and there was an increasing relationship from C3 to C7 (P < 0.05). There was significant difference between male and female with regard to c1, c2, e and d values (P < 0.05). No significant differences were observed between men and women regard to the ratio of related parameters (a/c1, b/c2, a/f, b/f, d/e).ConclusionsAnatomical consideration of this area is useful to estimate amount of vertebral body resection when performing the bony cut made in ACAF surgery; however, pre‐operative examinations with appropriate radiographic analysis are also recommended.

Is the T-shaped acetabular fracture really likes a "T"? A study based on three-dimensional fracture mapping

ObjectivesTo explore the morphological pattern of T-shaped acetabular fractures (T-SAFs) by mapping the fracture line using 3D software. Material and methodsWe retrospectively reviewed 1298 consecutive patients with acetabular fractures, and a total of 56 T-SAF patients were enrolled. After the simulated reduction of each fracture in the software, the fracture lines of all patients were overlaid and plotted on a template. A frequency heat map was generated according to the differences in fracture line density distribution. According to the location of fracture lines, all cases were divided into three groups: posterior group, anterior group, extra-posterior group. In surgically treated patients, the surgical approach, fixation methods, and reduction quality were recorded or evaluated. ResultsThe transverse fracture line was sinuous without involving the acetabular roof, and the longitudinal fracture line sloped forward or backward along the edge of the acetabular fossa to split the obturator foramen. The anterior and posterior edges of the acetabular fossa, the transition zone of the acetabular roof and anterior wall, the transition zone of the superior pubic ramus and anterior wall, and the posterior wall near the greater sciatic notch were areas with high rates of fracture incidence. The posterior group included 26 patients (46.4%) and the distribution of fracture lines resembled a “T” or “Y”. The anterior group included 25 patients (44.6%) and the distribution of fracture lines resembled a “7″. The extra-posterior group included 5 patients (8.9%) and the fracture lines run through the ischial body. The surgical strategies vary among different groups of T-SAF patients. ConclusionOur findings shed light on the characteristics of fracture lines for T-SAFs and provide a reference for surgical treatment strategies.

Pseudolaguvia meghalayaensis, a new diminutive sisorid catfish (Teleostei: Siluriformes) from Northeastern India

Pseudolaguvia meghalayaensis, a new diminutive sisorid catfish, is described from the confluence of Rongkil and Rongdal streams (tributaries of the Brahmaputra River) in Meghalaya, India. It is distinguished from its congeners by a combination of characters: striae in thoracic adhesive apparatus strongly anastomosing and break up into small rounded plaques posteromedially, smooth anterior edge of dorsal spine, 8 branched pectoral-fin rays, supraoccipital spine not reaching nuchal shield, pectoral-fin length 17.120.1% standard length (SL), predorsal length 40.443.8% SL, preanal length 71.173.1% SL, body depth at anus 15.618.1% SL, anal-fin base length 12.212.7% SL, and post adipose fin length12.312.6% SL.

Anatomical and Imaging Study on the Optimum Entry Point and Trajectory for Anterior Transpedicular Root Screw Placement into the Lower Cervical Spine.

Objective To study the optimum entry point and trajectory for anterior transpedicular root screw (ATPRS) placement into the lower cervical spine (LCS), so as to provide a basis for clinical application. Methods A retrospective analysis of cervical CT images of patients who underwent cervical CT examination in the Spinal Surgery of Ningbo No. 6 Hospital from January 2020 to August 2021 was conducted. The data were obtained and modeled. On the coronal plane, the vertebral body (VB) between the anterior midline of cervical vertebral segments C3-7 and the left P line (by drawing the line parallel to the anterior midline of the VB at the intersection of the anterior edge of the Luschka's joint and the upper endplate) was equally divided into 9 zones (a-i). The ideal entry point and path of cervical ATPRS were designed and recorded. Additionally, 7 cadaveric specimens were selected, and the screw placement parameters were regenerated according to the above methods for screw placement. Results Zone i of each segment, with the longest screw length, was the best area for screw placement. In all patients, the horizontal angles of vertebrae C3-7 in zones a, d, and g, zones b, e, and h, and zones c, f, and i showed a gradually decreasing trend. The sagittal angle range of C3-7 in all patients showed a gradually increasing trend in zones a-c, d-f, and g-i. The distance from the anterior midline of C3-7 to the P line increased in all patients, and the distance was longer in males than in females, with statistical significance. Pedicle screws were successfully inserted in all the 7 cadaveric specimens. Conclusions ATPRS placement can be used for LCS internal fixation, and the precise screw placement parameters can be simulated by the software, which provides theoretical basis for its future clinical application.

Une petite taille et une faible distance entre le rebord acétabulaire antérieur et le nerf fémoral sont des facteurs de risque de paralysie du nerf fémoral après une arthroplastie totale de hanche primaire par l’approche modifiée de Watson-Jones

BackgroundNerve palsy following total hip arthroplasty (THA) critically impacts patient clinical function. However, few studies have focused on femoral nerve palsy (FNP) following THA via the modified Watson-Jones approach. Previous reports have suggested that THA, regardless of the approach, is associated with several FNP risk factors, including female gender, hip dysplasia, revision surgery, and short stature. Magnetic resonance imaging (MRI) has suggested that a shorter distance between the femoral nerve and the anterior acetabular edge (dFN) is related to FNP after THA. The purposes of this study were: 1) to determine the presumed risk factors through a retrospective investigation of FNP clinical courses; and 2) to identify the relationships between FNP occurrence and the short dFN following primary THA via the modified Watson-Jones approach. HypothesisShort stature is a risk factor for femoral nerve palsy following THA, i.e. a significant difference in dFN exists between patients with and without FNP. Patients and methodsThis retrospective case-control study was performed at a single university hospital. From January 2016 to December 2020, 676 THAs were performed via the modified Watson-Jones approach at our institution. These included 495 THAs performed in the supine position and 181 in the lateral position. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test<grade 3) with or without sensory disturbance over the anteromedial aspect of the thigh. The incidence of FNP was calculated. Patient background factors (age, sex, preoperative diagnosis, surgical position, height, weight, body mass index, surgeon experience, type of components, the method of anesthesia, leg lengthening during the surgery, and operation time) were compared between the FNP group and a non-FNP control group. The dFN was measured in T1-weighted MRI axial images at the level of the hip center. The distance between the femoral nerve and the anterior acetabular edges, where retractors are commonly placed during surgery, was also measured and compared between the FNP group and the non-FNP control group. The FNP group and non-FNP control group were extracted by 1:4 matching of patient height and weight. All data were statistically evaluated using the Mann-Whitney U test, and p-values less than 0.05 were considered statistically significant. ResultsFNP occurred in 6 out of 676 joints (0.88 %) following primary THA via the modified Watson-Jones approach. In all 6 cases, the motor deficit recovered completely within a year. Patient height was significantly shorter in the FNP group than in the non-FNP control group (148.4±3.3cm vs. 155.4±8.1cm (p=0.01)). The dFN was significantly shorter in the FNP group (16.3±4.1mm vs. 21.5±4.0mm (p=0.034)). ConclusionShort stature and short dFN are risk factors for FNP after THA using the modified Watson-Jones approach. Level of evidenceIII, case-control study.

Acanthopagrus oconnorae, a new species of seabream (Sparidae) from the Red Sea.

A new species of sparid fish, Acanthopagrus oconnorae, is described based on 11 specimens collected in the shallow (0-1m depth) mangrove-adjacent sandflats of Thuwal, Saudi Arabia. The new species is distinguished from its congeners by the following combination of characters: second anal-fin spine 12.8%-16.6% of standard length (SL); 3½ scale rows between the fifth dorsal-fin spine and lateral line; suborbital width 5.7%-6.7% of SL; eyes positioned at the anterior edge of the head, often forming a weakly convex break in an otherwise gently curved head profile, when viewed laterally; caudal fin light yellow with black posterior margin (approximately half of fin); anal fin dusky grey, with posterior one-fifth of the fin light yellow; black streaks on inter-radial membranes of anal fin absent. The most similar species to A. oconnorae is Acanthopagrus vagus, which differs by the presence of a w-shaped anterior edge of the scaled predorsal area, a more acute snout and black streaks on the inter-radial membranes of the anal fin. Phylogenetic placement and species delimitation of A. oconnorae are discussed based on COI, CytB and 16S sequences. It is hypothesized that ecology and behaviour explain how this species avoided detection despite its likely occurrence in coastal areas of the Red Sea with historically high fishing pressure.

Clinical Effect of Bone Filling Mesh Container Vertebroplasty in Osteoporotic Compression Fracture.

Objective To investigate the clinical application of bone filling mesh container vertebroplasty in osteoporotic vertebral compression fractures (OVCFs). Methods Patients with OVCF from October 2018 to April 2020 were selected. Patients in the control and study groups underwent percutaneous kyphoplasty (PKP) and bone filling mesh container vertebroplasty, respectively. The Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), visual analog scale (VAS) scores before and after surgery, and the incidence of complications were compared between the two groups. Results The operation time and fluoroscopy time of the study group were significantly lower than those of the control group (P < 0.05). There was no significant difference in the injection volume of bone cement between the study group and the control group (P > 0.05). There was no significant difference in Cobb angle between the two groups. Three months after the operation, the height of the anterior edge increased and the Cobb angle decreased in the two groups (P < 0.05), but there was no significant difference in the height of the anterior edge and the Cobb angle between the two groups (P > 0.05). The JOA scores increased, while the ODI and VAS scores decreased in both groups after surgery (P < 0.05). There was no significant difference in the total effective rate between the study group (96.15%) and the control group (92.31%) (P > 0.05). The incidence of complications in the study group (3.85%) was significantly lower than that in the control group (15.38%) (P < 0.05). Conclusions For the treatment of OVCFs, bone filling mesh container vertebroplasty is comparable to PKP in terms of functional recovery, but it can safely reduce operative time, fluoroscopy time, and complication rates.

Combined Application of Grid Body Surface Locator and Preemptive Analgesia in Daytime Vertebroplasty.

Objective To explore the clinical advantages of grid body surface locator combined with preemptive analgesia in the treatment of osteoporotic lumbar fractures in daytime vertebroplasty. Methods A retrospective study was conducted on 120 patients who underwent lumbar vertebroplasty in the Department of Orthopedics of General Hospital of Northern Theater Command from January 2017 to January 2020. According to the preoperative planning and analgesic mode of treatment, they were divided into the daily operation experimental group and the traditional mode control group. Prone positioning of a patient under anesthetic is safe of ensuring optimum surgical access for many procedures, providing that the risks are fully understood. The general baseline data, intraoperative fluoroscopy times and operation time, bone cement injection volume, bone cement permeability, VAS score before operation, 1 day, and 3 months after operation, and the recovery of anterior vertebral height before and after operation were analyzed. Results There was no statistically significant difference in the preoperative general data between the two groups. One day after operation, the VAS score of the experimental group was lower than that of the control group, but there was no difference after 3 months. The permeability of bone cement in the experimental group was lower than that in the control group, the height of anterior edge of injured vertebra was better than that in the control group, and the operation time was less than that in the control group. Conclusion The daytime operation experimental group can significantly alleviate postoperative pain, increase the amount of bone cement injection, and reduce the permeability of bone cement through preoperative planning of puncture path and key puncture points, combined with advanced labor pain, but there is no significant difference in long-term pain relief.

Coronamoeba villafranca gen. nov. sp. nov. (Amoebozoa, Dermamoebida) challenges the correlation of morphology and phylogeny in Amoebozoa

Coronamoeba villafranca gen. nov. sp. nov. is a small amoeba isolated from the surface planktonic biotope in the Bay of Villefranche (Mediterranean Sea). It has a confusing set of morphological and molecular characters. Its locomotive form is subcylindrical and monopodial with monoaxial cytoplasmic flow and occasional hyaline bulging at the anterior edge (a monotactic morphotype). Based on this set of characters, this amoeba is most similar to members of the genus Nolandella (Tubulinea, Euamoebida). However, molecular phylogenetic analysis based on only the small subunit ribosomal RNA (SSU rRNA) gene and on two concatenated markers (SSU rRNA gene and actin) robustly places this species in the Discosea, specifically, in a clade with Dermamoeba and Paradermamoeba (Dermamoebida) as the closest described relatives, and several SSU rRNA clones from environmental DNA. A unique glycocalyx of the studied amoeba consisting of complex separate units with pentameric symmetry may be considered a unifying character of this species with other dermamoebids. The monotactic morphotype demonstrated by these amoebae primarily occurs in Tubulinea but was recently confirmed in other clades of Amoebozoa (e.g. Dactylopodida and Variosea). This morphotype may be the plesiomorphic mode of cell organization in Amoebozoa that might have evolved in the last amoebozoan common ancestor (LACA) and conserved in several lineages of this group. It may reflect basic characteristics of the cytoskeletal structure and functions in Amoebozoa.

Clinical Effect of Minimally Invasive Percutaneous Pedicle Screw Internal Fixation Combined with Injured Vertebrae Bone Grafting in the Treatment of Thoracolumbar Fractures in Orthopedic Surgery.

Objective To observe the clinical effect of minimally invasive percutaneous pedicle screw internal fixation combined with injured vertebrae bone grafting in the treatment of thoracolumbar fractures in orthopedic surgery. Methods A total of 132 patients with thoracolumbar fractures admitted to the hospital were enrolled between January 2020 and April 2021. Both groups underwent minimally invasive percutaneous pedicle screw internal fixation. According to the presence or absence of intraoperative injured vertebrae bone grafting, they were divided into the grafting group (73 cases) and the injured vertebrae ungrafted group (59 cases). The perioperative indexes, pain at 2 weeks after surgery, surgical stress, recovery of an injured vertebra, self-care ability, quality of life, and postoperative complications were compared between the two groups. Result There was no significant difference in intraoperative blood loss, operation time, or hospitalization time between the grafting group and the nongrafting group (P > 0.05).2 weeks after surgery, scores of the Visual Analogue Scale (VAS) in the grafting group were lower than those in the nongrafting group (P < 0.05).At 3d after surgery, levels of serum cortisol (COR), epinephrine (E), and norepinephrine (NE) in both groups were higher than those before surgery, which were lower in the grafting group than in the nongrafting group (P < 0.05).At 3 months after surgery, the anterior edge height of the injured vertebra in both groups was increased, which was higher in the grafting group than in the nongrafting group (P < 0.05). At 3 months after surgery, the Cobb angle of sagittal kyphosis in both groups was decreased, which was lower in the grafting group than that in the nongrafting group (P < 0.05). At 3 months after surgery, the scores of activity of daily living (ADL) and the MOS item-short form health survey (SF-36) in both groups were higher than those before surgery, which were higher in the grafting group than in the nongrafting group (P < 0.05). The difference in the incidence rate of injured vertebrae collapse, internal fixation breakage, or kyphosis between the grafting group and the nongrafting group was not statistically significant (1.37% vs 6.78%) (P > 0.05). Conclusion Minimally invasive percutaneous pedicle screw internal fixation combined with injured vertebrae bone grafting in orthopedic surgery can improve postoperative pain and surgical stress in patients with thoracolumbar fractures, which is conducive to the recovery of injured vertebrae and improvement in the quality of life.

A new species of the genus Misgurnus (Cypriniformes, Cobitidae) from Ryukyu Islands, Japan.

A new loach species, Misgurnus amamianus, is described based on 27 type specimens sampled from Ryukyu Islands, Japan. This new species can be distinguished from its congeners by the following combination of characteristics. 1) In adult males, a lamina circularis at the base of the pectoral fin is poleaxe-shaped and rounded at the back. 2) The last ray of dorsal fin is not branched, and its length is less than half the length of the second-branched soft ray. 3) The projected length from the posterior edge of the anal-fin base to the caudal-fin base is longer than the length from the insertion point of the pelvic fin to the anterior edge of the anal-fin base. 4) The ridges on the caudal peduncle at the upper and lower edges are weakly developed. The validity of this new species is also supported by the phylogenetic analysis of the mitochondrial DNA control region.

Comparison of Arthroscopic versus Open Placement of the Fibular Tunnel in Posterolateral Corner Reconstruction.

Precise fibular tunnel placement in posterolateral corner (PLC) reconstruction is crucial in restoring rotational and lateral stability. Despite the recent progress of arthroscopic PLC reconstruction techniques, landmarks for arthroscopic fibular tunnel placement and a comparison to open tunnel placement have not yet been described. This study aimed to (1) identify reasonable soft-tissue and bony landmarks, which can be identified by either arthroscopy, fluoroscopy, or open surgery in anatomic fibular tunnel placement and (2) to compare accuracy and reliability of arthroscopic fibular tunnel placement with open surgery. In a retrospective study, 41 magnetic resonance images (MRIs) of the knee were analyzed with emphasis on distances of an ideal anatomic fibular tunnel to 11 soft-tissue and bony landmarks. Subsequently, in eight cadaver knees, the ideal fibular tunnel was created arthroscopically and with a standard open technique from antero-latero-inferior to postero-medio-superior with a 2-mm K-wire. Positions of both tunnels were compared on postinterventional computed tomography scans. Based on MRI measurements, the anatomic tunnel entry should be 14.50 (±2.18) mm distal to the tip of the fibular styloid and 10.76 (±1.37) mm posterior to the anterior edge of the fibula. The anatomic fibular tunnel exit was located 12.89 (±2.35) mm below the tip of the fibular head. Arthroscopic fibular tunnel placement was reliable in all cases. Instead, in five out of the eight cases with open surgery, the fibular tunnel crossed the defined safety distance to the closest cortical edge/tibiofibular joint (distance < 8 mm). Reliable soft-tissue and bony landmarks of the fibular head allow arthroscopic anatomic fibular tunnel placement in PLC surgery, which shows a lower risk of tunnel malposition compared with open surgical techniques. Future studies will have to show whether clinical results of arthroscopic PLC reconstruction are in line with this study's technical results. Level III.

Quantifying the physiologic motions of the pelvic viscera during evacuation in nulligravid asymptomatic women.

Pelvic organ prolapse (POP) is often diagnosed during an in-office examination, which looks for motion of the vaginal wall while performing a strain maneuver. It is believed that the pelvic organs in adequately supported women are relatively stationary. This study was aimed at investigating the physiological displacements of pelvic organs using MR defecography. This prospective cohort study included 19 volunteers. Midsagittal slices representing rest and the maximum movement of the posterior vaginal fornix during three maneuvers were identified. Normalized axes for analysis were defined as the x' (line connecting the inferior-posterior-most point on the pubic symphysis to the anterior edge of the sacrococcygeal joint) and the y' (line orthogonal to the x axis that passed through the sacral promontory). The positions of the posterior vaginal fornix, mid-vagina, bladder neck, anorectal junction, and hymen were recorded. These subjects were then analyzed using the current radiological grading system of POP to determine any overlap between asymptomatic subjects and diagnostic ranges of POP. Evacuation caused the most motion in the landmarks. The majority of the motion of the landmarks was along the y axis. The posterior vaginal fornix experienced significant descent (125% of the initial distance) without much anterior-posterior translation (7% of the initial distance) during defecation. All landmarks experienced similar trends. We have shown that there is significant rotational motion of the pelvic organs around the pubic bone in adequately supported women. This motion when described using radiological grading is likely to be considered mild or moderate prolapse, which may contribute to overdiagnosis of POP.

Poster 138: Hypertrophy of the Anterior Coracoacromial Ligament as an Etiology of Shoulder Pain in the Young Overhead Athlete: The CALPYSO condition

Objectives:Shoulder pain in the young overhead athlete is commonly thought to result from instability and SLAP pathology, but not from a primary subacromial space pathology. We encountered a series of young overhead athletes with shoulder pain not due to instability or SLAP pathology. All had pain at the anterolateral (AL) corner of the acromion. We report the clinical characteristics, pathology, and results of treatment of this previously unreported association.Methods:92 young (mean age 19 [13-26]) overhand athletes presented with shoulder pain unresponsive to conservative treatment. There were 54 (59%) males and 38 (41%) females. 76% had pain at the AL acromial corner. 71% had pain with an overhand arc of motion from Abd/ER to Abd/IR position. 53% had SLAP-type physical exam findings, but none had instability symptoms. Patients most commonly participated in the following sports: Baseball 38.5%, Swimming 16%, Softball 15%, and Volleyball 11%.Pre-op mean scores were: ASES= 60, SST= 7.5, and VAS pain= 4.3. All underwent EUA and arthroscopy. There was no evidence of instability or SLAP pathology. All had varying degrees of subacromial bursitis. But, the primary pathology was a thickened anterior CA ligament (CAL). The hypertrophic CAL inserted on the acromion, but also extended far laterally under the deltoid muscle. This formed an “awning” at the AL acromial corner which resulted in significant subacromial space compromise. The hypertrophic CAL anterior edge and lateral extension was excised and bursectomy performed in all and in 90% an osseous acromioplasty was performed as well. There were associated pathologic findings: 15 (16%) had posterior capsular contracture with GIRD, 10 (11%) had a posterior labral split tear at the equator of the glenoid.Results:At average follow-up of 2.2 years (1-5), all had returned to the former level of overhead sport activity. Rapid rehabilitation was possible and average time to return to sport was 19 weeks (8-52, SD 10.2). Seventy-five (81.5%) returned to the same level of sport. At final follow-up, mean VAS decreased from a preoperative level of 3.7 (SD 2.5, range 0-8) to a postoperative level of 0.6 (SD 1.1, range 0-4) (p<0.0001). Mean ASES score improved 30.7 points after surgery, corresponding to an improvement from a preoperative level of 63.1 (SD 19.7, range 26.7-100) to a postoperative level of 93.8 (SD 9.3, range 73.3-100) (p<0.0001). Simple shoulder test (SST) scores also improved from a preoperative level of 8.8 (SD 3.1, range 0-12) to a postoperative level of 11.6 (SD 1.0, range 8-12) (p<0.0001). There were no complications, re-operations, and no occult instability was revealed.Conclusions:Younger age (avg 19 yrs, high school and collegiate athletes) participating in overhand sports, typically year-round were defining, consistent factors in this patient population. Female athletes made up a substantial 41% of the series.We feel that symptomatic, hypertrophic anterior CAL is a variant of impingement, most likely due to use and overuse in a repetitive overhead sport. Overuse is recognized as an etiology for shoulder pathology including instability, SLAP lesion, and labral injury, but subacromial pathology is more thought of as a condition of an older age group. This clinical entity in this series, we feel, is another form of overuse pathology and is a primary subacromial space pathology. It was not secondary to occult instability or posterior capsule tightness or SLAP pathology. Thus, not all shoulder problems in young, overhead athletes should be attributed to occult instability or SLAP pathology.We have developed a mnemonic for this clinical entity: CALYPSO. C: Coracoacromial ligament A: Anterior band hypertrophy and L: Lateral extension under the deltoid. Y: Youth (high school and college age) P: Posterior capsular contracture and labral pathology. S: Subacromial bursitis; O: Overuse and Overhead sportClinicians should maintain a high index of suspicion for this clinical entity when evaluating young overhead athletes. In all cases, arthroscopy was successful in identifying and treating the pathology and all athletes were able to return to their previous level of sport.

MRI-Based Optimization Design of the Pre-Spinal Route of Contralateral C7 Nerve Transfer for Spastic Arm Paralysis.

PurposeThe prespinal route of contralateral cervical 7 nerve transfer developed by Prof. Wendong Xu helps realize the direct anastomosis of the bilateral cervical 7 nerves. However, 20% of operations still require a nerve graft, which leads to an unfavorable prognosis. This study aims to explore the optimized prespinal route with MRI to further improve the prognosis.MethodsThe current study enrolled 30 patients who suffered from central spastic paralysis of an upper limb and who underwent contralateral cervical 7 nerve transfer via Prof. Xu’s prespinal route through the anterior edge of the contralateral longus colli. MRI images were used to analyze the route length, vertebral artery exposure, and contralateral cervical 7 nerve included angle. Three prespinal routes were virtually designed and analyzed. The selected optimal route was applied to another 50 patients with central spastic paralysis of an upper limb for contralateral cervical 7 nerve transfer.ResultsBy the interventions on the 30 patients, the middle and posterior routes were shorter than the anterior route in length, but with no statistical difference between the two routes. Of 30 contralateral vertebral arteries, 26 were located at the posterior medial edge of the longus colli. The average included angles of the anterior, middle, and posterior routes were 108.02 ± 7.89°, 95.51 ± 6.52°, and 72.48 ± 4.65°, respectively. According to these data, the middle route was optimally applied to 50 patients, in whom the rate of nerve transplantation was only 4%, and no serious complications such as vertebral artery or brachial plexus injury occurred.ConclusionThe low rate of nerve transplantation in 50 patients and the absence of any serious complications in these cases suggests that the middle route is the optimal one.

The Feasibility and Treatment Results of Transcanal Endoscopic Myringoplasty

We reported on transcanal endoscopic myringoplasty in 25 cases preliminarily in 2014. Now our number of transcanal endoscopic myringoplasty reached to 209 ears and allowed us to adequately investigate the visibility, necessity of canalplasty, treatment results, and multivariate analysis. A prospective case series. Tertiary referral center. Transcanal endoscopic myringoplasty was performed on 209 ears in 201 patients between 2011 and 2019 and followed up over 1 year. Preoperative endoscopic and microscopic views for the same patient were compared. We examined success rates at 1 year after surgery according to operation type, perforation size, operation side, gender, cause of perforation, and age, and also examined hearing results. Logistic regression analysis was performed to investigate the basic demographic and clinical characteristics of the patients associated with perforation closure. The anterior edge of the preoperative perforation was not visible under microscopy in 14.4% of patients. In contrast, endoscopic views revealed the entire tympanic membrane in one field. However, canalplasty was required in 2.4% of tympanic procedures due to difficulty of manipulation. The overall closure rate for perforations was 90.4%. Logistic regression analysis revealed that age > 11 was the only significant factor associated with perforation closure. The average reduction in air-bone gap was 12.1 dB. The endoscopic myringoplasty produced better visualization, the same or better closure rates, and the same or lower complication rates as compared with traditional microscopic techniques.

Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome.

ObjectiveThis study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.MethodsA series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including “lesion perforating”, “aspiration”, “cutting‐and‐scraping” and “biopsy forceps utilization” were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.ResultsEight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow‐up period (1–39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.ConclusionWith a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well‐tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.