Anterior Slope Research Articles

Anterior Slope–Modifying Osteotomies Alter the Length Change Behavior of the Superficial Medial Collateral Ligament: A Biomechanical Study

Background: Increased tibial slope has been shown to lead to higher rates of anterior cruciate ligament graft failure. A slope-decreasing osteotomy can reduce in situ anterior cruciate ligament force and may mitigate this risk. However, how this procedure may affect the length change behavior of the medial ligamentous structures is unknown. Purpose/Hypothesis: The purpose of this study was to examine the effect of anterior slope–modifying osteotomies on the medial ligamentous structures. It was hypothesized that (1) decreasing the tibial slope would lead to shortening of the superficial medial collateral ligament (sMCL), (2) while the fibers of the posterior oblique ligament (POL) would be unaffected. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen cadaveric knee specimens underwent anatomic dissection to precisely identify the medial ligamentous structures. The knees were mounted in a custom-made kinematics rig with the quadriceps muscle and iliotibial tract loaded. An anterior slope–modifying osteotomy was performed and fixed using an external fixator, which allowed modification of the wedge height between −15 and +10 mm in 5-mm increments. Threads were mounted between pins positioned at the anterior, middle, and posterior parts of the tibial and femoral attachments of the sMCL and POL. For different tibial slope modifications, length changes between the tibiofemoral pin combinations were recorded using a rotary encoder as the knee was flexed between 0° and 120°. Results: All sMCL fiber regions shortened with slope reduction (P < .001) and lengthened with slope increase (P < .001), with the anterior sMCL fibers more affected than the posterior sMCL fibers. A 15-mm anterior closing-wedge high tibial osteotomy (ACWHTO) resulted in a 6.9% ± 3.0% decrease in the length of the anterior sMCL fibers compared with a 3.6% ± 2.3% decrease for the posterior sMCL fibers. A 10-mm anterior opening-wedge high tibial osteotomy (AOWHTO) increased anterior sMCL fiber length by 5.9% ± 2.3% and posterior sMCL fiber length by 1.6% ± 1.0%. The POL fibers were not significantly affected by a slope-modifying osteotomy. Conclusion: Tibial slope–modifying osteotomies changed the length change pattern of the sMCL such that an AOWHTO increased whereas an ACWHTO decreased the sMCL strain. This effect was most pronounced for the anterior fibers of the sMCL. The length change pattern of the POL remained unaffected by slope-modifying osteotomy. Clinical Relevance: Surgeons should be aware that anterior tibial slope–modifying osteotomies affect the biomechanics of the sMCL. After an extensive ACWHTO, patients may develop a medial or anteromedial instability, while an AOWHTO may overconstrain the medial compartment.

Variation of chin morphology and mandibular incisor length in different facial divergence patterns: New insights from CBCT records.

Evaluate constitutional differences in chin morphology and volume, and mandibular tooth size, between different facial divergence patterns. The sample consisted of 284 pretreatment cone beam computed tomography (CBCT) images of growing and non-growing patients who were stratified into 4 groups based on mandibular plane inclination to cranial base (SN) angle. Linear and angular measurements were made on the lateral CBCT images: mandibular lateral incisor crown (I-C) total (I-A) lengths, the distances between point D (centre of symphysis) and both incisor apex (D-A) and menton (D-Me) and between cemento-enamel junction and menton (CEJ-Me); chin width at the level of the central incisor apex (CWA) and point D (CWD); and the angles of the anterior and posterior symphyseal slopes. The volume of the symphysis was measured using a specialized 3D imaging software. Group differences and associations between parameters were gauged through the three-way ANOVA analysis. I-C, I-A, D-A, D-Me and CEJ-Me were greater in the hyperdivergent group (p < .001). CWA and CWD were wider in the hypodivergent group (p = .003). Volume of the chin and inter-slope angles were similar in all groups (p > .05). The anterior slope angle decreased with hyperdivegence (p < .005) in opposite pattern to the posterior slope angle (p < .005). Shape differences in mandibular symphysis were observed between opposite divergence patterns. Mandibular incisors were longer with hyperdivergence and shorter with hypodivergence. However, chin volumes were similar across divergence groups. These findings underline the role of genetic and environmental factors that impact facial growth.

Prognostic factors for recurrent instability in recreational athletes following arthroscopic Bankart repair: a retrospective study with an average 4.1-year follow-up

BackgroundExtensive research has been conducted to investigate the short-term and long-term outcomes of arthroscopic Bankart repair, yielding varying results across different populations. However, there remains a dearth of studies specifically focused on evaluating outcomes in recreational athletes.MethodsA retrospective case series study was conducted on recreational athletes who underwent isolated arthroscopic Bankart repair between 2013 and 2021. The primary outcome assessed was recurrent instability, defined as dislocation or subluxation. Secondary outcomes included patient satisfaction, rates of returning to the same sports (RTS) and RTS at preinjury level, and patient-reported outcomes. Evaluation of the Rowe score, Constant score, American Shoulder and Elbow Surgeons score, and VAS pain score were performed. Prognostic factors for recurrent instability, including demographic and clinical characteristics, as well as postoperative magnetic resonance imaging (MRI) appearance of the labrum were analyzed.ResultsA total of 191 patients met the selection criteria, with 150 (78.5%) available for the final follow-up. Recurrent instability occurred in 10.7% of patients, with a mean follow-up duration of 4.1 years. Younger age at surgery and more critical glenoid bone loss were significantly associated with recurrent instability (p = .038 and p = .011, respectively). The satisfaction rate regarding surgery was 90.0%. Rates of return to the same sports (RTS) and RTS at preinjury level were 82.0% and 49.3%, respectively. Clinical outcomes measured at the final follow-up were as follows: Rowe score − 92.8; Constant score − 98.0; ASES score − 98.3; VAS pain score − 0.2. Patients with recurrent instability had significantly inferior outcomes in terms of satisfaction rate, RTS at preinjury level rate, Rowe score, and Constant score (p = .000, p = .039, p = .000, and p = .015, respectively). A total of thirty-seven patients underwent MRI examination six months after surgery in our institution. The T2-weighted anterior labrum morphology was found to be poorer in patients with recurrent instability. No significant difference was observed between patients with or without recurrent instability in terms of anterior Slope, anterior labral glenoid height index (LGHI), inferior Slope, inferior LGHI, and T2-weighted inferior labrum morphology.ConclusionArthroscopic Bankart repair can yield satisfactory medium-term outcomes for recreational athletes. Younger age at surgery, more critical glenoid bone loss, and poorer T2-weighted anterior labrum morphology assessed six months postoperatively were significantly associated with recurrent instability.

Anterior Opening-Wedge Proximal Tibial Osteotomy for Slope Correction of Genu Recurvatum

Background: Symptomatic genu recurvatum is defined as greater than 5° of knee hyperextension and can be caused by osseous deformity, soft tissue laxity, or a combination. Common symptoms include pain, weakness, instability, decreased range of motion, leg length discrepancy, and stretching of the posterior capsuloligamentous structures of the knee. In instances where the genu recurvatum is caused by reverse tibial slope, literature supports the use of anterior opening-wedge proximal tibial osteotomy (OW PTO) to treat genu recurvatum by increasing tibial slope. Correction of anterior slope to a more anatomic, posterior orientation allows any stressed ligaments to return to their normal tension and restores the native biomechanics of the knee. Indications: The primary indication for OW PTO is genu recurvatum that is nonresponsive to physical therapy or genu recurvatum with concurrent ligamentous injury. The heel-height test provides an objective assessment for the identification and measurement of knee hyperextension. Technique Description: 2 guide pins are placed parallel to the tibial plateau, engaging the posterior cortex. A small micro sagittal saw is used to cut the anterior cortex. Osteotomes are used to complete the osteotomy, preserving a posterior hinge. An opening spreader device is placed and opened slowly while keeping the posterior cortex intact. The new slope is maintained by use of an opening wedge osteotomy plate and screws. Allograft bone graft is packed thoroughly into the osteotomy site. Fluoroscopy is used throughout the case to assess appropriate orientation and depth of the osteotomy, as well as the final opening width. Results: A review of 5 studies demonstrated adequate reduction in hyperextension, with a mean knee hyperextension ranging from 17° to 32° preoperatively and 0° to 7° postoperatively. Patients had significantly improved postoperative clinical outcomes compared with the preoperative state. Discussion/Conclusion: Anterior OW PTO has been shown to be a safe method of accurately correcting tibial plateau slope for the treatment of genu recurvatum. Patients can expect correction of knee hyperextension, restoration of anatomic posterior tibial slope, decreased posterior tibial translation, and increased subjective outcome scores. Patient Consent Disclosure Statement: The author(s) attest that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Tibial Slope Is Not Associated With Implant Migration Following Cemented Total Knee Arthroplasty With a Single Implant Design

BackgroundThe influence of tibial slope on tibial component migration following total knee arthroplasty has not been widely studied, although excessive posterior slope has been implicated in some failures. As implant micromotion measured with radiostereometric analysis can indicate successful fixation, the purpose of this study was to determine the associations between tibial slope, tibial component migration, and inducible displacement. MethodsRadiostereometric analyses at 6 visits over 2 years quantified implant migration for 200 cemented total knee arthroplasties. Longitudinal data analysis examined the influence of postoperative tibial slope on implant migration (overall maximum total point motion (MTPM) migration and anterior–posterior tilt migration), accounting for age, sex, and body mass index. The correlations of tibial slope with 1-year migration, continuous migration, and inducible displacements were also examined. Additionally, the amount of change in slope was compared to migration. ResultsThe mean posterior tibial slope was 8.0° (standard deviation [SD] 3.8°) preoperatively and 3.8° (SD 3.1°) postoperatively, with a mean reduction in slope of 4.2° (SD 4.7°). Postoperative tibial slope (range 14.0° posterior slope to 3.4° anterior slope) was not associated with longitudinal overall migration (P = .671) or anterior–posterior tilt migration (P = .704). There was no association between postoperative tibial slope and migration at 1 year postoperatively (P = .441 for MTPM migration, P = .570 for tilt migration), change in migration from 1 to 2 years (P = .951), or inducible displacement (P = .970 MTPM, P = .730 tilt). The amount of change in tibial slope was also not associated with migration or inducible displacement. ConclusionsResidual and change in postoperative tibial slope were not associated with implant migration into tilt or overall migration, or inducible displacement for a single implant design. These findings support positioning tibial implants in a range of slopes, which may support patient-specific approaches to implant alignment.

Overlooked shell features: asymmetrical columellar folds in volutid gastropods

ABSTRACT Many gastropods have columellar folds, defined as continuous spiral ridges extending from the aperture to the shell interior on the adaxial side of the aperture. Despite their ubiquity, columellar folds have received little phylogenetic or functional study. In the vast majority of cases, columellar folds have a symmetrical profile, with the anterior (abapical) slope similar to the posterior (adapical) slope. Here I draw attention to the highly unusual phenomenon of asymmetry of columellar folds, where the anterior slope is markedly less inclined than the posterior slope of each fold. I have detected this condition in the volutid genera Scaphella Swainson, 1832; Cymbiola Swainson, 1831 and Lyrischapa Aldrich, 1911; as well as in the Palaeocene and Eocene genus Eovasum Douvillé, 1920. Following a review of Lyrischapa and Eovasum, I suggest that these two genera are closely related members of the volutid subfamily Indovolutinae, and that asymmetrical columellar folds have evolved three times in Volutidae. Although their function remains elusive, asymmetrical folds might prevent abapical displacement of the soft parts during rapid extension of the foot or feeding organs.

FEATURES OF THE TREATMENT OF HYPERMOBILITY OF THE ARTICULAR HEADS AND DISLOCATIONS OF THE LOWER JAW ON THE BACKGROUND OF FRACTURES OF THE CONDYGAL PROCESSES OF THE MANDIBLE, AS A PREVENTION OF ALLOPLASTIC REPLACEMENTS OF THE TEMPOMANDIBULAR JOINT

Acute, chronic, and recurrent dislocations are currently defined as conditions in which the mandibular process becomes dislocated from its joints and requires manipulation by another person to return to its normal position. Such conditions are usually preceded by either iatrogenic factors, including fractures of the mandibular branch, or joint instability and hypermobility of its heads. This pathology requires a personalized treatment algorithm: in each case, the clinical and radiological signs of this pathology should be clearly taken into account and the method of conservative or surgical treatment should be determined. Each of them has its advantages and disadvantages, and their combined use is also possible, which is the key to preventing more significant complications that can lead to allostatic replacements, joint components, or joint replacement as a whole.&#x0D; The purpose of the study is to conduct a comparative analysis of the data of clinical examinations, conservative and surgical treatment, complications and postoperative results, taking into account the prevalence of chronic dislocations of the mandible against the background of condylar fractures.&#x0D; Clinical cases of chronic dislocations of the mandible lasting from one to three months after osteosynthesis were analyzed by the authors. Attempts at manual reduction did not bring a positive result, so it was decided to treat the patients conservatively, using bite blocks made of self-hardening plastic and the use of elastic methods of fixation of the mandible, which gave a positive result already in the third week of treatment. Also, these patients were observed in the clinic for 6 months without visualization of complications of both mechanical and inflammatory nature.&#x0D; The analysis of clinical case data allows us to state that the goal of treatment should be to return the condyles to their original physiological position, and conservative methods should be in the first place when creating an algorithm. Early manual reduction of the joint heads is the best method of treatment, if it is possible to carry it out in a timely manner. As the duration of the dislocation increases, the joint cavity is filled with connective tissue, cartilaginous changes occur, adhesions between the articular surfaces are formed, the masticatory muscles shorten with possible fibrosis of the temporalis muscle. We have confirmed the fact that one of the best conservative treatments is the use of an elastic chin-parietal bandage, which acts as a fulcrum to move the heads back under the anterior slope of the articular tubercle, with the simultaneous use of arches and posterior occlusal rollers. If this treatment does not bring a positive result, we use intraoral splints with a fulcrum in the area of the second molar in combination with extraoral traction to move the heads in the posterior direction with simultaneous stretching of the capsule of the temporomandibular joint and its intracapsular ligaments.&#x0D; It should be noted that in each case, all the features of the pathogenesis of this disease should be taken into account and a personalized treatment algorithm should be developed, consisting of conservative methods, and, if ineffective, surgical treatment.

CT data analysis of temporomandibular joint morphology in patients with Open-mouth breathing

ObjectiveThis study aims to investigate the correlation between open-mouth breathing and temporomandibular joint morphology by examining CT data in patients. MethodsFrom January to December 2022, 31 patients with open-mouth breathing and 20 with normal breathing were chosen from those attending the Stomatological Hospital of Chongqing Medical University. We compared condylar measurements among normal breathers (NB), pre-operative open-mouth breathers (Pre-OB), and post-operative open-mouth breathers (Post-OB) to identify statistically significant differences. ResultsUpon comparing the measurement parameters of the NB with the Pre-OB, we found significant statistical differences in the bilateral condylar height, depth of the articular fossa, anterior joint space, and the anterior inclined plane length of the condyle (p < 0.05).Further examination of the Pre-OB, when considering duration of open-mouth breathing, revealed pronounced differences in the condylar mediolateral diameter, fossa depth, anterior joint space, condylar height, and the condyle's horizontal angle (p < 0.05).Regarding the A/N ratio, it showed no significant correlation with the preoperative oral breathing group. Lastly, compared with Pre-OB, Post-OB highlighted a distinct statistical increase in the anterior slope length of the condyle (p < 0.05). ConclusionA discernible correlation between open-mouth breathing and condylar morphology exists. Continuous open-mouth breathing contributes to adaptive changes in the condylar morphology. Although limited post-operative data suggests that halting open-mouth breathing doesn't immediately result in condylar modifications, a relationship between the two phenomena remains evident.

MRI evaluation of condylar bone regeneration after temporomandibular joint disc reduction and suture and analysis of factors affecting bone regeneration

Objective: To evaluate the MRI manifestations of condylar bone regeneration after disc reduction and suture for anterior disc displacement without reduction (ADDWoR) patients and to analyze the relevant factors affecting bone regeneration. Methods: A total of 61 patients of 75 joints with ADDWoR who attended the Department of Maxillofacial Surgery of the Affiliated Hospital of Stomatology of Nanjing Medical University from April 2020 to December 2021 were enrolled in the study. The characteristics of MRI condylar bone regeneration were analyzed before and after surgery (follow-up for 6 months or more), and logistic regression analysis was performed on the influencing factors of bone regeneration. Results: The new bone formation of the condyle was found in 28 patients, with age of (20.2±4.9) years. However, there were 33 patients that had no condylar bone regeneration, with age of (41.9±17.5) years. A total of 35 joints in this study were found new bone formation. There were 16 joints (45.7%) had new bone formation on the posterior slope of the condyle, 10 joints (28.6%) around the condyle, 6 joints (17.1%) on the anterior slope of the condyle, and only 3 joints (8.6%) on the top of the condyle. Multivariate logistic regression analysis showed that age, preoperative disc length and degree of condylar bone resorption correlated with postoperative condylar bone regeneration(P<0.05). Patients younger than 30 years with non-shortened preoperative disc length and less condylar bone resorption have a higher probability of new bone formation. Conclusions: The condyle has bone regeneration capacity after correcting the abnormal relationship between disc and condyle, and young age, non-shortened preoperative disc length and less condylar bone resorption are conducive to postoperative condylar bone regeneration.

Poster 318: CHANGE IN POSTERIOR TIBIAL SLOPE FOLLOWING DISPLACED PEDIATRIC TIBIAL TUBERCLE FRACTURES: A POTENTIAL MODEL FOR GROWTH MODULATION IN THE ACL DEFICIENT KNEE

Objectives: Increased posterior tibial slope angle (PTSA) increases the risk for anterior cruciate ligament (ACL) tear and ACL graft failure. Proximal tibial slope changing osteotomies are employed in the adult population; growth modulation procedures may present a treatment opportunity in the skeletally immature. This procedure has not been described in the context of ACL injuries, and the rate at which posterior tibial slope could be corrected is unknown. Our purpose was to quantify the rate of change in PTSA following operatively treated displaced tibial tubercle fractures in skeletally immature patients, and to determine how this rate is affected by skeletal age. We hypothesized that there would be a progressive loss of posterior tibial slope after injury, and that rate of change in PTSA would be highest during peak growth velocity Methods: We retrospectively reviewed skeletally immature patients with tibial tubercle fractures treated with ORIF. We measured posterior tibial slope angle (PTSA) at ˜3-, 6-, 12-months, and further postoperative time points if available. All subjects had a minimum of 6-months follow up. Bone age at the time of injury was determined. Negative PTSA was indicative of posteriorly directed slope, positive PTSA indicated anterior slope. Linear regression analysis was used to evaluate rate of change in PTSA (ΔPTSA) for individual patients and total cohort trend. Patient regression coefficients were averaged into bone age cohorts. The unit of analysis was the knee. Results: Twenty-two patients with 23 knees were included. 86% of patients were male. Average chronologic and bone age was 14 years at time of injury. Average follow-up was 17 months (range 6 to 52 months). Patients had a mean PTSA of -12˚ ± 2.4˚ at the time of injury. The overall mean ΔPTSA for the cohort was 0.30˚ ± 0.31˚ per month (range -0.27˚ to 0.97˚ per month). Linear regression revealed a significant relationship between months post-fixation and PTSA, demonstrating a ΔPTSA of +0.31˚ per month (CI 95% (0.24, 0.38); p&lt;.001) (Figure 1). The highest average ΔPTSA was seen at 14-years (0.58˚ ± 0.44˚ per month). The average overall absolute change in PTSA from injury to final follow-up was +4.1˚ (range -3.4˚ to 21˚) (Figure 2). Conclusions: Our data suggest progressively more anterior slope following ORIF. The greatest rate of change in PTSA corresponded with peak growth velocity. These findings may serve as a model for predicting the effect of anterior proximal tibia epiphysiodesis on tibial slope in ACL surgery.

Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders.

This study aimed to explore the quantitative and qualitative condylar changes following stabilization splint (S.S) therapy, including condylar position, morphology, and bone mineral density (BMD) in subjects with temporomandibular disorders (TMD). In this retrospective clinical study, we enrolled 40 TMD subjects (80 joints) aged 18 to 35years, for whom a S.S was used to treat TMD. The 80 TMD consists of 32 masticatory muscle disorders (myalgia) and 48 TMJ disorders (arthralgia). Cone beam computed tomography (CBCT) was used to scan the TMJs of subjects pre- and post-treatment for three-dimensional analysis (3D). Using Mimics software v.21.0, quantitative (3D condylar and joint spaces dimensions parameters were measured using linear measurements in millimeters, according to the Kamelchuk method and Ikeda method, while the assessment of anteroposterior condyle position within the glenoid fossa was based on the method of Pullinger and Hollender), and qualitative (a round bone tissue with an area of 2 mm2 in three representative areas according to the Kamelchuk method to measure condylar BMD) pre- and post-treatment. Intra- and inter-group statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal-Wallis test, respectively. The course of treatment was 6-12months, with an average of 9.1months. For the pre- and post-treatment quantitative comparisons, there was a statistically significant difference in the anterior joint space (AJS) and coronal medial space, as well as the condyle length in the myalgia group and condylar width in the arthralgia group. For qualitative measurements, a significant difference was observed in the posterior slope of the myalgia group and the arthralgia group's anterior, superior, and posterior slopes. The inter-group comparisons revealed significant differences in AJS, condylar length, and anterior slope density. In short-term follow-up, the S.S influenced patients with TMD from different origins; it changes anterior and coronal medial joint space, condyle length in myalgia, and width in arthralgia. Furthermore, it improved the condyle bone density more evidently in arthralgia. This study highlights the influence of S.S on symptomatic populations with TMD of different origins from a qualitative and quantitative perspective.

A pilot investigation of condylar position and asymmetry in patients with unilateral posterior scissors-bite malocclusion based on three-dimensional reconstructive imaging technique

ObjectiveUnilateral posterior scissors-bite (uPSB) malocclusion is common clinically. This study aimed to investigate the condylar morphological alterations and condyle-fossa relationship in patients with uPSB, through cone beam computed tomography (CBCT) and three-dimensional reconstructive imaging technique.MethodsA retrospective study was designed to comparatively analyze 95 patients with uPSB between July 2016 and December 2021. They were divided into three subgroups: 12 to 20, 21 to 30, and ≥ 31 years, according the age distribution. The morphological parameters regarding condyle, fossa, and joint space after three-dimensional reconstruction were measured and analyzed by a series of digital software. SPSS 26.0 software package was performed for statistical analysis on data sets, using paired t–test, one–way analysis of variance, Wilcoxon signed–rank sun test, Kruskal–Wallis H test, and Bonferroni correction.ResultsThe condylar volume (CV) of scissors-bite side was greater than that of the non-scissors-bite side (CVA = 1740.68 ± 559.80 mm3 > CVN = 1662.25 ± 524.88 mm3, P = 0.027). So was the condylar superficial area (CSA) (CSAA = 818.71 ± 186.82 mm2 > CSAN = 792.63 ± 173.44 mm2, P = 0.030), and the superior joint space (SJS) [SJSA = 2.46 (1.61, 3.68) mm) > SJSN = 2.01 (1.55, 2.87) mm), P = 0.018], and the anterior joint space (AJS) (AJSA = 3.94 ± 1.46 mm > AJSN = 3.57 ± 1.30 mm, P = 0.017). The constituent ratios of the different parts of the bilateral condyles were 23% on the posterior slope, 21% on the top, 20% on the anterior slope, 19% on the lateral slope and 17% on the medial slope, respectively.ConclusionDue to long-term abnormal occlusion of uPSB, the pathological bite force in temporomandibular joint would cause changes in the shape of the condyle. Among them, CV, CSA, SJS and AJS had significant changes in the scissors-bite status, which has the greatest damage to the posterior slope of the condyloid process.

РЕНТГЕНОЛОГИЧЕСКАЯ ОЦЕНКА СТРУКТУРНО-ТОПОГРАФИЧЕСКИХ ПАРАМЕТРОВ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА ПОСЛЕ ОРТОГНАТИЧЕСКОГО ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ЗУБОЧЕЛЮСТНЫХ АНОМАЛИЙ С ЯВЛЕНИЯМИ КОНДИЛОРЕЗОРБЦИИ

Purpose: Using the methods of radiation diagnostics, to trace in dynamics the structural and topographic state of the temporomandibular joint (TMJ) before and after orthognathic treatment of patients with air conditioning Material and Methods: A CT analysis of the TMJ condition was carried out before and after orthodontic surgical removal of the dentofacial anomaly (skeletal form) with the effects of Candyline resorption. We used the method of Fadeev R.A. et al. to assess the TMJ parameters: height of the head of the lower jaw; anterior and posterior articular angle; the width of the joint space in the upper, anterior, posterior, mesial and lateral sections; maximum width of the head of the lower jaw; density of cortical and cancellous bones of the head of the lower jaw; height of the articular fossa; the length of the anterior slope of the articular fossa; angle of the anterior slope of the articular fossa; the length of the posterior slope of the articular fossa; angle of the posterior slope of the articular fossa. Results: Comparison of CT parameters of TMJ before and after orthognathic treatment reveals a positive trend in remodeling of the articular process of the lower jaw after surgery, as evidenced by a noticeable increase in the width of the head of the lower jaw with a slight decrease in its height. The absence of compression in the bilaminar zone of the TMJ is recorded due to an increase in the width of the joint space in the posterior section, although the width of the joint space in the upper and anterior sections still does not correspond to normal values. The preservation of a lower density of the cortical and spongy layers of the articular head in comparison with the norm is apparently associated with continued adaptation to the new position of the articular processes and changed functional loads. Conclusion: A comprehensive orthodontic and surgical approach to the elimination of dentoalveolar anomalies is effective and can be recommended in the treatment of patients with skeletal anomalies and condyloresorption, as it provides not only a significant improvement in facial aesthetic parameters, but also has a positive effect on the structural and topographic parameters of the temporomandibular joint.

The effect of lumbar spinal fusion on native acetabular anteinclination in standing position.

The complex and dynamic spinopelvic interplay is not well understood. The aims of the present study were to investigate the following: (1) whether native acetabular anteinclination (AI) in standing position changes following lumbar spinal fusion (LSF); (2) potential correlations between AI change (ΔAI) and several spinopelvic parameters such as the change in lumbar lordosis (ΔLL), pelvic tilt (ΔPT), and anterior pelvic plane angle (ΔaPP). A total of 485 patients (Males: 262, Females: 223) with an average age of 64 ± 13years who underwent a primary LSF were identified from our institutional database. The difference (Δ) between pre-and postoperative acetabular anteinclination (AI), lumbar lordosis (LL), anterior pelvic plane angle (aPP), sacral slope (SS), and pelvic tilt (PT) were measured on a standing lateral radiograph (EOS®) and compared to find the effect of LSF on the lumbopelvic geometry. Following LSF, the average absolute ΔAI was 5.4 ± 4 (0to26)°, ΔLL: 5.5 ± 4 (0 to 27)°, ΔaPP: 5.4 ± 4 (0 to 38)°, ΔPT: 7 ± 5 (0to 33)° and ΔSS: 5.3 ± 4 (0to 33)°. No significant differences were observed between LSF levels. A ΔAI ≥ 10° was observed in 66 (13.6%) and ΔAI ≥ 20° in 5 (1%) patients. The Pearson correlation demonstrated a strong negative correlation of ΔAI with ΔLL (r = 0.72, p < .001). Clinical decision-making should consider the relationship between native anteinclination and lumbar lordosis to reduce the risk of functional acetabular component malalignment in patients with concomitant hip and spine pathology. Retrospective case-control study, Level III.

Endurance running during late murine adolescence results in a stronger anterior cruciate ligament and flatter posterior tibial slopes compared to controls

BackgroundAnterior cruciate ligament (ACL) injury rates continue to rise among youth involved in recreational and competitive athletics, requiring a better understanding of how the knee structurally and mechanically responds to activity during musculoskeletal growth. Little is understood about how anatomical risk factors for ACL injury (e.g., small ACL size, narrow intercondylar notch, and steep posterior tibial slope) develop and respond to increased physical activity throughout growth. We hypothesized that the ACL-complex of mice engaged in moderate to strenuous physical activity (i.e., endurance running) throughout late adolescence and young adulthood would positively functionally adapt to repetitive load perturbations.MethodsFemale C57BL6/J mice (8 weeks of age) were either provided free access to a standard cage wheel with added resistance (n = 18) or normal cage activity (n = 18), for a duration of 4 weeks. Daily distance ran, weekly body and food weights, and pre- and post-study body composition measures were recorded. At study completion, muscle weights, three-dimensional knee morphology, ACL cross-sectional area, and ACL mechanical properties of runners and nonrunners were quantified. Statistical comparisons between runners and nonrunners were assessed using a two-way analysis of variance and a Tukey multiple comparisons test, with body weight included as a covariate.ResultsRunners had larger quadriceps (p = 0.02) and gastrocnemius (p = 0.05) muscles, but smaller hamstring (p = 0.05) muscles, compared to nonrunners. Though there was no significant difference in ACL size (p = 0.24), it was 13% stronger in runners (p = 0.03). Additionally, both the posterior medial and lateral tibial slopes were 1.2 to 2.2 degrees flatter than those of nonrunners (p < 0.01).ConclusionsPositive functional adaptations of the knee joint to moderate to strenuous exercise in inbred mice offers hope that that some anatomical risk factors for ACL injury may be reduced through habitual physical activity. However, confirmation that a similar response to loading occurs in humans is needed.

The relation between incisal guidance angle and the growth and development of temporomandibular joint: a multi-cross-sectional retrospective study

BackgroundThe incisal guidance angle (IGA) is related to temporomandibular joint (TMJ), and changes to the IGA are often involved in the prosthetic and orthodontic treatment of anterior teeth. However, the influence of incisal guidance on the growth, development and remodelling of the TMJ is not yet clear. The aim of this study was to investigate age-related morphological differences in the TMJ in subjects with different IGAs.MethodsCone-beam computed tomography (CBCT) images of 274 patients were included (group 1, IGA < 45°; group 2, 45° ≤ IGA ≤ 60°; group 3, IGA > 60°). Each group was then divided into 4 age groups (group a, 6–12 years; group b, 13–16 years; group c, 17–25 years; group d, 26–33 years). TMJ morphology was assessed by linear measurements, angular measurements, and subjective evaluations. The IGA and occlusal plane angle were also measured.ResultsAnterior inclination of condyle (AIC) increased with age in the three IGA groups but decreased from 17 years onward in group 2 (P < 0.05). In the age groups analysis, the AIC in group 1 was smaller than that in group 3 but larger than that in group 2 (P > 0.05). Articular eminence inclination (AEI) decreased with age in group 1 (P = 0.027) but increased with age in group 3 (P = 0.053). The AEI in group 2 was larger than that in group 1 at 17–25 years (P = 0.046), and it was larger in group 3 than in group 1 at 26–33 years (P = 0.047). The IGA had a weak correlation with AEI (P < 0.05).ConclusionThe articular fossa of patients with shallower incisal guidance changed to a flatter shape with age, whereas the condylar anterior slope and articular eminence of patients with steeper incisal guidance changed towards a steeper alignment. There was a correlation between IGA and TMJ shape.

The magnetic resonance imaging evaluation of condylar new bone remodeling after Yang\u2019s TMJ arthroscopic surgery

To evaluate the post-operative condylar bone remodeling after the treatment of Yang’s arthroscopic surgery. Consecutive cases from Jan 2017 to May 2018 that received Yang’s arthroscopic surgery were included in this study, the TMJ MRI examinations were performed preoperatively and postoperatively (follow up for 1 year or more), and condylar bone remodeling was estimated. A total of 229 patients (29 male and 200 female) were included in the study, 161 patients had new bone formation, and the average age was 17.5 ± 2.1a. There was no new bone formation in 68 patients with an average age of 24.5 ± 0.7a. The percentage of new bone formation patients in 10–15 years of age was 94.33% and decreases as the age increases. In the position of new bone formation, the posterior slope of condyle was the most (129 joints), the second was the top of condyle (54 joints), the third was around condyle (33 joints), only 25 joints had new bone on the anterior slope of condyle. After TMJ arthroscopic surgery, the condyle has the ability to form new bone, and the younger the age, the stronger the ability of new bone formation. The formation of new bone was most in posterior slope and least in anterior slope of condyle.

The posterior horn of the medial and lateral meniscus both reduce the effective posterior tibial slope: a radiographic MRI study

The purpose of this study was to quantify the posterior horn meniscal slope and determine its contribution to the reduction in posterior tibial slope. Patients aged between 16 and 60years and had intact menisci with no evidence of previous injury or surgery were included. Patients with radiological evidence of osteoarthritis Grade II-IV, any acute or chronic meniscus injuries, fractures, and ligamentous injuries were excluded. The posterior bony slope (PTS) and the meniscus slope (MS) of the posterior horns were measured at 25, 50, and 75% from the medial and lateral borders of the tibial plateau. 325 MR images (mean age 37.1 ± 10.9years) were included. There were 194 males and 131 females, with 162 left and 163 right knees. The PTS in the medial compartment ranged from (-) 2.8° to 3.7° and from (-) 1.3° to 1.9° in the lateral compartment (p = 0.0001). The MS in the medial compartment ranged from 27.4° to 28.2°, and from 27.8° to 28.7° in the lateral compartment (p > 0.05). The differences between the medial and lateral knee compartment were statistically significant. At the 25% interval the p level was 0.037, at 50% p = 0.00001, and at 75% p = 0.0001. There were no significant between gender differences. The results of this study demonstrated a significant reduction in posterior tibial bone slope by the posterior horns of both the medial and lateral meniscus, from a mean of (-) 1° to 2° to a more horizontal anterior slope. The posterior bone slope was larger in the medial compartment by 1°, resulting in a smaller slope reduction in the lateral compartment.

Zygomatic-maxillary cortical bone thickness in hyper, normo and hypodivergent patients

ABSTRACTObjective: The aim of this study was to evaluate the thickness of the zygomatic-maxillary cortical bone using computed tomography in different skeletal patterns. Methods: A total of 54 patients of both sexes, divided into three groups according to the vertical skeletal pattern, were evaluated for cortical bone thickness of the anterior slope of the zygomatic process of the maxilla, using cone beam computed tomography. Measurements were made at 2mm, 4mm, 6mm, 8mm and 10mm above from first molar mesial root apex. Vertical skeletal pattern was determined by Frankfurt mandibular angle (FMA).Results: The hyperdivergent pattern had the lowest cortical thickness value, nevertheless, no patient in the hyperdivergent group presented cortical thickness exceeding 2mm, and no patient in the hypodivergent group presented cortical thickness less than 1mm. However, the correlation between cortical thickness and mandibular plane angle was weak and not significant. Conclusion: Although higher prevalence of thick cortical was observed in the hypodivergent patients, and thin cortical groups in the hyperdivergent group, the vertical skeletal pattern could not be used as determinant of the zygomatic-maxillary cortical thickness.

The relation of the pelvis and the perineal function in incontinent women: A neglected subject.

To Compare the angular parameters of the pelvis of continents and incontinent women and to correlate them with the electrical activity and the function of the pelvic floor muscles. Cross-sectional study. Incontinent and continent women, aged between 18 and 59 years. The anatomical points were marked following the SAPO protocols, the photographic records were made and analyzed through the SAPO Software. The evaluation of the function of the MPF was performed by bidigital vaginal palpation, using the PERFECT scheme. Surface electromyographic analysis was performed in dorsal decubitus and orthostasis. The sample consisted of 40 women, 20 with SUI (IG) and 20 continents (CG), matched by age. The mean age in the CG was 43.5 years (SD 8.4), while in the IG it was 47.1 years (SD 7.8) (P = 0.16). The pelvic angle in the CG presented a mean of -14.3 ± 4.6 and the IG -16.6 ± 4.4 (P = 0.02). When compared to normality, IG presented an accentuation of anterior slope in both analyzed views (P = 0.01). There was a moderate correlation in the IG between the electrical activity of the basal pelvis in orthostasis and the anterior pelvic tilt angles in the right lateral views r = 0.51 (P = 0.02) and left lateral r = 0.46 (P = 0.04). No correlation was found in the CG. In the present sample, incontinent women have a greater anterior slope of the pelvis, and the greater the degree of anterior slope, the greater the electrical activity of the PFM, during rest, and in orthostasis.