Attachment Sites Research Articles

RGD Peptidomimetic MMAE-Conjugate Addressing Integrin αVβ3-Expressing Cells with High Targeting Index.

Small molecule-drug conjugates (SMDCs) mimicking the RGD sequence (-Arg-Gly-Asp-) with a non-peptide moiety require a pharmacophore-independent attachment site. A library of 36 sulfonamide-modified RGD mimetics with nM to pM affinity for integrin αV β3 was synthesized and analysed via DAD mapping. The best structure of the conjugable RGD mimetic was used and a linker was attached to an aromatic ring by Negishi cross-coupling. The product retained high affinity and selectivity for integrin αV β3 . The conjugable RGD mimetic was then attached to an enzymatically cleavable GKGEVA linker equipped with a self-immolative PABC and the antimitotic drug monomethyl auristatin E (MMAE). The resulting SMDC preferred binding to integrin αV β3 over α5 β1 in a ratio of 1 : 4519 (ELISA) and showed selectivity for αV β3 -positive WM115 cells over αV β3 -negative M21-L cells in the in vitro cell adhesion assay as well as in cell viability assays with a targeting index of 134 (M21-L/WM115).

Iripin-1, a new anti-inflammatory tick serpin, inhibits leukocyte recruitment in vivo while altering the levels of chemokines and adhesion molecules.

Serpins are widely distributed and functionally diverse inhibitors of serine proteases. Ticks secrete serpins with anti-coagulation, anti-inflammatory, and immunomodulatory activities via their saliva into the feeding cavity to modulate host's hemostatic and immune reaction initiated by the insertion of tick's mouthparts into skin. The suppression of the host's immune response not only allows ticks to feed on a host for several days but also creates favorable conditions for the transmission of tick-borne pathogens. Herein we present the functional and structural characterization of Iripin-1 (Ixodes ricinus serpin-1), whose expression was detected in the salivary glands of the tick Ixodes ricinus, a European vector of tick-borne encephalitis and Lyme disease. Of 16 selected serine proteases, Iripin-1 inhibited primarily trypsin and further exhibited weaker inhibitory activity against kallikrein, matriptase, and plasmin. In the mouse model of acute peritonitis, Iripin-1 enhanced the production of the anti-inflammatory cytokine IL-10 and chemokines involved in neutrophil and monocyte recruitment, including MCP-1/CCL2, a potent histamine-releasing factor. Despite increased chemokine levels, the migration of neutrophils and monocytes to inflamed peritoneal cavities was significantly attenuated following Iripin-1 administration. Based on the results of in vitro experiments, immune cell recruitment might be inhibited due to Iripin-1-mediated reduction of the expression of chemokine receptors in neutrophils and adhesion molecules in endothelial cells. Decreased activity of serine proteases in the presence of Iripin-1 could further impede cell migration to the site of inflammation. Finally, we determined the tertiary structure of native Iripin-1 at 2.10 Å resolution by employing the X-ray crystallography technique. In conclusion, our data indicate that Iripin-1 facilitates I. ricinus feeding by attenuating the host's inflammatory response at the tick attachment site.

Lab and field evaluation of tagging methods for the use of acoustic telemetry to observe sea urchin movement behaviour at ecologically relevant spatio-temporal scales

BackgroundAcoustic telemetry allows detailed observations of the movement behaviour of many species and as tags get smaller, smaller organisms may be tagged. The number of studies using acoustic telemetry to evaluate marine invertebrate movement is growing, but novel attachment methods include unknowns about the effects of tagging procedures on individual survival and behaviour. This study compared methods of tag attachment on green sea urchins (Strongylocentrotus droebachiensis) to determine the feasibility of using acoustic transmitters to track echinoid movement. Four tagging methods were compared in the lab and tag retention, urchin condition, and survival analysed. Two tagging methods (Dyneema® fishing line and T-bar tags) were evaluated in the field using an existing acoustic telemetry array. Urchins were tagged and the study area revisited one week and 2 months post-release by scuba divers to estimate movement and tag retention.ResultsThe best methods in the lab, with high tag retention, survival, and minimal effects on urchin condition, were fishing line methods. T-bar tags, although showing high tag retention, caused significant mortality and had deleterious long-term effects on urchin condition and behaviour. After 2 months in the field, as in the lab, fishing line was a more effective tagging method. Urchins tagged with fishing line showed increased estimates of space occupancy compared to T-bar-tagged urchins and a single fishing-line tagged individual was found by divers in good health after 80 days. Combined, these laboratory and field results demonstrate the feasibility of using acoustic telemetry to observe urchin movement.ConclusionsResults strongly suggest that surgical attachment methods that minimize injuries at the attachment site should be prioritized for echinoid tagging studies. Together, lab and field tests indicate that acoustic telemetry is a promising method to examine marine echinoid movement over ecologically relevant spatial and temporal scales.

Medial stability and lateral flexibility of the collateral ligaments during mid-range flexion in medial-pivot total knee arthroplasty patients demonstrates favorable postoperative outcomes.

The objectives of the present study were to investigate the length change in different bundles of the superficial medial collateral ligament (sMCL) and lateral collateral ligament (LCL) during lunge, and to evaluate their association with Knee Society Score (KSS) following medial-pivot total knee arthroplasty (MP-TKA). Patients with unilateral MP-TKA knees performed a bilateral single-leg lunge under dual fluoroscopy surveillance to determine the in-vivo six degrees-of-freedom knee kinematics. The contralateral non-operated knees were used as the control group. The attachment sites of the sMCL and LCL were marked to calculate the 3D wrapping length. The sMCL and LCL were divided into anterior, intermediate, and posterior portions (aMCL, iMCL, pMCL, aLCL, iLCL, pLCL). Correlations between lengths/elongation rate of ligament bundles from full extension to 100° flexion and the KSS were examined. The sMCL and LCL demonstrated relative stability in length at low flexion, but sMCL length decreased whereas LCL increased with further flexion on operated knees. The sMCL length increased at low flexion and remained stable with further flexion, while the LCL length decreased with flexion on the contralateral non-operated knees. The lengths of aMCL, iMCL, and pMCL showed moderate (0.5 < r < 0.7, p < 0.05) negative correlations with the KSS, and the lengths of aLCL, iLCL, and pLCL were positively correlated with the KSS at mid flexion on operated knees (p < 0.05). The elongation rates of aLCL, iLCL, and pLCL were negatively correlated with the KSS at high flexion on operated knees (p < 0.05). However, no significant correlations between the length of different bundles of sMCL or LCL with KSS were found on contralateral non-operated knees. The elongation pattern of sMCL/LCL on MP-TKA knees showed differences with contralateral non-operated knees. The sMCL is tense at low to middle flexion and relaxed at high flexion, while LCL is relaxed at low to middle flexion and tense at high flexion following MP-TKA. Medial stability and proper lateral flexibility during mid flexion were associated with favorable postoperative outcomes in MP-TKA patients. In contrast, lateral relaxation at deep flexion should be avoided when applying soft-tissue balancing in MP-TKA. Level III.

Catheter ablation of idiopathic left fascicular ventricular tachycardia: Implications of false tendons for mapping and ablation.

The anatomical substrate for idiopathic left ventricular tachycardia (ILVT) remains speculative. Purkinje networks surrounding false tendons (FTs) might be involved in the reentrant circuit of ILVT. The objective was to evaluate the anatomical and electrophysiological features of false tendons FTs in relation to ILVT. Intracardiac echocardiography (ICE) was conducted on patients with ILVT. The relationship of the FTs with ILVT was determined using electro-anatomical mapping. Electrophysiological evaluation and radiofrequency ablation were conducted in 23 consecutive patients with ILVT. FTs were identified in 19/23 cases (82.6%) with P1 potentials during VT recorded at the FT in 14 of these patients (73.7%). Three FT types were identified. In type 1, the FT attached the septum to the base of the posteromedial papillary muscle (PPM) (4/19); type 2 FTs ran between the septum and the PPM apex (3/19), while in type 3, the connection occurred between the septum and apex (11/19) or between the septum and the LV free wall (1/19). The effective ILVT ablation sites were situated at the FT-PPM (3/19) and the FT-septum (16/19) attachment sites. This series demonstrates the association between Purkinje fibers and FTs during catheter ablation of ILVT and verifies that left ventricular FTs are an important substrate in this type of tachycardia.

Linking the proximal tibiofibular joint to hominid locomotion: A morphometric study of extant species

AbstractObjectivesWe perform a comparative assessment of shape variation of the proximal fibula in extant humans and great apes, intending to investigate the possible link between proximal fibular shape and locomotor patterns.MethodsOur sample includes 94 fibulae of 37 Homo sapiens, 15 Gorilla, 17 Pongo, and 25 Pan. Fibular morphology was investigated through three‐dimensional (semi)landmark‐based geometric morphometric methods.ResultsWe found unique features of the human fibular head compared to that of great apes (i.e., oblique articular surface, the presence of the styloid process, specific morphology of muscle attachment sites), supporting the functional role of this bone in relation to human obligate bipedalism. Great apes also showed distinctive traits in their proximal fibula morphology, in agreement with differences in locomotor behavior.ConclusionThe morphology of the proximal fibula in extant humans and great apes is indicative of locomotor behavior, offering the potential for the comparative analysis of fossil hominin remains.

Infection behavior of Listeria monocytogenes on iceberg lettuce (Lactuca sativa var. capitata)

Iceberg lettuce among leafy vegetables is susceptible to contamination with foodborne pathogens, posing a risk of food microbial safety. Listeria monocytogenes (L. monocytogenes) is a highly lethal pathogen that can survive and proliferate on leafy vegetables. In this paper, the contamination stage, attachment site, internalization pathway, proliferation process, extracellular substance secretion and virulence factors expression of L. monocytogenes on iceberg lettuce were researched. Results showed that the contamination stage of L. monocytogenes on iceberg lettuce was 0–20 min, the proliferation stage was after 20 min. The attachment tissues were stomata and winkles. The internalization distance of L. monocytogenes in the midrib was farther than that in the leaf blade. They enhanced the movement ability of cells by up-regulating the expression of flaA and motA genes, and enhanced the adhesion ability of cells by up-regulating the expression of actA and inla genes, which was beneficial to the proliferation. During proliferation, cells gradually secreted extracellular substances to promote the biofilm formation on iceberg lettuce. The formation of biofilms experienced: individual bacteria, cell aggregation and biofilm maturation. Biofilms were more likely to form on the leaf blade of iceberg lettuce.

Reconstruction of the pectoral girdle and forelimb musculature of Megaraptora (Dinosauria: Theropoda).

Megaraptora is a group of enigmatic, carnivorous non-avian theropod dinosaurs from the Cretaceous of Asia, Australia, and especially South America. Perhaps the most striking aspect of megaraptoran morphology is the large, robustly constructed forelimb that, in derived members of the clade, terminates in a greatly enlarged manus with hypertrophied, raptorial unguals on the medialmost two digits and a substantially smaller ungual on digit III. The unique forelimb anatomy of megaraptorans was presumably associated with distinctive functional specializations; nevertheless, its paleobiological significance has not been extensively explored. Here we draw from observations of the pectoral girdle and forelimb skeletons of Megaraptora and myological assessments of other archosaurian taxa to provide a comprehensive reconstruction of the musculature of this anatomical region in these singular theropods. Many muscle attachment sites on megaraptoran forelimb bones are remarkably well developed, which in turn suggests that the muscles themselves were functionally significant and important to the paleobiology of these theropods. Furthermore, many of these attachments became increasingly pronounced through megaraptoran evolutionary history, being substantially better developed in derived taxa such as Australovenator wintonensis and especially Megaraptor namunhuaiquii than in early branching forms such as Fukuiraptor kitadaniensis. When considered alongside previous range of motion hypotheses for Australovenator, our results indicate that megaraptorans possessed a morphologically and functionally specialized forelimb that was capable of complex movements. Notable among these were extensive extension and flexion, particularly in the highly derived manus, as well as enhanced humeral protraction, attributes that very probably aided in prey capture.

Calmodulin Functionalized Porous Silicon Based Electrical Calcium Detector and its Comparison with Optical Detector

In this work a bi-parametric, highly selective, electrical calcium detecting platform is fabricated. The fabricated detector consists of porous silicon substrate which is surface functionalized by calmodulin. The use of porous silicon provides many fold increment in surface area, facilitating effective absorption, whereas, calmodulin functionalization upon the porous surface provides excellent calcium attachment sites. The electrical parameters of this detecting platform are then tested with calcium and several other ionic solutions, at concentration relevant physiologically. The fabricated detector showed tremendous selectivity towards calcium ion. Even in mixture ionic solution the detector exhibited its high discrimination towards calcium ion. Thus the fabricated detecting platform can work as an effective calcium detector. Its bi-parametric approach provides enhanced calcium detection efficiency. Hence the detector imparts a highly selective, robust, label free and cost-effective alternative for calcium detectors, effective even in biologically relevant concentrations. Later a comparative study is performed between the optical and electrical response of the detector platform to provide a better understanding of the consistency of the detector developed that in future will facilitate multi-parametric approach to enhance the response, selectivity and thus the efficiency of the detector platform developed in this work.

A balance between native footprint coverage and overlap of the anterolateral meniscal root in tibial tunnel positioning during anterior cruciate ligament reconstruction: A 3D MRI study

BackgroundTibial footprint of anterior cruciate ligament (ACL) is situated close to the anterior lateral meniscal root (ALMR) attachment. PurposeTo investigate the impact of the size and location of the tibial tunnel for ACL reconstruction on the ACL footprint coverage and overlap to the ALMR. Study designControlled laboratory study. MethodsTwenty knee MRI scans from twenty healthy subjects were recruited, and three-dimensional (3D) tibia models were created to show the tibial attachment sites of ACL and ALMR. Surgical simulation of the tibial tunnel drilling was performed on each 3D model, entering the joint at an angle set at 60 degrees from the tibial plateau plane and 55 degrees from the posterior tibial condylar axis, with analysis for six different drill sizes; 7.5, 8, 8.5, 9, 9.5 and 10 mm; and nine locations; the center of the ACL attachment and eight locations 2% of the tibial width apart surrounding it. The width of the tibial plateau, the distance between ACL and ALMR attachment centers, and the size and location of the potential tibial tunnel were evaluated to determine association with the area of the ACL footprint coverage and ALMR overlap using a linear mixed effects model. ResultsA large tunnel (p <.001), a central and anterior location (p <.029), and small tibial width (p =.015) were all associated with larger coverage of the ACL footprint. A large tunnel (p <.001), posteriorly and laterally located (p ≤ 0.001), and a small distance between the ACL and ALMR centers (p =.001) were significantly associated with a larger ALMR overlap. The association of the tunnel size to ALMR overlap reduced with a medial tunnel location. ConclusionsThe short distance between the centers of the ALMR attachment and native ACL footprint suggests that the ALMR will always be susceptible to overlap when the tibial tunnel is drilled in ACL reconstruction. Small alterations in tunnel location can lead to a statistically significant alteration with the amount of ALMR overlap. To minimize this overlap, whilst maintaining acceptable coverage of the ACL footprint, a tibial tunnel positioned in a medial or anteromedial location from the center of the ACL footprint is recommended.

The choice of endoscopic surgical approach and four steps of operation of inverted papilloma of the maxillary sinus

ObjectiveThe aim of this study was to determine the long-term efficacy of four steps of operation on the treatment of maxillary sinus (MS) inverted papilloma (IP).Methods83 patients who were diagnosed with IP that originated from the MS, underwent four step procedure of attachment sites, including mucosal stripping, periosteum ablation, bone drilling and bone ablation and had postoperative follow-up of 3 years were enrolled.ResultsOf the 83 patients, 59 (71.1%) patients were primary surgery and revision surgery in 24 (28.9%), single attachment was in 31(37.3%) patients and multifocal attachments in 52 (62.7%).When the numbers were not mutually exclusive, the most common origin sites of IPs were the medial wall in 54 (37.2%), lateral wall in 29 (20.0%), anterior wall in 18 (12.4%), inferior wall in 22 (15.2%), posterior in 15 (10.3%), and superior wall in 7 (4.8%). Large MMA alone was performed in 5 (6.0%), MMA combined with medial maxillectomy 76 (91.6%), and MMA combined with Caldwell-Luc approach in 2 (2.4%). No major intra- or postoperative complications were observed. The average follow-up was 41 months (range, 37–61 months). CT and endoscope showed that tumor and symptom recurrence occurred in 2 patients (2.41%). In addition, although the opening of antrostomy was closed and CT revealed the uniform soft tissue shadow and hyperostosis of MS in 11(13.3%) patients, they didn’t report any symptoms and showed well epithelization of middle meatus mucosa.ConclusionThe four steps of operations of attachment sites of MS IP, including mucosal stripping, periosteum ablation, bone drilling and bone ablation, may effectively prevent the recurrence of MS IP.

Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes

Background: Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. Purpose/Hypothesis: The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. Study Design: Descriptive laboratory study. Methods: Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. Results: Mean ACL strain increased with decreasing knee flexion angle (ρ = −0.3; P = .002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, −0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = −0.01; P = .9). Conclusion: ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. Clinical Relevance: These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs.

A rare femoral heterotopic bone formation in a 14th-19th century female skeleton from Constância (Portugal)

ObjectiveThis paper aims to: (1) document a rare femoral heterotopic ossification (HO), and (2) discuss its aetiology and impact on the individual's locomotion and daily living activities. MaterialsAdult female skeleton (SG.14-SK.7) from the village of Constância (Portugal), and dated from the 14th-19th centuries CE. MethodsThe biological profile and the macroscopic analysis of the bone changes were assessed using standardized methods. ResultsThe macroscopic analysis revealed a large bony mass (8 cm length) located immediately inferior to the small trochanter of the right femur. The lesion exhibited a compact, tubular appearance located at the site of attachment of the pectineus muscle. No signs of bone fracture were observed. ConclusionsThe morphology of the SG.14-SK.7 femoral lesion is compatible with a probable case of myositis ossificans traumatica (MOT), secondary to acute trauma of the pectineus muscle. The underlying trauma episode, such as random accidental and/or occupation-related injury, is unknown. However, it is highly possible that this self-limiting condition significantly impaired the individual's daily life and mobility. SignificanceEvidence of severe acute muscle trauma is a rare finding compared with HO secondary to bone trauma and other minor muscle injuries. Moreover, no cases of MOT affecting the pectineus muscle have been reported in the paleopathological literature to date. LimitationsAlthough unlikely, a case of neurogenic or burn-related HO cannot be completely disregarded. It was not possible to undertake radiography as part of this study. Suggestions for further researchThe use of imaging techniques to complement the paleopathological description is advised.

The effect of age on entheseal changes: A study of modifications at appendicular attachment sites in a large sample of identified human skeletons

AbstractEntheseal changes (EC) are frequent in older individuals, and age at death is the main variable explaining the distribution of EC stages in adult skeletal samples. While this is already well known, the underlying process has not been studied in biological anthropology to date. The aim of the article is to describe the relationship between age and stages of EC in detail for 30 appendicular entheses in a large sample of adult skeletons (N = 721) with known age at death and sex, using several statistical tools (such as Spearman's rank correlation coefficients, logistic regression models, adjusted standardized residuals, and generalized odds ratios). The analyses indicate a moderate to strong relationship between age at death and EC for all the appendicular attachment sites, but also striking differences between fibrous and fibrocartilaginous entheseal attachment sites. These differences are discussed in light of the available biomedical data.

Immune response in pregnancy: An evolutionary challenge against external and internal stimuli

Immune response in pregnancy: An evolutionary challenge against external and internal stimuli

Hydrolysis-Resistant Ester-Based Linkers for Development of Activity-Based NIR Bioluminescence Probes.

Activity-based sensing (ABS) probes equipped with a NIR bioluminescence readout are promising chemical tools to study cancer biomarkers owing to their high sensitivity and deep tissue compatibility. Despite the demand, there is a dearth of such probes because NIR substrates (e.g., BL660 (a NIR luciferin analog)) are not equipped with an appropriate attachment site for ABS trigger installation. For instance, our attempts to mask the carboxylic acid moiety with standard self-immolative benzyl linkers resulted in significant background signals owing to undesirable ester hydrolysis. In this study, we overcame this longstanding challenge by rationally designing a new hydrolysis-resistant ester-based linker featuring an isopropyl shielding arm. Compared to the parent, the new design is 140.5-fold and 67.8-fold more resistant toward spontaneous and esterase-mediated hydrolysis, respectively. Likewise, we observed minimal cleavage of the ester moiety when incubated with a panel of enzymes possessing ester-hydrolyzing activity. These impressive in vitro results were corroborated through a series of key experiments in live cells. Further, we showcased the utility of this technology by developing the first NIR bioluminescent probe for nitroreductase (NTR) activity and applied it to visualize elevated NTR expression in oxygen deficient lung cancer cells and in a murine model of non-small cell lung cancer. The ability to monitor the activity of this key biomarker in a deep tissue context is critical because it is associated with tumor hypoxia, which in turn is linked to drug resistance and aggressive cancer phenotypes.

Fibular- Versus Tibiofibular-Based Reconstruction of the Posterolateral Corner of the Knee: A Systematic Review and Meta-analysis

Background: Fibular- and tibiofibular-based reconstructions are the gold standard treatment for posterolateral corner (PLC) injuries of the knee. Despite comparable outcomes in biomechanical studies, clinical results comparing these constructs remain elusive with no consensus reached regarding the best treatment option. Purpose: To perform a systematic review and meta-analysis to compare fibular- and tibiofibular-based techniques for posterolateral corner reconstruction. We aimed to identify whether any differences existed between the 2 techniques in terms of clinical outcomes and rotational and varus stability. Study Design: Meta-analysis; Level of evidence, 4. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms (“posterolateral corner” OR “fibular collateral ligament” OR “lateral collateral ligament” OR “popliteus tendon” OR “popliteofibular ligament”) AND (“reconstruction” OR “LaPrade” OR “Larson” OR “Arciero”). Data pertaining to all patient-reported outcome measures (PROMs), postoperative complications, and valgus and rotational stability were extracted from each study. The pooled outcome data were analyzed by random- and fixed-effects models. Results: After abstract and full-text screening, 6 clinical studies were included. In total, there were 183 patients, of which 90 received fibular-based and 93 tibiofibular-based reconstruction. The majority of studies used similar surgical techniques regarding tunnel orientation, attachment sites, and graft fixation sequence. There were no differences between the groups in terms of PROMs and subjective knee scores at a mean of 20.3 months. The techniques were equally effective in restoring varus and rotational stability. Subgroup analysis revealed that the stability of a posterior cruciate ligament reconstruction postoperatively was not affected by either construct. Conclusion: Both constructs had comparable clinical outcomes and were equally effective in restoring varus and rotational stability for PLC knee injuries. The fibular-based technique may offer advantages in view of being less technically demanding and invasive and requiring fewer grafts with a quicker operative time. However, higher quality studies are required to reinforce or refute such conclusions, as the majority of studies in this review were poor to fair quality.

Rehabilitation Features for Patients with Diaphyseal Humerus Fractures During Conservative Treatment

Aim: Determination of the key criteria for selecting the optimal physical rehabilitation scheme depending on the chosen method of conservative treatment. Materials and Methods: The study involved 53 patients with diaphyseal humerus fractures. In all cases, conservative functional treatment methods have been applied. Results: Based on the applied methods of conservative treatment, four clinical groups for medical rehabilitation have been identified: A, B, C, D, each containing 2 subgroups, depending on the relationship between the bone fragments and the sites of muscle attachment in the diaphyseal segment of the humerus. Subgroup “1” involved patients with diaphyseal humerus fractures, where the fragments serve as the sites of attachment for muscles. Subgroups “2” encompassed cases with fractures in the specified area, where the fragments do not serve as the sites of muscle insertion. The assessment of the functional activity of the elbow and shoulder joints was performed using the MEPS and CMS scales, respectively. Conclusions: The anatomical and topographical features of the muscle component are crucial for selecting the optimal tactics for conducting rehabilitation measures.

A prospective study to evaluate the functional and clinical outcome of anterior cruciate ligament reconstruction with standard hamstring autograft

Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are the availability of a greater sectional area and the unaffected integrity of the extensor mechanism. Moreover, the tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications such as extension loss, anterior knee pain, and surgical site infections was also lower than in other procedures such as in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for the initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods such as the interference screws allow for early firm fixation and heal with a tight bone–tendon interface.Objective: A prospective study to evaluate the functional and clinical outcome of ACL reconstruction with standard hamstring autograft.Materials and Methods: The study results included 30 patients admitted with clinical and radiological deficiency of ACL from September 2019 to March 2021 using endobutton and bioabsorbable interference screw in terms of range of motion, postoperative knee stability, subjective knee functions, and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.Results: Sports injuries were the most common mode of injury (n = 17, 56.7%). The mean size of graft used was 8.2 ± 0.39 mm. Postoperatively at 2-year follow-up, 30 cases (100%) had 0 grade pivot-shift test, 0 grade Lachman test, and anterior drawer test. The mean postoperative Lysholm score improved from preoperative score of 62.83 ± 5.2–91.0 ± 5.54. The overall satisfactory result (excellent + good) at 6-month follow-up was (excellent – 30 and good – 70) 100%. Out of this, 27 (90%) patients had returned to preinjury level of activity in 1 year. In this study, one patient had superficial infection and two patients had knee pain.Conclusion: Arthroscopy-assisted ACL reconstruction using hamstring tendon autograft provides a stable knee, reduces postoperative morbidity, and enables early rehabilitation.

A study of functional outcome in patients undergoing arthroscopic reconstruction of anterior cruciate ligament injury using hamstring tendon graft with interference screws

The Anterior Cruciate Ligament is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting the rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion and easier rehabilitation. Approximately 100,000 anterior cruciate ligament (ACL) reconstructions are performed in the USA each year. Interference screw fixation is considered the standard for rigid fixation of the graft and provides higher fixation strength compared with other devices such as staples or buttons. Most studies showed no intergroup difference in terms of outcomes measured with validated clinical scores such as IKDC (International Knee Documentation Committee), Lysholm score and Tegner activity level. There was no significant difference regarding range of motion. Knee stability as evaluated with pivot shift and KT arthrometer showed a significant difference only in one study, favouring metallic interference screws. Materials and Methods: Patients admitted to CG hospital and Bapuji hospital in Davangere, Karnataka between 2019 October to 2021 October were taken into the study after taking informed consent. Results: This study consists of 25 cases of Anterior Cruciate Ligament injury. All cases were performed arthroscopically. ACL rupture was common in second and third decade. In our study, male preponderance was found with 23 (92%) and female preponderance of 2 (8%). Side affected was 13 (52%) right side and 12 (48%) left side. Mode of injury in the present study includes various sources such as sports, RTA, fall. Results were evaluated by using International Knee Documentation committee (IKDC) and Lysholm knee scoring scale. In present study we have 22 patients with Excellent results, 2 cases as Good, 1 case as Fair and 0 cases as Poor. No case needed re-surgery. In the present study there were no cases of superficial infection. Conclusion: Arthroscopic reconstruction of ACL using Semitendinous and Gracilis tendon graft (Hamstring tendon) with Interference screws can be considered the best mode of treatment for ACL rupture.