Bony Morphology Research Articles

Ethnic differences in bony hip morphology predisposing for hip osteoarthritis: A cohort of 445 professional soccer players

Ethnic differences in bony hip morphology predisposing for hip osteoarthritis: A cohort of 445 professional soccer players

Different Level of Intraspecific Variation of the Bony Labyrinth Morphology in Slow- Versus Fast-Moving Primates

The vestibular system of the inner ear detects the motions of the head and is involved in maintaining balance. For this reason, this organ has been deeply studied and several scientists have tried to link its morphology with the locomotor behavior of an animal. Via high-resolution computed microtomography and geometric morphometric methods, we analyzed the intraspecific variation of the 3D morphology of the bony labyrinth (inner ear) in four species of primates differing in their locomotor adaptations: two being slow-moving taxa (Nycticebus and Perodicticus), and two being fast-moving taxa (Callithrix and Microcebus). Basically, there are very few analyses of the inter-individual variation of this organ in mammals in general, and this approach has never been attempted in primates thus far. Our results show that variation of the bony labyrinth morphology is expressed by the same ways in the different species (e.g., differences in the size, shape, and orientation of the semicircular canals, and in the width and height of the cochlea), but that slow-moving taxa exhibit a higher amount of intraspecific variation than do fast-moving taxa. Our results strengthen support for a previously published hypothesis, according to which a relaxation of the selective pressure applied to the morphology of the bony labyrinth is the likely reason for this higher amount of intraspecific variation in slow-moving taxa, and that it may be related to a reduced functional demand for rapid postural adjustments.

A review of trabecular bone functional adaptation: what have we learned from trabecular analyses in extant hominoids and what can we apply to fossils?

Many of the unresolved debates in palaeoanthropology regarding evolution of particular locomotor or manipulative behaviours are founded in differing opinions about the functional significance of the preserved external fossil morphology. However, the plasticity of internal bone morphology, and particularly trabecular bone, allowing it to respond to mechanical loading during life means that it can reveal greater insight into how a bone or joint was used during an individual's lifetime. Analyses of trabecular bone have been commonplace for several decades in a human clinical context. In contrast, the study of trabecular bone as a method for reconstructing joint position, joint loading and ultimately behaviour in extant and fossil non-human primates is comparatively new. Since the initial 2D studies in the late 1970s and 3D analyses in the 1990 s, the utility of trabecular bone to reconstruct behaviour in primates has grown to incorporate experimental studies, expanded taxonomic samples and skeletal elements, and improved methodologies. However, this work, in conjunction with research on humans and non-primate mammals, has also revealed the substantial complexity inherent in making functional inferences from variation in trabecular architecture. This review addresses the current understanding of trabecular bone functional adaptation, how it has been applied to hominoids, as well as other primates and, ultimately, how this can be used to better interpret fossil hominoid and hominin morphology. Because the fossil record constrains us to interpreting function largely from bony morphology alone, and typically from isolated bones, analyses of trabecular structure, ideally in conjunction with that of cortical structure and external morphology, can offer the best resource for reconstructing behaviour in the past.

Clinical Evaluation of Bioabsorbable Mesh for Secondary Bone Grafts in the Alveolar Cleft

Purpose: This study investigates whether a poly-L-lactic acid (PLLA)-polyglycolic acid (PGA) mesh-type bone joining material (PLLA-PGA mesh), a bioabsorbable osteosynthetic material, can replace titanium mesh for secondary bone grafts in the alveolar cleft. Methods: The subjects were 6 patients who underwent secondary bone grafting in the alveolar cleft using the PLLA-PGA mesh and 6 patients treated with titanium mesh. Intraoral X-ray images and dental small-field CT (3DX) were taken over a period of 6 months postoperatively. Analysis of Covariance (ANCOVA) was performed for two objective variables obtained from CT images namely the vertical height of the bony bridge and the labial-lingual thickness. A generalized linear model was also used to analyze a discrete objective variable, i.e., the score for the bony bridge height obtained from the occlusal X-ray image. In these analyses, the five explanatory variables used were mesh type, sex, age, grafted bone mass, and width of the alveolar cleft measured on the CT image. Results: No significant factors were observed among the 5 explanatory variables with regard to influence on bony bridge thickness. Mesh type was the only significant factor influencing bony bridge height, and the height was greater when using PLLA-PGA mesh than when using titanium mesh. However, there were no significant factors influencing alveolar crest height on occlusal X-ray images. Conclusions: There were no marked differences in bony bridge morphology in the alveolar cleft area between the PLLA-PGA and titanium mesh groups.

Bony labyrinth shape variation in extant Carnivora: a case study of Musteloidea.

The bony labyrinth provides a proxy for the morphology of the inner ear, a primary cognitive organ involved in hearing, body perception in space, and balance in vertebrates. Bony labyrinth shape variations often are attributed to phylogenetic and ecological factors. Here we use three-dimensional (3D) geometric morphometrics to examine the phylogenetic and ecological patterns of variation in the bony labyrinth morphology of the most species-rich and ecologically diversified traditionally recognized superfamily of Carnivora, the Musteloidea (e.g. weasels, otters, badgers, red panda, skunks, raccoons, coatis). We scanned the basicrania of specimens belonging to 31 species using high-resolution X-ray computed micro-tomography (μCT) to virtually reconstruct 3D models of the bony labyrinths. Labyrinth morphology is captured by a set of six fixed landmarks on the vestibular and cochlear systems, and 120 sliding semilandmarks, slid at the center of the semicircular canals and the cochlea. We found that the morphology of this sensory structure is not significantly influenced by bony labyrinth size, in comparisons across all musteloids or in any of the individual traditionally recognized families (Mephitidae, Procyonidae, Mustelidae). PCA (principal components analysis) of shape data revealed that bony labyrinth morphology is clearly distinguishable between musteloid families, and permutation tests of the Kmult statistic confirmed that the bony labyrinth shows a phylogenetic signal in musteloids and in most mustelids. Both the vestibular and cochlear regions display morphological differences among the musteloids sampled, associated with the size and curvature of the semicircular canals, angles between canals, presence or absence of a secondary common crus, degree of lateral compression of the vestibule, orientation of the cochlea relative to the semicircular canals, proportions of the cochlea, and degree of curvature of its turns. We detected a significant ecological signal in the bony labyrinth shape of musteloids, differentiating semi-aquatic taxa from non-aquatic ones (the taxa assigned to terrestrial, arboreal, semi-arboreal, and semi-fossorial categories), and a significant signal for mustelids, differentiating the bony labyrinths of terrestrial, semi-arboreal, arboreal, semi-fossorial and semi-aquatic species from each other. Otters and minks are distinguished from non-aquatic musteloids by an oval rather than circular anterior canal, sinuous rather than straight lateral canal, and acute rather than straight angle between the posterior and lateral semicircular canals - each of these morphological characters has been related previously to animal sensitivity for detecting head motion in space.

The bony labyrinth of the middle Pleistocene Sima de los Huesos hominins (Sierra de Atapuerca, Spain)

We performed 3D virtual reconstructions based on CT scans to study the bony labyrinth morphology in 14 individuals from the large middle Pleistocene hominin sample from the site of the Sima de los Huesos (SH) in the Sierra de Atapuerca in northern Spain. The Atapuerca (SH) hominins represent early members of the Neandertal clade and provide an opportunity to compare the data with the later in time Neandertals, as well as Pleistocene and recent humans more broadly. The Atapuerca (SH) hominins do not differ from the Neandertals in any of the variables related to the absolute and relative sizes and shape of the semicircular canals. Indeed, the entire Neandertal clade seems to be characterized by a derived pattern of canal proportions, including a relatively small posterior canal and a relatively large lateral canal. In contrast, one of the most distinctive features observed in Neandertals, the low placement of the posterior canal (i.e., high sagittal labyrinthine index), is generally not present in the Atapuerca (SH) hominins. This low placement is considered a derived feature in Neandertals and is correlated with a more vertical orientation of the ampullar line (LSCm < APA), posterior surface of the petrous pyramid (LSCm > PPp), and third part of the facial canal (LSCm < FC3). Some variation is present within the Atapuerca (SH) sample, however, with a few individuals approaching the Neandertal condition more closely. In addition, the cochlear shape index in the Atapuerca (SH) hominins is low, indicating a reduction in the height of the cochlea. Although the phylogenetic polarity of this feature is less clear, the low shape index in the Atapuerca (SH) hominins may be a derived feature. Regardless, cochlear height subsequently increased in Neandertals. In contrast to previous suggestions, the expanded data in the present study indicate no difference across the genus Homo in the angle of inclination of the cochlear basal turn (COs < LSCm).Principal components analysis largely confirms these observations. While not fully resolved, the low placement of the posterior canal in Neandertals may be related to some combination of absolutely large brain size, a wide cranial base, and an archaic pattern of brain allometry. This more general explanation would not necessarily follow taxonomic lines, even though this morphology of the bony labyrinth occurs at high frequencies among Neandertals. While a functional interpretation of the relatively small vertical canals in the Neandertal clade remains elusive, the relative proportions of the semicircular canals is one of several derived Neandertal features in the Atapuerca (SH) crania. Examination of additional European middle Pleistocene specimens suggests that the full suite of Neandertal features in the bony labyrinth did not emerge in Europe until perhaps <200 kya.

Limitation of previous Allen classification and subaxial cervical spine injury classification (SLIC) system in distractive-extension injury of cervical spine: proposal of modified classification system.

To verify the clinical applicability of a modified classification system in distractive-extension cervical spine injury that reflects the degrees of soft tissue damage and spinal cord injury while complementing previous Allen classification and subaxial cervical spine injury classification (SLIC) system. A total of 195 patients with cervical spine distraction-extension (DE) injury were retrospectively classified. We added stages IIIA (with concomitant spinal cord injury without bony abnormalities) and IIIB (with concomitant additional soft tissue swelling) to the existing stages I and II of the Allen classification. We also supplemented the SLIC system by refining and assigning scores to bony morphology and soft tissue damage. The previous and proposed classification systems were compared by analyzing their scoring performances in terms of clinical features and prognosis. The Allen classification yielded 153 and 42 patients with stage 1 and 42 stage 2 injuries, respectively. Patients classified according to the proposed system were stratified as follows: stage I, 58; stage II, 27; stage IIIA, 33; and stage IIIB, 77. Regarding neurological symptoms and prognosis, stages IIIA and IIIB were poorer than stage I but significantly better than stage II (P < 0.05). On the SLIC system, 146 patients scored ≥5; and 37 and 12 patients scored 4 and ≤3 points, respectively, whereas the numbers of patients who scored ≥5, 4, and ≤3 points on the modified SLIC system were 170, 21, and 4, respectively. The proposed classification and scoring system to complement the Allen classification and SLIC system with respect to the degrees of soft tissue damage and spinal cord injury is considered effective for diagnosing and determining therapeutic directions and prognosis in cases of cervical spine extension injury.

The Relationship Between the Bony Morphology of First Metacarpal Base and the Stability of the Thumb Carpometacarpal Joint in a Normal Female Population: Level 1 Evidence

remaining 34 patients form the basis of this study. Five fellowship-trained hand surgeons, blinded to DEXA scores, evaluated the x-rays and classified them as osteoporotic, osteopenic, or normal bone mineral density. The surgeons viewed the images on a standard PACS terminal and were permitted use of the digital manipulation tools to replicate the common clinical scenario. Four weeks after the initial assessment, the X-rays were again randomized and a second assessment was performed. Accuracy relative to DEXA score was tabulated, and interobserver and intraobserver agreement were also calculated. Results: The observers performed a total of 340 assessments. The assessments relative to DEXA scores were correct in 169 of the assessments (49%). Only one x-ray was correctly diagnosed by all physicians over both assessments while two x-rays were never correctly diagnosed. Analysis of the incorrect assessments revealed that observers tended to underestimate or overestimate bone mineral density at an approximately similar rate (49% and 51% respectively). When the observations were inaccurate, reviewers were off two grades (normal vs. osteoporosis and vice versa) in 17% of the evaluations and 1 grade (normal vs. osteopenia, osteopenia vs. osteoporosis and vice versa) in 83% of the evaluations. A mean weighted kappa coefficient of agreement between observers was 0.29 (range 0.02-0.41) indicating fair agreement. The mean weighted kappa coefficient for intraobserver agreement between the first and second assessment for all five physicians was 0.46 (range 0.19-0.78) indicating moderate agreement. Summary Points: Abnormally low bone mineral density is a common occurrence in patients treated for upper extremity disorders. There is poor accuracy and only fair agreement in diagnosing osteoporosis compared toDEXAusing visual assessments of digital hand andwrist x-rays. Digital hand x-rays have significant limitations as a tool for evaluating bone mineral density.

Preliminary data on the effect of osseous anatomy on exvivo joint mobility in the equine thoracolumbar region.

The thoracolumbar region is clinically important in horses; however, the link between joint mobility and bony joint morphology has not been tested quantitatively. To establish which aspects of vertebral morphology correlate with exvivo range of motion in the thoracolumbar region of Equus caballus, and demonstrate methodologies for linking vertebral form and function. Morphometric study of osteological specimens. A digital model was created of a disarticulated thoracolumbar region to examine bone-to-bone interactions during in silico bending. Linear measurements and geometric morphometric landmarks were taken from 6 vertebrae per specimen (specimens n=5, vertebrae n=30), and compared with experimental range of motion in dorsiflexion, ventroflexion, lateroflexion and axial rotation data using Spearman's rank correlation, to test a priori hypotheses regarding thoracolumbar functional anatomy. Decreased sagittal mobility correlates with a tall, heart-shaped vertebral body, although bony interactions restrict dorsiflexion more than ventroflexion. Lateroflexion correlates with a narrow vertebral body, a short transverse process lever arm, and narrowly placed horizontally oriented zygapophyses. Lateral joints also restrict lateroflexion in the posterior lumbar region. Axial rotation is related to the shape of the zygapophyseal joint. These preliminary data suggest that vertebral joint morphology does determine experimentally measured range of motion, but patterns depend upon the type of motion. These methods are useful for identifying functionally relevant morphological variation and suggest osteological features are important in determining motion.

Craniomandibular signals of diet in adapids.

The craniomandibular morphology of the adapid primates of Europe, especially Adapis and Leptadapis (sensu lato), suggests that they possessed enormous jaw adductor muscles. The goal of this study is to estimate jaw adductor muscle mass, physiological cross-sectional area (PCSA), and fiber length in adapid primates from the Eocene of Europe. We also estimated muscle leverage, bite force, and gape parameters. We use bony morphology and osteological correlates of soft tissues in a sample of extant strepsirrhines to estimate these soft-tissue and performance variables in Adapis and Leptadapis. Our results suggest that, compared to a broad sample of extant strepsirrhines, Adapis and Leptadapis had relatively great jaw adductor muscle mass, PCSA, and bite force. They had moderately great jaw adductor leverage but no sign of adaptation for wide gapes. There is no support for the hypothesis that either adapid was a gouger. Our estimates support the inference that Adapis and Leptadapis were primarily folivorous, perhaps also consuming small to medium-sized tough fruits, nuts, and seeds. Explanations for the likely extreme development of the jaw adductor muscles in adapids remain speculative. These include (1) foods that were generally tougher and/or of higher yield strength than those eaten by strepsirrhines today, (2) using the muscles "in shifts" to avoid muscle fatigue in the context of an obdurate diet, and (3) potential constraints on reshaping of the skull for more efficient food processing.

Humeral Torsion as a Risk Factor for Shoulder and Elbow Injury in Professional Baseball Pitchers

Objectives:Participation in baseball causes increased mechanical stress to the throwing arm and has been linked to alterations in shoulder range of motion (ROM) and bony morphology. Range of motion changes, specifically GIRD, has been associated with increased shoulder injury. However, the role of humeral torsion is unclear in shoulder injury. The purpose of this study was to prospectively compare humeral torsion (HT) in professional pitchers who remain healthy as compared with those who go on to suffer shoulder injuries.Methods:We prospectively measured and observed 255 professional pitcher-player seasons prior to 2009-2013 spring training. Bilateral HT was assessed in pitchers who were currently asymptomatic and participating without restriction, in all training, and practices. Humeral torsion was assessed via validated, indirect ultrasonography. Two trials of HT were averaged for data analysis. The side-to-side difference in HT was calculated by subtracting the dominant arm (D) HT from the non-dominant (ND) HT. The pitchers were then followed for the development of shoulder injury over the course of each season. Separate mixed model ANOVAs(side X injury) were used to compare pitchers’ dominant and non-dominant HT between those who suffered shoulder injury to those who did not miss games due to arm injury (α=0.05). Tukey's Post-Hoc tests were used to determine minimum significant differences for significant interaction effects.Results:We observed 30 shoulder injuries. Pitchers with previous elbow injuries(n=30) were excluded from the comparison.(Table 1) Pitchers who suffered a shoulder injury displayed 3.5° less D humeral retrotorsion compared to those pitchers without injury(n=195; P=0.04).(Figure 1).Conclusion:This study showed that pitchers with decreased humeral retrotorsion had a significantly increased risk of shoulder injury. Decreased humeral retrotorsion may hinder the ability of the shoulder to obtain needed ROM, thus increasing stress to the shoulder in late cocking and follow through. Our results should be viewed in context of the relatively small injury numbers but provide preliminary evidence that the influence of HT should be closely examined when considering shoulder injury risk in professional pitchers.

Assessing Patellar Instability

Objectives:Patients with patellar instability and tibial tubercle to trochlear groove (TT-TG) distances ≥ 20 mm are often considered to have pathologic lateralization of the tibial tubercle (TT) relative to the femoral trochlea and may be candidates for TT realignment surgery. Although this variable has proven valuable in predicting risk of recurrent dislocations, the measure is limited in that it is not individualized to the patient and does not consider patient size, bony morphology, or patellofemoral mechanics. The purpose of this study was to develop a Patellar Instability Ratio (PIR) that predicts the risk of recurrent instability based on the TT-TG distance relative to patient specific anatomy.Methods:Fifty-nine patients with a clinical diagnosis of patellar instability were included in the study. A number of measures were calculated on MRI by two observers (one staff orthopedic surgeon and one senior resident) in a blinded and randomized fashion. Variables analyzed included: TT-TG, tibial tubercle to posterior cruciate ligament distance (TT-PCL), sagittal patellar length (PL), sagittal trochlear length (TL), axial patellar width (PW), axial trochlear width (TW), sagittal patellofemoral engagement (SPE; SPE=TL/PL) and axial patellofemoral engagement (APE; APE=PW/TW). Patients were divided into two groups: those with ≤ 1 dislocation and those with ≥ 2 dislocations. Using these groups, the ability of TT-TG, TT-PCL, and 12 different ratios with cut-off values to predict recurrent instability was assessed by calculating odds ratios (OR), C-statistics, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each of the ratios. P values < 0.05 were considered significant.Results:Mean follow up was 6.6 years. Twelve patients (20%) did not experience recurrent instability while 47 (80%) sustained two or more dislocations during the study period. Pathologic TT-TG (≥ 20 mm) was predictive of recurrent instability with an OR of 5.38 (p=0.29). The highest OR's for recurrent instability were noted for TT-TG/PW ≥ 0.40 (OR > 7.37, p=0.02) and TT-TG/TW ≥ 0.5 (OR 8.88, p=0.04)(Table 1). PW was defined as the largest medial to lateral width of the articular surface of the patella. TW is defined as the largest articular width of the trochlea that is articulating with the patella and can be conceptualized as the “jump distance” that must be overcome for the patella to dislocate. The sensitivity and specificity of TT-TG/PW ratio ≥ 0.40 was 61% and 83% and that of TT-TG/TW ≥ 0.50 was 59% and 92%, respectively. PPV for TT-TG/PW ≥ 0.40 was 94% while that of TT-TG/TW ≥ 0.49 was 97%.Conclusion:Two distinct PIR (TT-TG/PW and TT-TG/TW) have been identified that predict recurrent patellar instability more accurately than TT-TG ≥ 20 mm with PPV's ≥ 94% and OR's > 7 for both measures. These ratios take into consideration the TT-TG relative to patient specific size and anatomy. Further research is needed to determine if patients with increased PIR benefit from TT osteotomy.

Exploring Active and Passive Contributors to Turnout in Dancers and Non-Dancers

Lower-extremity external rotation, or turnout, is a fundamental skill in dance. Active standing turnout has previously been measured using low-friction turnout disks. Turnout is influenced by passive range of motion (ROM) and strength, with passive ROM a function of bony morphology and ligamentous/capsular restraints. Our study explored the relationship between standing active turnout and femoral bony morphology, hip passive ROM, and strength among dancers and non-dancers. Cross-sectional cohort study. Twenty-three female dancers and 13 female non-dancers aged 18 to 30 yrs were recruited. Standing active turnout on reduced-friction disks, ultrasound images of femoral version, supine passive turnout, and hip abductor and external rotator strength were collected. Dancers demonstrated greater standing turnout (107° ± 18°) than non-dancers (92° ± 28°), but the difference was not statistically significant (p=0.054). A significant difference was found for femoral version (p<0.001), 4.7° ( ± 2.8°) for dancers vs 12.1° ( ± 4.6°) for non-dancers. Dancers demonstrated greater supine turnout, 102.7°±18.8°, compared to non-dancers, 84.3° ± 30.4° (p=0.031). Dancers were able to achieve greater peak force in turnout compared to non-dancers: 2.44 ± 0.44 N/kg and 1.72 ± 0.59 N/kg, respectively (p<0.0001). Supine total turnout was the best predictor of active turnout, contributing 48% of the variance (r=0.696, p<0.001). Our findings suggest supine turnout is the largest predictor for standing turnout. Investigating dancers and non-dancers independently, our finding were similar to previous studies suggesting the femoro-acetabular complex may be influenced by dance training, contributing to differences in bony morphology between dancers and non-dancers. Although strength did not significantly contribute to active standing turnout, dancers demonstrated greater peak force compared to non-dancers.

Differences in glenohumeral joint morphology between patients with anterior shoulder instability and healthy, uninjured volunteers

Traumatic glenohumeral joint (GHJ) dislocations are common, resulting in significant shoulder disability and pain. Previous research indicates that bony morphology is associated with an increased risk of injury in other joints (eg, the knee), but the extent to which bony morphology is associated with traumatic GHJ dislocation is unknown. This study assessed GHJ morphology in patients with anterior GHJ instability and in a control population of healthy volunteers. Bilateral computed tomography scans were used to measure GHJ morphology in both shoulders of 11 patients with instability and 11 control subjects. Specific outcome measures included the glenoid radius of curvature (ROC) in the anterior/posterior (A/P) and superior/inferior (S/I) directions, humeral head ROC, A/P and S/I conformity index, and A/P and S/I stability angle. Compared with the control subjects, the glenoid of the instability the injured shoulder in patients with instability was flatter (ie, higher ROC) in the A/P (P=.001) and S/I (P=.01) directions and this finding was also true for uninjured, contralateral shoulder (A/P: P=.01, S/I: P=.03). No differences in GHJ morphology were detected between the instability patients' injured and contralateral shoulders (P>.07). Similarly, no differences in GHJ morphology were detected between the control subjects' dominant and nondominant shoulders (P>.51). There are significant differences in GHJ morphology between healthy control subjects and both shoulders (injured and uninjured, contralateral) of patients diagnosed with anterior instability after GHJ dislocation. These findings are important clinically because they suggest that glenoid morphology may influence the risk of GHJ dislocation.

Estimating thumb-index finger precision grip and manipulation potential in extant and fossil primates.

Primates, and particularly humans, are characterized by superior manual dexterity compared with other mammals. However, drawing the biomechanical link between hand morphology/behaviour and functional capabilities in non-human primates and fossil taxa has been challenging. We present a kinematic model of thumb-index precision grip and manipulative movement based on bony hand morphology in a broad sample of extant primates and fossil hominins. The model reveals that both joint mobility and digit proportions (scaled to hand size) are critical for determining precision grip and manipulation potential, but that having either a long thumb or great joint mobility alone does not necessarily yield high precision manipulation. The results suggest even the oldest available fossil hominins may have shared comparable precision grip manipulation with modern humans. In particular, the predicted human-like precision manipulation of Australopithecus afarensis, approximately one million years before the first stone tools, supports controversial archaeological evidence of tool-use in this taxon.

Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports

The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P= .005), level (P= .02), and risk category (P= .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P= .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients. Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion. Level IV, therapeutic case series.

Relationship between levator ani and bony pelvis morphology and clinical grade of prolapse in women

The aim of this study was to assess the morphological features of the levator ani and bony pelvis in women with different grades of prolapse. Ninety Chinese women with different grades of uterine prolapse were studied, 18 in each stage of prolapse from I to IV, and 18 asymptomatic nulliparous volunteers as normal controls. Three-dimensional (3D) models that included the pelvic bones, levator ani, pubic symphysis, sacrum, and coccyx were generated from magnetic resonance (MR) images. The width and length of the levator hiatus and levator symphysis gap, the width of the iliococcygeus, and the iliococcygeal angle were measured to quantify levator ani morphology; the intertuberous diameter, interspinous diameter, subpubic angle, and pubococcygeal line were measured to characterize the morphology of the bony pelvis. Four patterns of levator ani morphology among women with and without prolapse were distinguished. Among the bony pelvis parameters, no measurement differed significantly between the subjects with prolapse and normal controls, or among subjects with different grades of prolapse. There were significant differences in the width and length of the levator hiatus and levator symphysis gap between women with prolapse and normal controls. Our pilot data help to elucidate bony pelvis and levator ani morphology in women with and without pelvic organ prolapse. In contrast to the iliococcygeus muscle, changes in the morphological features of the pubovisceral muscle are more likely to accompany prolapse.

The Basicranium and Orbital Region of the Early MioceneEucholoeops ingensAmeghino, (Xenarthra, Pilosa, Megalonychidae)

New, exceptionally well preserved skulls of the basal megalonychid ground sloth Eucholoeops ingens Ameghino have been recovered through recent field work in the late early Miocene Santa Cruz Formation of southern Argentina (Patagonia, Santacrucian SALMA). These specimens have permitted detailed description of the anatomy of the basicranium, endocranium, and orbital wall, including descriptions of the morphology and sutural relationships of the bones from this portion of the skull, and their associated cranial foramina. Comparisons are made to other megalonychid and megatherioid sloths, including the extant two-toed sloth Choloepus Illiger (Megalonychidae). As the descriptions are based on multiple specimens of E. ingens, we have been able to examine intraspecific variation in the features described, and have found marked differences among individual specimens in sutural patterns (e.g., the bones that surround the foramen ovale aperture), cranial foramina (e.g., the presence/absence of a postglenoid foramen), and bony morphology (e.g., fusion of the alae of the vomer). The basicranial and orbital morphology of Eucholoeops ingens is shown to possess numerous plesiomorphic aspects, including the presence of a descending lamina of the pterygoid that is hemispherical in outline, and the absence of an alisphenoid/parietal contact, no doubt due to its position as the oldest megalonychid known from relatively complete material. The presence of distinct grooves on the promontorial surface directed toward the fenestra ovalis suggest that Eucholoeops ingens may be the only known xenarthran to have retained a functional stapedial artery Into adulthood.

UNUSUAL PRESENTATION OF SPLIT CORD MALFORMATION TYPE I ASSOCIATED WITH MYELOMENINGOCELA

Objective – We report an unusual case of split cord malformation (SCM) associated with open spinal dysraphism and other anomalies of the central nervous system. Case report – A male newborn was admitted to the Pediatric Intensive Care Unit immediately after birth by Caesarean delivery. Clinical examination and diagnostics (MRI) showed open spinal dysraphism in the distal part of the spine (level L5 and S1), split cord malformation type I which separated two hemicords, tethered cord and syringomyelia. Two days after birth microneurosurgery was performed. Cranial and cervical MRI showed Chiari I and corpus callosum hypoplasia. There was no hydrocephalus. Preoperatively the patient had paraparesis and discretely moved his left foot. MRI showed a dilated bladder so he may have had urinary retention. The postoperative recovery was satisfactory. The patient did not have any additional neurological deficit. The patient was followed up by a neurosurgeon, pediatric surgeon, pediatrician and physiatrist. Control MRI scans showed significant regression of the syrinx and some ascensus of the medulla. About 18 months after operation the patient had discrete paresis of the left foot. Conclusion – Complex spina bifida is an extremely rare condition. In this paper we describe this interesting case of complex spina bifida: a split cord malformation characterized by atypical bony morphology with a dural fold into the bone septum.

MRI of the Hip for the evaluation of femoroacetabular impingement; past, present, and future

The concept of femoroacetabular impingement (FAI) has, in a relatively short time, come to the forefront of orthopedic imaging. In just a few short years MRI findings that were in the past ascribed to degenerative change, normal variation, or other pathologies must now be described and included in radiology reports, as they have been shown, or are suspected to be related to, FAI. Crucial questions have come up in this time, including: what is the relationship of bony morphology to subsequent cartilage and labral damage, and most importantly, how is this morphology related to the development of osteoarthritis? In this review, we attempt to place a historical perspective on the controversy, provide guidelines for interpretation of MRI examinations of patients with suspected FAI, and offer a glimpse into the future of MRI of this complex condition. J. Magn. Reson. Imaging 2015;41:558–572. © 2014 Wiley Periodicals, Inc.