Femoral Area Research Articles

Radiographic quantification of the normal and near-normal coxofemoral conformation in Labrador Retrievers and German Shepherds: a comparative study

BackgroundCanine hip dysplasia (CHD) is a multifactorial disease affecting large breed dogs with associated joint laxity and incongruity that predisposes them to osteoarthritis. The purpose of the study is to objectively compare the conformation of normal and near-normal coxofemoral joints (CFJS) in Labrador Retrievers versus German Shepherds on the extended ventrodorsal radiograph. Investigated groups were categorized as normal and near-normal CFJS according to the morphometric criteria established by the FCI scoring system. Center-edge (CE) angle, Norberg angle (NA), indices of dorsal AFH coverage width and area, acetabular slope (AS) angle, and inclination angle were determined for each group. CE angle and AS angle were modified from previously described human techniques. The width and area of dorsal AFH coverage were standardized by the corresponding femoral head diameter and area. Variables were compared between groups using an unpaired, two-tailed t-test. A Spearman correlation coefficient determined the relationship between selected variables.ResultsIn Labradors, CE angle (lateral coverage) and dorsal AFH coverage area index (dorsal coverage) were greater in normal versus near-normal CFJS. In German Shepherds, lateral AFH coverage (CE angle and NA) was greater in normal versus near-normal hip joints; whereas, dorsal AFH coverage did not differ between the two groups. Lateral AFH coverage was greater in normal versus near-normal CFJS of both breeds. In Labradors, the inclination angle was greater in near-normal versus normal CFJS. Normal CFJS of Labradors revealed greater lateral and dorsal AFH coverages compared to German Shepherds. Near-normal joints of Labradors showed greater lateral AFH coverage compared to those of German Shepherds; whereas, dorsal AFH coverage did not differ between the two breeds. A steeper acetabular slope angle was noted in normal and near-normal CFJS of German Shepherds compared to Labrador Retrievers. The inclination angle of near-normal joints was greater in Labrador Retrievers compared to German Shepherds.ConclusionsOverall, normal and near-normal CFJS of German Shepherds had lesser AFH coverage and steeper acetabular slope angle compared to Labrador Retrievers. Labrador Retrievers and German Shepherds with CE-angles < 27° and < 21.8°, dorsal AFH coverage width indices < 51 and < 49%, and/or dorsal AFH coverage area indices < 53 and < 50%, respectively, may be consistent with CHD. Thus, the authors would recommend excluding subjects with lower values from breeding. Validating the reported measurements is still warranted.

MsgeCNN: Multiscale geometric embedded convolutional neural network for ONFH segmentation and grading.

The incidence of osteonecrosis of the femoral head (ONFH) is increasing gradually, rapid and accurate grading of ONFH is critical. The existing Steinberg staging criteria grades ONFH according to the proportion of necrosis area to femoral head area. In the clinical practice, the necrosis region and femoral head region are mainly estimated by the observation and experience of doctor. This paper proposes a two-stage segmentation and grading framework, which can be used to segment the femoral head and necrosis, as well as todiagnosis. The core of the proposed two-stage framework is the multiscale geometric embedded convolutional neural network (MsgeCNN), which integrates geometric information into the training process and accurately segments the femoral head region. Then, the necrosis regions are segmented by the adaptive threshold method taking femoral head as the background. The area and proportion of the two are calculated to determine thegrade. The accuracy of the proposed MsgeCNN for femoral head segmentation is 97.73%, sensitivity is 91.17%, specificity is 99.40%, dice score is 93.34%. And the segmentation performance is better than the existing five segmentation algorithms. The diagnostic accuracy of the overall framework is 90.80%. The proposed framework can accurately segment the femoral head region and the necrosis region. The area, proportion, and other pathological information of the framework output provide auxiliary strategies for subsequent clinicaltreatment.

Quantitative assessment of hip morphology to enhance the identification of hip dysplasia in German Shepherd Dogs

To develop quantitative measures that, when combined with the Fédération Cynologique Internationale (FCI) score, would potentially enhance the accuracy of the scoring process. 153 client-owned purebred German Shepherd Dogs with normal and near normal (71 dogs) and dysplastic coxofemoral joint (82 dogs). Center edge (CE) angle, Norberg angle (NA), indexes of dorsal acetabular femoral head (AFH) coverage width and area, acetabular index angle, and inclination angle were determined. We also investigated the correlation between selected variables. Coxofemoral joints were classified into normal, near normal, and mildly, moderately, and severely dysplastic joints based on the morphometric criteria previously established by the conventional FCI scoring. Variables were compared among the 5 groups using ANOVA. Linear relationships were determined using Spearman correlation coefficients. All radiographic measurements differed significantly (P < .0001) among the 5 assigned groups (normal, near normal, mildly dysplastic, moderately dysplastic, and severely dysplastic hip joints). NA was the only measure that differed significantly (P ≤ .03) between the 5 assigned groups. Positive correlations were identified between Norberg and CE angles (rs = 0.93), between width and area indexes of dorsal AFH coverage (rs = 0.92), and between the measurement techniques utilized to assess lateral versus dorsal AFH coverage (rs ≥ 0.65). Evaluation of lateral and dorsal AFH coverage may help to refine the scoring system used to select German Shepherd Dogs for breeding. German Shepherd Dogs with NA < 103°, CE angle < 20.8°, dorsal AFH coverage width index ≤ 49%, and/or dorsal AFH coverage area index ≤ 51% should be considered to have mild, moderate, or severe hip dysplasia and are therefore not good candidates for breeding. Borderline values between near normal and mildly dysplastic joints should be reevaluated.

Bone Metabolism Parameters in Azerbaijani Pre and Postmenopausal Women with Diabetes.

This study aimed to determine the directionality of changes in serum bone remodeling markers and bone mineral density in the pre- and postmenopausal women with diabetes mellitus. This study was carried out during the years 2016-2017 on the basis of Azerbaijan Medical University and included 142 pre- and postmenopausal women with type 1 and 2 diabetes mellitus (DM 1and DM2) were compared with 43 age-matched non-diabetics. The groups evaluated Ca2+, PTH, CT, 25(OH)D levels, serum bone remodeling markers (ALP, P1NP, b-CTx), lumbar spine, proximal and femoral neck areas using DXA assessment. The results showed inconsistency observed between bone remodeling processes in women with diabetes. A negative correlation was observed between duration of diabetes and Lumbar T-scores (DM1: r = -0.568, P = 0.001; DM2: r = -0.267, P = 0.04). Lumbar T-scores was negatively correlated with b-CTx level (DM1: r = -0.452, P = 0.002; DM2: r = -0.357, P = 0.09). Postmenopausal groups with DM1 and DM2 were slightly higher b-CTx levels than premenopausal. The patients with DM2 compared to DM1 had higher average BMD at all measured areas. Bone fragility is the result not so much of a decrease in BMD, but alterations in bone microstructure, as indicated by the disregulation of bone remodeling markers. This suggests that patients with diabetes are at a higher risk of bone turnover disorders compared to individuals without diabetes, which does not necessarily correlate with differences in BMD.

The Role of Femoral Head Size and Femoral Head Coverage in Dogs with and without Hip Dysplasia.

The subject of hip dysplasia in dogs is still current and preoccupies both animal owners and veterinarians. Major factors affecting the development of the disorder are hip laxity and incongruent joints. Many studies on etiology, pathogenesis, and early diagnosis have been performed to reduce prevalence and select healthy dogs for breeding. The purpose of the present study was to investigate a possible relationship between dysplasia and femoral head area (FHA), femoral coverage by the acetabulum (CFH) and cranio-caudal distance of the dorsal acetabular rim (CrCdAR). Radiographs of a total of 264 skeletally mature dogs with similar physical characteristics (German wirehaired pointers (GWP), German shepherd dogs (GSD) and Labrador retrievers (LAB)) presented for routine hip dysplasia screening were recruited for the study. FHA, CFH and CrCdAR were measured and related to dysplasia status. Evaluations of FHA (p = 0.011), CFH (p < 0.001) and CrCdAR length (p = 0.003) measurements revealed significant interactions between breed, sex and FCI scores, so they had to be assessed separately. The results revealed that FHA tends to decrease as the hip dysplasia score worsens. There was no significant relationship between FHA and dysplasia assessment. FHA is breed-specific and is larger in normal and near-normal male (p = 0.001, p = 0.020) and female (p = 0.001, p = 0.013) GWP compared to GSD, respectively. FHA is greater in normal male GWP (p = 0.011) and GSD (p = 0.040) compared to females. There was a significant and strong positive correlation between FHA and CrCdAR in all breeds and sexes. Additionally, FCI scoring had a medium (GWP, GSD) to strong (LAB) negative correlation with CFH.

Association of CT-Derived Extracardiac Features and Aortic Annulus Size in Patients Planned for TAVI

Transcatheter aortic valve implantation (TAVI) is commonly used to treat patients with stenosed aortic valves. CT is one of the crucial steps in planning TAVI to obtain measurements of the aortic annulus to choose an appropriately sized prosthesis. Incorrect measurements can lead to patient-prosthesis mismatch and other complications. However, some patients cannot undergo ECG-gated CT with radiocontrast because of the presence of radiopaque objects in the thorax, arrhythmia, renal failure, etc. Aim: To explore supplementary methods to improve aortic annulus sizing for TAVI by extracardiac measurements. We included all patients who underwent CT as part of TAVI planning. Measurements of femoral and iliac arteries and the femoral head cross-sectional area were performed. CT scans of 139 patients were included in this study. Sixty-three patients (45%) were males. Mean age of the female patients was 79.6 ± 7.1 years and of the male patients was 81.3 ± 6.1 years. Mean aortic annulus perimeter among female patients was 74.3 ± 6 mm (range 61.9-88.2) and 83 ± 7.9 mm among male patients (range 70.1-74.3 mm). Mean diameters of common iliac, external iliac, and common femoral arteries were 9.2 ± 1.8, 7.6 ± 1, 7.6 ± 1 mm, respectively, for females and 10.2 ± 1.8, 8.5 ± 1.3, and 8.6 ± 1.4 mm for males. Mean perimeter of the femoral head (average value of right and left femoral heads) among the female patients was 137.8 ± 6.3 mm, and among male patients was 155 ± 9.6 mm. A significant correlation was observed between the perimeter of the aortic annulus and the perimeter of the femoral head (Pearson's R2 = 0.224). The correlation between the aortic annulus perimeter and the femoral head perimeter was stronger among men than among women (Pearson's R2 = 0.66 and 0.19, respectively). Femoral head diameter is associated with annulus size. This may help size the appropriate prosthesis in cases where the measurements by CT are in the border zone if corroborated by clinically driven data.

A Deep Learning Method for Quantification of Femoral Head Necrosis Based on Routine Hip MRI for Improved Surgical Decision Making.

(1) Background: To evaluate the performance of a deep learning model to automatically segment femoral head necrosis (FHN) based on a standard 2D MRI sequence compared to manual segmentations for 3D quantification of FHN. (2) Methods: Twenty-six patients (thirty hips) with avascular necrosis underwent preoperative MR arthrography including a coronal 2D PD-w sequence and a 3D T1 VIBE sequence. Manual ground truth segmentations of the necrotic and unaffected bone were then performed by an expert reader to train a self-configuring nnU-Net model. Testing of the network performance was performed using a 5-fold cross-validation and Dice coefficients were calculated. In addition, performance across the three segmentations were compared using six parameters: volume of necrosis, volume of unaffected bone, percent of necrotic bone volume, surface of necrotic bone, unaffected femoral head surface, and percent of necrotic femoral head surface area. (3) Results: Comparison between the manual 3D and manual 2D segmentations as well as 2D with the automatic model yielded significant, strong correlations (Rp > 0.9) across all six parameters of necrosis. Dice coefficients between manual- and automated 2D segmentations of necrotic- and unaffected bone were 75 ± 15% and 91 ± 5%, respectively. None of the six parameters of FHN differed between the manual and automated 2D segmentations and showed strong correlations (Rp > 0.9). Necrotic volume and surface area showed significant differences (all p < 0.05) between early and advanced ARCO grading as opposed to the modified Kerboul angle, which was comparable between both groups (p > 0.05). (4) Conclusions: Our deep learning model to automatically segment femoral necrosis based on a routine hip MRI was highly accurate. Coupled with improved quantification for volume and surface area, as opposed to 2D angles, staging and course of treatment can become better tailored to patients with varying degrees of AVN.

The Presence of Hip Joint Effusion on MRI Is Predictive of a Grade 4 Femoral Neck Stress Injury.

One of the most debilitating types of bone stress injuries is those occurring at the femoral neck. This problem occurs in the military population with much higher incidence than in the normal population and is of great concern to military medical providers. Early detection and accurate diagnosis are key in protecting soldiers and recruits from sustaining a potentially career-ending fracture. In a case study, a 16-year-old elite male distance runner presented with hip pain. MRI found hip joint effusion but was unremarkable for marrow edema and a low-signal fracture line. The initial diagnosis was acute arthritis; however, a follow-up radiograph 1 month later, after the patient had been refraining from running, confirmed a significant non-displaced compression-side Grade 4 femoral neck stress injury (FNSI). In light of the case study and our similar clinical experience, we tested the hypothesis that an MRI study positive for an FNSI, combined with the evidence of a hip joint effusion, is indicative of a Grade 4 FNSI, even without visualization of a low-signal intensity fracture line on T1 or short tau inversion recovery images. Recruits in Army Basic Combat Training were included in the investigation if 1) diagnosed with a unilateral FNSI, 2) had an initial positive MRI for an FNSI, 3) had a positive bone scan for uptake in the femoral neck area (to validate the diagnosis), 4) had no other hip/pelvis injuries, and 5) had a follow-up MRI within 60 days. Hip joint effusion was defined as 1) ≥2-mm measurable difference in the thickness of fluid along the length of the involved femoral neck when compared to the contralateral uninvolved femoral neck on the initial MRI; 2) visibly assessed as a prominent collection of fluid distending the posterior hip joint capsule on the initial MRI coronal short tau inversion recovery sequence (called the "flash sign"). A total of 162 recruits met the study inclusion criteria. For the detection of a Grade 4 FNSI on the first MRI, the sensitivity, specificity, and positive predictive value of the measured joint effusion criteria were 0.52, 0.94, and 0.89, respectively. or the non-measured flash sign, these values were 0.70, 0.83, and 0.80, respectively. Both the measured hip joint effusion criteria and the non-measured flash sign were predictive of a Grade 4 FNSI and may be useful in clinical evaluation.

Relation between Biochemical Parameters and Bone Density in Postmenopausal Women with Osteoporosis.

Osteoporosis is the most prevalent metabolic bone disease in postmenopausal women associated with reduced bone mass and increased bone fracture. Measuring bone density in the lumbar spine and hip is a reliable measure of bone mass and can therefore specify the risk of fracture. Dual-energy X-ray absorptiometry (DXA) is an accurate non-invasive system measuring bone density, with a low margin of error and no complications. The present study aimed to investigate the relationship between biochemical parameters with bone density in postmenopausal women. This cross-sectional study was conducted on 87 postmenopausal women referred to osteoporosis centers in Isfahan. Bone density was measured in the spine and hip area using the DXA system. Serum levels of calcium, phosphorus, alkaline phosphatase, and magnesium were measured by an autoanalyzer, and serum levels of vitamin D were measured by high-performance liquid chromatography (HPLC). The mean parameters of calcium, phosphorus, alkaline phosphatase, vitamin D, and magnesium did not show a significant difference between the two groups (P-value > 0.05). In the control group, the relationship between alkaline phosphatase and bone mineral content (BMC) and bony area (BA) in the spine was significant with a correlation coefficient of - 0.402 and 0.258, respectively (P-value < 0.05) and BMD and T-score in the femoral neck area showed a direct and significant relationship with phosphorus (correlation = 0.368; P value = 0.038). There was a significant relationship between the Z-score with calcium (correlation = 0.358; P value = 0.044). There was no significant relationship between the values of calcium, phosphorus, alkaline phosphatase, vitamin D, and magnesium parameters and bone density (spine and hip) in postmenopausal women with osteopenia or osteoporosis.

Growth of long bones in European and Japanese quail from the 13th day of incubation to day 35 post-hatch.

This study described the growth, morphometric, biomechanical, and chemical properties of the femur, tibiotarsus, and tarsometatarsus of European and Japanese quail. Analyses were performed at 13 and 15 days of incubation, at hatch, and at 4, 7, 10, 14, 21, 28, and 35 days post-hatch (n=6/subspecies/period). Bone specimens were analyzed by cone-beam computed tomography, biomechanical assays, chemical analyses, and histomorphometry. Variables were fitted by the Gompertz function and its derivative or assessed using the analysis of variance. Analysis of the derivative of Gompertz curves showed that the growth behavior of the tarsometatarsal bone was similar between quail subspecies, and the femur and tibiotarsus of European quail increased first in width and then in length, whereas the opposite occurred in Japanese quail. There was an interaction between quail subspecies and days of growth on femoral, tarsometatarsal, and tibiotarsal bone densities. Femoral and tibiotarsal cross-sectional areas were influenced by the interaction of quail subspecies and day of growth. Interaction effects were significant for breaking strength and phosphorus percentage. European and Japanese quail have different femoral and tibiotarsal growth patterns, especially in the first few days after hatching, whereas tarsometatarsal growth is similar between subspecies.

BODY WEIGHT INFLUENCES MUSCULOSKELETAL ADAPTATION TO LONG-TERM VOLUNTARY WHEEL RUNNING DURING AGING

Abstract Frailty is a key hallmark of aging and exercise has been shown to delay aging effects. This study was initiated based on the hypothesis that voluntary wheel running (VWR) starting at 12 mo until 18 or 22 mo of age would benefit the female murine musculoskeletal system. Based on the final body weight, the mice were separated into high (HBW) and low body weight (LBW) subgroups. Beneficial effects of VWR were observed on soleus muscle mass and contractile force at both ages, although HBW led to greater increases at 22 mo. VWR increased fiber cross-sectional area by 20%, leading to more type I and fewer IIA fibers in soleus. HBW mice were resistant to age-related decline in Extensor digitorum longus (EDL) mass and contractile force. EDL in 18 mo HBW also showed 15% higher contractile force following VWR while muscle from 18 &amp; 22 mo LBW responded to VWR with greater osteocyte protective factor secretion. Skeletal adaptation to VWR was also dependent on body weight, with HBW showing higher femoral cortical thickness and area under sedentary conditions. VWR maintained osteocyte dendrite number in HBW. VWR increased periosteal and endosteal circumferences in HBW, suggesting compensation for loss of material strength. Consistent with this, VWR maintained higher bone mechanical properties in 18mo LBW. In summary, VWR alters musculoskeletal parameters depending on body weight with HBW contributing to more muscle mass and strength to prevent sarcopenia while bone retains better mechanical properties in LBW but HBW contributes structural modification to prevent osteopenia.

Biomechanical assessment of disease outcome in surgical interventions for medial meniscal posterior root tears: a finite element analysis

BackgroundThe adverse consequences of medial meniscus posterior root tears have become increasingly familiar to surgeons, and treatment strategies have become increasingly abundant. In this paper, the finite element gait analysis method was used to explore the differences in the biomechanical characteristics of the knee joint under different conditions.MethodsBased on CT computed tomography and MR images, (I) an intact knee (IK) model with bone, cartilage, meniscus and main ligaments was established. Based on this model, the posterior root of the medial meniscus was resected, and (ii) the partial tear (PT) model, (iii) the entire radial tear (ERT) model, and (iv) the entire oblique tear (EOT) model were established according to the scope and degree of resection. Then, the (v) meniscus repair (MR) model and (vi) partial meniscectomy (PM) model were developed according to the operation method. The differences in stress, displacement and contact area among different models were evaluated under ISO gait loading conditions.ResultsUnder gait loading, there was no significant difference in the maximum stress of the medial and lateral tibiofemoral joints among the six models. Compared with the medial tibiofemoral joint stress of the IK model, the stress of the PM model increased by 8.3%, while that of the MR model decreased by 18.9%; at the same time, the contact stress of the medial tibiofemoral joint of the ERT and EOT models increased by 17.9 and 25.3%, respectively. The displacement of the medial meniscus in the ERT and EOT models was significantly larger than that in the IK model (P < 0.05), and the tibial and femoral contact areas of these two models were lower than those of the IK model (P < 0.05).ConclusionsThe integrity of the posterior root of the medial meniscus plays an important role in maintaining normal tibial-femoral joint contact mechanics. Partial meniscectomy is not beneficial for improving the tibial-thigh contact situation. Meniscal repair has a positive effect on restoring the normal biomechanical properties of the medial meniscus.

Preparation and evaluation of osteoinductive porous biphasic calcium phosphate granules obtained from eggshell for bone tissue engineering

The synthetic bone graft substitutes currently used clinically are osteoconductive but not osteoinductive; their low success rate is thus their biggest disadvantage. The use of biomass raw materials for synthesizing calcium phosphate has gradually attracted increased research attention. In this study, hydroxyapatite powder was prepared through liquid-phase precipitation from eggshell, and porous biphasic calcium phosphate granules (EBGs) were then obtained using a pore former and sintering procedure. The EBGs were discovered to have high biocompatibility and no cytotoxicity. The results of animal experiments showed that the area of new bone growth was high, numerous Haversiancanals could be observed, and almost all EBGs were surrounded by new bone tissue, which proved that the EBGs had excellent osteoinductivity. By contrast, numerous fat cells were found in the femoral defect area when a commercial bone graft was employed. Various biological inorganic ions (Mg, Sr, Na, and Fe) originally in the eggshell raw materials were incorporated into the EBGs, and the EBGs exhibited excellent osteogenic abilities. The developed approach provides an economical and feasible solution for the treatment of bone defects.

The impact of vitamin D deficiency on cortical bone area and porosity at the femoral midsection in children from post‐medieval London

AbstractObjectivesCortical bone structure undergoes dynamic changes during appositional growth and is highly sensitive to mechanical, hormonal, and nutritional influences. Vitamin D deficiency rickets can significantly disrupt the normal mineralization of newly formed bone leading to compromised bone structure. Here, we document ontogenetic trends in femoral cortical bone area and porosity during early growth and examine how vitamin D deficiency during childhood may impact these parameters in a sample of children from post‐medieval London, UK.Materials and MethodsMicro‐CT scans of the femur were collected from a documented sample of 138 children aged from birth to 8.5 years who were grouped by the presence and stage of rickets. Cross‐sections were extracted at the midsection and area and porosity measurements recorded. A local regression (LOESS) was used to fit curves to the dataset of children without rickets, which were used as comparative baselines for children with active and healed rickets.ResultsCortical bone porosity was elevated in all children with active rickets most likely reflecting delayed mineralization of osteoid and increased resorption due to secondary hyperparathyroidism. Total subperiosteal area and cortical bone area were higher in children with healed rickets than children without rickets reflecting the mineralization of osteoid following recovery from the deficiency.DiscussionThe results demonstrate marked differences in cortical bone structure in children with rickets, which vary according to age and disease stage. This study illustrates the complex interaction between metabolic bone diseases and bone formation and the importance of considering ontogenetic changes in bone structure in the study of disease during childhood.

Comparison of the morphology of the anterior cruciate ligament and related bony structures between pigs and humans.

Pigs are widely used for clinical research on the anterior cruciate ligament (ACL) because of the similarity of the knee structure to the human knee. But evidence to support the suitability of using porcine samples to guide clinical practices is limited. This study aims to explore the qualitative and quantitative morphological features of the porcine knee and ACL, and to compare these with data on humans reported in literature. Nineteen porcine knees were used for this study. The bone structures were measured on coronal X-ray images. The length of the ACL was measured using a caliper. The ACL bone insertion sites were marked and measured on a digital photograph. The lengths of the long and short axis of the ACL isthmus were measured on the X-ray microscopy reconstructed images. The outcomes were compared with previously reported data on humans using an abstract independent-samples T test. Qualitative observation indicated a similar location, orientation and general morphology of the porcine ACL to human ACLs. The major difference was the location of the ACL tibial insertion with respect to the anterior horn of the lateral meniscus (AHLM). The porcine ACL was split into AM and PL bundles by the AHLM, while the AHLM was adjacent to the anterolateral border of the ACL tibial insertion in human knees. The quantitative comparison showed no significant difference between the human and porcine ACL in terms of the length of the ACL, the width of the femoral condyle and tibial plateau, and the tibial interspinal width. However, the CSA, the lengths of the long and short axis of the ACL isthmus, and the femoral and tibial insertion areas of the porcine ACL were all significantly larger than the reported features in human knees. The location, orientation and basic morphology of the porcine ACL and knee are similar to humans. However, the two-bundle structure is more distinct in a porcine ACL, and the dimensions of the porcine ACL are generally larger. This study may provide useful information to researchers when assessing the feasibility and limitations of using porcine samples for research on the human ACL and knee.

ПЛОТНОСТЬ КОСТНОЙ ТКАНИ И ЕЕ РЕГУЛЯЦИЯ В ЗАВИСИМОСТИ ОТ СОСТОЯНИЯ ОБМЕНА МАГНИЯ У ЖЕНЩИН ПОСТМЕНОПАУЗАЛЬНОГО ВОЗРАСТА С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

The aim of study was to identify markers of bone turnover such as osteoprotegerin (OPG), receptor activator for nuclear factor kappa-B ligand (RANKL), 25-hydroxyvitamin D (25(OH)D), and bone density (BMD) in postmenopausal women with arterial hypertension (AH) and heart failure with preserved ejection fraction (HFpEF), depending on magnesium (Mg) status. Material and methods. 140 postmenopausal women aged 52 to 76 years with AH and HFpEF were examined. Based on the Mg-tolerance test, patients were divided into 2 groups: with Mg deficiency (n=72) and without one (n=68). BMD in the neck and proximal femoral area, as well as L1-L4 vertebrae, was measured in by dual-energy X-ray absorptiometry. OPG, soluble RANKL (sRANKL) and 25(OH)D level was also determined by enzyme immunoassay. Results. In Mg deficiency group were noted lower BMD indices in L1-L4 vertebrae area (0,990±0,159 g/cm2 vs 1,046±0,193 g/cm2; p=0,041) and higher osteopenia incidence (RR=1,60; 95% CI: 1,08–2,38; p=0,019). Also, Mg deficient women had higher level of OPG (85,2 [69,1; 103,1] pg/ml vs 79,9 [63,4; 92,7] pg/ml, p=0,035) and sRANKL (3,98 [2,70; 5,45] pg/ml vs 2,85 [1,95; 3,82] pg/ml, p&lt;0,0001) expression, but lower OPG/sRANKL ratio (22.59 [15.34; 33.71] vs 26.01 [19.42; 41.19], p=0.028) in opposite to control group parameters. At the same time, patients with Mg deficiency had higher 25(OH)D impaired status incidence (97% vs 87%; p=0,028). Conclusion. Lower BMD and OPG/sRANKL ratio, but higher OPG and sRANKL expression and higher frequency of 25(OH)D impaired status were revealed in postmenopausal women with AH, HFpEF and Mg deficiency compared to the control group.

Factors Influencing Treatment Outcome and Proprioception after Electrocoagulation of the Femoral Insertion of the Anterior Cruciate Ligament.

(1) Background: Studies have established that exercises shaping the sense of deep sensation are an important element of medical rehabilitation of patients after vaporization of the femoral insertion of the anterior cruciate ligament and affect the restoration of correct movement patterns, thus reducing the risk of injuries. The aim of this study was to determine the factors influencing the treatment outcome and deep-feeling function after applying a specific rehabilitation scheme 12 weeks after anterior cruciate ligament electrocoagulation surgery. (2) Methods: The study group consisted of 41 patients after partial rupture of the anterior cruciate ligament, who underwent electrocoagulation of the femoral cruciate ligament attachment and microfracture of the femoral attachment area. All patients were operated on by the same surgeon and then rehabilitated according to the same medical rehabilitation protocol. The anthropometric and clinical data were collected through an anterior drawer test, Lachman test, assessment of the range of movements in the knee joint, muscle strength test, Unterberger test and Lysholm questionnaire. The assessment was performed before the surgery, and then on days 7–10, after 6 and 12 weeks of rehabilitation treatment. (3) Results: Statistical improvement of the parameters was demonstrated by strength of the quadriceps and hamstrings muscle, the Unterberger test, and the Lysholm scale after surgery. A negative correlation was found between the Unterberger test and Lysholm scale at the end of the research period and it differed depending on the gender and the dominant limb. The Lysholm scale and muscle strength were independent of sex, dominant extremity and associated damage of the meniscus and cartilage. The Lysholm scale 6 weeks after surgery negatively correlated with BMI. (4) Conclusions: Stability of the knee joint and improvement of proprioception were demonstrated 12 weeks after treatment with an ACL electrocoagulation and rehabilitation regimen. The factors contributing to a better treatment outcome were greater muscle strength, less thigh asymmetry, better sense of depth, younger age and lower body weight.

Lateral posterior tibial slope does not affect femoral but does affect tibial tunnel widening following anatomic anterior cruciate ligament reconstruction using a Bone–Patellar Tendon–Bone graft

BackgroundTunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction has been a research area of interest in ACL reconstruction. In recent years, it has been noted that posterior tibial slope (PTS) affects several types of outcomes after ACL reconstruction including TW. However, the relationships between femoral and tibial TW and between PTS and TW following anatomical ACL reconstruction using a bone–patellar tendon–bone (BTB) graft are often not understood. Therefore, the purpose of this study was to retrospectively clarify the magnitude of femoral and tibial TW and the effect of PTS on TW following anatomical ACL reconstruction using a BTB graft. MethodsA total of 111 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. Femoral and tibial tunnel aperture areas were measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and femoral and tibial TW (%) was calculated. Lateral and medial PTS was also measured using 3D CT. ResultsAs compared with 1 week postoperatively, the mean tibial tunnel aperture areas increased by 30.6% ± 28.5%, and the mean femoral tunnel aperture areas increased by 28.3% ± 27.9% when measured at 1 year postoperatively. Although no significant difference was observed between femoral and tibial TW, a significant positive correlation was noted between femoral and tibial TW (r = 0.240, p = 0.011). A significant correlation was observed only between lateral PTS and tibial TW (r = 0.354, p < 0.001). There was no significant correlation between medial PTS and tibial TW, lateral PTS and femoral TW, or medial PTS and femoral TW. ConclusionSignificant positive correlation was observed between femoral and tibial TW. Steeper lateral PTS correlated with greater tibial TW; on the other hand, medial PTS did not correlate with tibial TW. Although lateral PTS affected tibial TW, it did not affect femoral TW.

The Hybrid Transtibial Technique for Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: A Finite Element Analysis Model of Graft Bending Angles and Peak Graft Stresses in Comparison With Transtibial and Anteromedial Portal Techniques.

The purpose of this finite element analysis was to compare femoral tunnel length; anterior cruciate ligament reconstruction graft bending angle; and peak graft stress, contact force, and contact area created by the transtibial, anteromedial portal (AMP), and hybrid transtibial techniques. Finite element analysis modeling was used to examine anterior cruciate ligament reconstruction models based on transtibial, AMP, and hybrid transtibial femoral tunnel drilling techniques. An evaluation of femoral tunnel length, graft bending angle, peak graft stress, contact force, and contact area was done in comparison of these techniques. The femoral tunnel created with the hybrid transtibial technique was 45.3 mm, which was 13.3% longer than that achieved with the AMP technique but 15.2% shorter than that with the transtibial technique. The femoral graft bending angle with the hybrid transtibial technique (105°) was less acute than that with the AMP technique (102°), but more acute than that with the transtibial technique (109°). At 11° knee flexion, the hybrid transtibial technique had 22% less femoral contact force, 21% less tibial contact force, 21% less graft tension than the AMP technique. Yet, the hybrid transtibial technique had 41% greater femoral contact force, 39% greater tibial contact force, 33% greater graft tension, and 6% greater graft von Mises stress than the transtibial technique. A similar trend was found for the anterior knee drawer test. At both 6-mm anterior tibial displacement and 11° knee flexion, the hybrid transtibial and AMP techniques had at least 51% more femoral contact area than the transtibial technique. This finite element analysis highlights that the hybrid transtibial technique is a true hybrid between the AMP and transtibial techniques for femoral tunnel drilling regarding femoral tunnel length, graft bending angle, and peak graft stress.

Characteristics of femoral neck fractures in young and middle-aged adults based on fracture mapping technology

To analyze the characteristics of femoral neck fractures in young and middle-aged adults by means of medical image analysis and fracture mapping technology to provide reference for fracture treatment. A clinical data of 159 young and middle-aged patients with femoral neck fractures who were admitted between December 2018 and July 2019 was analyzed. Among them, 99 patients were male and 60 were female. The age ranged from 18 to 60 years, with an average age of 47.9 years. There were 77 cases of left femoral neck fractures and 82 cases of right sides. Based on preoperative X-ray film and CT, the fracture morphology was observed and classified according to the Garden classification standard and Pauwels' angle, respectively. Mimics19.0 software was used to reconstruct the three-dimensional models of femoral neck fracture, measure the angle between the fracture plane and the sagittal plane of the human body, and observe whether there was any defect at the fracture end and its position on the fracture surface. Through reconstruction, virtual reduction, and image overlay, the fracture map was established to observe the fracture line and distribution. According to Garden classification standard, there were 6 cases of type Ⅰ, 61 cases of type Ⅱ, 54 cases of type Ⅲ, and 38 cases of type Ⅳ. According to the Pauwels' angle, there were 12 cases of abduction type, 78 cases of intermediate type, and 69 cases of adduction type. The angle between fracture plane and sagittal plane of the human body ranged from -39° to +30°. Most of them were Garden type Ⅱ, Ⅳ and Pauwels intermediate type. The fracture blocks were mainly in the form of a triangle with a long base and mainly distributed below the femoral head and neck junction area. Twenty-six cases (16.35%) were complicated with bone defects, which were mostly found in Garden type Ⅲ, Ⅳ, and Pauwels intermediate type, located at the back of femoral neck and mostly involved 2-4 quadrants. The fracture map showed that the fracture line of the femoral neck was distributed annularly along the femoral head and neck junction. The fracture line was dense above the femoral neck and scattered below, involving the femoral calcar. The proportion of displaced fractures (Garden type Ⅲ, Ⅳ) and unstable fractures (Pauwels intermediate type, adduction type) is high in femoral neck fractures in young and middle-aged adults, and comminuted fractures and bone defects further increase the difficulty of treatment. In clinical practice, it is necessary to choose treatment plan according to fracture characteristics. Anatomic reduction and effective fixation are the primary principles for the treatment of femoral neck fracture in young and middle-aged adults.