Healthy Side Research Articles

Quantitative Assessment of Calf Muscle Volume, Strength, and Quality After Achilles Tendon Rupture Repair: A 1-Year Prospective Follow-up Study

Background: A number of studies have reported that calf muscle atrophy is a common long-term problem after Achilles tendon repair; however, there is still a lack of data concerning early postoperative morphological changes in the calf muscle after surgery. Purpose: To investigate changes over time in calf muscle volume and fatty degeneration during 1 year after Achilles tendon repair. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective 1-year serial magnetic resonance imaging study was carried out with 20 patients who underwent tendon repair for unilateral acute Achilles tendon rupture. The magnetic resonance imaging assessment in addition to clinical and functional evaluations was performed at 1, 3, 6, and 12 months after surgery. The muscle volume of the medial and lateral gastrocnemius, soleus, and flexor hallucis longus (FHL) and fatty degeneration of the medial and lateral gastrocnemius and soleus were measured for the calf muscles, and the relative volume and fatty degeneration changes in the affected leg compared with the healthy contralateral leg were calculated as a percentage ([injured/healthy control] × 100) to assess structural changes over time. Results: Muscle volumes of the medial gastrocnemius, lateral gastrocnemius, soleus, and FHL were 92.3%, 92.8%, 84.6%, and 95.9% at 12 months after surgery, respectively. Medial and lateral gastrocnemius and FHL muscle volumes improved over time and recovered to almost equal to that of the healthy side at 12 months after surgery. The soleus muscle volume did not recover significantly over time and was statistically significantly smaller than that of the healthy side at 12 months (P = .029). Fatty degeneration rates of the medial gastrocnemius, lateral gastrocnemius, and soleus were 118.2%, 113.9% and 121.1% at 12 months after surgery, respectively. Fatty degeneration of the medial and lateral gastrocnemius did not change significantly, but there was a statistically significant increase in fatty degeneration of the soleus over time (P < .001). Conclusion: Within the triceps surae muscle, the soleus was the most negatively affected by injury and repair for both muscle volume and fatty degeneration. Postoperative management to recover the soleus muscle function before a return to sporting activities should be considered in the future.

NIMG-72. CONTRALATERAL PREDOMINANT BLOOD SUPPLY OF FALX AND PARASAGITTAL MENINGIOMA BASED ON ANGIOGRAPHIC ANALYSIS

Abstract INTRODUCTION Preoperative prediction of blood supply in meningiomas is important to avoid unexpected intraoperative bleeding. Herein, we investigated the relationship between the location of meningioma and the dominant side of feeding arteries. METHOD: Between January 2018 and December 2020, a total of 101 consecutive patients underwent craniotomy for meningioma at our hospital. Among them, 43 cases in which the lesions were clearly localized on the right or left sides received preoperative angiography including bilateral common or external carotid artery (ECA) imaging. A region of interest (ROI) was set at the most stained area in (X) meningioma and (Y) main trunk of the ECA. In each affected side (AS) and healthy side (HS), the ratio of ROI (X) value to ROI (Y) value; tumor / vessel ratio (TVR = 0 ~ 1) was calculated. Multivariate analysis was performed to compare TVR between AS and HS, and to analyze factors associated with TVR, such as site of origin (convexity, skull base and relating falx), age, gender, WHO grading, and tumor diameter. RESULTS TVR was significantly higher in AS (0.60; 0.41 - 0.91) than HS (0.47; 0.39 - 0.99) (p=0.0003). HS was superior to AS in 10 cases, all of which were falx (6 of 9 cases) or parasagittal (4 of 10 cases) meningioma. 53% of falx and parasagittal meningiomas showed HS predominant TVR. Concerning factors associated with the TVR of HS predominance, falx origin was extracted as an independent factor (p&amp;lt; 0.0001). DISCUSSION The vessels crossing in the falx, which consist with particular anatomical structure, fusing the meningeal layers in each side of dura mater would contribute to this finding. CONCLUSION Falx and parasagittal meningiomas should consider the predominant influx of tumor feeding vessels from HS.

Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients.

This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft. 39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis. In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05). In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

Arthroscopic biceps tenodesis using press-fit bony plug: a case series study.

To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique. This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24months at least. Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis. Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies. Registration number: N-1562023. Registration date: June 2022 "Retrospectively registered".

Nordic hamstring exercises in functional knee rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomised, controlled study

To study the effect of using Nordic hamstring exercise method on muscle strength and knee joint stability of patients after ACL reconstruction. 60 patients admitted to our hospital for ACL reconstruction were randomly divided into a test group (n = 30, applying Nordic hamstring exercise) and a control group (n = 30, applying conventional rehabilitation training methods), and the difference in the circumference of the thighs of the patients in the two groups was analysed after training, and the peak torque (PT), total torque (PT), and flexion and extension strength were measured by using the Biodex system3 Multi-joint Isokinetic Testing System at knee joints with an angular velocity of 60°/s and 120°/s. The peak torque (PT), total work (TW), and average peak torque (AVG PT) were measured by extension and flexion strength at angular velocity, and the Lysholm Knee Score was used to assess the knee function of 60 patients. There was no difference in the difference in thigh circumference between the two groups before surgery (P > 0.05); the difference in thigh circumference between the patients in the test group at 12 and 24 weeks after surgery was (− 0.35 ± 0.22) cm and (0.12 ± 0.03) cm, respectively, which were higher than those in the control group, (− 0.51 ± 0.15) cm and (− 0.41 ± 0.34) cm (P < 0.05). At the 12th and 24th postoperative weeks, the popliteal muscle strength of both groups was improved compared with that before surgery; among them, by comparing the popliteal peak moments with different angular velocities, the ratio of popliteal peak moment on the affected side/peak moment on the healthy side of the popliteal muscle of the experimental group was significantly higher than that of the control group, and the difference was significant (P < 0.05), but there was still a gap compared with that of the healthy side. The Lachmen test and the anterior drawer test were negative in the test and control groups at the 24th postoperative week of review, and the anterior tibial shift was < 5 mm in the KT-1000 test, and the difference in the anterior shift was < 3 mm compared with the healthy side, and there was no significant difference between the two groups. By Nordic hamstring exercise can make patients after knee ACL reconstruction reduce patient pain, accelerate the recovery of knee function, improve the swelling of the lower limb, reach the level of flexor strength of the healthy side within 24 weeks, and can increase the stability of the knee joint.

Effects of TAPP Combined with Biological Mesh on Reproductive Function in Male Inguinal Hernia Patients of Reproductive Age: A Single-Center Retrospective Study

Objective. To explore the effect of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) combined with biological mesh on the reproductive function of male inguinal hernia patients during the reproductive period. Methods. Sixty male inguinal hernia patients during the reproductive period admitted to our department from October 2015 to October 2021 were selected for retrospective analysis. All patients were treated with TAPP combined with biological mesh by the same team. Bilateral testicular volume, testicular temperature, testicular blood perfusion, peripheral serum testosterone concentration, and semen analysis were examined before surgery, 3 months after surgery, 6 months after surgery, and 12 months after surgery. Results. The preoperative testicular volume, temperature, and blood perfusion were compared between the healthy side and the affected side; the testicular volume, temperature, blood perfusion of the affected side, peripheral blood testosterone concentration, and semen analysis were compared among the four time points, which were before operation, 3 months after operation, 6 months after operation, and 12 months after operation. All p values were &gt;0.05. Conclusions. The presence of inguinal hernia had no significant effect on the volume and blood perfusion of male testis. In addition, TAPP combined with biological mesh has no negative effect on postoperative reproductive function of male inguinal hernia patients of childbearing age, which manifested as a safe and feasible surgical method.

Effects of trunk training using motor imagery on trunk control ability and balance function in patients with stroke

ObjectiveTo explore the effects of trunk training using motor imagery on trunk control and balance function in patients with stroke.MethodsOne hundred eligible stroke patients were randomly divided into a control group and trial group. The control group was given routine rehabilitation therapy, while the trial group was given routine rehabilitation therapy and trunk training using motor imagery.ResultsPrior to treatment, there was no significant difference between the two groups (P > 0.05) in Sheikh’s trunk control ability, Berg rating scale (BBS), Fugl-Meyer assessment (FMA), movement length, movement area, average front-rear movement speed, average left-right movement speed, and surface electromyography (sEMG) signal of the bilateral erector spinae and rectus abdominis. After treatment, Sheikh’s trunk control ability, FMA, and BBS in the two groups were significantly higher than those before treatment (P < 0.05). The movement length, movement area, the average front-rear movement speed, and the average left-right movement speed in the two groups decreased significantly (P < 0.05). The differences of these indicators between the two groups were statistically significant (P < 0.05). After treatment, the rectus abdominis and erector spinae on the affected side of the two groups improved when compared with those before treatment (P < 0.05). The rectus abdominis and erector spinae on the healthy side of the trial group descended after treatment (P < 0.05), while little changes were observed on the healthy side of the control group after treatment (P > 0.05). The rectus abdominis and erector spinae on the affected side of the trial group improved when compared with those in the control group (P < 0.05). There was no significant difference between the two groups in the decline of abdominalis rectus and erector spinal muscle on the healthy side.ConclusionTrunk training using motor imagery can significantly improve the trunk control ability and balance function of stroke patients and is conducive to promoting the recovery of motor function.

Predicting Breast Cancer Risk Using Radiomics Features of Mammography Images.

Mammography images contain a lot of information about not only the mammary glands but also the skin, adipose tissue, and stroma, which may reflect the risk of developing breast cancer. We aimed to establish a method to predict breast cancer risk using radiomics features of mammography images and to enable further examinations and prophylactic treatment to reduce breast cancer mortality. We used mammography images of 4000 women with breast cancer and 1000 healthy women from the 'starting point set' of the OPTIMAM dataset, a public dataset. We trained a Light Gradient Boosting Machine using radiomics features extracted from mammography images of women with breast cancer (only the healthy side) and healthy women. This model was a binary classifier that could discriminate whether a given mammography image was of the contralateral side of women with breast cancer or not, and its performance was evaluated using five-fold cross-validation. The average area under the curve for five folds was 0.60122. Some radiomics features, such as 'wavelet-H_glcm_Correlation' and 'wavelet-H_firstorder_Maximum', showed distribution differences between the malignant and normal groups. Therefore, a single radiomics feature might reflect the breast cancer risk. The odds ratio of breast cancer incidence was 7.38 in women whose estimated malignancy probability was ≥0.95. Radiomics features from mammography images can help predict breast cancer risk.

Model test study on treatment of Pruzansky type ⅡB and Ⅲ hemifacial microsomia with artificial condyle-mandibular distractor complex

To preliminarily verify the effectiveness of self-designed artificial condyle-mandibular distraction (AC-MD) complex in the treatment of Pruzansky type ⅡB and Ⅲ hemifacial microsomia (HFM) through model test. Five children with Pruzansky type ⅡB and Ⅲ HFM who were treated with mandibular distraction osteogenesis (MDO) between December 2016 and December 2021 were selected as the subjects. There were 3 boys and 2 girls wih an average age of 8.4 years (range, 6-10 years). Virtual surgery and model test of AC-MD complex were performed according to preoperative skull CT of children. The model was obtained by three-dimensional (3D) printing according to the children's CT data at a ratio of 1∶1. The occlusal guide plate was designed and 3D printed according to the children's toothpaste model. The results of the model test and the virtual surgery were matched in three dimensions to calculate the error of the residual condyle on the affected side, and the model test was matched with the actual skull CT after MDO to measure and compare the inclination rotation of the mandible, the distance between the condylar of the healthy side and the residual condyle of the affected side, and the lengthening length of the mandible. The error of residual condyle was (1.07±0.78) mm. The inclination rotation of the mandible, the distance between the condylar of the healthy side and the residual condyle of the affected side, and the lengthening length of the mandible after 3D printing model test were significantly larger than those after MDO ( P<0.05). In the model test, the implantation of AC-MD complex can immediately rotate the mandible to the horizontal position and improve facial symmetry, and the residual condyle segment can be guided close to the articular fossa or the preset pseudoarticular position of the skull base after operation.

Functional reorganization of intranetwork and internetwork connectivity in patients with Ménière’s disease

Ménière’s disease (MD) is associated with functional reorganization not only in the auditory or sensory cortex but also in other control and cognitive areas. In this study, we examined intranetwork and internetwork connectivity differences between 55 MD patients and 70 healthy controls (HC) in 9 well-defined resting-state networks. Functional connectivity degree was lower in MD compared to HC in 19 brain areas involved in the somatomotor, auditory, ventral attention, default mode, limbic, and deep gray matter networks. In addition, we observed lower intranetwork connectivity in the auditory, ventral attention, and limbic networks, as well as lower internetwork connectivity between the somatomotor and limbic networks, and between the auditory and somatomotor, deep gray matter, and ventral attention networks, and between the deep gray matter and default mode network. Furthermore, we identified 81 pairs of brain areas with significant differences in functional connectivity between MD patients and HC at the edge level. Notably, the left amygdala’s functional connectivity degree was positively correlated with MD’s disease stage, and the ventral attention network’s intranetwork connectivity was positively correlated with the healthy side vestibular ratio. Our findings suggest that these functional network reorganization alterations may serve as potential biomarkers for predicting clinical progression, evaluating disease severity, and gaining a better understanding of MD’s pathophysiology. Large-scale network studies using neuroimaging techniques can provide additional insights into the underlying mechanisms of MD.

Examination of Myofascial Stiffness and Elasticity in the Upper Trapezius Region in Patients with Unilateral Neck Pain: A Cross-Sectional Study.

(1) Background: Globally, neck pain is prevalent, affecting around thirty percent of the population annually. To better understand the influence of pain on the myofascial layers, the present study investigated these on the upper trapezius muscle in unilateral, more severe neck pain. (2) Methods: This study was a cross-sectional study. Forty patients (42.2 ± 14.7) with a confirmed diagnosis of unilateral neck pain were examined using durometry and indentometry. This study evaluated the stiffness, elasticity, and pressure pain threshold of both sides of the neck (symptomatic side: SS; healthy side: HS). Furthermore, the range of motion of the cervical spine (lateral flexion, rotation) was quantified using a digital goniometer. (3) Results: A significant lateral discrepancy was observed in stiffness between groups (durometry: SS-33.76 ± 7.78, HS-29.75 ± 7.45, p < 0.001; indentometry: SS-59.73 ± 33.93, HS-4.18 ± 12.69, p = 0.024). In contrast, no differences were found between the comparison sides of the upper trapezius for the parameter's elasticity (SS-0.101 ± 1.09, HS--0.006 ± 0.29, p = 0.416), cervical spine mobility (lateral flexion: SS-37.08 ± 8.15, HS-37.73 ± 7.61, p = 0.559; rotation: SS-73.55 ± 12.37, HS-72.85 ± 11.10, p = 0.660), and algometry (SS-36.41 ± 17.53, HS-37.22 ± 17.00, p = 0.657). (4) Conclusion: Overall, it can be concluded that more severe neck pain unilaterally shows differences in stiffness on the same side. Future research is needed to investigate the links.

Clinical Analysis of 3D-Fluid Attenuated Inversion Recovery and T1volume interpolated body examination Sequences on Delayed Gadolinium-Enhanced Scanning in Ramsay Hunt Syndrome.

Through the clinical analysis of 4 clinically confirmed cases of delayed gadolinium enhancement of Ramsay Hunt syndrome 3D-Fluid Attenated Inversion Recovery'and 'T1volume interpolated body examination (3D-FLAIR and T1VIBE) sequences, the more suitable sequences and pathologically damaged tissue sites of deep tissues of Ramsay Hunt syndrome by magnetic resonance imaging gadolinium enhancement were preliminarily explored. From October 2020 to March 2021, 4 clinically confirmed patients with Ramsay Hunt syndrome, 2 males and 2 females, aged 27-63, were continuously collected in the hospital otology clinic. Siemens Avento 1.5T magnetic resonance imaging 3D-FLAIR and T1VIBE sequencedelayed gadolinium enhancement scans and serological laboratory tests were performed, respectively, and corresponding antiviral and antiinflammatory therapy was given. The magnetic resonance imaging gadolinium enhancement of 4 cases of Ramsay Hunt syndrome was as follows: 3D-FLAIR sequence delay of 4.5 hours scanning 4 patients labyrinthine and/or middle ear signal was enhanced at the same time as the healthy side; T1VIBE sequence scanning disease in 3 cases of vestibular nerve development was enhanced than the healthy side, 2 cases of facial nerve development was enhanced than the healthy side, and 2 cases of cochlear nerve development was enhanced than the healthy side. All 4 patients were cured with related treatment. Through the comparison of 3D-FAIR and T1VIBE sequence of 4.5 hours delay before intravenous gadolinium injection and 4.5 hours delay after intravenous gadolinium injection in 4 patients with Ramsay Hunt syndrome, it was found that (i) 3D-FLAIR sequence delay of 4.5 hours scan was more likely to show whether the inner ear labyrinth barrier permeability increased and (ii) Ramsay Hunt syndrome deep ear tissue damage can be manifested as labyrinthitis, vestibular cochlear neuritis, facial neuritis, and otitis media.

Congruent Weber-B Ankle Fractures do not affect Tibiotalar Contact Mechanics: No Need for the Scalpel?

Category: Trauma; Ankle Introduction/Purpose: Weber-B ankle fractures represent an increasingly common injury world-wide, and the decision for operative fixation often hinges on the stability and congruency of the ankle. While tibiotalar displacement is typically evaluated using the medial clear space on plain radiographs, this method remains prone to inaccuracy because of x-ray beam rotation and manual measurement errors. Furthermore, the influence of these fractures on the mechanical environment of the ankle remains unknown. The recent advent of weightbearing cone-beam CT (WBCT) overcomes these drawbacks by imaging during bipedal stance, allowing a 3D anatomical and mechanical analysis. Therefore, the aim of this study was to analyze the 3D mortise displacement and contact mechanics in weber B ankle fractures by use of WBCT in comparison to their healthy contralateral side. Methods: In this retrospective study, our ankle trauma database was searched for Weber-B ankle fractures imaged by bilateral WBCT imaging between 2015 and 2022. Exclusion criteria consisted of metal or motion artifacts, presence of ankle osteoarthritis, and an age less than 18 years or more than 75 years. Segmentation into 3D models of bone was performed semi-automatically, while personalized cartilage layers were modeled based on a previously validated methodology. Bilateral ankle models were imported in custom-made Matlab® script for an automated anatomical and mechanical analysis. 3D mortise congruency was evaluated by use of following parameters: fibular length, talocrural angle, distance mapping of the medial gutter and tibiofibular clear space distance mapping. Contact mechanics were evaluated by the mean and maximum contact stress of the tibia and talus, as well as the contact area (Figure 1). A student’s T-test was performed to investigate the difference between the fractured and healthy side. Results: Thirty-two patients, with mean age 38.50 years (SD = 15.81 ) and weight 79.12 kg (SD = 16,24), were confirmed eligible for analysis. Statistical analysis revealed that there were no significant differences for all anatomical parameters (P &gt; 0.05). The mean contact stress of the fractured and healthy side was 2.10 (SD = 0.42) MPa and 2.10 (SD = 0,41) MPa, respectively, whereas the maximum stress was 7.67 MPa (SD = 1.55) and 7,47 MPa (SD = 1,67), respectively. No statistical significant differences were found between all mechanical parameters (P &gt; 0.05). Conclusion: This study demonstrates that contact mechanics are not affected in Weber-B fractures with a congruent mortise. Therefore, non-operative treatment could be considered, as there will theoretically be no increased risk for the patients to develop posttraumatic osteoarthritis in the long term. In clinical practice, WBCT could prove useful to determine the 3D anatomical and mechanical environment of ankle fractures and guide patients towards (non-) operative treatment. However, further studies should focus on the minimal clinical important difference/rehabilitation factors associated with mortise malalignment based on concomitant contact stress increase, which would warrant and identify which cases need surgical reduction.

Evaluation of microcirculation in asymptomatic cerebral infarction with multi-parameter imaging of spectral CT

ObjectiveTo investigate the role of spectral CT multiparametric imaging in the evaluation of cerebral microcirculatory perfusion. MethodsThe imaging data of 145 patients with asymptomatic cerebral infarction confirmed by MR were retrospectively analyzed, and all cases underwent head CTA and cranial CT perfusion imaging (CTP) on double-layer detector spectral CT. Single energy level images (MonoE45 keV), iodine density maps, and effective atomic number maps were reconstructed based on spectral CTA data, and CT values, iodine density values, and effective atomic number values were measured in the infarcted area, healthy control area, centrum semiovale and posterior limb of the internal capsule, respectively; perfusion values, such as cerebral blood volume (CBV) values, cerebral blood flow (CBF) values, time to peak (TTP) values, and mean passage time, were measured in the above-mentioned areas on CTP images. (TTP) values, and mean time to passage (MTT) values. CT values, iodine density values, effective atomic number values, and perfused CBV, CBF, TTP, and MTT values were compared between the infarcted area and the healthy side, the center of the hemianopia, and the posterior limb of the internal capsule. The role of spectral CT parameters and perfusion parameters in the evaluation of asymptomatic cerebral infarction was analyzed. ResultsCT values, iodine density values, and effective atomic number values were statistically different between the infarcted area and the healthy side; CT values, iodine density values, and effective atomic number values were not statistically different between the infarcted side and the healthy side of the hemispheric centrum and the posterior limb of the internal capsule; CBV and CBF were statistically different between the infarcted side and the healthy side, and MTT and TTP were not statistically different. There were statistically significant differences in TTP between the infarcted area and the healthy side of the hemiaxial center, and no statistically significant differences in CBV, CBF, and MTT. There were no statistical differences in CBV, CBF, TTP, and MTT in the inner capsule area. ROC curve analysis of spectral CT-related parameters and CT perfusion parameters for the diagnosis of asymptomatic cerebral infarction: area under the curve of MonoE 45Kv 0.71, area under the curve of iodine density values 0.76, area under the curve of effective atomic number values 0.74; area under the curve of CBV value 0.64, area under the curve of CBF value 0.61, area under the curve of MTT value 0.50, The area under the TTP curve was 0.52. The area under the ROC curve of the multivariate logistic regression model based on spectral parameters is 0.76, which is higher than that of the logistic regression model with perfusion parameters (P < 0.05). ConclusionSpectral CT can better demonstrate small intracranial ischemic lesions, and iodine density values have a better evaluation of microcirculation in asymptomatic cerebral infarcts.

Syndesmosis Evaluation Under WBCT: 3rd Base to Get a Cut-Off Point to Diagnosis

Category: Sports; Arthroscopy Introduction/Purpose: Evaluation of syndesmal injury remains challenging for Foot &amp; Ankle Surgeons. As objective data to provide an accurate preoperative diagnosis of syndesmal instability is lacking, arthroscopy has remained the Gold Standard. However, the costs and risks associated with surgery make arthroscopy challenging to indicate in all cases. Therefore, significant interest exists in determining objective criteria to safely indicate surgery. Comparative WBCT is a valuable tool, allowing a precise evaluation of the healthy and injured joints. Specifically, the difference in the syndesmal area correlates with diastasis at the inferior tibiofibular joint, while the cut value for diagnostic instability remains undetermined. Objective: To compare the difference in syndesmal area between healthy patients and patients with syndesmal sprains under WBCT. Methods: IRB approval was obtained for a retrospective case-control study. Patients with suspected syndesmal injuries from April 2019 to August 2022 were included in the case group. Patients with chronic ankle instability, age over 55 years, or surgery of the inferior limb were excluded. The control group was obtained from a previous study of comparative WBCT of the ankle joint, obtained for reasons different than trauma or instability. All patients were evaluated under WBCT by a fellowship-trained MSK radiologist. After evaluating the syndesmal area at 1 cm from the ankle joint line in an axial WBCT slice, the percentage difference from the injured to the healthy side was recorded. Demographic data were obtained from the patient chart. For those patients undergoing surgical stabilization, the operative note was examined. Statistical evaluation was performed by an independent statistician using SPSSv27 using the ANOVA test. Results: Thirty-nine patients were recruited for the study group, and a control group of 25 patients with healthy ankles was obtained. Demographics data for both groups were comparable Arthroscopy was indicated in 7/39 patients (17,9%), which confirmed diagnosis and warranted stabilization of the joint. The mean percentage area difference of the confirmed injured syndesmosis was 15,14% (IC 4,89-25,39), suspected injured syndesmosis was 9,25% (IC 3,11-15,39), and the healthy syndesmosis was 1,54 (IC 1,08-2,01). Statistically significant differences were obtained for healthy, operated, and non-operated patients with a p=0,021. Conclusion: A comparative WBCT scan and the percentage difference in the syndesmal area between the healthy, confirmed, and suspected syndesmal injury demonstrated a handy diagnostic tool. Although the limitations of this study, our results suggest that a 15% difference in the syndesmal area between healthy and injured sides might be used as the cut-off point to indicate diagnostic arthroscopy.

The Influence of Multiplanar Talar Displacement on Articular Ankle Loading: A 3D Finite Element Study

Category: Trauma; Ankle Introduction/Purpose: Ankle fractures represent an increasingly common injury world-wide and the decision for operative fixation often hinges on the definition of acceptable stability. Mortise malalignment has generally been considered as the main predictive factor leading to poorer outcomes and the development of post-traumatic osteoarthritis. Following pioneering work by Ramsey &amp; Hamilton, 1-2 mm of lateral talar displacement has commonly been regarded as a cutoff value for surgical decision making. However, isolated lateral talar translation (as studied in previous works) does not fully replicate the multidirectional joint subluxation seen in ankle fractures. Furthermore, previous studies have been limited by low fidelity methodologic techniques. Therefore, the aim of this study was to analyze the influence of multiplanar talar displacement on tibiotalar contact mechanics utilizing finite element analysis (FEA). Methods: 19 patients having undergone advanced computed tomography (CT) scanning of the ankle were included. A female patient (age 18 years, weight 60 kg) without preexisting articular ankle pathology underwent a weightbearing CT-arthrogram of the left ankle. Additionally, 18 ankles derived from the contralateral healthy side in patients who underwent bilateral weightbearing CT scans (WBCT ) for evaluation of a contralateral ankle fracture were included (mean age = 38.70 years, mean weight = 80.00 kg, left/right: 9/9). Segmentation of the WBCT images into 3D models of bone and cartilage was performed semi-automatically, while on the non-arthrography WBCT images, personalized cartilage layers were modeled based on a previously validated methodology. 3D multiplanar talar displacement was simulated to investigate their respective influence on the tibiotalar contact mechanics. Tibial peak contact stress, talar peak contact stress and contact area were extracted from the FEA models for each condition. Results: The talar peak contact stress (in MPa), tibial peak contact stress (in MPa) and contact area (in mm²) for each condition are presented in Table 1. Overall, both the mean and peak contact stress for the talus and tibia incrementally increased when the talus was displaced, for all directions. Correspondingly, the contact area incrementally decreased. Contact stress maps of the talus and tibia were computed for each of the conditions, demonstrating unique patterns of pressure derangement. 1 mm of lateral translation resulted in 11% increase in peak contact pressure and a 12% decrease in contact area. External rotation exhibited the greatest influence on contact stress, reaching a peak talar stress of 510% above baseline after 20 degrees of external talar rotation. Conclusion: In this study, we were able to build on the paradigm of prior uniplanar cadaveric studies and provide a multiplanar mortise malalignment model. The use of advanced computational technologies allowed for more precise quantitative evaluation of articular contact mechanics. With lateral talar translation, our model demonstrated less dramatic increases in tibiotalar contact area compared to previous studies, whereas external rotation had the largest effect regarding pathologic joint loading. Clinically, this study provides a novel understanding of the mechanical sequelae of 3D talar displacement and the importance for adequate mortise alignment.

Value of paraspinal muscle myography in diagnosing L5 radiculopathy

Introduction. Electromyography (EMG) is an important diagnostic tool for the evaluation of radiculopathy. Since 1990s a paraspinal mapping technique is used, which detects spontaneous activity in paraspinal muscles (PM) at the level of several vertebral segments. This modality seems to be highly conclusive for diagnosing radicular lesions. The main limitation of this method is spontaneous activity dependence on the disease duration.&#x0D; The aim of the study is to assess if PM EMG with motor unit potential (MUP) analysis is conclusive for diagnosing lumbar radiculopathy.&#x0D; Materials and methods. The study examined 58 patients (26 men and 32 women) aged 2673 years with MRI-confirmed symptomatic L5 mono-radiculopathy due to L4L5 herniated discs. The study assessed the neurological status and needle EMG of m. tensor fasciae latae (TFL) and PM at L4L5 and L3L4 levels on both symptomatic and healthy sides immediately before radicular microscopic decompression surgery. Surgery outcomes were evaluated by early and late postoperative questioning.&#x0D; Results. In PMs of the affected level and side, the average MUP duration was significantly different from opposite MUPs at the higher segment (р 0.001). At 3-month disease duration, a neurogenic pattern was significantly more frequent in affected PMs (p = 0.031) with neurogenic PM MUP rearrangement in 73.3% of patients. In the TFL (L5), neurogenic changes were reported only in 47.4% of patients. When compared to normal values, significant differences were found in the average duration of TFL MUPs (р = 0.001) and PM MUPs of the affected level and side (р 0.001) both in patients with motor disorders and those with isolated pain syndrome or sensory disorders.&#x0D; Conclusions. For diagnosing radiculopathy, the sensitivity of needle PM EMG is 82.6% (48/58; 95% CI 70.691.4%). Compared to limb myotome assessment, the highest informative value of PM EMG was reported in patients with the disease duration for up to 3 months. PM EMG was conclusive for diagnosing radicular lesions in patients with isolated pain syndrome or sensory disorders.

Changes of the facial soft tissue after mandibular reconstruction using vascularized iliac flap.

To reveal the change patterns of the facial soft tissue after applying mandibular reconstruction. 16 Patients with mandibular benign tumor were recruited in this retrospective study. For all patients, segmental mandibular osteotomy and concurrent reconstruction using vascularized iliac flap were conducted. The soft tissue thickness of patients' lower face was measured with CT scans before surgery, 1week, 6months and 1year after surgery. The time-dependent changes of tissue thickness were analyzed. The most significant tissue swelling was 28.86%, at 1week after the surgery. The average increase of tissue thickness was 4.78 ± 5.30mm across patient. After 1year of the surgery, tissue thickness decreased to the level before operation or the level of the healthy side. The thickness of the low-density tissue fluctuated mildly, while the thickness of the high-density tissue fluctuated significantly. The disuse atrophy of the masseter occurred 1week after the surgery, and was reversed after 1year. The removal of the submandibular gland caused depression in submandibular area, which intensified over time. Across patients, soft tissue thickness in the lower face after mandibular osteotomy and reconstruction increased significantly 1week after the surgery, and decreased over time. After 1year, tissue thickness went back to the pre-surgery level, where matched up with the healthy side. We documented the change patterns of the facial soft tissue after mandibular reconstruction. These results can help improve the planning of virtual surgeries and the timing for aesthetic assessment. ClinicalTrials.gov Identifier: ChiCTR2100054103.

Clinical application of modified hip joint lateral position in femoral neck fracture

BackgroundTo show the femoral neck better in hip lateral view of X-ray, we design a modified hip lateral view and then investigate the value in femoral neck fractures.MethodsCT images of 10 normal hip joints for 3D reconstruction were selected, the Mimics Medical 21.0 was used, and rotating the proximal femur was to find the most suitable angle for showing the femoral neck well, designed the modified lateral view according to this angle. We collected 35 healthy cases and 35 femoral neck fractures as the normal and fracture group. And two groups were all taken hip anteroposterior view, cross-table lateral view and modified lateral view, which were analyzed by two radiologists to score the anatomical structures of the articular surface, femoral head, head neck junction, femoral neck, basal region and intertrochanteric region. Friedman test was used to analyze the score of femoral neck at different angles. T test and Wilcoxon signed-rank test were to compare inter-groups.ResultsThe modified lateral view was designed as follows: The subjects were supine, with the sagittal axis biased toward the healthy side at an angle of approximately 20° to the long axis of the examination table, the hip joint flexed at 45°, the lower extremity abducted at 40°, the centerline inclined 45° toward the head and the centerline aligned with the center of the groin. The modified lateral view showed the femoral head, head neck junction and femoral neck more clearly than the cross-table lateral view, but the cross-table lateral view showed the femoral neck basal and intertrochanteric region better. In addition, the time of taking the modified lateral view was significantly less than the cross-table lateral view (normal group: 0.789 min ± 0.223 vs 0.623 min ± 0.207, P < 0.001; fracture group: 1.131 min ± 0.362 vs 0.946 min ± 0.390, P < 0.001).ConclusionsThe modified lateral view can obtain a standard sagittal image of femoral neck, which can show the dislocation and angulation of the sagittal femoral neck fracture clearly, and improve the accuracy of diagnosis. And it is more convenient and easier for patients to cooperate, which is worthy promoting and applying in clinical work.

Three-Dimensional (3D) Analysis of Orbital Morphometry in Healthy Anatolian Adults: Sex, Side Discrepancies, and Clinical Relevance.

Background and objective The complex structural integrity of the orbit is crucial for visual functions. Three-dimensional (3D) reconstructions from radiological images have revolutionized anatomical understanding, eliminating the limitations of two-dimensional (2D) imaging and offering intricate spatial details for complex structures. The aim of this study was to analyze the detailed morphometry of the orbit in healthy Anatolian adults, considering sex, side discrepancies, and clinical relevance using 3D models reconstructed from multidetector computed tomography (MDCT) images. Materials and methods Fifty-six (44.44%) males and 70 (55.56%) females (total: 126, mean age: 48.62) MDCT images were randomly selected and 3D skull models were reconstructed using 3D Slicer software. Measurements were conducted in millimeters (mm) for transverse and vertical diameters, circumference of the orbital opening, orbital wall lengths, as well as intraorbital and extraorbital distances. Results The method of measurements showed high reproducibility of results. The mean values for transverse and vertical diameters, circumference of the orbital opening, medial and lateral wall lengths, roof and floor lengths, and intraorbital and extraorbital distances were 40.23±2.12 mm (p<0.001), 34.94±2.16 mm (p=0.365), 44.74 ±3.02 mm (p<0.001), 46.30±2.69 mm (p<0.001), 51.26±2.91 mm (p<0.001), 49.01±3.22 mm (p<0.001), 126.10±5.71 mm (p<0.001), 19.63±2.35 mm (p=0.026), and 94.09±4.84 mm (p<0.001), respectively. Conclusion The study's high measurement reproducibility contributes significantly to the existing literature and clinical practice. These findings offer specific insights into Anatolian orbital morphometry, aiding in surgical planning, implant placement, and diagnostic assessments. The precise measurement values serve as a reliable reference for clinicians, facilitating the identification of normal and abnormal orbital anatomy and enhancing patient care. We believe this study provides valuable data for craniofacial and ophthalmological research, benefiting both clinical practice and future research endeavors in these fields.