Lateral Tibia Research Articles

Detection of Osteophytes and Subchondral Cysts in the Knee with Use of Tomosynthesis

To evaluate the diagnostic performance of tomosynthesis in depicting osteophytes and subchondral cysts, with use of magnetic resonance (MR) imaging as the reference, and to test whether the lesions detected at radiography and tomosynthesis are associated with pain. The study was approved by local institutional review board, and all subjects gave written informed consent. Forty subjects (80 knees) older than 40 years were recruited irrespective of knee pain or radiographic osteoarthritis. Knees were imaged with radiography, tomosynthesis, and MR imaging. Presence of osteophytes and subchondral cysts in four locations of tibiofemoral joint (medial and lateral femur and tibia) was recorded. Knee pain was assessed by using the Western Ontario and McMaster University pain subscale. MR imaging depicted 171 osteophytes and 51 subchondral cysts. Tomosynthesis had a higher sensitivity for osteophyte detection in left and right lateral femur (0.96 vs 0.75, P = .025, and 1.00 vs 0.71, P = .008, respectively), right medial femur (0.94 vs 0.72, P = .046), and right lateral tibia (1.00 vs 0.83, P = .046). For subchondral cyst detection, the sensitivity of tomosynthesis was 0.14-1.00 and that of radiography was 0.00-0.56. Both modalities had similar specificity for both lesions. Subjects with tomosynthesis-depicted osteophytes (odds ratio, 4.2-6.4; P = .001-.011) and medially located subchondral cysts (odds ratio, 6.7-17.8; P = .004-.03) were more likely to feel pain than those without. However, radiography-depicted osteophytes were more strongly associated with pain than were tomosynthesis-depicted osteophytes. Tomosynthesis depicted more osteophytes and subchondral cysts than did radiography. Subjects with tomosynthesis-depicted osteophytes and subchondral cysts were more likely to feel pain than those without such lesions.

LDL receptor deficiency results in increased osteophyte formation during experimental osteoarthritis both under low and high cholesterol conditions

Purpose: Synovial macrophages have previously shown to be involved in joint destruction during experimental collagenase-induced osteoarthritis (OA). The low density lipoprotein (LDL) receptor expressed by synovial macrophages is involved in transport of cholesterol, carrying lipoprotein particles into cells, thereby regulating cholesterol homeostasis. In the present study we investigated whether the LDL receptor is involved in joint destruction during experimental osteoarthritis both under normal and high cholesterol conditions. Material and Methods: LDL receptor deficient (LDLR-/-) mice and their wild type (WT) controls received either a high cholesterol or control diet for 120 days. Experimental osteoarthritis was induced by injection of collagenase into the mice's knee joints on day 84 and 86. Paraffin sections of total knee joints were stained with safranin-o or haematoxylin-eosin to determine OA development. Synovial activation (thickening of the lining layer) was measured using an arbitrary scale from 0 to 3. Cartilage destruction was determined in four cartilage surfaces (lateral and medial femur and tibia) using the OA score (with a maximum of 30 per knee joint) developed by Pritzker et al (2006) and adapted by our lab for mice. Size of osteophyte formation was measured on the edges of the femur/tibia area using image analysis. Results are depicted as mean ± SD. Results: On day 36 after induction of collagenase-induced OA, WT mice which received a normal diet (n=10) developed moderate synovial activation (1.4 ± 0.6), cartilage destruction (6.1 ± 2.6) and osteophyte formation (32.4 μm2 ± 25.4). In LDLR-/- mice (n=10) no significant differences were found on synovial activation or cartilage destruction when compared to WT controls. In contrast, mean osteophyte formation was tremendously increased by 345 % suggesting that the absence of the LDL receptor induces osteophyte formation in the OA knee joint. On day 36 after OA induction, the bodyweight of WT mice receiving a high cholesterol diet (n=10) had increased by 21 % compared to WT mice which received a normal diet. Although synovial activation and cartilage destruction was not altered, osteophyte formation was over 33 times higher (p = 0.0495) in the medial femur of the high cholesterol group. LDLR-/- mice which received a high cholesterol diet (n=10) expressed high cholesterol levels (500 % higher when compared to WT) within the serum and a significantly increased thickening of the lining layer consisting of macrophages containing high amounts of fat as seen after staining of total knee joints with red oil. Although the OA knee joints of WT mice already showed increased osteophyte formation, the OA knee joints of LDLR-/- developed even higher osteophyte formation (2.7 times higher in the in the lateral tibia; p = 0.0063) indicating that the absence of the LDL receptor also induces osteophyte formation under high cholesterol conditions. Conclusions: LDL receptor deficiency induces osteophyte formation during collagenase-induced osteoarthritis both under low and high cholesterol conditions.

Longitudinal changes in cartilage thickness in knees with osteophytes but no joint space narrowing versus contralateral knees without radiographic OA

Sagittal oblique T1-weighted fast spin echo, sagittal source 3D T1-weighted fat-suppressed (FS) spoiled gradient recalled echo with reformation performed in the axial and coronal planes, and sagittal and coronal T2-weighted FS fast spin echo sequences were acquired at baseline and follow-up. The knee was divided in 6 regions: patella, trochlea, medial femur, lateral femur, medial tibia, and lateral tibia. Baseline MRI-detected SS, defined as low-signal intensity abnormalities in the subchondral bone in both T1-weighted and T2-weighted sequences, were graded in each region of the knee from 0 to 3. The presence of baseline SS is considered as grades 1. The absence of baseline SS (grade 0) is considered as the reference group. Cartilage morphology was assessed in each region of the knee from 0 to 4. Grades 0 (normal) and 1 (intrasubstance signal changes) represent normal cartilage morphology. Any increase of cartilage grade from baseline to follow-up was considered as cartilage loss, except the increase from grade 0 to 1. Regions having stable or decreasing cartilage scores from baseline to follow-up were used as the reference for the analysis. Each region of the knee was assessed separately (regional analysis). The association of baseline SS (grades 1) with cartilage loss over time in the same region of the knee was assessed using logistic regression, adjusted for baseline age, gender, BMI, and Kellgren-Lawrence grade in the first model, and with the addition of presence at baseline of concomitant edema-like BMLs in a second model. We also assessed the correlation between radiographic SS and MRI-detected SS in the three compartments of the knee using Spearman's rank correlation. Results: From the 163 subjects included, 88 (54%) were female and 64 (39.3%) had baseline radiographic OA (Kellgren-Lawrence grade 2). The prevalence of baseline MRI-detected SS in regions varied between 1.6% at the trochlea and 17% at the medial tibia. The occurrence of cartilage loss over time in regions varied between 6.0% at the lateral tibia and 13.1% at the medial femur. The prevalence of baseline SS on radiographs varied between 2.9% at the patellofemoral compartment and 14.2% at the medial tibiofemoral compartment. In both adjusted models we found no significant association between baseline MRI-detected SS and cartilage loss over time in the same region of the knee. Moderate and significant correlations were found between MRI-detected and radiographic-detected SS at the medial tibiofemoral (0.58; p<0.001) and lateral tibiofemoral (0.61; p<0.001) compartments. In the patellofemoral compartment, correlation was 0.26 (p<0.001). Conclusion: Subchondral sclerosis was not associated with an increased risk of cartilage loss in the same knee region at the 3 years follow-up visit. The role of subchondral sclerosis in regard to structural disease progression in the knee using cartilage as the outcome needs to be questioned.

Reduction in synovial tissue volume following intra-articular steroid injection in knee osteoarthritis

Reduction in synovial tissue volume following intra-articular steroid injection in knee osteoarthritis

Identification of genes involved in the initiation of osteoarthritis

Identification of genes involved in the initiation of osteoarthritis

T3 effect through SCR2 on chondrogenesis in vitro

T3 effect through SCR2 on chondrogenesis in vitro

Effects of training intervention on quadriceps heads in untrained middle-aged women

Effects of training intervention on quadriceps heads in untrained middle-aged women

Nocturnal Changes in Knee Cartilage Thickness in Young Healthy Adults

Magnetic resonance imaging (MRI) allows one to analyze cartilage physiology in vivo. Cartilage deforms during loading, but little is known about its recovery after deformation. Here we study ‘nocturnal’ changes in knee cartilage thickness and whether postexercise deformation differs between morning and evening. Axial magnetic resonance (MR) images were acquired in the right knees of 17 healthy volunteers (age 23.5 ± 3.0 years) after a normal day, and then after 30 deep knee bends. Coronal images were additionally acquired in 8 of these volunteers after a normal day and then after 2 min of static loading of the leg with 150% body weight. The volunteers then remained unloaded overnight and the same protocol was repeated in the morning. A significant increase (p < 0.01) in cartilage thickness was observed between evening (preexercise) and morning (preexercise): +2.4% in the patella, +8.4% in the medial tibia and +6.2% in the lateral tibia. Deformation in the morning (–6.8/ –4.6/–5.1%) was generally greater than that in the evening (–5.4/–3.2/–3.7%), but this difference did not reach statistical significance. No significant difference in the nocturnal thickness increase (or postexercise deformation) was observed between men and women. We conclude that knee cartilage (thickness) recovers overnight by approximately 2–8%, independent of sex. Given the lack of ‘predeformation’ after nocturnal periods of unloading, morning postexercise deformation of the cartilage may have a greater magnitude than evening postexercise deformation.

Computer Assisted Surgery(CAS)를 이용한 개방형 근위경골절골술 시 전내측피질골경사각이 경골후방경사각에 미치는 영향

The leading surgical method for correcting the misalignment of the varus and valgus in the knee joint is the high tibial osteotomy (HTO). In the opening wedge HTO (OWHTO), there is no concern about damaging the peroneal nerve on the lateral tibia of the proximal fibula. OWHTO has been the preferred choice, as the opening of the correction angle can be modulated during the operation. The correction of the varus and valgus on the coronal plane are performed adroitly. Nevertheless, there have been numerous reports of unintended changes in the medial tibial plateau and posterior slope angle (PSA). The authors have developed an HTO method using computer-assisted surgery with the aim of addressing the abovementioned problems from an engineer's perspective. CT images of the high tibia were reconstructed three-dimensionally, and a virtual osteotomy was performed on a computer. In addition, this study recommends a surgical method that does not cause changes in the PSA after OWHTO. The results of the study are expected to suggest a clear relationship between the anteromedial cortex oblique angle of each patient and the PSA, and an optimal PSA selection method for individuals.

‘Alarmins’ S100A8 and A9 are actively involved in regulation of synovial activation and joint destruction during mouse and human osteoarthritis

Background and objectivesProminent proteins released by activated macrophages are the ‘alarmins’ S100 A8 and A9. There is increasing belief that synovial tissue activation contributes to OA cartilage pathology. The aim...

Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device

Objective evaluation of both antero-posterior translation and rotatory laxity of the knee remains a target to be accomplished. This is true for both preoperative planning and postoperative assessment of different ACL reconstruction emerging techniques. The ideal measurement tool should be simple, accurate and reproducible, while enabling to assess both ‘‘anatomy’’ and ‘‘function’’ during the same examination. The purpose of this study is to evaluate the clinical effectiveness of a new in-house developed testing device, the so-called Porto-knee testing device (PKTD). The PKTD is aimed to be used on the evaluation of both antero-posterior and rotatory laxity of the knee during MRI exams. Between 2008 and 2010, 33 patients with ACLdeficient knees were enrolled for the purpose of this study. All patients were evaluated in the office and under anesthesia with Lachman test, lateral pivot-shift test and anterior drawer test. All cases were studied preoperatively with KT-1000 and MRI with PKTD, and examinations performed by independent observers blinded for clinical evaluation. During MRI, we have used a PKTD that applies antero-posterior translation and permits free tibial rotation through a standardized pressure (46.7 kPa) in the proximal posterior region of the leg. Measurements were taken for both knees and comparing side-to-side. Five patients with partial ruptures were excluded from the group of 33. For the 28 remaining patients, 3 women and 25 men, with mean age of 33.4 ± 9.4 years, 13 left and 15 right knees were tested. No significant correlation was noticed for Lachman test and PKTD results (n.s.). Pivot-shift had a strong positive correlation with the difference in anterior translation registered in lateral and medial tibia plateaus of injured knees (cor. coefficient = 0.80; p\0.05), and with the difference in this parameter as compared to side-to-side (cor. coefficient = 0.83; p\0.05). Considering the KT-1000 difference between injured and healthy knees, a very strong positive correlation was found for side-to-side difference in medial (cor. coefficient = 0.73; p\0.05) and lateral (cor. coefficient = 0.5; p\0.05) tibial plateau displacement using PKTD. The PKTD proved to be a reliable tool in assessment of antero-posterior translation (comparing with KT-1000) and rotatory laxity (compared with lateral pivotshift under anesthesia) of the ACL-deficient knee during MRI examination. Therapeutic studies, Level IV.

Arthroscopy

In this issue of Clinical Orthopedics and Related Research, we present papers related to the indications and benefits of minimally invasive or endoscopic surgery for treating athletic injuries in different joints. These papers were selected from those presented at the 11th Biannual Meeting of the Argentina Arthroscopy Association held in Buenos Aires, Argentina, in May 2010. This meeting was organized in conjunction with the XIII Annual Meeting of the Argentina Association of Sports Trauma and the IV Annual Meeting of the Latin America Society of Arthroscopy, Knee Surgery, and Sport Medicine. The American Orthopaedic Society for Sports Medicine participated as the guest society. The forum provided a unique opportunity for members of these societies to share scientific information in an intimate setting. Three of the eight articles address the ongoing difficulty in diagnosing and treating recurrent anterior shoulder instability. The first study explored the relationship between generalized joint laxity and the potential increased risk of recurrent shoulder instability, as has been suggested in the literature. However, there are conflicting data on the association between generalized joint laxity and traumatic recurrent shoulder instability. Although these findings are not definitive, they add to the body of literature suggesting generalized joint laxity does not predispose to recurrent shoulder instability. The second study compared the frequency of lesions associated with traumatic anterior instability in patients with primary and recurred instability. Associate injuries are more common in shoulders with recurrent dislocations, suggesting delay of the reconstruction may increase these secondary morbidities. The third study analyzed a group of patients with revision surgery of a previous arthroscopic instability repair. In this situation, the surgeon is faced with the following dilemma: to perform either an open repair technique in an attempt to minimize the chance of recurrence or an arthroscopic repair aiming to minimize soft tissue damage and enable the patient to regain as much function as possible. The authors suggested the recurrence rate after revision arthroscopic and open instability repairs would be similar in the absence of glenoid or humeral bone loss and if the patient was willing to avoid contact sports. Another paper evaluated patients with irreparable tears of the scapholunate interosseous ligament area, which is a common cause of mechanical wrist pain. The authors determined whether arthroscopic reduction is feasible, controls pain, and improves wrist function while preserving ROM. Although arthroscopic reduction is a minimally invasive alternative to the open procedure, its effectiveness in controlling pain and preserving wrist function has not been established. Three articles analyzed novel events or therapies for ACL ruptures, knee instability, or chronic patellar tendinopathy. The first paper reported a clinical and MRI study of patients with spontaneous healing in complete ACL ruptures and determined whether patients were able to return to athletic activity. Although most orthopaedists believe the ACL does not spontaneously heal after a complete rupture, the authors’ observations indicate the injured ACL may eventually spontaneously heal without using an extension brace, allowing return to athletic activity. The second study described a series of patients with rotatory knee instability associated with depressions of the lateral tibial plateau despite an intact arcuate ligament complex. The authors found correcting the bone deformity with an open-wedge osteotomy of the lateral tibia plateau and elevating the depressed bone could restore knee stability. The third paper explored whether an arthroscopically assisted approach to débride not only the tendon and bone but also the peritenon could relieve pain from patellar tendinopathy and allow athletes to return to their former activities. Another paper compared percutaneous repair versus open repair in acute Achilles tendon rupture in terms of function, cosmesis, and complications. I would like to thank all of the authors for their hard work in presenting their observations and data on minimally invasive surgery for various sports-related problems (Fig. 1).Fig. 1: Dr. Miguel A. Ayerza is shown.

Morphometrical measurement of resected surface of medial and lateral proximal tibia for Chinese population

The objective of this study was to analyze the morphology of the medial tibial plateau and lateral tibial plateau in Chinese knees and compared these measurements and features with those of commercial unicondylar tibial baseplates. Three-dimensional knee models were reconstructed from computed tomography slices of 81 subjects. Among the series, 27 knees were from male subjects and 54 knees from female subjects. The dimensions and shape of the medial and lateral tibial plateaus were measured and compared with six commercially available unicondylar tibial baseplates. The results showed significant differences between the shapes of the medial and lateral tibial plateaus. For the lateral tibial plateau, the shape was symmetric about the mediolateral axis. The medial plateaus presented their widest mediolateral width in an obviously more posterior position than the lateral compartment. Additionally, the plateau aspect ratio decreased with increasing mediolateral dimensions, in contrast to the constant aspect ratio shown by conventional unicondylar knee prostheses. Compartment-specific designs may optimize coverage between the prosthesis and resected tibial surface. The morphometrical measurements presented may allow manufacturers to design tibial baseplates that accommodate the structural variability between different ethnic groups. Prospective comparative study, Level II.

Evaluation of Popliteal Artery Injury Risk With Locked Lateral Plating of the Tibial Plateau

This study was undertaken to determine if there is increased likelihood of popliteal artery injury as one places a fixed-angle lateral proximal tibia locking plate with posterior plate lift off and or anterior plate translation from the ideal position. A Synthes (Synthes USA, West Chester, PA) 3.5-mm and 4.5-mm lateral proximal tibia locking plate was placed consecutively on each of six specimens in the straight lateral (SL) position. Screw position with respect to the medial cortex was recorded as well as the distance of the posterior most screw tip to the popliteal artery. Next a 3-mm shim was placed under the posterior edge of the same plate to mimic posterior plate lift off (LO) followed by placement of a 6-mm shim. The same experiment was repeated with the plate translated 5 mm anteriorly (AT). The popliteal artery was injured in zero of six specimens using the 3.5-mm plate. The popliteal artery was injured in six of six specimens using the 4.5-mm plate in the 5-mm AT 6-mm LO position, five of six with 5-mm AT and 3-mm LO, two of six with only 5-mm AT, four of six with SL and 6-mm LO, two of six with SL and 3-mm LO, and zero of six with SL. The Synthes 4.5-mm plate can put the popliteal artery at risk with as little as 3-mm posterior liftoff in the intended straight lateral position or with 5-mm anterior plate translation with no posterior liftoff. Therefore, placement of the 4.5-mm plate in the proper position and confirmation of its position with a true lateral radiograph is paramount to avoid injury to the popliteal artery.

Assessment of subchondral bone marrow lipids in healthy controls and mild osteoarthritis patients at 3T

The compartment-specific lipid changes in femoral-tibial bone of healthy controls and mild osteoarthritis (OA) patients were quantified at 3.0 T. Healthy volunteers [Kellgren-Lawrence (KL) grade = 0; n = 15, 4 females, 11 males, mean age 39 ± 16 years, age range = 24-78 years] and mild OA patients (KL = 1, 2; n = 26, 12 females, 14 males, mean age 61 ± 14 years, age range = 27-80 years) were scanned on a 3 T scanner. Clinical proton density (PD)-weighted fast spin echo (FSE) images in the sagittal (without fat-saturation), axial and coronal (fat-saturation) planes were acquired for cartilage Whole-Organ MR Imaging Score (WORMS) grading. A voxel of 10 × 10 × 10 mm(3) was positioned in the medial and lateral compartments of the tibia [medial tibial (MT) and lateral tibial (LT)] and femur [medial femoral (MF) and lateral femoral (LF)] for MRS measurements using the single voxel-stimulated echo acquisition mode (STEAM) pulse sequence. All MRS data were processed with Java-based Magnetic Resonance User Interface (JMRUI). Wilcoxon's rank sum test and mixed model two-way analysis of variance (ANOVA) were performed to determine significant differences between different compartments as well as examine the effect of OA grade and compartment, and their interactions. Generally, the MF compartment index of unsaturation was increased in healthy subjects compared with OA subjects (whether graded by KL or WORMS score). Differences between MF at KL0 and all other compartments at KL1 except LF approached statistical significance (p < 0.05). Differences in saturated lipids signals could be observed predominantly in the 2.03 p.p.m. frequency shift. Healthy controls in the MF compartment had the lowest saturated lipid signals, and mild OA patients with KL2 and WORMS5-6 in the MF compartment had the highest saturated lipid signals compared with other compartments at 2.03 p.p.m. (p < 0.05).

Dysplasia Epiphysealis Hemimelica of the Ankle Joint: A Case Report

Dysplasia epiphysealis hemimelica is a rare non-hereditary epiphyseal disease that mimics synovial chondromatosis of the joints. The disease mainly targets long bones of the lower extremities and tarsal bones. We report one such case manifesting in the lateral tibia of a 13-year-old boy. He presented with a 7-month history of pain and a bony mass (3x4 cm) at the right ankle. The mass restricted ankle dorsiflexion over the lateral malleolar area. It was ossific with a lobulated appearance and reached the marrow with the underlying epiphysis and adjacent bones. The mass was excised completely from the epiphysis. The detached syndesmos was sutured anatomically.

Morphometric Differences between the Medial and Lateral Meniscus in Healthy Men – A Three-Dimensional Analysis Using Magnetic Resonance Imaging

The objective of this work was to characterize tibial plateau coverage and morphometric differences of the medial (MM) and lateral meniscus (LM) in a male reference cohort using three-dimensional imaging. Coronal multiplanar reconstructions of a sagittal double-echo steady state with water excitation magnetic resonance sequence (slice thickness: 1.5 mm, and in-plane resolution: 0.37 × 0.70 mm) were analyzed in 47 male participants without symptoms, signs or risk factors of knee osteoarthritis of the reference cohort of the Osteoarthritis Initiative. The medial and lateral tibial (LT) plateau cartilage area and the tibial, femoral and external surfaces of the MM and LM were manually segmented throughout the entire knee. This process was assisted by parallel inspection of a coronal intermediately weighted turbo spin echo sequence. Measures of tibial coverage, meniscus size, and meniscus position were computed three-dimensionally for the total menisci, the body, and the anterior and the posterior horn. The LM was found to cover a significantly greater (p < 0.001) proportion of the LT plateau (59 ± 6.8%) than the MM of the medial plateau (50 ± 5.5%). Whereas the volume of both menisci was similar (2.444 vs. 2.438 ml; p = 0.92), the LM displayed larger tibial and femoral surface areas (p < 0.05) and a smaller maximal (7.2 ± 1.0 vs. 7.7 ± 1.1 mm; p < 0.01) and mean thickness (2.7 ± 0.3 vs. 2.8 ± 0.3 mm; p < 0.001) than the medial one. Also, the LM displayed less (physiological) extrusion than the medial one. These data may guide strategies for meniscal tissue engineering and transplantation aiming to restore normal joint conditions.

Deformational behaviour of knee cartilage and changes in serum cartilage oligomeric matrix protein (COMP) after running and drop landing

To investigate (1) the effect of running and drop landing interventions on knee cartilage deformation and serum cartilage oligomeric matrix protein (COMP) concentration and (2) if the changes in cartilage volume correlate with the changes in serum COMP level. Knee joint cartilage volume and thickness were determined using magnetic resonance imaging (MRI) as well as COMP concentration from serum samples before and after in vivo loading of 14 healthy adults (seven male and seven female). Participants performed different loading interventions of 30 min duration on three different days: (1) 100 vertical drop landings from a 73 cm high platform, (2) running at a velocity of 2.2m/s (3.96 km), and (3) resting on a chair. Blood samples were taken immediately before, immediately after and 0.5h, 1h, 2h and 3h post intervention. Pre- and post-loading coronal and axial gradient echo MR images with fat suppression were used to determine the patellar, tibial and femoral cartilage deformation. Serum COMP levels increased immediately after the running (+30.7%, pre: 7.3U/l, 95% confidence interval (CI): 5.6, 8.9, post: 9.1U/l, 95% CI: 7.2, 11.0, P=0.001) and after drop landing intervention (+32.3%, pre: 6.8U/l, 95% CI: 5.3, 8.4; post: 8.9U/l, 95% CI: 6.8, 10.9, P=0.001). Cartilage deformation was more pronounced after running compared to drop landing intervention, with being significant (volume: P=0.002 and thickness: P=0.001) only in the lateral tibia. We found a significant correlation (r(2)=0.599, P=0.001) between changes in serum COMP (%) and in cartilage volume (%) after the drop landing intervention, but not after running. In vivo exercise interventions differentially regulate serum COMP concentrations and knee cartilage deformations. The relation between changes in COMP and in cartilage volume seems to depend on both mechanical and biochemical factors.

WNT5A is a novel regulator of cytokine and chemokine expression in bone marrow stromal cells

WNT5A is a novel regulator of cytokine and chemokine expression in bone marrow stromal cells

Deep Peroneal Nerve Injury following External Fixation of the Ankle: Case Report and Anatomic Study

We present a case of deep peroneal nerve injury after application of external fixator and conducted a cadaveric study of the relationship of the deep peroneal nerve to the lateral tibial cortex. A case of toe drop after application of the external fixator is reported. Twelve cadaveric lower legs were dissected to identify the course of the deep peroneal nerve. The tibia were divided into four Zones with equal length. The course of the nerve through each Zone of the tibia was studied Result: In Zone 1, the deep peroneal nerve went around the fibular neck and was found on the interosseous membrane at the distal portion of Zone 1. In Zone 2, the nerve still lay on the interosseous membrane in all specimens at the posterior edge of the lateral tibia. In Zone 3, the nerve moved away from the interosseous membrane and had direct contact with the tibia in nine specimens. In Zone 4, the nerve was on the anterior surface of the distal tibia. The deep peroneal nerve can be injured during the application of a unilateral frame ankle external fixator. The nerve is particularly at risk in Zone 2 and 3. The study provided an anatomic basis for the safe application of a unilateral external fixator of the tibia.