Mild Degenerative Changes Research Articles

Interlaminar Spacers: Looks Good, Smells Bad

The role of interspinous devices (ISD) after lumbar herniated disc surgery for the prevention of postoperative back pain is controversial. The aim of this comparative prospective study was to determine outcomes in a selective cohort with L5–S1 disc herniation and degenerative disc changes after microdiscectomy with or without insertion of an ISD. One hundred and two consecutive patients underwent an L5–S1 microdiscectomy with or without implantation of an ISD. Group 1 consisted of 47 patients, with mild (n = 22), moderate (n = 14) or severe (n = 11) degenerative disc changes who had microdiscectomy alone. Group 2 comprised 45 patients with similar types of disc changes who underwent microdiscectomy with an ISD implant. The Visual Analogue Scale (VAS) was used to grade low-back pain and postoperative clinical status was rated according to the modified MacNab criteria. Mean VAS score for low-back pain improved significantly at 1 year follow-up from 7.3 at baseline to 2.75 (p < 0.001) in Group 1 and from 6.7 to 1.5 (p = 0.001) in Group 2. VAS score at 1 year showed significant improvements in 21 Group 1 patients versus 30 Group 2 patients (p = 0.001). Forty four percent of Group 1 patients and 80% of Group 2 patients showed improvement using the modified MacNab criteria. Patients in both groups reported significant improvement in sciatic pain and disability after microdiscectomy with or without an ISD implant. Patients with mild degenerative disc changes were more likely to achieve improvement of their low-back pain when treated with both microdiscectomy and ISD insertion.

Modified Pull-Out Wire Suture Technique for the Treatment of Chronic Bony Mallet Finger

Twenty-three patients with a chronic bony mallet finger deformity (more than 3 months after the injury) and fracture fragment involving more than one-third of the articular surface underwent surgical treatment. The fracture fragment was fixed, and the mallet finger deformity was corrected in all patients using a modified pull-out wire (wire passed through the dorsal fragment directly) with a transarticular Kirschner wire fixation technique. Active motion of the proximal interphalangeal and metacarpophalangeal joints was not restricted. According to Crawford's evaluation criteria, there were 17 excellent, 4 good, and 2 fair results. Four patients showed radiologic signs of mild degenerative changes, which did not limit their daily activities. The modified pull-out wire suture with the transarticular Kirschner wire fixation technique provides an alternative and acceptable treatment modality for the treatment of chronic bony mallet finger deformities with or without subluxation of the distal phalanx.

Modified Extension-Block K-Wire Fixation Technique for the Treatment of Bony Mallet Finger

This article describes the treatment of a bony mallet finger deformity using 2 extension-block Kirschner wires (K-wires) with a transarticular K-wire fixation technique for precise alignment of the terminal extensor tendon-bone relationship and effective immobilization of the distal interphalangeal joint. Twenty-nine patients (33 fingers) with a bony mallet finger deformity and fracture fragment involving more than one-third of the articular surface were treated surgically. The fracture fragment was fixed and the mallet finger deformity was corrected in all patients using modified extension-block K-wires (2 dorsal extension-block pins) with a transarticular K-wire (volar side pin) fixation technique. Active motion of the proximal interphalangeal and metacarpophalangeal joints was not restricted. The wires are removed in the clinic 6 weeks postoperatively when the bridging trabeculae were observed in the radiographs, and immobilization in a stock splint was continued for an additional 2 weeks. According to Crawford's evaluation criteria, there were 24 (73%) excellent, 7 (21%) good, and 2 (6%) fair results. Three patients showed radiological signs of mild degenerative changes, which did not limit their daily activities. Nail ridging occurred in 3 cases (9%), which disappeared after an average of 6 months with normal growth, and mild scarring at the dorsal pin site occurred in 2 cases (6%). Modified extension-block K-wires with a transarticular K-wire fixation technique is an acceptable alternative treatment modality for the management of bony mallet finger deformities with or without subluxation of the distal phalanx.

Hiding in Plain Sight: A Case of Tarlov Perineural Cysts

A 52-year-old woman sought help for intractable lumbosacral pain, which began after she lifted a heavy object and fell onto her back more than 2 decades ago. Additional symptoms included burning, numbness, tingling, and pain in her right hip, posterior thigh, leg, and toes, and diminished sensation and sensitivity throughout her right leg and foot. Muscle spasms/ cramps, which often interrupted sleep, were intermittently present in her right buttock and right lower extremity. Right-foot drop impaired her ability to walk, and she used a wheeled walker with a seat because she could not walk more than a few steps without sitting. Other problems included: Severe pressure-type headaches, chronic abdominal and pelvic pain, cervical and thoracic back pain, frequent urinary tract infections, and urinary incontinence. Her pain increased with sitting, standing, and walking, and had been refractory to ibuprofen 800 mg tid, gabapentin 300 mg tid, oxycodone/acetaminophen 5/325 mg q4h PRN, and cyclobenzaprine 10 mg tid. Her medical history was unremarkable and her family history was notable for above-average height; most women in her paternal family are 5’10’’ to 6’ tall, and most men are 6’4’’ and taller. Many died in their 40s, and her brother and sister had been diagnosed with possible multiple sclerosis. Magnetic resonance imaging (MRI) of her pelvis revealed sacral nerve root cysts that were more completely imaged by sacral MRI (Fig 2). An MRI of the cervical spine from 2007 showed only mild C4-5 disc protrusion, but a repeat MRI in 2009 noted multilevel mild degenerative changes and small (#.6 cm) perineurial cysts at C4-5, C5-6, C6-7, C7-T1. In 2007, an MRI of the thoracic spine was interpreted as normal. The patient stated, ‘‘Everything in my life has been destroyed by these symptoms. It took over 2 decades

Treatment of chronic anterior shoulder dislocation by open reduction and simultaneous Bankart lesion repair.

BackgroundUntreated chronic shoulder dislocation eventually leads to functional disability and pain. Open reduction with different fixation methods have been introduced for most chronic shoulder dislocation. We hypothesized that open reduction and simultaneous Bankart lesion repair in chronic anterior shoulder dislocation obviates the need for joint fixation and leads to better results than previously reported methods.MethodsEight patients with chronic anterior dislocation of shoulder underwent open reduction and capsulolabral complex repair after an average delay of 10 weeks from injury. Early motion was allowed the day after surgery in the safe position and the clinical and radiographic results were analyzed at an average follow-up of one year.ResultsThe average Rowe and Zarin's score was 86 points. Four out of eight shoulders were graded as excellent, three as good and one as fair (Rowe and Zarins system). All patients were able to perform their daily activities and they had either mild or no pain. Anterior active forward flexion loss averaged 18 degrees, external active rotation loss averaged 17.5 degrees and internal active rotation loss averaged 3 vertebral body levels. Mild degenerative joint changes were noted in one patient.ConclusionThe results show that the overall prognosis for this method of operation is more favorable than the previously reported methods and we recommend concomitant open reduction and capsulolabral complex repair for the treatment of old anterior shoulder dislocation.Level of EvidenceTherapeutic study, Level IV (case series [no, or historical, control group])

Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair

BackgroundThe purpose of our study was to analyze the clinical and radiological long-term outcomes of surgically treated traumatic knee dislocations and determine prognostic factors for outcome.MethodsRetrospective consecutive series of patients treated surgically for traumatic knee dislocation with reconstruction/refixation of the anterior (ACL) and posterior cruciate ligaments (PCL) and primary complete repair of collaterals and posteromedial and posteromedial corner structures. 68 patients were evaluated clinically (IKDC score, SF36 health survey, Lysholm score, Knee Society score, Tegner score, visual analogue scale - VAS pain and satisfaction, Cooper test) and radiologically (weight bearing and stress radiographs) with a mean follow up of 12 ± 8 years. Instrumented anterior-posterior translation was measured (Rolimeter, KT-1000). Pearson correlation and stepwise regression analysis was used.Results82% of patients (n = 56) returned to their previous work. At final follow-up 6 patients (9%) suffered from pain VAS > 3. The mean side-to-side difference of anterior/posterior translation (KT-1000, 134N) was 1.6 ± 1.6 mm and 2.6 ± 1.4 mm. Valgus and varus stress testing in 30° flexion was <3 mm (normal) in 57 patients (86%). The IKDC score was normal/nearly normal in 38 (58%) patients and the mean Lysholm score 83 ± 17 (intact 98 ± 7). The median Tegner score decreased from 7 preinjury (range 3-10) to 5 at follow-up (range 0-10). The mean Knee Society score was 187 ± 15 (out of maximum 200). In 7 patients (10%) a secondary ligament reconstruction was performed. Three patients (4%) underwent a high tibial osteotomy and four (6%) received a primary unconstrained total knee replacement. According to the Kellgren Lawrence osteoarthritis score only mild degenerative changes were present. The stress radiographs showed stable results for anteroposterior translation. Injury of the lateral collateral ligament, refixation of the ACL/PCL and delayed surgery >40 days were significantly associated with worse outcome (p < 0.05).ConclusionsEarly complete reconstruction can achieve good functional results and patient satisfaction with overall restoration of sports and working capacity. Negative predictive factors for outcome were injury pattern, type of surgical procedure and timing of surgery.

The Effect of Dietary Alpinia officinarum (Hance) Supplementation in Bovns-type Chicks

The galangal (the rhizome of Alpinia officinarum, Hance) is popular as a traditional herbal medicine. The present study investigates the effect of diet containing 2%, 5% and 10 % of A. officinarum (Hance) on the biochemical, haematological and histological parameters in Bovans-type chicks treated for 4 weeks. The body weight of the chicks revealed that feeding levels of 2, 5 and 10% dietary A. officinarum was significantly decreased (p<0.05 0.01) compared to the control chicks. Significant changes were observed in the activities of AST and ALT and the concentration of total protein, uric acid, albumin and globulin and cholesterol levels. Mild degenerative changes were observed in the liver and kidneys of chicks while no significant differences were recorded in haematological parameters.

Interaction study on garlic and atorvastatin with reference to nephrotoxicity in dyslipidaemic rats

A total of 56 male Sprague dawley rats of uniform weight and age were randomly divided into seven groups consisting of eight rats in each group. Groups 1, 2, and 3 served as plain control, dyslipidaemic control (DL), and atorvastatin control, respectively. Groups 4, 5, 6, and 7 received 1, 0.5, 0.25, and 0.75% fresh garlic w/w in feed, respectively in addition to the high-fat and high-cholesterol diet and administered with atorvastatin orally for 12 weeks at the rate of 10, 5, 7.5, and 2.5 mg/kg b.wt., respectively. Plasma creatinine was estimated at 4-week intervals, whereas histopathology, electron microscopy, and estimation of TBARS concentration in kidney were conducted at the end of experiment. The TBARS concentration in DL was significantly (P<0.05) increased when compared with groups 1, 3, 6, and 7. On histopathological examination, kidney sections of group 3 had mild degenerative changes in the tubules with fatty change in few tubules, while groups 4 and 5 exhibited mild-to-moderate degenerative and fatty changes in tubules with inter tubular hemorrhages. The electron microscopy of group 2 showed hypertrophy of Bowman’s capsule, while that of group 4 showed secretary deposits in the cytoplasm. The interaction studies on kidney indicated that high dose of atorvastatin + garlic has negative safety profile when compared with groups having low dose of statin and high dose of garlic.

A glomus tumor anterior to the patellar tendon: a case report

Glomus tumors are benign neoplasms originating from the glomus body. They are most frequently found in the nail bed of the hands, and their occurrence in other parts of the body is rare. A 75-year-old man presented with left anterior knee pain of 30-year history, that became more intense with light touch or clothing and increased in severity despite medical treatment. Physical examination showed a painful, soft, mobile, red-purple colored mass, 2 x 2 cm in size, at the inferior border of the patella. Plain radiographs showed no pathology other than mild degenerative changes. Magnetic resonance imaging revealed a mass lesion, 1.5 x 1.1 x 2 cm in size, located at the anterior border of the patellar tendon, which showed hypointensity on T1A-weighted sequences and hyperintensity on T2-weighted sequences and T2-weighted sequences with fat saturation. The mass was excised and the histopathological diagnosis was reported as glomangioma. Postoperatively, the patient had no complaint of pain and no recurrence was observed during a two-year follow-up.

Herpes Zoster Radiculopathy Treated with Fluoroscopically-Guided Selective Nerve Root Injection

Background: Varicella-zoster virus, a member of the herpes virus family, is a neurotrophic virus that primarily affects afferent sensory neurons. Reactivation of latent virus within the dorsal root ganglion and axoplasmic transport to epithelial nerve terminals causes the segmental cutaneous rash and neuralgic pain characteristic of herpes zoster. Setting: Outpatient orthopedic practice. Case Description: A 75-year-old male developed a herpetic rash followed by burning pain in the right L5 distribution. The pain was exacerbated by standing or walking. Six weeks later, the rash had improved, but the patient developed a right foot drop requiring use of a molded ankle-foot orthosis. MRI of the lumbar spine revealed mild degenerative changes without evidence of significant spinal stenosis or disc disease. Electrodiagnostic studies confirmed the diagnosis of right L5 radiculopathy. Results: The patient had dramatic improvement of pain and weakness after undergoing a fluoroscopically guided right L5 selective nerve root block with Depo-Medrol and Lidocaine. He then began a course of physical therapy and, 6 weeks later, had only trace weakness of the ankle dorsiflexor group on the right side. The patient has continued without significant weakness or pain since the procedure and has returned to normal functioning. Discussion: This case demonstrates apparent treatment of a relatively uncommon phenomenon, herpes zoster radiculopathy, using selective nerve root block. Limitations: There is a limited amount of data regarding this disorder presently available regarding Herpes Zoster Radiculopathy. A second limitation would be an inability to exclude spinal pathology as an alternative etiology of this patient’s condition. Conclusion: Cases of herpes zoster-induced radiculopathy may become more frequent, as evidenced by the increasing number of cases of herpes zoster in the United States noted epidemiologically. Key words: Herpes zoster, shingles, lumbar radiculopathy, lumbar stenosis, dermatome, electrodiagnosis, selective nerve, root injection

Cardioprotective Actions of Ascorbic Acid during Isoproterenol-Induced Acute Myocardial Infarction in Rats

Background/Aims: In the present study, we tested whether or not acute antioxidant treatment with vitamin C is able to protect the heart during myocardial infarction. The effects of vitamin C on the autonomic balancing of the heart and on the histopathological and immunohistochemical changes in response to isoproterenol administration (ISO) were evaluated. Methods: Four groups of male Wistar rats (n = 32) were studied: control; ISO treated; vitamin C treated; ISO + vitamin C treated. ISO 150 mg/kg was administered for 2 consecutive days. Vitamin C (250 mg/kg, oral) was administered 30 min before each ISO treatment. Phenylephrine and sodium nitroprusside were administrated to increase or decrease blood pressure in conscious rats. Results: The baroreceptor reflex index for bradycardia was significantly reduced in the ISO group (control, –3.4 ± 0.3 beats/mm Hg; ISO –2 ± 0.4 beats/mm Hg) and vitamin C treatment significantly improved the reflex index (–2.9 ± 0.7 beats/mm Hg). Treatment with vitamin C showed mild degenerative changes in the myocardial tissue of the ISO group. The antioxidant was able to decrease the inducible nitric oxide (iNOS) expression in rats treated with vitamin C. Conclusion: Vitamin C administration proved to be effective in reducing the extent of myocardial damage during ISO-induced myocardial infarction in rats associated with an iNOS downregulation and improving the autonomic balancing of the heart.

Ascorbic acid prevents acute myocardial infarction induced by isoproterenol in rats: role of inducible nitric oxide synthase production

The goal of this study was to investigate whether sub-chronic anti-oxidant treatment with ascorbic acid (Vit C) is able to protect the heart against myocardial infarction. The effects of Vit C treatment on the histopatological changes and immunohistochemistry for p53, COX-2 and iNOS were evaluated in rats submitted to acute myocardial infarction induced by isoproterenol (ISO). Male Wistar rats (n = 32) were divided into four groups: group 1, control; group 2, ISO treated; group 3, Vit C treated; group 4, ISO + Vit C treated. An amount of 150 mg/kg of isoproterenol was administered for two consecutive days. The rats were treated with Vit C once a day (150 mg/kg, orally) for seven consecutive days. In the day 5 and 6 the rats from group ISO + Vit C were submitted to acute administration of ISO third minutes after Vit C treatment. The results pointed out that treatment with Vit C showed mild degenerative changes of myocardial tissue in ISO group. Also, the antioxidant was able to decrease the iNOS expression in rats treated with Vit C. Taken together, our results suggest that chronic Vit C administration was able to prevent the myocardial infarction induced by ISO as a result of iNOS downregulation. Certainly, this finding offers new insights into the mechanisms underlying the relation between oxidative stress and cardiac mortality after myocardial infarction.

Efficacy of a proposed binder against mycotoxins in rats.

A mycotoxin binder (MB) was hypothesized to decrease adverse effects of mycotoxins. 84 Sprague‐Dawley rats (21 day old) were fed control diet (AIN93G), MB (0.5% in diet), Toxins (12 ppm FB1, 8 ppm DON and 0.5 ppm ZEN), Toxins+MB or pairfed AIN93G equal to the Toxin‐fed group. Kidney wt in Toxin‐fed rats was decreased 5.1 % compared with controls (P&lt;0.05), but Toxin+ MB‐fed rats did not differ from controls on d 15. Plasma alanine transaminase increased 48.6% and 27.9% in Toxin‐fed males and females, showing liver damage (P&lt;0.05) compared with control group, and these FB1‐associated changes were prevented in rats fed Toxin+ MB. By HPLC analysis, the concentrations of urinary sphingosine (So) and sphinganine (Sa), biomarkers of FB1 toxicity, as Sa/So increased 11.3 and 12.0 fold in males or 11.6 and 10.4 fold in females fed the toxins (P&lt;0.05) on both the 14th and 28th d compared with controls, with significantly less increase in males and females fed Toxin+MB (P&lt;0.05) than in toxin fed animals on d 14. This lessened Sa/So ratio in rats fed Toxin + MB persisted at d 28 only in males. Histopathology analysis of tissues indicated that mild degenerative changes of tubular epithelial cells were found in males fed toxins, but they were not seen in the Toxin+MB group suggesting protection from toxic effects. Therefore, MB prevented or lessened effects of mycotoxins in rats. Funded by Kemin Nutrisurance, Des Moines, IA.

Single level cervical disc herniation: A questionnaire based study on current surgical practices

Background:Operative procedures like simple discectomy, with or without fusion and with or without instrumentation, for single level cervical disc herniation causing neck pain or neurological compromise have been described and are largely successful. However, there is a debate on definitive criteria to perform fusion (with or without instrumentation) for single level cervical disc herniation. Hence, we conducted a questionnaire based study to elicit the opinions of practicing neurosurgeons.Materials and Methods:About 148 neurosurgeons with atleast 12 years of operative experience on single level cervical disc herniation, utilizing the anterior approach, were enrolled in our study. All participating neurosurgeons were asked to complete a practice based questionnaire. The responses of 120 neurosurgeons were analysed.Results:The mean age of enrolled surgeons was 51 yrs (range 45-73) with mean surgical experience of 16.9 yrs (range 12-40 yrs) on single level cervical disc herniation. Out of 120 surgeons 10(8%) had 15-25 years experience and always preferred fusion with or without instrumentation and six (five per cent with 17-27 yrs experience had never used fusion techniques. However, 104 (87%) surgeons with 12-40 yrs experience had their own criteria based on their experiences for performing fusion with graft and instrumentation (FGI), while. 85 (75%) preferred auto graft with cage.Conclusions:Most of surgeons performed FGI before the age of 40, but for others, patient criteria such as job (heavier job), physical examination (especially myelopathy) and imaging findings (mild degenerative changes on X-ray and signal change in the spinal cord on MRI) were considered significant for performing FGI.

Protective Effects of Erdosteine on the Testes of Cisplatin- Treated Adult Male Albino Rats: A Light and Scanning Electron Microscopic Study

Background: Cisplatin is considered a potent chemotherapeutic drug used in clinical oncology but causes testicular damage as a side effect. Erdosteine is a mucolytic drug possessing an antioxidant capacity. Aim of the Work: The present study was planned to evaluate the possible protective effect of erdosteine against cisplatin-induced testicular toxicity in rats. Material and Methods: Forty adult male albino rats were divided into four groups, ten rats each: control, erdosteine-treated (50 mg/kg body weight/day, orally for 7 days), cisplatin-treated (a single dose of 7mg/ kg intraperitoneally) and erdosteine/cisplatin-treated. Erdosteine was administered 24h before cisplatin injection and was continued until animal sacrifice. Six days after cisplatin administration, all rats were anaesthetized with ether. The scrotum of each animal was incised and the testes were removed and processed to be examined by both the light and scanning electron microscopy. Results: Examination of the testicular specimens of the cisplatin-treated group revealed severe testicular damage with significant reduction in the tubular diameter and germinal epithelium thickness compared to the control group. Shrunken tubules, germ cell loss and apoptotic changes in most of the cells, especially the primary spermatocytes and round spermatids were noticed. The mature spermatids appeared markedly decreased in number and the existing ones showed abnormal forms. Increased interstitial edema and apparent decrease in the Leydig cells were also observed. Erdosteine administration before cisplatin showed amelioration of the testicular architecture. Despite the mild degenerative changes in some spermatogenic cells, cell loss was markedly decreased and most of the tubular lumina were full of mature spermatids. Apparent increase in the Leydig cells and decreased interstitial edema was also noticed. Conclusions: Erdosteine partially protected the rat testes against the cisplatin-induced toxicity most probably via its potent antioxidant and radical scavenging activities.

Immunohistochemical Demonstration of Nitrosative Tissue Damage in Copper Induced Liver Toxicity in Japanese Quails

Summary Excess copper may cause liver toxicosis in various species. In this study, nitrosative tissue damage was investigated in an experimental chronic copper toxicity model in Japanese quails by immuno-histopathological means. Four groups (control, 1 st , 2 nd and 3 rd ), each comprised of 10 one-day-old chicks, were fed for 6 weeks with rations containing none, 100, 250 and 500 ppm copper sulfate, respectively. At the end of the feeding period, animals were euthanized, liver tissues were collected and processed routinely for histopathologic applications. Immunohistochemical staining was performed for inducible nitric oxide synthase (iNOS) and nitrotyrosine antibodies with indirect avidin-biotin peroxidase technique. Apoptotic cell death was investigated with in situ TUNEL staining. Microscopically, there were only mild and moderate degenerative changes in the liver of the chicks of 2 nd and 3 rd groups, respectively. In immunohistochemical staining, little immunoreactivity was detected in the control group for both antibodies. Immunoreactivities were gradually stronger with the increasing copper concentration. A few apoptotic hepatocytes were present only in the 3 rd group. These findings suggest that nitric oxide play a role in the oxidative

Subchronic toxicity study of urea molasses mineral block in kids

A study was conducted on twenty indigenous goat kids allocated into two different groups. All animals were offered ad libitum rice straw and berseem hay (40:60). Group I (T(1)) was fed concentrate mixture (100 g/d). Group II (T(2)) was supplemented with urea molasses mineral block (200 g/d). The experiment lasted for 90 days. There was significant decrease in serum sodium (60.68 mEq/L), increase in serum potassium (34.50 mEq/L) and increased activity of AST (340.42 U/L) and ALT (164.96 U/L) was observed in kids of group T(2) in comparison to the controls (T(1)). On histopathological examination mild degenerative changes in kidney of group T(2) with congestion in intertubular vessel, granular cytoplasm of the epithelial cells in PCT and DCT, necrosis and swelling of the epithelial cells, congestion of vessels and cloudy swelling was observed in PCT and DCT. Albuminious mass was also present in tubule. On histopathological observation of liver of kid of group T(2) oedema in liver parenchyma and proliferation of fibrious tissue in periportal area was observed.

The lumbar spine in Neanderthals shows natural kyphosis

Nowadays, lumbar spondylosis is one of the most frequent causes of lower back pain. In order to improve our understanding of the lumbar spine anatomy and functionality over time, we compared the lumbar vertebrae of Neanderthals with those of anatomically modern humans. The fossil record reports on only two Neanderthal skeletons (i.e., Kebara 2 and Shanidar 3, both predating the appearance of modern humans) with full preservation of the entire lumbar spine. Examination of these early hominids showed that they display natural lumbar kyphosis, with only mild degenerative changes of the lumbar spine (ages at death: 30-35 years, Kebara 2; and 35-50 years, Shanidar 3). This finding is highly unexpected since Neanderthals are known to have had extraordinary physical activity due to demanding living conditions. The adult lumbar spines discussed here therefore show no correlation between high physical activity and degenerative spine disease as known from recent times. We speculate that both the kyphosis itself and the massive and heavily muscled skeleton of Neanderthals are causative for the minimal bone degeneration. We conclude that a kyphotic lumbar spine is the natural anatomy in these two Neanderthal individuals. Future research will reveal if this holds true for the entire Neanderthal species.

Anterior cruciate ligament reconstruction with the peroneous longus tendon

The aim of the study was to evaluate the results of anterior cruciate ligament (ACL) reconstruction using a peroneus longus tendon (PLT) autograft. The study included 29 patients (27 males, 2 females; mean age 30 years; range 21 to 39 years) who underwent ACL reconstruction using a PLT autograft and interference nail fixation. Fourteen patients (48.3%) also had partial meniscectomy during surgery. The results were assessed according to the Lysholm scores and the International Knee Documentation Committee (IKDC) scale at the end of at least five years of follow-up. According to the IKDC scale, 17 patients (58.6%) were rated as normal or nearly normal, and 12 patients (41.4%) were rated as abnormal or severely abnormal. The mean Lysholm score was 83.7 (range 45 to 100), with excellent or good results in 23 patients (79.3%). Radiographic examination showed mild (n=10) or moderate (n=1) degenerative changes in the knee joint. Compared with the normal side, no flexion or extension losses occurred in the affected knees. Stability of the ACL was assessed by the Lachman test, which showed normal findings in 12 patients (41.4%), while nine patients had 1+, five patients had 2+, and three patients had 3+ anteroposterior laxity. Pivot-shift test was negative in 13 patients (44.8%); ten patients had 1+ pivot glide, and six patients had 2+ pivot shift. Two patients (6.9%) complained of mild to moderate pressure pain, paresthesia and dysesthesia at the donor site of PLT. No patient experienced ankle joint dysfunction or difficulty in sports activities due to PLT graft transfer. Our data show that PLT can be an appropriate autograft source for ACL reconstruction, avoiding potential complications of autografts obtained from the knee region.

The Effect of Local Corticosteroid or Ketorolac Exposure on Histologic and Biomechanical Properties of Rabbit Tendon and Cartilage

Tendonitis, tenosynovitis, and the arthritides are clinical problems commonly encountered in daily orthopaedic practice. Systemic anti-inflammatories, physical therapy, and local corticosteroid injections all are used as nonoperative treatments of these conditions. Systemic anti-inflammatory agents and local corticosteroid agents, however, can be associated with adverse effects that render them intolerable to some patients. As a preliminary study assessing the feasibility of local injection of nonsteroidal anti-inflammatory medication, the histological and biomechanical effects of local exposure of rabbit cartilage and tendon to injectable steroidal (corticosteroid) and injectable nonsteroidal anti-inflammatory agents (ketorolac tromethamine, KT) were determined. Thirty rabbits underwent bilateral knee joint, patellar tendon, and Achilles tendon injections with either normal saline, corticosteroid, or KT. Mechanical and histologic evaluation of the tissues was performed at 6 and 15 weeks after injection. Gross tendon adhesions were observed in more corticosteroid-treated specimens than those exposed to normal saline or KT. Microscopic evaluation of tendons revealed no significant differences among the three groups. Mild cartilage degenerative changes were noted across all groups. Evidence of cartilage necrosis was noted for the corticosteroid-treated group only. Tendons exposed to corticosteroid or KT demonstrated increased load and energy to failure, but exhibited no difference in material stiffness or strain. The use of an injectable nonsteroidal anti-inflammatory agent may be safe and even pose less threat to local tissues after intra-articular and peri-tendinous administration.