Non-operated Side Research Articles

Reconstruction of the temporomandibular joint using a vascularized medial femoral condyle osteocartilaginous flap: an experimental investigation in miniature pigs

BackgroundReconstruction of the temporomandibular joint (TMJ) is a significant challenge in maxillofacial surgery. A vascularized medial femoral condyle (MFC) osteocartilaginous flap is a good choice for TMJ reconstruction. In this study, we evaluated the radiographic and histological changes of MFC after TMJ reconstruction.MethodsA ramus-condyle unit (RCU) defect was created unilaterally in five adult male Bama miniature pigs. The ipsilateral vascularized MFC osteocartilaginous flap was used to reconstruct the TMJ, and the non-operative sides served as controls. Multislice spiral computed tomography (CT) was performed preoperatively, immediately postoperatively, and at two weeks, three months, and six months postoperatively. Three animals were euthanized at 6 months postoperatively. Their reconstructed condyles, natural condyles and the MFCs on the opposite side were collected and subjected to µCT and histological evaluation.ResultsIn the miniature pigs, the vascularized MFC osteocartilaginous flap was fused to the mandible, thus restoring the structure and function of the RCU. The postoperative radiographic changes and histological results showed that the reconstructed condyle was remodeled toward the natural condyle, forming a similar structure, which was significantly different from the MFC.ConclusionsIn miniature pigs, the RCU can be successfully reconstructed by vascularized osteocartilaginous MFC flap. The reconstructed condyle had almost the same appearance and histological characteristics as the natural condyle.

Preoperative assessment of the individual anatomy of the superior petrosal vein complex using balanced fast field echo magnetic resonance imaging.

Here, we sought to examine the validity and reproducibility of balanced fast field echo (bFFE) for assessing superior petrosal vein (SPV) complex (SPVC) anatomy. Preoperative bFFE or equivalent scans and operative videos were studied and directly compared with regard to the individual anatomical features of SPVCs and their relation to the operative field. The anatomical details of the bFFE findings of the non-operated side (group 2) of all 50 patients were then reviewed, including the presence of petrosal-galenic anastomosis, and finally compared to the operated SPVCs (group 1). A complete correlation between bFFE and intraoperative findings was observed in 62% of cases and had a significant correlation with 3 Tesla magnet strength and higher pixel bandwidth (rbis = -0.47; p = 0.005). The sensitivity and specificity of bFFE magnetic resonance imaging were 93.7 and 95.2%, respectively, for detecting an SPV disturbing the operative field, and 97.3% and 95% for a disturbing tributary, respectively. Each group had 50 SPVCs, with a total of 70 and 64 SPVs, 10 and 11 general SPVC configurations, as well as 29 and 28 different individual anatomical variations in groups 1 and 2, respectively. Both groups had 1-3 SPVs with a similar distribution of frequencies [Chi-square (4) = 27.56; p = 0.0145 (Fisher's exact test)]. The similarity of the general configurations was not statistically significant. The same four predominant configurations constituted 80% of the SPVCs in each group. The vein of the cerebellopontine fissure was most frequently found in 86% and 88% of cases, and a petrosal-galenic anastomosis was seen in 38% and 40% of groups 1 and 2, respectively. Individual SPVC variations are extensive. Good quality bFFE or equivalents are feasible for preoperative SPVC assessments. However, methods improving vascular visualization are recommended.

Replacement of the distal radio-ulnar joint with asemi-constrained Scheker DRUJ prosthesis.

To describe the indications, operative technique, and long-term outcomes of patients treated with the Scheker (Aptis) distal radio-ulnar joint (DRUJ) prosthesis. The Scheker prosthesis is intended to replace the DRUJ in patients with rheumatoid, degenerative, or posttraumatic arthritis of the sigmoid notch and/or ulnar head, or in cases of gross instability of the DRUJ. Moreover, aScheker prosthesis can be used to treat failed salvage procedures, such as the Sauvé-Kapandji procedure, ulnar head resection, and ulnar head arthroplasty. Severe osteoporosis, active infection, immature skeleton, less than 14cm of the proximal ulna remaining. In supine position with the forearm in full pronation, an ulnar S‑shaped incision is made. The ulnar head is resected and the proximal part is brought to the palmar side to enable visualization of the sigmoid notch. Following preparation of the sigmoid notch and the proximal ulnar part of the radius, aradial plate is attached. When the position is verified with fluoroscopy, screw holes are drilled together with aseparate hole for the radial peg. Ametal stem is inserted in the ulnar shaft. Apolymer ball is then slid on to apolished peg on top of the ulnar stem. This polymer ball is seated in the socket of the radial plate and fixed with asmall metal cap. Radiographic images are made for confirmation of correct positioning and full pro- and supination is tested, after which the wound is closed. After 48 h of pressure bandages, patients are instructed to start with full range of motion and weight-bearing exercises under the guidance of ahand therapist. Weight-bearing is constrained to 10kg. We retrospectively assessed 50Scheker prostheses in 48patients treated between 2016 and 2021. The median age was 56years (IQR: 50-65) and 30 (60%) were female. Median follow-up was 29months (IQR: 12-48). The primary outcome was the PRWE score. The median PRWE score at the final follow-up was 23 (IQR: 4-52) for the operated side versus amedian PRWE score of 5 (IQR: 0-25) for the non-operated side (p < 0.005). Six patients had acomplication. Three patients developed extensor carpi ulnaris tendinitis with one patient requiring additional surgery. One patient developed aneuroma of the distal branch of the ulnar nerve that was surgically removed. One synovectomy was performed because of synovitis and one endoscopic ulnar release was performed because of hyperesthesia of the ulnar area. None of the prostheses had to be removed.

Evaluation of Psoas Muscle Atrophy and the Degree of Fat Infiltration After Unilateral Hip Arthroplasty.

Atrophy of the muscles around the hip and thigh has been reported in patients with hip osteoarthritis (OA). Total hip arthroplasty (THA) reduces pain and improves quality of life and activity levels. Muscle strength of the hip and thigh also improves after THA. This study aimed to determine whether there is significant psoas muscle atrophy and to evaluate the degree of fat infiltration after unilateral hip arthroplasty. Patients who underwent unilateral total hip arthroplasty for primary hip osteoarthritis and who had lumbar vertebra magnetic resonance imaging (MRI) for any reason in the one-year preoperative and postoperative period were evaluated retrospectively. The degree of fat infiltration was also graded visually based on a modified Goutallier rating system. The study was conducted with a total of 58 patientsaged between 38 and 75, including 15 males and 43 females. Compared to the preoperative psoas muscle area values on the operated sides of the patients participating in the study, the decrease in the postoperative psoas muscle area was found to be statistically significant (p:0.000; p<0.05). Furthermore, the decrease in psoas muscle area on the non-operated side of the patients was also statistically significant (p:0.000; p<0.05). There was also a positive correlation between preoperative and postoperative psoas muscle areas (p:0.000; p<0.05). Early identification of psoas muscle mass reduction may allow for a more proactive psoas strength improvement program to improve post-operative function and mobility.

End-to-Side vs. Free Graft Nerve Reconstruction-Experimental Study on Rats.

The long history of regeneration nerve research indicates many clinical problems with surgical reconstruction to be resolved. One of the promising surgical techniques in specific clinical conditions is end-to-side neurorrhaphy (ETS), described and then repeated with different efficiency in the 1990s of the twentieth century. There are no reliable data on the quality of recipient nerve regeneration, possible donor nerve damage, and epineural window technique necessary to be performed. This research attempts to evaluate the possible regeneration after end-to-side neurorrhaphy, its quality, potential donor nerve damage, and the influence of epineural windows on regeneration efficiency. Forty-five female Wistar rats were divided into three equal groups, and various surgical technics were applied: A-ETS without epineural window, B-ETS with epineural window, and C-free graft reconstruction. The right peroneal nerve was operated on, and the tibial nerve was selected as a donor. After 24 weeks, the regeneration was evaluated by (1) footprint analysis every two weeks with PFI (peroneal nerve function index), TFI (tibial nerve function index), and SFI (sciatic nerve function index) calculations; (2) the amplitude and latency measurements of motor evoked potentials parameters recorded on both sides of the peroneal and tibial nerves when electroneurography with direct sciatic nerve electrical stimulation and indirect magnetic stimulation were applied; (3) histomorphometry with digital conversion of a transverse semithin nerve section, with axon count, fibers diameter, and calculation of axon area with a semiautomated method were performed. There was no statistically significant difference between the groups investigated in all the parameters. The functional indexes stabilized after eight weeks (PFI) and six weeks (TFI and SFI) and were positively time related. The lower amplitude of tibial nerve potential in groups A and B was proven compared to the non-operated side. Neurophysiological parameters of the peroneal nerve did not differ significantly. Histomorphometry revealed significantly lower diameter and area of axons in operated peroneal nerves compared to non-operated nerves. The axon count was at a normal level in every group. Tibial nerve parameters did not differ from non-operated values. Regeneration of the peroneal nerve after ETS was ascertained to be at the same level as in the case of free graft reconstruction. Peroneal nerves after ETS and free graft reconstruction were ascertained to have a lower diameter and area than non-operated ones. The technique of an epineural window does not influence the regeneration result of the peroneal nerve. The tibial nerve motor evoked potentials were characterized by lower amplitudes in ETS groups, which could indicate axonal impairment.

Combining Shelf Osteotomy With Proximal Femoral Reconstruction After Oncologic Resection

Introduction: Oncologic proximal femoral resection and reconstruction in skeletally immature children remains a formidable task due to the risk of developing hip instability with patient growth or interval leg lengthening through the prosthesis. Shelf pelvic osteotomy increases femoral head coverage and containment, and favorable long-term results have been reported in the setting of developmental dysplasia of the hip and Perthes disease. We present a technique of combining shelf osteotomy with expandable proximal femoral endoprosthesis reconstruction in pediatric limb-sparing surgery. Materials and Methods: Four surgeons at 2 centers from 2012 to 2020 performed proximal femoral reconstruction with shelf osteotomy. Data were collected retrospectively on operative technique, radiographic measurements, and complications including dislocation, subluxation, implant loosening, pain, function, and radiographic outcomes. Results: Five patients were included in the study. The mean follow-up was 49 months (range: 17 to 104 mo). The mean lateral center edge angle status postproximal femoral resection and reconstruction shelf osteotomy was 56.1 degrees (±30.5). There were no reported incidences of subluxations, dislocations, periprosthetic fractures, or soft tissue complications. The 3 patients with the longest follow-up at 3, 5, and 8 years tolerated serial lengthening of the endoprosthesis totaling 1 cm, 7.25 cm, and 9 cm, respectively, and demonstrated earlier triradiate cartilage closure in the operative side compared with the nonoperative side. All patients have returned to independent ambulation. Discussion: Combining proximal femoral reconstruction with shelf osteotomy in limb salvage pediatric orthopedic oncology may help to improve hip stability with serial lengthening and patient growth.

3D-printed temporomandibular joint-mandible combined prosthesis: A prospective study.

The study aimed to introduce and evaluate a new customized temporomandibular joint-mandible combined prosthesis with 3D printing fabrication. This was a prospective study including patients with temporomandibular joint-mandible combined lesions. A 3D-printed customized temporomandibular joint-mandible combined prosthesis was implanted to repair the joint and jaw defect. Clinical follow-up and radiographic examinations were taken to assess the clinical efficacy. The assessment indices were compared by the Wilcoxon signed rank test. Eight patients were treated with the combined prosthesis and included in this study. All prostheses were accurately positioned and fixed without wound infection, prosthesis exposure, displacement, loosening, or fracture. All cases had no mass recurrence at the last follow-up point. Pain, diet, mandibular function, lateral mandibular movement to the diseased side, and maximal interincisal opening showed significant improvements at every follow-up point and went to a stable condition at 6 months after the operation. But the lateral movement to the non-operated side was still limited following surgery. The 3D-printed combined prosthesis may be an alternative to other well-established reconstructions for temporomandibular joint and mandible defects.

Comparison of Hip and Knee Biomechanics during Sidestep Cutting in Male Basketball Athletes with and without Anterior Cruciate Ligament Reconstruction.

This study aimed to compare hip and knee biomechanics during sidestep cutting on the operated and non-operated sides in individuals with anterior cruciate ligament reconstruction (ACLR), and in an uninjured control group. Twenty male basketball athletes, 10 individuals with ACLR and 10 controls, were recruited. Hip and knee joint angles and angular velocities were investigated with a three-dimensional motion analysis system, and ground reaction forces (GRF) along with moments were collected during the deceleration phase of the stance limb during sidestep cutting maneuvers. We found significantly higher peak hip flexion, hip internal rotation angular velocities, and peak thigh angular velocity in the sagittal plane in the ACLR group. In addition, the peak vertical GRF and peak posterior GRF of the ACLR group were significantly higher than those of the control group. Univariate analyses indicated that the posterior GRF of the non-operated side was significantly higher than in the matched operated side in the control group. The operated and non-operated sides in male basketball athletes with ACLR showed alterations in hip and knee biomechanics compared with a control group, especially in the sagittal plane. Therefore, the emphasis of neuromuscular control training for the hip and the knee in basketball players with ACLR is required.

Not only muscle mass but also muscle quality is associated with knee extension muscle strength in patients with hip fractures

This study aimed to assess the relationship between isometric knee extension muscle strength on the operated or nonoperated sides and PhA in patients with hip fractures at approximately 6months postoperatively. This study was a cross-sectional study. Skeletal muscle index (SMI), PhA, knee extension muscle strength on the operated and nonoperated sides, and other physical function variables were assessed at approximately 6months postoperatively. To identify predictors of knee extension muscle strength on the operated and nonoperated sides, hierarchical multiple regression analysis was performed. A total of 90 patients with hip fractures were included (mean age, 80.1 ± 6.9years). SMI (0.45) and PhA on the operated side (0.27) were the significant associated factors extracted for isometric knee extension muscle strength on the operated side (standardized partial regression coefficients), independent of age, sex, and body mass index (BMI). Movement control during one-leg standing on the nonoperated side (0.26), SMI (0.32), and PhA on the nonoperated side (0.40) were the significant associated factors extracted for isometric knee extension muscle strength on the nonoperated side, independent of age, sex and BMI. Our results revealed that the decrease in isometric knee extension muscle strength on the operated and nonoperated sides in patients with hip fractures at approximately 6months postoperatively was associated with not only a decrease in skeletal muscle mass but also a decrease in muscle quality, characterized by a decreased PhA.

Bone remodeling and cortical thinning distal to the femoral stem: a retrospective review.

There is a paucity of information on the bone remodeling that occurs distal to the femoral stem following total hip arthroplasty as most previous studies have focused on proximal changes. In this study, we report the cortical thinning that occur distal to the femoral stem after primary total hip arthroplasty. A retrospective review was performed at one institution over a 5-year period. 156 primary total hip arthroplasty procedures were included. The Cortical Thickness Index (CTI) was measured on both operative and non-operative hips at 1cm, 3cm and 5cm below the prosthetic stem tip on anteroposterior radiographic images pre-operatively as well as at 6months, 12months and 24months post-operatively. The difference in average CTI was measured using paired t-tests. There were statistically significant decreases in CTI distal to the femoral stem at 12months and 24months (-1.3% and -2.8%, respectively). Greater losses were seen in female patients, patients older than 75, and patients with BMI less than 35 at 6months postoperative. There were no differences in CTI at any time point on the non-operative side. The current study demonstrates that patients undergo bone loss as measured by CTI distal to the stem in the first 2years following total hip arthroplasty. Comparison to the contralateral non-operative side confirms that this change is greater than expected for the natural aging process. A greater understanding of these changes will help optimize post-operative management and direct future innovations in implant design.

Scaphoid Nonunions Treated with Nonvascularized Bone Grafting and Screw Fixation.

Background Vascularized bone grafting with screw fixation is currently considered the treatment of choice for scaphoid nonunions with avascular necrosis (AVN) of the proximal pole. A viable alternative to using vascularized bone grafts for scaphoid nonunions with AVN is nonvascularized bone grafting with screw fixation. Question What are the functional outcomes of patients with scaphoid nonunions and associated proximal pole AVN who are treated with nonvascularized distal radius bone grafting and screw fixation? Patients and Methods Eight scaphoid nonunions with AVN, which received nonvascularized distal radius bone graft and screw fixation, underwent a retrospective review. Range of motion, strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were obtained. Follow-up X-rays were compared with immediate postoperative X-rays. Results At a mean follow-up of 88.9 months, thumb palmar abduction and radial abduction were significantly higher on the operative side ( p = 0.28 and 0.49, respectively). Extension/flexion arc was significantly lower in the operative wrist ( p = 0.148). There was no significant difference between the operative and nonoperative sides with regard to strength. The median postoperative DASH score was 2.9 (interquartile range [IQR]: 8.3). There was no progression of osteoarthritis when immediate postoperative and follow-up X-rays were compared. Radiographic union was observed in six of the seven (85.7%) patients who were able to return to the office for follow-up radiographs. The mean scapholunate and radioscaphoid angles measured on X-rays were within normal anatomic range postoperatively. Conclusions Using nonvascularized distal radius bone graft and screw fixation in the treatment of scaphoid nonunions with associated AVN has favorable radiologic and functional outcomes and should be considered a viable treatment option for this difficult problem.

Comparison of all-suture anchors with metallic anchors in arthroscopic cuff repair: Structural and functional properties and clinical suitability

PurposeThis study examined and compared all-suture anchors with metallic anchors in the arthroscopic repair of small to medium supraspinatus tears; a multi-dimensional evaluation protocol assessed (i) clinical, (ii) ultrasonographical, and (iii) functional criteria at mid-term. Materials and methodsA sample of 40 patients, prescreened from a larger group who had undergone arthroscopic rotator cuff repair, were resolved into two groups of 20, based on the type of anchor used in their surgery (all-suture or metallic) and were evaluated postoperatively (mean = 44.3 months, SEM = 22.4 months, minimum period = 10.3 months). Clinical assessments included (i) objective and subjective scores (Constant, DASH, SPADI, SST), (ii) ultrasonographical examination, as well as (iii) isometric and isokinetic strength testing. Raw data from the operated side was compared with those from the contralateral side within each group. Raw data for the PROMs and for the US evaluation were compared between groups. Strength data, as well as the Constant score values, were further analyzed based on (i) the difference between operated and intact sides, as well as (ii) the strength ratio between operated and intact sides; the transformed data were then compared between the two groups. ResultsWe found no statistically significant differences in any of the parameters considered between shoulders operated using ASAs or MAs, nor between operated and non-operated sides in each group. ConclusionOur findings indicate that the reliability and performance characteristics of all-suture anchors and metallic anchors are practically indistinguishable for arthroscopic treatment of small to medium lesions of the supraspinatus tendon.

Strength after the arthroscopic Latarjet procedure: Are shoulder internal rotation, elbow flexion & supination strength decreased?

The Latarjet procedure is an effective shoulder stabilizing surgery, however, the procedure results in an alteration of anatomy that may result in shoulder and elbow weakness. Thus, the purpose of this study was to assess post-operative shoulder and elbow strength after the Latarjet procedure. We hypothesized that shoulder and elbow strength are not affected after the procedure. The study group consisted of patients that had undergone the arthroscopic Latarjet procedure. An isokinetic dynamometer was used to evaluate the strength of bilateral shoulder internal rotation, elbow flexion, forearm supination using peak torque (N/m), as well as grip strength (kilograms). Shoulder range of motion and the potential effects of hand dominance were further analysed. Nineteen patients with a mean age of 29 years and an average follow up of 47 months were included. Shoulder internal rotation strength, elbow flexion and forearm supination strength and grip strength were not significantly different when compared to the non-operative side (p > 0.13). The range of shoulder external rotation was significantly reduced (p < 0.001) on the Latarjet side. The results from this study demonstrate no statistically significant differences in the strength of shoulder internal rotation, elbow flexion, forearm supination or grip strength despite the surgical alterations to the subscapularis and conjoint tendon.

Comparative Study of Different Entry Spots on Postoperative Gluteus Medius Muscle Cross-Sectional Area in Patients With Intertrochanteric Fractures Nailing.

Introduction In a preliminary study of cephalo-medullary (CM) nailing in patients with femoral intertrochanteric fractures, the authors of this study found a 25% to 30% decrease in muscle strength, especially abduction force, during the postoperative follow-up period. This decline was partially attributed to the entry point for the nail insertion causing damage to the gluteus medius tendon at the junction of the greater trochanter after reaming. Therefore, we assumed that changing the position of nail insertion to a "bald spot (BS)" could mitigate postoperative functional impairment. Automated computed tomography (CT) imaging of skeletal muscle cross-sectional area (CSA) and adipose tissue ratio (ATR) can show pathological changes on the operated side compared with the non-operated side. In this study, the authors quantified the difference in postoperative CSA and ATR of the gluteus medius muscle after bald spot nailing versus nail insertion through the conventional tip of the greater trochanter. It was hypothesized that bald spot nailing could avoid significant injury to the gluteus medius muscle. Materials and methods Patients with femoral intertrochanteric fractures were grouped according to the site of cephalo-medullary nailing: greater trochanteric tip (TIP) in 27 patients (8 men and 19 women, mean age 84.9±5.1 years) and BSin 16 patients (3 men and 13 women, mean age 86.9±6.2 years). The CSA and ATR of the gluteus medius muscles were assessed in three slices (A, B, and C from proximal to distal). Each slice was manually traced and automatically calculated based on its contour. Adipose tissue (-100 to -50 in Hounsfield units) in the designated area was distinguished by a bimodal image histogram resulting from the distribution of CT numbers of adipose tissue and muscle. The body mass index (BMI) was used to correct the CSA in each patient. Results In the TIP group, the mean CSA values (mm2) from the non-operated/operated sides were as follows: slice A, 2180.2 ± 616.5/1976.3 ± 421.2; slice B, 2112.3 ± 535.7/1857.7 ± 386.7; and slice C: 1671.8 ± 460.0/1404.1 ± 404.3 (p<0.01 in slices A, B, and C). In the BS group, slice A was 2044.1 ± 473.0/2016.9 ± 388.4; slice B was 2073.2 ± 540.7/1848.3 ± 411.1; and slice C was 1659.1 ± 477.2/1468.5 ± 341.7 (p=0.34 in slice A, and p<0.05 in slices B and C, respectively). The mean CSA values (mm2) of the non-operated minus operated side between the TIP/BS groups were as follows: slice A, 241.3 ± 424.3/-11.8 ± 285.6; slice B, 290.3 ± 313.0/211.8 ± 333.2; and slice C, 276.4 ± 270.4/162.8 ± 319.3 (p < 0.05 in slice A, 0.45, 0.24 in slices B, C, respectively). The mean adjusted CSA per BMI values (mm2) of the non-operated minus the operated side between the TIP/BS groups were slice A, 10.6 ± 19.7/-0.4 ± 14.8; slice B, 13.3 ± 15.0/10.1 ± 16.3; and slice C, 13.1 ± 13.4/ 8.7 ± 15.3 (p < 0.05 in slice A and 0.54 and 0.36 in slices B and C, respectively). Conclusion Nail insertion at the bald spot resulted in a significantly smaller decrease in the CSA of the gluteus medius muscle compared with the conventional tip entry. In addition, an examination of BMI-adjusted CSA showed that CSA was maintained in some image slices. These results suggest that nailing from the BS of the greater trochanter can reduce damage to the gluteus medius muscle and highlight the importance of imaging beyond the usual assessment of skeletal changes.

The Relationship between Lower Extremity Functional Performance and Balance after Anterior Cruciate Ligament Reconstruction: Results of Patients Treated with the Modified All-Inside Technique.

Anterior cruciate ligament (ACL) ruptures are common injuries, and ACL reconstruction (ACLR) is among the most common surgical procedures in sports surgery. Our research aims to compare the 6-month post-operative results of the modified all-inside (MAI) ACLR technique, single leg hop tests (SLHT), and Y balance tests applied in different directions on the operated and non-operated sides. A retrospective cohort of 22 male recreational athletes who underwent MAI ACLR techniques performed by the same surgeon were evaluated. The functional knee strengths of the participants on the operated and non-operated sides were evaluated with five different tests of SLHTs: single hop for distance (SH), triple hop for distance (TH), crossover triple hop for distance (CH), medial side triple hop for distance (MSTH), and medial rotation (90°) with hop for distance (MRH). Their dynamic balance was evaluated with the Y balance Test. Compared to pre-operative levels, there was a significant improvement in the mean Lysholm, Tegner, and IKDC scores during the post-operative period (p < 0.05). There was a difference between SH, THD, CHD, MSTH, and MRH on the operated and non-operative sides (p < 0.05). There was no difference between Y balance scores on the operated and non-operative sides, and there were no differences between LSI scores resulting from SLHTs (p > 0.05). There were no significant relationships between YBT (composite scores) and SH, TH, CH, MSTH, and MRH distances in the healthy leg (p > 0.05), but a significant correlation with only CH in the ACL leg (p < 0.05). Our research shows that sixth-month post-operative SLHT findings were lower on the ACL side compared to the healthy side in patients tested with the MAI ACLR technique. However, when these scores are evaluated in terms of balance, it can be seen that both sides reveal similar findings. The similarity of LSIs in SLHTs applied in different directions, and balance scores of ACL and healthy sides revealed that the MAI technique is also an ACLR technique that can be used in athletes from a functional point of view.

Preoperative Predictors of Instrumental Activities of Daily Living Disability in Older Adults 6 Months After Knee Arthroplasty

ObjectiveTo investigate preoperative predictors of instrumental activities of daily living (IADL) disability in older adults 6 months after knee arthroplasty (KA). DesignProspective cohort study. SettingGeneral hospital with an orthopedic surgery department. ParticipantsTwo hundred twenty (N=220) patients 65 years or older with total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA). InterventionsNot applicable. Main Outcome MeasuresIADL status was evaluated for 6 activities. Participants chose “able,” “need help,” or “unable” according to their capacity of executing these IADL. If they chose “need help” or “unable” for 1 or more items, they were defined as “disabled.” Their usual gait speed (UGS), range of motion for the knee, isometric knee extension strength (IKES), pain status, depressive symptoms, pain catastrophizing, and self-efficacy were evaluated as predictors. Baseline and follow-up assessments were conducted 1 month before and 6 months after KA, respectively. Logistic regression analyses with IADL status as the dependent variable were performed at follow-up. All models were adjusted using age, sex, severity of the knee deformity, operation type (TKA or UKA), and preoperative IADL status as covariates. ResultsIn total, 166 patients completed the follow-up assessment, and 83 (50.0%) reported IADL disability 6 months after KA. Preoperative UGS, IKES on the non-operated side, and self-efficacy were statistically significantly different between those with a disability at follow-up and those who did not and were therefore included in logistic regression models as independent variables. UGS (odds ratio, 3.22; 95% CI, 1.38-7.56; P=.007) was determined as a significant independent variable. ConclusionsThe present study demonstrated the importance of evaluating preoperative gait speed to predict the presence of IADL disability in older adults 6 months after KA. Patients with poorer preoperative mobility should be provided careful postoperative care and treatment.

The Usefulness of Motor Potentials Evoked Transvertebrally at Lumbar Levels for the Evaluation of Peroneal Nerve Regeneration after Experimental Repair in Rats

Motor evoked potentials (MEPs) are used in neurology as part of a precise diagnostic method to study the transmission of efferent neural impulses at the central and peripheral levels of the nervous system. Previous attempts have been made to apply MEPs in animal studies for evaluating neural transmission at the motor cortex center level to the muscles of the forelimbs and hindlimbs. In clinical and experimental studies, little attention is focused on the significance of the magnetic stimulation of spinal cord structures with the direct recording of the evoked potentials from peripheral nerve motor fibers. The aim of this paper was to evaluate the usefulness of the motor potentials evoked transvertebrally at lumbar levels in the evaluation of experimental peroneal nerve regeneration in rats. The bilateral transmission of efferent impulses in the distal parts of the peroneal and tibial nerves was verified by recordings of evoked potentials following transvertebral magnetic stimulation at lumbar levels (MEPs) and the electrical stimulation of the sciatic nerve in classical electroneurographic (ENG) tests for comparison. Recordings were performed 24 weeks after grafts on surgically treated hindlimbs as well as on non-operated hindlimbs as controls. Both the MEP and ENG stimulations resulted in evoked potentials with larger amplitude values following the application of the magnetic pulses, with more being recorded on the non-operated hindlimbs than on the operated ones when recordings were taken from peroneal nerve branches. We observed statistically significant correlations between the MEP and ENG results for peroneal and tibial nerve amplitude on the non-operated side and peroneal nerve amplitude on the operated side. The recorded latencies of the evoked potentials were shorter in the ENG studies than in the MEPs for the non-operated side. The results demonstrated the phenomenon of regeneration in the motor fibers of the peroneal nerves 24 weeks after grafting in the experimental conditions. In this study, the MEPs were as useful as the ENG studies for evaluating regeneration in the motor fibers of hindlimb nerves in rats, although they were not significantly different. This paper discusses the clinical importance of transvertebral MEPs induced at the lumbosacral and cervical levels with a magnetic field for the diagnostic evaluation of efferent impulse transmission at different levels of the motor pathway.

Patellofemoral Angle, Pelvis Diameter, Foot Posture Index, and Single Leg Hop in Post-Operative ACL Reconstruction.

Background and Objectives: Anterior cruciate ligament (ACL) injuries occur as a result of the deterioration of the static and dynamic stability of the knee. One of the structures involved in providing static stability is the patellofemoral angle (Q angle). The aim of this study was to investigate the relationships between Q angle, pelvis diameter, lower extremity length, and foot posture index (FPI) in patients who had undergone ACL reconstruction (ACLR) with the semitendinosus/gracilis (ST/G) technique on both the operated and non-operated sides. Materials and Methods: Twenty-five male recreational athletic patients between the ages of 18 and 35 who had undergone semitendinosus/gracilis (ST/G) anterior cruciate ligament reconstruction at least 6 months earlier were included in the study. Femur length, lower extremity length, pelvis diameter, and Q angle measurements, total foot posture index (FPI) scores, and single leg hop (SLH) and triple hop distance (THD) test results were determined on the operated and non-operated sides. Results: When the findings of the patients were evaluated statistically between the operated and non-operated sides, no significant differences were found in Q angle, femur length, and lower extremity length (p > 0.05). In terms of FPI scores, a significant difference was found only in the inversion/eversion of the calcaneus (CALC) parameter (p < 0.05). When the single hop test (SLHT) results were evaluated statistically on the operated and non-operated sides, the results were in favor of the non-operated side (p < 0.05). In the correlation analysis conducted for both the operated and non-operated sides, positive and significant correlations were found only between SLH and THD (p < 0.05). No significant difference was found in the other parameters. Conclusions: The fact that ST/G ACLR 6th month post-operative findings revealed similar results in Q angle, lower extremity length, and total FPI scores between the operated and non-operated sides showed that the 6-month process did not cause a difference in these parameters. However, it was found that the operated sides showed lower findings compared to non-operated sides for SLHTs, although these findings were within normal ranges in terms of the limb symmetry index.

Comparison of balance and function in the long term after all arthroscopic ATFL repair surgery.

We compared the balance, ROM, clinical scores, kinesiophobia and functional outcomes of patients after all-arthroscopic ATFL repair surgery with the non-operated side and healthy control group. Twenty-five patients with follow up time 37.32 ± 12.51months and twenty-five healthy controls participated in the study. Postural stability was evaluated with the Biodex® balance system by measuring overall (OSI), anterior-posterior (API), and mediolateral (MLI) stability index. Dynamic balance and function were measured using the Y-balance test (YBT) and single-leg hop test (SLH). Limb symmetry index for SLH and contralateral comparisons (YBT, OSI, API, MLI) was performed. The AOFAS score and the Tampa Scale of Kinesiophobia (TSK) were applied. Two subgroups were created (with OLT and without OLT). There was no statistically significant difference between subgroups. There was no statistically significant difference between bilateral OSI, API, MLI values and YBT anterior reach distances of all groups. Single leg OSI (0.78 ± 0.27/0.55 ± 0.12), API (0.55 ± 0.22/0.41 ± 0.10), and MLI (0.40 ± 0.16/ 0.26 ± 0.08) values were significantly worse and YBT posteromedial (73.88 ± 15.70/89.62 ± 12.25), posterolateral reach (78.03 ± 14.08/92.62 ± 8.25) and the SLH distance (117.14 ± 27.84/165.90 ± 20.91) were significantly lower on the patients than controls (p < 0.05), respectively. In contralateral comparisons, all reach distances on YBT were similar and SLH limb symmetry index of the operated side was 98.25%. AOFAS scores of the patients were 92.62 ± 11.13, TSK scores were 46.45 ± 11.32, and 21 patients (84%) had kinesiophobia. AOFAS score, limb symmetry index, and bilateral balance of the patients were successful; however, there is single-leg postural stability insufficiency and kinesiophobia. Although the extremity symmetry index of the operated side of the patients was 98.25, the fact that these values are lower than those of the healthy control may have been caused by kinesiophobia. During the long-term rehabilitation, kinesiophobia should be considered and single-leg balance exercises should be monitored during the rehabilitation period. Level III.

Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy.

To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.