Non-operated Side Research Articles

Does the Hip Capsule Remain Closed After Hip Arthroscopy With Routine Capsular Closure for Femoroacetabular Impingement? A Magnetic Resonance Imaging Analysis in Symptomatic Postoperative Patients

The purpose of this study was to examine the hip capsule in a subset of symptomatic patients who underwent capsular closure during hip arthroscopy. All patients undergoing primary hip arthroscopy for femoroacetabular impingement (FAI) with routine capsular closure between January 1, 2012, and December 31, 2015, were eligible. Only patients with unilateral surgery and a postoperative magnetic resonance imaging (MRI; ordered for persistent symptoms) were included. Four independent reviewers evaluated each hip capsule for thickness and the absence or presence of defects. During the study, 1,463 patients had hip arthroscopy for FAI with routine capsular closure, and 53 (3.6%) underwent a postoperative MRI. Fourteen of the 53 were excluded owing to revision status or additional procedures. The final study population included 39 patients (23 female patients and 16 male patients), with an average patient age of 31.7 ± 11.4years and an average body mass index of 23.3 ± 2.9. There were 3 (7.5%) capsular defects, and the intraclass correlation coefficient (ICC) was 0.82. The operative hip capsule was significantly thicker in the zone of capsulotomy, and subsequent repair as compared with the unaffected, contralateral hip capsule (5.0 ± 1.2mm vs 4.6 ± 1.4mm; P= .02), ICC 0.83. Additionally, males had thicker hip capsules as compared with their female counterparts, on the operative side (5.4 ± 1.1mm vs 4.5 ± 1.2mm; P= .02) and the nonoperative side (4.8 ± 1.6mm vs 4.1 ± 0.9mm; P= .08). In a subset of symptomatic patients after hip arthroscopy for FAI, the majority (92.5%) of the repaired hip capsules remained closed at greater than 1year of follow-up. The hip capsule adjacent to the capsulotomy and subsequent repair is thickened compared with the same location on the contralateral, nonoperative hip. Aside from gender, patient-related and FAI-related factors do not correlate with capsular thickness nor do they seem to correlate with the propensity to develop a capsular defect. Level IV, prognostic case series.

The effect of preoperative lateral flexibility of the lumbar spine on perceived leg length discrepancy after total hip arthroplasty.

Leg length discrepancy (LLD) after total hip arthroplasty (THA) is a significant factor of patient dissatisfaction. Patients with dissociation between preoperative radiographic LLD and perceived LLD sometimes feel LLD postoperatively even if bilateral leg lengths are equal. There is no publication describing how to decide the amount of leg lengthening in such cases. By examining the influence of preoperative lumbar lateral flexibility on postoperative perceived LLD, this study aims at creating a guideline for the optimal planning of leg lengthening in THA. In 59 cases undergoing primary unilateral THA, radiographic LLD, perceived LLD, pelvic tilting and lumbar lateral flexibility were measured preoperatively. The amount of leg lengthening and the sequential change of the perceived LLD were measured postoperatively. Twelve cases (20%) felt the perceived LLD at two years after surgery. All these cases felt the operative side longer than the non-operative side. In 32 cases with preoperative pelvic inclination to the affected side, postoperative perceived LLD was significantly greater if lumbar spine was rigid. In eight cases with pelvic tilting and rigid lumber spine, the amount of leg lengthening that exceeded preoperative perceived LLD affected the postoperative perceived LLD. In cases with preoperative pelvic inclination downward to the affected side and with rigid lumbar spine, amount of leg lengthening should not be excessively greater than preoperative perceived LLD. In other cases, lengthening the leg to the same length as the contralateral side rarely results in postoperative perceived LLD.

Impact of previous surgery on sentinel lymph node mapping: Hybrid SPECT/CT before and after a unilateral diagnostic breast excision

BackgroundEarlier studies have shown conflicting results regarding the accuracy of sentinel lymph node biopsy after previous breast surgery, especially after a surgical biopsy. PurposeTo compare lymph drainage patterns before and after a diagnostic unilateral surgical biopsy using the exact anatomical localisation of sentinel lymph nodes defined by SPECT/CT. Material and methodsThirty-seven women planned for unilateral surgical excision of an unsuspicious breast lesion were prospectively examined between September 2011 and January 2015. Hybrid SPECT/CT lymphoscintigraphy of the thorax and neck region with bilateral subareolar injections of 99mTc-Nanocoll was performed one week before and six weeks after surgery. The non-operated side served as a control. The primary outcome measure was the concordance between pre- and postoperative number and localisation of sentinel lymph nodes. ResultsSentinel lymph node detection rate with SPECT/CT on operated sides was 91.9 per cent (34 of 37 procedures), to be compared with a detection rate of 93.7 per cent on all non-operated sides (104 of 111 procedures, P = 0.771). Partial or total concordance regarding the localisation and number of sentinel lymph nodes was 85.7 per cent (30 out of 35) on operated and 88.9 per cent (32 out of 36 patients) on non-operated breast sides (P = 0.735). ConclusionBreast surgery slightly decreased the concordance between pre- and postoperative sentinel lymph nodes, but this finding was not statistically significant. Our results thus support that it is feasible to perform a sentinel lymph node biopsy after previous breast excisional surgery with an acceptable level of safety.

Role of spinal κ-opioid receptors in remifentanil-induced central sensitization after operation in rats with incisional pain

Objective To investigate the role of spinal κ-opioid receptors in remifentanil-induced central sensitization after operation in the rats with incisional pain. Methods Thirty male Sprague-Dawley rats, weighing 230-270 g, in which intrathecal catheters were successfully implanted, were randomly divided into 5 groups (n=6 each) using a random number table: control group (group C); incisional pain group (group I); remifentanil group (group R); remifentanil plus incisional pain group (group R+ I); κ receptor agonist U50488H group (group U). A 1 cm longitudinal incision was made in the plantar surface of the right hindpaw in anesthetized rats in I, R+ I and U groups except C and R groups.Remifentanil 10 μg·kg-1·min-1 was infused intravenously for 1 h in R, R+ I and U groups except C and I groups.U50488H 10 μg/10 μl was intrathecally injected in group U. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured before catheterization (T0), before operation (T1) and at 1 h, 4 h and 1, 2 and 3 days after operation (T2-6). After assessment of pain behaviors on postoperative day 3, the lumbar enlargement segments of the spinal cord were removed for determination of the expression of spinal κ-opioid receptors and mRNA using Western blot and real-time polymerase chain reaction, respectively. Results Compared with group C, the bilateral MWT was significantly decreased at T5, 6, the bilateral TWL was significantly shortened at T5, 6, and the expression of spinal κ-opioid receptors and mRNA was significantly down-regulated in group R, and the MWT on the operated side at T2-6 and on the non-operated side at T5, 6 was significantly decreased, the TWL on the operated side at T2-6 and on the non-operated side at T5, 6 was significantly shortened, and the expression of spinal κ-opioid receptors and mRNA was significantly down-regulated in group R+ I (P<0.05). Compared with group I, the MWT on the operated side at T4-6 and on the non-operated side at T5, 6 was significantly decreased, the TWL on the operated side at T4-6 and on the non-operated side at T5, 6 was significantly shortened, and the expression of spinal κ-opioid receptors and mRNA was significantly down-regulated in group R+ I (P<0.05). Compared with group R+ I, the MWT on the operated side at T2-6 and on the non-operated side at T5, 6 was significantly increased, the TWL on the operated side at T2-6 and on the non-operated side at T5, 6 was significantly prolonged, and the expression of spinal κ-opioid receptors and mRNA was significantly up-regulated in group U (P<0.05). Conclusion The mechanism by which remifentanil induces central sensitization after operation may be related to inhibition of the function of spinal κ-opioid receptors in the rats with incisional pain. Key words: Piperidines; Hyperalgesia; Receptors, opioid, kappa; Spinal cord

The Oblique Metaphyseal Shortening Osteotomy of the Distal Ulna: Surgical Technique and Results of Ten Patients.

Background Ulnocarpal abutment is a common condition following distal radius fractures. There are different surgical methods of treatment for this pathology: open and arthroscopic wafer procedure or an ulnar shortening osteotomy. We describe an oblique metaphyseal shortening osteotomy of the distal ulna using two cannulated headless compression screws. We report the results of 10 patients treated with this method. Materials and Methods Out of 17 patients, 10 could be reviewed retrospectively for this study. Patient-rated outcomes were measured using the VAS (visual analogue scale) for pain, PRWHE (patient-rated wrist and hand evaluation) survey, and Quick-DASH (disability of arm, shoulder and hand) survey for functional outcomes. At the review we measured the range of motion (ROM) of the wrist (extension and flexion, ulnar and radial deviation, pronation and supination). Grip strength, pronation, and supination strength of the forearm was measured using a calibrated hydraulic dynamometer. ROM and strength of the affected wrist was compared with ROM and strength of the unaffected wrist. Surgical Procedure Oblique long metaphyseal osteotomy of the distal ulna (from proximal-ulnar to distal-radial), fixed with two cannulated headless compression screws. Results The average postoperative VAS score for pain was 23.71 (standard deviation [SD] of 30.41). The average postoperative PRWHE score was 32.55 (SD of 26.28). The average postoperative Quick-DASH score was 28.65 (SD of 27.21). The majority of patients had a comparable ROM and strength between the operated side and the non-operated side. Conclusion This surgical technique has the advantage of reducing the amount of hardware and to decrease the potential hinder caused by it on medium term. Moreover, the incision remains smaller, and the anatomic metaphyseal localization of the osteotomy potentially allows a better and rapid healing.

An automated whisker tracking tool for the rat facial nerve injury paradigm

BackgroundThe two-dimensional videographic analysis of vibrissal movements in behaving rodents has become a standard method to estimate the degree of functional impairment and recovery after facial nerve injuries quantitatively. The main limitation of the method is the time consuming, uneconomic process of manually tracking the vibrissae in video sequences. New methodWe developed a novel tool allowing automated detection of untagged vibrissae (two on each side of the snout). To compare the new method with the standard manual tracking approach, we used videos of unrestrained rats with unilateral section and immediate suture of the facial nerve performed two months earlier. ResultsMeasurement agreement analyses showed that the two methods are equivalent for both “normal” high-amplitude vibrissal movements (non-operated side) and low-amplitude whisking (reinnervated side). Spectral analysis revealed a significant deviation in the power spectra on the control and injured side, indicating that bilaterally coordinated whisker movements are not present two months after surgery. Comparison with existing method(s)The novel method yields results equal to those of the manual tracking approach. An advantage of our tool is the possibility to significantly increase sample size without additional labor cost. ConclusionsThe novel tool can increase the efficacy and spectrum of functional measures used in facial nerve regeneration research.

Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study.

We describe the use of structured light plethysmography (SLP)-a novel, non-contact, light-based technique for measuring tidal breathing-among a cohort of patients undergoing lung resection. In this feasibility study, we examined whether changes in chest wall motion or in asynchrony between regions of the thoraco-abdominal wall could be identified after surgery. Fifteen patients underwent wedge resection (n = 8) or lobectomy (n = 7). All patients underwent two SLP assessments (before surgery and on Day 1 post-surgery). Each assessment captured data during 5 min of quiet (tidal) breathing. When data were averaged across all patients, motion on the operated side of the thorax was significantly reduced after surgery (mean change from presurgery ± standard deviation: -14.7 ± 16.5%, P = 0.01), while motion on the non-operated side increased (15.9 ± 18.5%, P = 0.01). Thoraco-abdominal asynchrony also increased (mean change ± standard deviation: 43.4 ± 55.1%, P = 0.01), but no significant difference was observed in right-left hemi-thoracic asynchrony (163.7 ± 230.3%, P = 0.08). When analysed by resection type, lobectomy was associated with reduced and increased motion on the operated and non-operated side, respectively, and with an increase in both right-left hemi-thoracic and thoraco-abdominal asynchrony. No significant changes in motion or asynchrony were identified in patients who underwent wedge resection. SLP was able to detect changes in chest wall motion and asynchrony after thoracic surgery. Changes in this small group of patients were consistent with the side of the incision and were most apparent in patients undergoing lobectomy.

Atrophy of the tongue following complete versus partial hypoglossal nerve transection in a canine model.

The hypoglossal nerve (XII) has been used as a donor nerve in facial and laryngeal reinnervation. The purpose of this study was to investigate the neuromuscular changes that occur within the tongue following partial or complete transection of XII using a canine model. Histopathological comparison of tongue denervation following two types of XII resection in a canine model. Ten adult canines underwent complete unilateral resection of XII or resection of only the medial terminal branch of the hypoglossal nerve (mXII). After 6 months of recovery, tongue specimens were analyzed histopathologically using whole cross-sections. Routine histologic sections were assessed by two neuropathologists blinded to the type of denervation. The cross-sectional area was calculated of both sides of the tongue, and the amount of myosin was quantified morphometrically using immunohistochemistry for myosin (antimyosin heavy chain, fast isotype). Statistical comparison between partial and complete denervation was performed using the Student t test. Six months following XII transection, quantitative measures of the cross-sectional area of the tongue and content of myosin demonstrated severe muscle atrophy on the operated side of the tongue for both groups, compared to the nonoperated side. For partial transection involving only mXII, the degree of atrophy was less severe (P < .05). This study provides new histological information demonstrating that partial resection of the hypoglossal nerve, sacrificing only the proximal medial branch of the hypoglossal nerve (mXII), results in less severe atrophy of the tongue than complete transection of the entire hypoglossal nerve. NA Laryngoscope, 126:2689-2693, 2016.

Arthroscopic knotless suprapectoral tenodesis of the long head of biceps: clinical and structural results.

Different techniques for tenodesis of the long head of biceps (LHB) have been described. Previous studies focused on intraosseously performed techniques while only little clinical data exists for epiosseously performed knotless LHB tenodesis. The hypothesis is that arthroscopic suprapectoral knotless epiosseous tenodesis of the LHB would have good clinical, cosmetic and structural results. Forty-nine patients [16 women, 33 men; mean age 58; mean follow-up 36.4months (range 24-57months)], in whom a tenodesis of the long biceps tendon (LHB) has been performed, were included into this study. The clinical evaluation included the Constant score as well as the LHB score. In addition elbow flexion and supination strength were assessed. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. The overall Constant score did not reveal any significant differences comparing both sides [mean, 86±19 points vs. 89±16 points (p>0.05)]. The mean LHB score reached 88.3 points (range 54-100 points). Thirty-four patients (69%) presented an examiner-dependent upper arm deformity although only three patients (6%) confirmed a subjective cosmetic deformity. Both, flexion and supination strength were significantly decreased compared to the non-operated side (p<0.05). In five patients (10%) it was not possible to verify the LHB sonographically in the bicipital groove. Therefore the biceps tenodesis was classified as a failure. The arthroscopic suprapectoral epiosseous knotless tenodesis of the LHB provides good functional results. The high rate of examiner-dependent upper arm deformities can be explained by a non-physiological situation of the primary length-tension relationship or an elongation of the tendon after fixation.

The influence of an external breast prosthesis on the posture of women after mastectomy.

Previous literatures showed no evidence that wearing an external breast prosthesis may prevent changes in body posture in women who underwent mastectomy. To determine whether the weight of an external breast prosthesis can contribute to posture changes in women post mastectomy. Fifty-one women with unilateral mastectomy (age 58 ± 11.39 years) were divided into 2 subgroups by their operation side. Asymmetry of body posture was evaluated by using the electromyography activity of erector spinae muscles with four different weights of breast prosthesis. Despite the operation side, the erector spinae muscle activities on the operation side and non-operation side were significantly different. Overall, for patients who had operation on the left side, their erector spinae muscle activity imbalance will be smaller, compared to the imbalance among patients with right operation side. The weight of the external breast prosthesis did not influence the differences of erector spinae muscle activities on the operation side and non-operation side. The weight of an external breast prosthesis for women after mastectomy may not be crucial when choosing a proper prosthesis.

Direct repair of chronic distal biceps tendon tears

ObjectiveTo present the results from direct tendon repair using EndoButton and interference screws in patients with lesions of the distal biceps that had evolved over a period of more than 28 days. MethodsBetween January 2012 and November 2013, eleven patients (all male) with a torn distal biceps and a time interval between injury and surgery of more than 28 days were evaluated. The patients’ mean age was 46 years and the most common mechanism of injury was eccentric loading with the elbow flexed and supinated. ResultsA subjective analysis on pain and function was conducted using a visual analog scale of pain (VAS) and the Mayo Elbow Performance Score (MEPS), before and after surgery. The VAS showed a decrease of 5 points to 0.8 points on average. The MEPS improved from 69.3 points before the operation to 97.5 points afterwards. The mean flexion was 133.1° on the operated side, versus 134.3°. The mean extension was −2.5° and 0° (operated side versus non-operated). Supination was 88.2° versus 89.5° and pronation was 82.5° versus 84.1°, comparing the operated side versus the non-operated side. Flexion and supination strengths were evaluated with the aid of a dynamometer, and the mean flexion and supination strengths were found to be respectively 78.57% and 89.65% of the strength of the non-operated limb. ConclusionUse of the technique of direct tendon repair using EndoButton and interference screws was shown to be a safe and effective alternative for repairing chronic lesions of the distal biceps.

The impact of unilateral salpingectomy on antral follicle count and ovarian response in ICSI cycles: comparison of contralateral side

Objective: To determine the impact of salpingectomy on the ovarian reserve. Comparisons are made with the contralateral side in patients with unilateral salpingectomy undergoing intracytoplasmic sperm injection (ICSI) cycles.Study design: Patients under 40 with unilateral salpingectomy and without history of ovarian surgery were selected for the multicentre retrospective study. Women with bilateral salpingectomy and history of endometriosis were excluded from the study. Antral follicle count, controlled ovarian hyperstimulation (COH) parameters and number of collected oocytes were the main outcome measures of the study.Results: A total of 56 patients were eligible for this study. The mean age of the patients was 31.6 ± 4.7 years. The reasons for the salpingectomy were hydrosalpinx (39.3%, n = 22) and ruptured ectopic pregnancy (60.7%, n = 34). The ongoing pregnancy rate per embryo transfer was 30.6%. There was no statistically significant difference between the operated and non-operated sides in antral follicle count (AFC), follicles ≥ 17 mm and 10–17 mm on day of human chorionic gonadotrophin (hCG), or number of aspirated oocytes. In the subgroup analysis, AFC, number of growing follicles on day of hCG and number of collected oocytes were comparable between the ectopic pregnancy group and hydrosalpinx group.Conclusion: The study suggests that salpingectomy is not associated with detrimental effects on AFC and ovarian response.

Laparoscopic TEP repair of inguinal hernia does not alter testicular perfusion

The effect of laparoscopic TEP repair on testicular perfusion is unclear. The procedure entails dissection of testicular blood vessels off the hernial sac and incorporation of a prosthetic mesh. This carries at minimum, a theoretical risk of compromise in testicular blood supply, which in turn may affect fertility. Our study aims to establish if any alteration in testicular perfusion occurs in very early (24h), early (1week) or late postoperative period (3months) after laparoscopic TEP repair in the Indian population. In our prospective trial, 20 patients underwent unilateral and 8 underwent bilateral laparoscopic TEP hernia repairs using standard technique by experienced surgeons. Flow parameters of testicular, capsular and intratesticular artery were noted using color Doppler ultrasound preoperatively and postoperatively and the postoperative resistive indexes of operated side (n=36) were compared with preoperative values. Additionally, for unilateral repairs, flow parameters on operated side were compared with the non-operated side. No statistically significant difference was noticed in the resistive index of the arteries upon comparing these postoperative with preoperative values. For unilateral repairs, the flow parameters of the operated side were comparable with that of non-operated side (i.e. p>0.05). Laparoscopic TEP performed by experienced surgeons does not alter testicular flow dynamics in early or late postoperative period.

The use of piezoelectric surgery to lateralize the inferior alveolar nerve with simultaneous implant placement and immediate buccal cortical bone repositioning: a prospective clinical study

A prospective study was conducted to assess a variation of inferior alveolar nerve (IAN) lateralization. This study included 13 patients. An osteotomy was made with a piezoelectric device, and the IAN bundle was moved buccally. Dental implants were then inserted medial to the nerve bundle, and the inner surface of the buccal cortical bone plate was shaped to reduce its thickness. Finally, the bone plate was repositioned to restore the original shape and contour of the mandible. Neurosensory examinations of the lower lip and chin were performed using three tests: light touch, pain, and two-point discrimination. Three months after surgery, the function of the IAN was judged to be completely restored at 11 of the 13 surgical sites. Differences in the tests comparing the operated and non-operated sides were not significant. No implants were lost, and all patients were satisfied with the result. Although IAN lateralization in conjunction with dental implant placement is rarely indicated, the use of a piezoelectric device to perform a buccal osteotomy with final repositioning of the buccal cortical plate over the bony defect contributes to the recovery of the contour and shape of the mandible, without impairment of IAN function.

Anterior cruciate ligament reconstruction in adolescents (Tanner stages 2 and 3).

Management of anterior cruciate ligament injuries in skeletally immature patients (in Tanner stages 2 and 3) is controversial. Conventional reconstruction used in adults can cause iatrogenic growth disturbance due to physeal damage, and studies that report long-term results using a specific technique are scarce. The aim of this study is to evaluate in a large series the mid- and long-term results of a partial transphyseal technique and define the safe percentage of lesions of the femoral growth plate. Between 1989 and 2012, 42 adolescents at risk of growth disturbances (growth prediction of lower limbs >5 cm-Tanner 2, 3) underwent reconstruction of the anterior cruciate ligament using the semitendinosus and gracilis tendons. Growth characteristics of all the patients were assessed preoperatively, and the percentage of damage that would be produced in the femoral physis by the drilling of a 6-mm-diameter tunnel was determined. The technique used achieved graft fixation at both insertion sites, drilling the femoral physis and avoiding the tibial physis. We distinguished two groups: (a) long-term follow-up (mean 13 years 7 months, min 10.9, max 16.2) and (b) medium follow-up (mean 6 years 3 months, min 3.7, max 9.9). All knees were evaluated subjectively by history and objectively by KT2000 testing, and X-rays of both knees were compared for osteoarthritis using the Kellgren-Lawrence classification. In group A (12 patients) one osteoarthritis grade 2, one instability, and ten good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +2.4 mm (range 1-4 mm) between the operated and non-operated sides (p < 0.05). In group B (21 patients) no growth disturbance of the lower limbs, two failures (reinjury while participating in pivoting sports), and 19 good stability and function were observed. The mean KT2000 arthrometer values at 30 lb showed a difference of +1.9 mm (range 1-5 mm) between the operated and non-operated sides (p < 0.05). The average IKDC score of all the patients was 90 (min: 68, max: 97). None of the adolescents had consequences on growth after an eccentric damage passing tendons less than 7% on the frontal plane and of 1% on cross-sectional area of the femoral physis, and after an oblique tunnel passing 6-mm-diameter tendons of the tibial epiphyseal nucleus. This study defines the possibility to perform a partial transphyseal intra-articular ACL reconstruction in patients in Tanner stages 2 and 3 that avoids tibial physis, involves the distal femoral physis, and produces good results at mid- and long-term follow-up without causing growth disturbances. IV.

Middle ear ventilation status postoperatively after translabyrinthine resection of vestibular schwannoma with mastoid obliteration and Eustachian tube occlusion: Is the Eustachian tube enough to ventilate the middle ear without the mastoid air cell system?

BackgroundGas pressure balance is essential for maintaining normal middle ear function. The mucosal surfaces of the middle ear, the mastoid air cell system (MACS), and the Eustachian tube (ET) play a critical role in this process; however, the extent that each of these factors contributes to overall middle ear ventilation is unknown. The objective of this study was to determine if the ET alone can maintain normal middle ear pressure without the MACS. To do this, we reviewed subjects who had their MACS completely removed with translabyrinthine (TL) surgery for vestibular schwannoma.MethodsA retrospective chart review was done to collect pre and postoperative tympanometry data from patients who underwent resection of vestibular schwannoma. Data from the operative side was compared to the non-operative side at 2 years post-op.ResultsTwenty-four patients were included in this study. Of these, 63 % achieved a type A tympanogram at 2 years post-op in the TL resection group, implying an ability to maintain middle ear pressure in the absence of a mastoid cavity. Because some had negative pressures post TL resection, the average change in pre and postoperative pressure was -37.5 daPa for the operative side and 7.8 daPa for the non-operative side. This was significantly different.DiscussionThe difference for change in pre and postoperative pressure and compliance between operative and non-operative side might be expected from the ET plugging during TL resection. However, more interesting are those patients in whom the ET presumably reopens, and in these subjects, despite having no mastoid compartment at all, and the space obliterated with fat, they were still able to maintain normal ventilation of the middle ear space.ConclusionOur findings imply that the ET alone is adequate to ventilate at least the reduced middle ear space following TL surgery in most subjects, and perhaps in 100 % if the ET hadn’t been plugged during surgery. Hence, the mastoid air cell system, even when healthy, is not needed to maintain air in the middle year cleft.

A Novel Surgical Approach for the Reconstruction of Critical-Size Mandibular Defects Using Calcium Sulphate/Hydroxyapatite Cement, BMP-7 and Mesenchymal Stem Cells-Histological Assessment

A novel construct has been developed to induce bone formation within a pedicle muscle flap. A critical size defect (20 × 15 mm2) was created in the mandible of ten rabbits. The masseter muscle was adapted to fill the surgical defect and a combination of calcium sulphate/hydroxyapatite cement (CERAMENT™ | SPINE SUPPORT), BMP-7 and rabbits' mesenchymal stromal cells (rMSCs) was injected into the muscle tissue. Bone regeneration was evaluated 3 months after surgery. Limited areas of bone formation anatomically bridged the defect, despite the new bone forming throughout the muscle and within the connective tissue surrounding the remnants of the cement. The bone was thicker in the bucco-lingual direction compared to the contra lateral (non-operated) side. Quantitative histomorphometry assessment showed that the average bone surface area was 21.2 ± 6.0 mm2, this was significantly greater than that of the contra-lateral non-operated control side. The calculated amounts of residual cement and soft tissue or spaces were 20 ± 12% and 41 ± 10%, respectively. The average mineral apposition rate (MAR) was 1.92 μm/day. The findings demonstrated the remarkable potential of the use of local muscle flaps for injectable bio-cement loaded with BMP and seeded with rMSCs to induce bone formation for the reconstruction of bony defects.

The function and the strength of the thumb is not affected when the extensor pollicis longus tendon is left out of the extensor retinaculum

Purpose: Leaving extensor pollicis longus (EPL) tendon out of the retinaculum in cases performed through a dorsal approach at the level of the extensor retinaculum after opening the 3rd extensor compartment reduces risk of adhesion and rupture. The aim of this study was to attempt to understand whether leaving EPL in the subcutaneous tissue that is released from the extensor compartment during surgery, without reconstructing the third extensor compartment, causes any change to extension strength and range of motion (ROM) of the interphalangeal (IP) and metacarpophalangeal (MCP) joints of the thumb. Patients and methods: 20 patients operated on between 1995 and 2013 were evaluated retrospectively. The EPL tendons of all patients were left out of the extensor retinaculum after opening the 3rd extensor compartment through a dorsal approach to wrist. The following surgeries were performed: wrist arthrodesis in four patients, vascularized bone flaps from the 4th ECA (extensor compartmental artery) for Kienbock’s disease in two patients, open reduction after perilunate fracture-dislocations in two patients, proximal row carpectomy after Kienbock’s disease in two patients, and distal radius fracture surgery through a dorsal approach in six patients. Extension strength (in kg) and voluntary ROM (in degree) of the MCP and IP joints of the thumb were measured. Opposite extremity values were assessed and compared statistically. Results: No statistically significant reduction was determined in strength and ROM of IP and MCP joints of the thumb on the operated side of patients whose EPLs were left out of the retinaculum compared with the non-operated side. Conclusion: It was determined that leaving the EPL tendon out of the retinaculum in cases with increased risk of adhesions and rupture did not cause marked muscle weakness or loss of range of movement.

In-vivo analysis of nerve regeneration after sciatic nerve injury in a rat model

We investigated the effectiveness of artificial silk-based nerve graft in nerve recovery and in helping regain motor functionality in rats. The purpose of this study is to test two questions: (1) Can nerve growth after transection be improved using artificial nerve guides? (2) Does nerve recovery have an impact on the walking patterns of the rat during the recovery period? Rats underwent sciatic nerve sectioning followed by reconstructive surgery. In these experiments, the sciatic nerve was substituted with an artificial silk guide that was biofunctionalized with growth factors and tested in vitro, as described previously. Three-dimensional motion capture and histological analyses were performed. After recovery periods of three and six months, the rats’ kinematics were analyzed during an over-ground walking task to evaluate the nerve recovery progress. The functional nerve recovery showed significant differences between the operated and non-operated sides of the rat, but no differences in their walking patterns during the recovery period. The histological analysis showed the reorganization of nerve tissue into the nerve as well as the presence of multiple neuronal extensions. Here, we have shown histological improvement in the absence of functional restoration after sciatic nerve transection and reconstruction at six months.

Magnetic Resonance Imaging Assessment of the Femoral Tunnel Position in Medial Patellofemoral Ligament Reconstruction: 用磁共振掃瞄來評估在內側髕韌帶重建手術中股骨隧道的位置

Background/PurposeCorrect femoral tunnel position in medial patellofemoral ligament (MPFL) reconstruction is essential to maintain proper biomechanics of the patellofemoral joint throughout the range of movement. Several techniques have been described for MPFL reconstruction, however, there are few reports describing the accuracy of femoral tunnel positioning assessed postoperatively. MethodsTen patients having recurrent patellar dislocation with MPFL reconstruction performed in our centre from 2009 to 2013 were analysed. Femoral tunnel position was guided by intraoperative X-ray with landmarks described by Schottle et al, 2007. Postoperative magnetic resonance imaging (MRI) was performed on both knees, and femoral tunnel was assessed with reference to the femoral origin of the MPFL in the nonoperated side. ResultsAll cases showed an intact MPFL graft, with the majority demonstrating satisfactory femoral tunnel position based on postoperative MRI. ConclusionMPFL reconstruction with anatomic positioning of the femoral tunnel guided by intraoperative X-ray showed satisfactory accuracy in postoperative MRI results, indicating that a well-positioned MPFL graft results in better clinical outcomes.