Normal Limb Research Articles

Surgical correction of polymelia in the perineal region of a 2-day-old indigenous bovine calf: a case report from Bangladesh

BackgroundPolymelia is an occasional and congenital malformation in bovine calves, characterized by the presence of single or multiple accessory limb(s) at various body regions, which are often called the supernumerary limb(s). One of these defects is known as pygomelia, where the additional limb is attached to the pelvis within the perineal region. This study describes such a case along with surgical management.Case presentationA 2-day-old indigenous bovine female calf of 22.7 kg BW was presented with an additional and non-functional fifth limb at the perineal region. The ectopic fifth limb was smaller in size than the other four normal limbs and was in a flexible hanging position. Other than this, the animal was apparently normal with a short and contracted tail. Clinical examinations involving the extension and flexion of the abnormal limb revealed no deep bony attachment/articulation with the pelvic girdle or the caudal spine. The curled tail having an S-shaped base indicated the skeletal defects in the caudal spine. Electrosurgery was performed under deep sedation with regional as well as local anesthesia, which exposed that the limb was internally seated into deep gluteal muscle layers with the attachments of fibrous connective tissues and cartilage to its proximal bony head and located partially to the left lateroventral extremity of the perineum without any direct involvement in the bony pelvis. Surgical excision was done to remove the supernumerary limb, and the wound was closed routinely. Postoperatively, the animal was provided with supportive medications for early healing and recovery. After 2 weeks of surgery, the calf completely recovered without any complications. The contracted tail and spine were left unaffected as no initial surgical maneuver was done due to the early age of the calf and would be considered for further long-term treatment options upon the growth and development with age.ConclusionsPygomelia of bovine calves is one of the rare congenital defects that can be found along with other developmental anomalies. However, this defect can be successfully corrected by surgical approaches following intensive postoperative care and management.

Ex vivo evaluation of a percutaneous thread-transecting technique for desmotomy of normal palmar/plantar annular ligaments in horses.

To develop and describe a minimally invasive, ultrasound-guided, percutaneous technique for the desmotomy of equine palmar/plantar annular ligaments (PALs) using a transecting thread. Ex vivo study. Twenty-one normal equine distal limb specimens. Under ultrasonographic guidance, a surgical thread was percutaneously placed around the PAL through 2 skin punctures (proximal and distal) using a 18 gauge spinal needle in equine limbs (11 forelimbs, 10 hindlimbs) with normal PALs. The ligament was transected by a back-and-forth motion of the thread until the loop emerged from the proximal skin puncture site. Each specimen was dissected and assessed for completeness of transection and iatrogenic damage under direct visualization. Descriptive statistics were reported. The PAL was completely transected in 17/21 limbs. The mean duration of the procedure was 16 minutes. Superficial needle puncture or subtle abrasion of the superficial digital flexor tendon was noticed in 4 limbs. No iatrogenic injury to other intrathecal structures was identified. After PAL division, the needle entry and exit points had a mean diameter of 1.2 and 1 mm, respectively. Desmotomy of normal PALs in equine limb specimens was performed effectively using the percutaneous thread-transecting technique with minimal iatrogenic damage to adjacent structures. Information from this study will allow refinement of the technique for use in equine clinical cases either in standing or anesthetized horses.

Jednoaktna procedura po Mutafu za urođene konstriktivne prstenove - bezbedna i efikasna

Introduction: Congenital constriction ring is a rare congenital malformation that especially affects the limbs. It is associated with fibrous bands that could encircle, strangle, or amputate some parts of the fetus. However, there are only a few techniques described for the correction of this anomaly. We aim to present a successful treatment of congenital constriction ring by means of the one-stage Mutaf technique. Patient Review: In our report, we presented two infants with congenital constriction rings. In the first case, we presented an infant with a constriction band on the right arm accompanied by deformity of the distal part and lymphoedema. In the second case, we presented an infant with multiple constriction bands on the distal part of the right leg with clubfeet and severe lymphoedema. They were both treated by the one-stage Mutaf technique using rectangular dermofat grafts to fill the groove. Using this technique we obtained a normal limb contour, with no oedema or neurovascular compromise. Filling the groove with the rectangular dermofat flaps parallel to the relaxed skin tension lines provides a better scar in comparison with multiple Zor W-plastics techniques. Additionally, advantages of the one-stage procedure are reduction of surgical and psychological trauma in patients and their parents, less time spent under general anesthesia and lower amount of anesthetic the patient receives, and lower treatment costs. Conclusion: We find the Mutaf technique to be an effective and safe technique for the treatment of congenital constriction rings.

Mycoplasma pneumoniae and Schistosoma mansoni co-infection in a young patient with extensive longitudinal acute transverse myelitis

Acute transverse myelitis is an uncommon inflammatory, intramedullary, disorder of the spinal cord. Spastic paraplegia, impaired sphincter functions, and sensory loss, with sensory level, are the clinical manifestations of this devastating disorder. The utilization of magnetic resonant imaging (MRI) contributes to the surge in the diagnosis of more ATM cases. Although the causes of ATM are numerous, both Mycoplasma pneumoniae and Schistosoma mansoni are uncommon causes and their co-existence in the same patient has not been reported before in Saudi Arabia. We report a 25-year-old ATM male patient presented with a history of sudden onset severe low back pain. Within four hours from the onset of the back pain, he became completely paraplegic with impaired functions of the bowel and urinary bladder sphincter. Furthermore, he lost all modalities of sensory functions in the lower limbs. His examination revealed spastic complete paraplegia with sensory level at T6. Clinical neurological examination revealed normal upper limbs and brain functions. The MRI of the cervico-dorsal spine showed extensive longitudinal hyperintense lesion extending from the upper cervical segments to the lower dorsal segments (extensive longitudinal transverse myelitis). A post-infectious immune-mediated predisposition was highly suspected due to the very high titers of anti-Mycoplasma pneumoniae IgM and IgG that were detected. The immunosuppressant therapy did not improve his paraplegia. A spinal cord biopsy revealed the presence of several Schistosoma mansoni ova surrounded by chronic inflammatory reactions and reactive gliosis. Both Mycoplasma pneumoniae and Schistosoma mansoni should be investigated in cases with extensive longitudinal ATM.

Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle.

Evaluate the validity of a recent approach to calculate the knee flexion or extension contracture contributing to the overall sagittal deformity using the sagittal mechanical axis angle (SMAA) for the overall alignment assessment and sagittal joint line angle (SJLA) for soft tissue contribution. The methods of evaluating these angles and their clinical applications are discussed. In total, 107 normal limbs met the criteria and were divided into two groups: skeletally mature and immature. Sagittal alignment was evaluated using the Bone Ninja iPad application, and the posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA), SMAA and SJLA were recorded. In skeletally immature patients, mean SJLA was 13.46° [standard deviation (SD), 4.55°], and in mature patients, it was 16.91° (SD, 2.948°). The PDFA and PPTA were consistent with previously published measurements. The SJLA method is a practical way to quantify the soft tissue contribution and degree of contracture. It can also be used for monitoring deterioration or improvement of knee range of motion during lengthening or physical therapy. All patients in this study presented to our clinic with symptoms on the contralateral side. This, in addition to the retrospective nature, was a limitation in our study.We recommend a validity study to compare our SJLA method to the classic anterior cortical line angle (ACL) method in addition to an inter-observer and intra-observer reliability study for the SJLA. We also recommend a study on completely normal asymptomatic subjects to better standardise the angle measurements in skeletally immature patients at different ages. Abalkhail TB, McClure PK. Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle. Strategies Trauma Limb Reconstr 2022;17(3):159-164.

Measurement of Lag-Screw Anteversion With an iPhone During Trochanteric Fracture Surgery.

Introduction A useful way to easily evaluate femoral rotation during surgery for trochanteric fractures is not known. Hence, this pilot study aimed to develop an intraoperative indicator to evaluate anteversion in femoral trochanteric fractures. Material and methods Prospectively, from June 2021 to January 2022, all patients with femoral trochanteric fractures (Orthopaedic Trauma Association classification: 31A1-3) treated using a cephalo-medullary nail with a lag-screw neck-shaft angle of 125° were included in this study. During surgery, lag-screw anteversion (LS-AV) was measured using the goniometer application in an iPhone with the fractured femur table-top-plane level with the traction table floor. Accuracy was analyzed by comparing axial-projected lag-screw anteversion (AxP-LS-AV) and three-dimensional computed tomography lag-screw anteversion (3DCT-LS-AV) measurements after surgery. Results Fifty patients (14 males and 36 females) were included in the study. The mean age was 87 (range; 69-98) years; the Orthopaedic Trauma Association classifications were A1 (28 patients), A2 (18 patients), and A3 (4 patients). The mean LS-AV was 10.7° ± 6.9°, the mean AxP-LS-AV was 12.8° ± 8.3°, and the mean 3DCT-LS-AV was 13.1° ± 8.6°. The median difference between AxP-LS-AV and 3DCT-LS-AV was 3.0° (range: 0°-12°), and 40 (80%) patients had differences of ≤5° (Bland-Altman plot: inside of limit of agreement = 86%, paired t-test p = 0.7, Pearson correlation coefficient r = 0.817, p <0.001). Conclusion Femur malrotation is defined as a deformity of >15° relative to the normal contralateral limb. Intraoperative LS-AV iPhone measurement on table-top-plane standard had sufficient accuracy as an indicator of anteversion in femoral trochanteric fractures.

Repair of a Comminuted Femur Fracture in a Komodo Dragon (Varanus komodoensis) Using a Double Plating Technique

This report describes double locking compression plate fixation of a moderately comminuted mid-diaphyseal right femur fracture in a Komodo dragon (Varanus komodoensis). The animal was restrained for a routine examination, during which the dragon struggled to escape restraint. When returned to the exhibit, the dragon did not use the right pelvic limb to walk. A right-sided, closed, mid-diaphyseal comminuted (type C3) femur fracture was diagnosed using palpation and radiographs, and the animal was transported to a specialty clinic within a few hours for fracture repair. Two locking compression plates (LCPs) were applied in bridging fashion for fracture repair. Radiographs performed at the four-month post-operative recheck revealed a healed fracture with significant callus formation and stable implants. The dragon was transitioned from cage rest in a restricted space to his normal large exhibit after healing was confirmed, no lameness was observed, and normal limb use was noted. After almost three years, he is still ambulating normally and without lameness. This is the first report of successful femur fracture stabilization using bone plate fixation in a Komodo dragon.

The role of ultrasonography in diagnosis of neuralgic amyotrophy.

To investigate the value of high frequency ultrasound in diagnosis of neuralgic amyotrophy. From January 2010 to December 2020, the ultrasonographic images of 117 patients with neuralgic amyotrophy diagnosed by the Department of Neurology and hand & foot surgery of Shandong Provincial Hospital Affiliated to Shandong First Medical University were retrospectively analyzed. The ultrasonographic features were summarized. High frequency ultrasound could clearly show the degree of the affected nerves: No ultrasonic findings were found in 12 cases (10%). The affected nerves were thickening and hypoechogenicity with loss of normal fascicular definition in 28 cases (24%). The affected nerves showed hourglass-like changes, including constriction and torsion in 77 cases (66%). In addition, ultrasound can determine the extent of the lesion, and microvascular imaging can display small blood flow signal within the nerve. There was a significant statistical difference between the diameter of the thickened nerve fascicle and the diameter of the nerve fascicle at the corresponding site of the contralateral normal limb. High frequency ultrasound is a valuable imaging method for diagnosis of neuralgic amyotrophy.

High-dose Tiger-Gian formula protects the knee joint from surgically induced osteoarthritis in rats.

Although the Tiger-Gian formula (TGF) has proven clinically effective at improving the symptoms of knee osteoarthritis (KOA), the pharmacological effects and underlying mechanisms of TGF have not been examined in any animal model. This study assessed the effects of TGF in male Sprague-Dawley rats with anterior cruciate ligament transection (ACLT) -induced KOA. Thirty rats underwent ACLT surgery and were assigned to either the control group, ACLT alone, ACLT + low-dose TGF (1000 mg/kg), ACLT + high-dose TGF (3000 mg/kg), or ACLT + celecoxib (30 mg/kg). All rats were subjected to micro-computed tomography (micro-CT), weight-bearing behavioral testing, and histological inspections of the knee joint for evidence of structural changes in articular bone, cartilage and synovium. After 6 weeks, force discrepancies in weight-bearing distribution between the normal hind and postoperative limbs revealed superiority with high-dose TGF (18.00 ± 5.93 g) and celecoxib (18.68 ± 5.29 g) versus both ACLT alone (41.29 ± 7.06 g) and low-dose TGF (37.00 ± 7.40 g). Micro-CT images revealed that high-dose TGF and celecoxib similarly improved subchondral bone architecture, protected articular cartilage after ACLT, and downregulated proinflammatory cytokines interleukin-1β and tumor necrosis factor-α in the cartilage and synovial sections. High-dose TGF induced the smallest amount of KOA-associated bone loss. Anti-inflammatory, anti-oxidative, and immunomodulatory effects of TGF were accompanied by reductions in proinflammatory cytokines and improvements in pain and function. TGF-induced anti-osteoporotic activity and inhibition of cartilage degradation were reflected by micro-CT and histological analysis. The findings help to explain how TGF alleviates symptoms of KOA.

Case report: Three-dimensionally printed patient-specific acetabular cage for revision surgery of aseptic loosening in a dog with micro total hip replacement

A 2-year-old castrated male Pomeranian dog was presented for regular follow-up after micro total hip replacement (mTHR) 16 months prior to presentation. Clinically, the dog did not show any noticeable lameness of the left hindlimb, except for external rotation during walking. However, radiographic findings, namely rotation and medialization of the acetabular cup with a periprosthetic lucent line and bone formation medial to the acetabulum, were interpreted as aseptic loosening of the acetabular component. Because the dog was incompatible with the conventional THR revision method owing to severe bone defects in the acetabulum, a patient-specific titanium acetabular cage prosthesis with biflanges and four cranial and one caudal screw hole was designed for revision surgery. A custom-made acetabular cage was prepared, and it had a 12-mm polyethylene cup fixed with polymethylmethacrylate bone cement and positioned in the acetabulum. After the custom-made acetabular cage was anchored to the pelvic bone with the five cortical screws, reduction of the prostheses was achieved smoothly. The dog showed almost normal limb function without external rotation of the left hindlimb 2 weeks postoperatively. Bone remodeling and stable implant position were noted on radiographic images 3 years after revision surgery, with no evidence of loosening. Based on the clinical outcomes, the use of a custom-made acetabular prosthesis can be an effective treatment option for revision arthroplasty in acetabula with severe bone loss and structural changes in small-breed dogs.

A Preliminary Study on Grip-Induced Nerve Damage Caused by a Soft Pneumatic Elastomeric Gripper.

Forceps, clamps, and haemostats are essential surgical tools required for all surgical interventions. While they are widely used to grasp, hold, and manipulate soft tissue, their metallic rigid structure may cause tissue damage due to the potential risk of applying excessive gripping forces. Soft pneumatic surgical grippers fabricated by silicone elastomeric materials with low Young’s modulus may offer a promising solution to minimize this unintentional damage due to their inherent excellent compliance and compressibility. The goal of this work is to evaluate and compare the grip-induced nerve damage caused by the soft pneumatic elastomeric gripper and conventional haemostats during surgical manipulation. Twenty-four Wistar rats (male, seven weeks) are subjected to sciatic nerve compression (right hind limb) using the soft pneumatic elastomer gripper and haemostats. A histopathological analysis is conducted at different time-points (Day 0, Day 3, Day 7 and Day 13) after the nerve compression to examine the morphological tissue changes between the rats in the ‘soft gripper’ group and the ‘haemostats’ group. A free walking analysis is also performed to examine the walking function of the rats after recovery from different time points. Comparing the rigid haemostats and soft gripper groups, there is a visible difference in the degree of axonal vacuolar degeneration between the groups, which could suggest the presence of substantial nerve damage in the ‘haemostats’ group. The rats in the haemostats group exhibited reduced right hind paw pressure and paw size after the nerve compression. It shows that the rats tend not to exert more force on the affected right hind limb in the haemostats group compared to the soft gripper group. In addition, the stance duration was reduced in the injured right hind limb compared to the normal left hind limb in the haemostats group. These observations show that the soft pneumatic surgical gripper made of silicone elastomeric materials might reduce the severity of grip-induced damage by providing a safe compliant grip compared to the conventional haemostats. The soft pneumatic elastomer gripper could complement the current surgical gripping tool in delicate tissue manipulation.

Clinical outcomes of canine total hip replacement utilizing a BFX lateral bolt femoral stem: 195 consecutive cases (2013-2019).

To evaluate the clinical outcomes of total hip replacements (THR) utilizing a BFX lateral bolt stem in dogs with coxofemoral joint disease. Retrospective study. A total of 149 dogs representing 195 THR. Consecutive THRs utilizing a BFX lateral bolt stem were studied. Preoperative, immediate postoperative, 1-, 2-, 3-, 4-, and 12-month postoperative radiographs were performed. All major and minor complications, revisions, outcomes, subsidence, canal flare index (CFI) were recorded. An intraoperative complication rate of 11.8% was observed. The postoperative complication rate was 13.6%, with 9.2% major and 4.4% minor complications. Complications included: postoperative femur fractures (3.6%), coxofemoral luxation (3.6%), stem failure (0.5%), septic loosening (0.5%), aseptic loosening (0.5%), and acetabular fracture (0.5%). Three dogs underwent prophylactic plating after subjective assessment of cortical thickness. Five of 195 (2.6%) cases underwent explant of their prostheses (median=3months). Mean stem subsidence at 1 month postoperatively was 1.22 ± 0.16 mm. An increased CFI was associated with postoperative femur fractures (p < .05). A total of 190 of 195 (97.4%) cases returned to normal function in the long-term follow-up period. Use of the BFX lateral bolt stem resulted in minimal postoperative subsidence, a low femoral stem complication rate, and a high rate of achieving normal limb function. The BFX lateral bolt stem should be considered in canine THR as the femoral failure rate is low and the long-term success rate is high.

OA04 Paediatric APS - children are not just small adults

OA04 Paediatric APS - children are not just small adults

Comprehensive Genome-Wide Analysis of Wnt Gene Family and Expression Profiling during Limb Regeneration in Portunus trituberculatus

Wnt genes encode a family of secretory glycoproteins that are involved in various stages of organ development through regulation of cell proliferation, differentiation, and growth. Recently, Wnt genes have been shown to play an important role in regeneration processes. However, there have been no previous genome-wide analyses of the Wnt gene family members in crab species. In this study, a total of 13 Wnt family genes were identified from the genome of the swimming crab Portunus trituberculatus and classified into three main groups based on the conserved domain, protein sequence, and motifs. Chromosome location analysis showed that tandem duplication may have resulted in the expansion of the PtWnt gene family. RNA-seq results indicated that most PtWnt genes had a higher Fragments Per Kilobase of transcript sequences per Million base pairs (FPKM) value in the regenerating limb bud muscle than in the normal limb muscle, and the genes were enriched in a number of pathways that had biological functions underlying limb regeneration such as the cell surface receptor signaling pathway, the hippo signaling pathway, receptor binding, and basal cell carcinoma. Moreover, quantitative real-time PCR (RT-qPCR) analysis confirmed that the expression levels of nine PtWnts except for PtWnt1, PtWnt2, and PtWnt6 had a consistently increasing trend during limb regeneration. PtWnt1, PtWnt2, and PtWnt6 exhibited significantly up- or down-regulated expression at different limb regeneration stages. These results provide valuable information for further evolutionary and functional characterization of PtWnt genes and indicate the complexity and specialized mechanism of the Wnt signaling pathway regulating regeneration in crustaceans.

Sonic hedgehog is not a limb morphogen but acts as a trigger to specify all digits in mice.

Limb patterning by Sonic hedgehog (Shh), via either graded spatial or temporal signal integration, is a paradigm for "morphogen" function, yet how Shh instructs distinct digit identities remains controversial. Here, we bypass the Shh requirement in cell survival during outgrowth and demonstrate that a transient, early Shh pulse is both necessary and sufficient for normal mouse limb development. Shh response is only short range and is limited to the Shh-expressing zone during this time window. Shh patterns digits 1-3, anterior to this zone, by an indirect mechanism rather than direct spatial or temporal signal integration. Using a genetic relay-signaling assay, we discover that Shh also specifies digit 1/thumb (thought to be exclusively Shh independent) indirectly, and this finding implicates Shh in a unique regulatory hierarchy for digit 1 evolutionary adaptations such as opposable thumbs. This study illuminates Shh as a trigger for an indirect downstream network that becomes rapidly self-sustaining, with mechanistic relevance for limb development, regeneration, and evolution.

Stifle hyperextension identified in a dog with an excessively negative tibial plateau angle and a grossly intact cranial cruciate ligament following inappropriate cranial closing wedge ostectomy

AbstractA cross breed dog was examined due to an abnormal right pelvic limb gait following cranial closing wedge ostectomy surgery. Gait evaluation revealed stifle hyperextension during the stance phase of the gait. Manipulation of the stifle revealed no cranial or caudal drawer and no cranial tibial thrust. Radiographs showed complete healing of the proximal tibial osteotomy, with a tibial plateau angle (TPA) of –14°. Computed tomography showed 20° of external tibial torsion on the right pelvic limb. A mini‐medial stifle arthrotomy revealed no gross damage to the cruciate ligaments and intact menisci. A cranial opening wedge osteotomy of 17° was performed and the torsional alignment corrected, after which the tibia was stabilised with orthogonal plates and an intramedullary pin. The postoperative radiographs confirmed a satisfactory TPA of 3° and normal tibial alignment. At 6 months follow‐up, a video record revealed normal right pelvic limb gait.

Leg lengthening and deformity correction in fibular hemimelia using ring external fixator

Background: The treatment of fibular hemimelia aims to achieve a functional limb nearly equal in length to the normal limb at maturity, with a plantigrade, stable and flexible foot. The aim of this work was to evaluate the functional results of reconstructive lengthening and deformity correction in fibular hemimelia using the ring external fixator. Methods: This observational study was carried out on 41 patients with fibular hemimelia. The cases either prospectively gathered (sixteen cases, 39 %) to start their management plan or retrospectively collected (twenty-five cases, 61 %) and followed up. Foot reconstruction surgery was done in 22 cases while lengthening surgery applied all cases. All patients were subjected to: history taking, clinical examination (local (lower limb), foot and knee), general examination and imaging. Results: regarding overall results, at the end of follow-up with an average period of 2 years, 4 patients had excellent results (9.76%), 21 patients (51.2%) had good results, 12 patients (29.28%) had fair results and 4 patients (9.76%) had poor result. Regarding subjective functional assessment, out of 41 patients, 20 of them (48.8%) were from 75 to 100% subjectively satisfied, 11 patients (26.8%) from 50 to 74% and 10 patients (24.4%) from 0 to 49% satisfied.

Q ANGLE VARIATIONS IN PREADOLESCENT CHILDREN WITH HEMIPLEGIC CEREBRAL PALSY

Background and Aim: Hemiplegic cerebral palsy children presented with wide variations of lower limb kinematics. The normal limb in children with spastic hemiplegic cerebral palsy shows variations in Q angle. So, this study aimed to determine the different values of Q angle from both legs among hemiplegic cerebral palsy children having age between the 7 to 12 years. Methodology: An observational cross-sectional study was conducted by using non-probability convenience sampling technique. 71 diagnosed cases with unilateral cerebral palsy in Mobility Quest clinic Lahore and Children Hospital Lahore were enrolled in the study during the duration of six months from September 2019 to March 2020. The consent was taken from those subjects who fulfill the inclusion criteria (n=71) and assessed by the Goniometer that is used to measure the Q angle in hemiplegic Cerebral palsy. Data entry and analysis was done by using SPSS version 25. Descriptive measures of mean and standard deviation were used to summarize data collection. Results: The study included 71 children diagnosed with unilateral cerebral palsy. The Mean Q angle for hemiplegic CP children in right leg is 14.65 ± 2.8 (Normal Range: 11.71-16.98) and in left leg it is 15.09 ± 3.4(Normal Range: 11.47 -18.33) but it differs with the distribution pattern of hemiplegia. Out of 71 children 39 kids were experienced with right sided weakness while 32 were with left sided weakness. Conclusion: Mean Q angles are higher in the affected leg as compared with the unaffected leg in hemiplegic CP. Q angle increase with age and more in female subjects as compared to male subjects.

Partial resection of lateral discoid meniscus changes lower limb axial alignment – A retrospective cohort study

AimThis study aimed to explore the changes in lower limb axial alignment and knee joint function after arthroscopic partial resection of the discoid lateral meniscus. MethodsPreoperative and postoperative full-length weight-bearing radiographs of the lower limb were obtained from a total of 161 patients with lateral menisci tears from September 2018 to September 2020 who underwent partial meniscal resection. The patients were divided into discoid meniscus group (DMG) and ordinary meniscus group (OMG). The measured mechanical axis deviation (MAD), proximal tibia angle (PTA), and distal femoral angle (DFA) in the axial alignment of the lower limb were determined before and after surgery. Knee joint function on the affected side was determined using the International Knee Documentation Committee (IKDC) subjective scale and the Lysholm knee scoring scale before surgery and at one, six, 12, and 24 months after surgery. ResultsFor MAD and DFA, there were statistically significant differences between the preoperative and postoperative findings within each group (P < 0.01); the MAD and DFA were smaller after surgery. The difference in preoperative and postoperative PTA of the DMG was statistically significant (P < 0.01), meaning that the PTA becomes larger after surgery. The differences in preoperative and postoperative PTA of the OMG, preoperative PTA between the two groups, and postoperative PTA between the two groups were not statistically significant (P > 0.05). Intragroup comparisons of the IKDC subjective scale and the Lysholm knee scoring scale before and after surgery revealed significant differences (P < 0.05). ConclusionArthroscopic partial resection of the discoid lateral meniscus is a safe and effective surgical method that can significantly improve knee joint function. Although the axial arrangement of the lower limbs will be slightly changed in the early stage, it will still be within the normal range after surgery in patients with normal lower limb axial alignment. For patients with varus or valgus before surgery, this procedure should be applied with caution.

Lower Limb Lipedema-Superficial Lymph Flow, Skin Water Concentration, Skin and Subcutaneous Tissue Elasticity.

Background: Lipedema of lower limbs is characterized by bilateral accumulations of excess adipose tissue starting from the ankle to the hips and buttocks. The studies with lymphoscintigraphy (LSC) and magnetic resonance (MR) lymphography show altered transport index and enlarged lymphatic vessels (LVs). Our studies aimed to investigate the superficial lymph flow, water accumulation, skin and subcutaneous tissue elasticity, and the possibility of using this information to diagnose lipedema. Methods and Results: Fifty patients with lipedema and 50 control subjects (women) were included. The Indocyanine Green (ICG) lymphography, LSC, skin water measurement, skin durometry, and deep tissue tonometry were done in all participants. ICG lymphography revealed: (1) Slower lymph flow in lipedema patients; after 3 minutes of feet movement in a horizontal position, the ICG-dyed lymph reached the upper calf level in 8% of lipedema patients compared with 56% in the control group (p ˂ 0.0001). (2) More than three LVs were noticed more often in lipedema patients. (3) The higher number of abnormal LV images at all limb levels and during each observation stage with a statistically significant number of foggy and dilated. (4) Statistically significant higher fluorescent intensity in all limb levels. Skin water concentration was higher in the feet in lipedema (p = 0.000189). Conclusion: Our studies have shown the differences in superficial lymph flow and water concentration between lipedema and normal limbs. Data proove the usefulness of ICG lymphography, skin water concentration and skin and subcutaneous tissue elasticity measurements in diagnosing lipedema.