Sagittal Research Articles

Mapping sagittal-plane reference brain atlas of the cynomolgus macaque (Macaca fascicularis) based on consecutive cytoarchitectonic images

The brain atlas is essential for exploring the anatomical structure and function of the brain. Non-human primates, such as cynomolgus macaque, have received increasing attention due to their genetic similarity to humans. However, current macaque brain atlases only offer coarse sections with intervals along the coronal direction, failing to meet the needs of single-cell resolution studies in functional and multi-omics research of the macaque brain. To address this issue, we utilized fluorescence micro-optical sectioning tomography to obtain sub-micron resolution cytoarchitectonic images of the macaque brain at the sagittal plane. Based on the obtained 8000 image sequences, a reference brain atlas comprising 45 sagittal sections was created, delineating 270 brain regions other than the cortex. Additionally, a website was established to share the reference atlas corresponding image data. This study is expected to provide an essential dataset and tool for scientists studying the macaque brain.

Head-Shaft Angle Influences Isometric Shoulder Strength Levels after Intramedullary Nailing of Proximal Humerus Fractures: A Pilot Study.

Proximal humerus fractures are common fractures of the elderly population which can lead to long-term compromise of a patient's shoulder function. Closed reduction and internal fixation with intramedullary nailing is a well-established surgical technique yielding good outcomes, as perceived by patients, obtained via Patient-Reported Outcome Measures, and objectified by clinical shoulder testing. Apart from conventional range-of-motion testing and clinical shoulder tests, strength testing of the shoulder is a yet-neglected but meaningful and standardizable outcome parameter. In this study, isometric shoulder strength is evaluated in relation to fracture morphology/postoperative reduction quality as well as with patient-reported outcomes. 25 patients (mean age 73.2 ± 10.5 years) underwent isometrics strength-testing of the shoulder joint in the scapular plane (abduction) as well as in the sagittal plane (flexion) as well as hand-grip strength-testing at 4.5 ± 1.88 years follow-up. Pre- and postoperative radiographs were analysed. Patients completed ASES and CMS questionnaires. Patients exhibited a decrease in abduction and flexion force (-24.47% and -25.30%, respectively, p < 0.001) using the contralateral, uninjured arm as reference. Abduction force tended to be decreased in three- and four-part fractures. Patient satisfaction correlated negatively with the relatively reduced force of the affected arm. Varus-angulated humeral heads produced significantly lower abduction force output than valgus- or physiologic angulation (p = 0.014), whereas flexion force was unaffected (p = 0.468). The anatomical reduction had no influence on shoulder strength. Proximal humerus fractures may cause a significant reduction in shoulder function, both reported by patients and objectified by shoulder strength testing. Varus head angulation demonstrated the greatest loss of shoulder strength and should be avoided to ensure proper functioning. Further, strength testing seems a valuable outcome parameter for a thorough shoulder examination with easy obtainability.

Gait signature changes with walking speed are similar among able-bodied young adults despite persistent individual-specific differences

Understanding individuals’ distinct movement patterns is crucial for health, rehabilitation, and sports. Recently, we developed a machine learning-based framework to show that “gait signatures” describing the neuromechanical dynamics governing able-bodied and post-stroke gait kinematics remain individual-specific across speeds. However, we only evaluated gait signatures within a limited speed range and number of participants, using only sagittal plane (i.e., 2D) joint angles. Here we characterized changes in gait signatures across a wide range of speeds, from very slow (0.3 m/s) to exceptionally fast (above the walk-to-run transition speed) in 17 able-bodied young adults. We further assessed whether 3D kinematic and/or kinetic (ground reaction forces, joint moments, and powers) data would improve the discrimination of gait signatures. Our study showed that gait signatures remained individual-specific across walking speeds: Notably, 3D kinematic signatures achieved exceptional accuracy (99.8%, confidence interval (CI) 99.1–100%) in classifying individuals, surpassing both 2D kinematics and 3D kinetics. Moreover, participants exhibited consistent, predictable linear changes in their gait signatures across the entire speed range. These changes were associated with participants’ preferred walking speeds, balance ability, cadence, and step length. These findings support gait signatures as a tool to characterize individual differences in gait and predict speed-induced changes in gait dynamics.

An Examination of Temporomandibular Joint Disc Displacement through Magnetic Resonance Imaging by Integrating Artificial Intelligence: Preliminary Findings.

Background and Objectives: This research was aimed at constructing a complete automated temporomandibular joint disc position identification system that could assist with magnetic resonance imaging disc displacement diagnosis on oblique sagittal and oblique coronal images. Materials and Methods: The study included fifty subjects with magnetic resonance imaging scans of the temporomandibular joint. Oblique sagittal and coronal sections of the magnetic resonance imaging scans were analyzed. Investigations were performed on the right and left coronal images with a closed mouth, as well as right and left sagittal images with closed and open mouths. Three hundred sagittal and coronal images were employed to train the artificial intelligence algorithm. Results: The accuracy ratio of the completely computerized articular disc identification method was 81%. Conclusions: An automated and accurate evaluation of temporomandibular joint disc position was developed by using both oblique sagittal and oblique coronal magnetic resonance imaging images.

Three-dimensional assessment of low-level laser therapy on orthodontic miniscrew displacement using CBCT: a retrospective study

BackgroundThis study aimed to assess the effect of Low-Level Laser Therapy (LLLT) on sagittal, transverse and vertical Orthodontic miniscrew displacement.Materials and methodsThe study included CBCTs from the records of 12 adult patients who underwent upper first premolar extraction and canine retraction with orthodontic miniscrews for maximum anchorage. The miniscrews on one side received LLL, while the other side served as a control. The Low-Level Laser was applied to assess its effect on the displacement of the miniscrews. The used CBCTs have been taken at two-time points: immediately after miniscrew insertion (T0) and four months after the start of canine retraction (T1) with a total of 24 CBCTs. Miniscrew displacement was assessed by measuring head (HMS) and tail (TMS) displacement to the axial, coronal and mid-sagittal planes on the CBCT at the two time points. Miniscrews displacement (T1-T0) was compared between LLL side and control side. Comparisons were performed using paired samples t-test. The significance level was set at p-value < 0.05. The reproducibility of measurements was assessed by intraclass correlation coefficient (ICC).ResultsAfter four months of canine retraction, HMS and TMS from both laser and control sides showed significant three-dimensional displacement at p < 0.05. No significant difference in mean displacement in the vertical, sagittal, nor transverse planes between both sides was elicited.ConclusionLLL application in the used protocol does not affect the amount of miniscrew displacement in any of the three planes of space. Miniscrew displacement was significant in both groups.

The impact of ankle-foot orthotics on selective motor control during gait in children and adolescents with cerebral palsy

BackgroundChildren with cerebral palsy (CP) often exhibit altered selective motor control during gait (SMCg). Ankle-foot-orthoses (AFOs) are used in this population to improve gait, by reducing the degrees of freedom at the ankle joint. However, the specific impact of AFOs on SMCg and whether this effect is more related to gait deviations or motor development remains unclear. Research questionDo AFOs impact SMCg, and is the change related to joint kinematics or age? MethodsGait analysis data from 53 children and adolescents with spastic CP, walking both barefoot and with AFOs, were included. Electromyography data from six lower-limb muscles, and lower limb joint kinematics were analyzed for both walking conditions. SMCg was quantified by the total variance in electromyography activity accounted for by one synergy (tVAF1), where an increase in tVAF1 indicates a decrease in SMCg. Kinematic gait deviation was assessed using the Gait-Profile-Score (GPS) and sagittal plane ankle Gait-Variable-Score (ankle-GVS). All analyses were performed for the more clinically involved leg only. ResultsWalking with AFOs resulted in a mean increase in tVAF1 of 0.02±0.07 (p=0.015) and a median increase in ankle-GVS of 3.4º (p>0.001). No significant changes were observed in GPS, and no correlation was found between the changes in tVAF1 and ankle-GVS. A significant positive moderate correlation was found between the change in tVAF1 and age, even with ankle-GVS as a covariate (r=0.45; p>0.001). SignificanceWalking with an AFO resulted in a small decrease in SMCg, with large inter-participant variability. Younger participants showed a greater decrease in SMCg, which may indicate greater neuromuscular plasticity in early developmental stages.

Visualization of Scleral Flap Patency in Glaucoma Filtering Blebs Using OCT

PurposeTo investigate the use of anterior segment-optical coherence tomography (AS-OCT) to visualise the aqueous outflow pathway and patency of the scleral flap in glaucoma filtration surgery blebs. DesignCross-sectional study Subjects205 filtering blebs of 112 patients with glaucoma who had undergone trabeculectomy (Trab, n = 97) or deep sclerectomy surgery (DS, n = 108) with/without mitomycin-C (MMC). MethodsSwept source AS-OCT raster slices were used to image the Trab and DS blebs in sagittal and coronal planes using a standardised protocol. Bleb appearances were classified into four categories based on the scleral flap and sclerostomy/TDW appearance; A—sclerostomy/TDW not visible, B—sclerostomy/TDW visible but scleral flap indiscriminate from sclera, C—scleral flap distinct but edges adherent to surrounding sclera, D—scleral flap edges non adherent to surrounding sclera. Surgical outcomes were classified into complete success (CS; IOP ≤18mmHg with no medications), qualified success (IOP ≤18 with medications) and failure (IOP>18mmHg). ResultsThe proportions of complete success, qualified success and failure in the Trab and DS cohorts were 45.0% and 29.6%, 33.0% and 31.5%, and 22.0% and 38.9% respectively, with a median post-operative follow up of 8.4 years (SD 7.9, IQR 3.2-9.0). In qualified success and failed blebs, category C (Trab, 53.7%; DS, 52.5%) accounted for the majority of scleral flap appearances, followed by categories A and B. Category D (86.0%; 71.9%) accounted for the majority of appearances in Trab and DS blebs with complete success. There was a significantly greater proportion of MMC use in categories C and D compared to categories A and B in both Trab (p < 0.0001) and DS (p = 0.02) cohorts, demonstrating the association of intraoperative MMC use with increased patency of the scleral flap. ConclusionSwept source AS-OCT may be used to visualise the position and patency of the sclerostomy/TDW and scleral flap in relation to surrounding structures in both sagittal and coronal planes. While free scleral flap edges are primarily correlated with MMC use, it may also correlate with surgical success. AS-OCT may be used to complement subjective bleb grading at the slit-lamp in the assessment of filtering blebs.

Symptomatic and Morphometric Analysis of Lumbosacral Transitional Vertebrae: Assessments by Age and Gender

Aim: Lumbosakral transitional vertebrae (LSTV) are anatomical variations where a vertebra exhibits characteristics of both lumbar and sacral vertebrae. This study aims to assess anatomical changes in LSTV patients by measuring intervertebral disc height (IVDh), vertebral foramen anteroposterior diameter (FVAPd), and intervertebral foramen height (FIVh), with consideration of age and gender differences. Materials and Methods: This retrospective study included 274 patients diagnosed with LSTV. All MRI images were acquired with a 1.5T MRI machine and a 32-channel lumbar coil. The presence of LSTV, forming the morphological data, was identified from coronal and sagittal reformat images and was classified as either lumbarization or sacralization. Morphometric data (IVDh, FIVh and FVAPd) were acquired from axial, sagittal, and coronal planes using both soft tissue and bone window settings. Results: The mean patient age was 41.6±13.0 years, with a female majority (55.8%). LSTV was predominantly lumbarization (96.4%), with sacralization in the remaining cases. The overall mean FVAPd was 11.2±2.4 mm, mean IVDh was 9.1±1.8 mm, and mean FIVh was 18.8±2.4 mm on the right and 19.1±2.4 mm on the left. IVDh levels were consistent across age groups, while FVAPd values were similar between genders. Patients aged 40 and under had higher FVAPd and FIVh levels, and male patients had higher IVDh and FIVh levels compared to females. Conclusions: The morphometric characteristics of LSTV may vary according to age and gender. Considering these factors in accurately identifying the anatomical variations of LSTV may play a significant role in determining appropriate treatment and management strategies.

Analysis of condylar positioning in the temporomandibular joint following mandibular reconstruction: Introduction of a new classification system and assessment of influencing factors on displacement.

This study investigates the unsatisfactory outcomes observed in mandibular reconstruction procedures attributed to improper condylar positioning in the Temporomandibular Joint. It also proposes a systematic classification for post-reconstruction condylar positioning dissatisfaction. A retrospective analysis was conducted on 337 patients who underwent tumor removal and mandibular reconstruction with vascularized osteocutaneous flaps. Reconstruction techniques included conventional surgery (43.3%) and 3D technology-guided procedures (56.7%). Evaluation utilized preoperative and postoperative CT scans to assess mandibular vertical ramus length (V) and condylar alignment in both sagittal (S) and coronal (C) planes. Accordingly, a classification system for condylar positioning was developed and abbreviated as VSC. It includes four classes: Class I, proper condylar reconstruction; Class II, short ramus length; Class III, one or two aspects of sagittal/coronal condylar positions dissatisfaction; and Class IV, two or three aspects dissatisfaction. The overall success rate for condylar reconstruction was 85.16%. Though not statistically significant, the success rate was marginally higher in the 3D-assisted group (85.86%) compared to the conventional group (84.25%). In terms of the VSC classification, the distribution of cases across Class I, II, III, and IV were 287, 4, 9, and 37 cases, respectively. Notably, condylar dislocation was significantly associated with the defect site, particularly the body and condyle (p < 0.001, OR = 49.734, 95% CI 12.995-190.342), and the number of reconstructed segments (p = 0.025, OR = 3.480, 95% CI 1.173-10.328). The findings highlight the importance of accurate reconstruction methods and reveal implications of the defect site and the number of reconstructed segments in condylar dislocation. Consequently, we propose a classification system to refine condylar positioning assessment and enhance surgical outcomes in mandibular reconstruction.

Investigating the relationship between sagittal spinal curvature and fall incidence and fall risk among elderly nursing home residents.

Poor balance is an underlying cause of falling in the elderly, for which a change in the natural curvature of the spine plays a major role. Little is known about the relationship between spinal curvatures and fall incidence in this population. We primarily aimed to investigate the relationship between sagittal plane spinal curvatures and fall incidence over 1year among nursing facility residents. Secondarily, we aim to determine associations of sagittal plane spinal curvatures with participants' perception of fall risk and balance capability. Participants (100 residents mean age 70.17 ± 6.01years) underwent standing measures of sagittal plane spinal curvatures (flexible ruler technique) and forward displacement of the head relative to the cervical spine. The Tinetti Performance Oriented Mobility Assessment (POMA) and Fall Efficacy Scale assessed participants' perception of balance and fear of falling. Incident falls were self-reported monthly and tracked across 1year. Spearman's correlations and logistic regression evaluated associations between fall incidence and spinal curvature. Predictive performance of spinal curvature and fall risk was determined by the corresponding ROC for defining a cut-off for variables of spinal curvature and fall risk indicators. Predictive performance of spinal curvature and fall risk factors indicated 84% and 77% of participants were correctly classified using models of kyphosis and head angle, respectively. Our study adds new data on spinal curvatures and incident falls among nursing facility residents. Efforts are needed to intervene to counter progression of spinal curvatures and improve fall prevention practices.

Quantitative Measurement of Rotation in Phalangeal Fracture Malunion Using Computed Tomography Imaging-"Linkage Simulation".

Malunion of thumb and finger fractures causes problems in the cosmetic and functional aspects of the hand. Malunion of phalangeal fractures usually manifests as a combination of rotational deformities in the coronal, sagittal, and transverse planes, and corrective osteotomy is performed on the planes that cause these problems. Quantification of the deformity is essential for precise osteotomy and is difficult to perform in the transverse plane, even with radiography or computed tomography. Thus, we developed a technique called linkage simulation for the quantitative measurement of rotational deformities for surgical planning. In this procedure, finger extension and flexion can be simulated based on the predicted rotational axis of the joint, which is useful for determining the appropriate correction. Furthermore, by performing a reduction simulation in the software, it is possible to simulate the surgery and predict the postoperative results. This paper reports the details of this technique.

Adjacent segment degeneration at a minimum 2-year follow-up after posterior lumbar interbody fusion: the impact of sagittal spinal proportion: a retrospective case series.

A retrospective cohort study. To investigate the sagittal plane configuration of the entire spine and its association with the risk of adjacent segment degeneration (ASD) after posterior lumbar interbody fusion (PLIF). Although PLIF has demonstrated satisfactory clinical outcomes, it is associated with ASD. However, the geometric mechanical changes that contribute to the occurrence of ASD are not well characterized. Radiological parameters were extracted from the whole lateral radiographs. Patients were divided into two groups: the ASD group (segmental kyphosis of ≥10º, and/or a ≥50% loss of disc height, and/or ≥3 mm of anteroposterior translation) and the non-ASD group. All 112 included patients underwent PLIF for lumbar degenerative diseases. The minimum follow-up period was 2 years, with an average follow-up time of 63.6 months. Fifty-two patients (46.4%) were classified into the ASD group and of these, 13 required reoperation due to failure of conservative treatment. Patients with ASD exhibited significantly more caudal and posterior inflection vertebrae (IV), while the lumbar apical vertebra was significantly more caudal immediately after surgery. The IV position was identified as a significant risk factor for ASD, and the ASD incidence was significantly higher in the group where IV ≤5 (L1 vertebral body) than in the group where IV ≥5.5 (T12-L1 disc) (69.0% vs. 38.6%). The IV position is a significant risk factor for ASD development. Although it is difficult to control intraoperative IV levels, we note a high risk of ASD in patients with IV lower than T12-L1.

Effect of the Material Properties and Knee Position to the Bone Bruise Pattern in Skeletally Mature and Immature Subjects.

A bone bruise is generated by a bony collision that could occur when the ACL is injured, and its pattern supposedly depends on the injury mechanism and level of skeletal maturity. The objective of this study was to determine the effect of material properties and knee position on the bone bruise pattern in skeletally mature and immature subjects using finite element analysis. Finite element models were created from an MR image in the sagittal plane of a skeletally mature and immature male subject. The femur and tibia were collided at 2 m/s to simulate the impact and determine the maximum principal stress. The analysis was performed at 15, 30 and 45 degrees of knee flexion, and neutral, 10 mm anterior and posterior translated position at each flexion angle. Although high stress was distributed toward the metaphysis area in the mature model, the stress did not cross the growth plate in the immature model. The size of the stress area was larger in the mature model than those in the immature model. The location of the stress area was dependent on the joint position as well as Young's modulus of cartilage and trabecular bone. Thus, the bone bruise pattern was affected by the knee position and tissue quality. In conclusion, although the bone bruise distribution was generally called footprint of the injury, the combined evaluation of the quality of the structure and the bone bruise distribution is necessary for properly diagnosing tissue injury based on the MR imaging.

MATCHING THE OTHER SIDE: RADIOLOGICAL VARIABILITY IN STAGED, BILATERAL TOTAL HIP ARTHROPLASTY

The purpose of this study was to assess the variability in implant position between sides in patients who underwent staged, bilateral THA and whether variation from one side to the other affected patient-reported outcomes.A retrospective review was conducted on 207 patients who underwent staged, bilateral THA by the same surgeon from 2017–2022. Leg length, acetabular height, cup version, and coronal and sagittal stem angles were assessed radiographically and compared to the contralateral THA. Surgical approach and technology utilization were further assessed for their impact on variability. Linear regression was used to model the relationship between side-to-side variability and patient-reported outcome measures (PROMS).Between sides, mean radiographic leg length varied by 4.6mm (0.0–21.2), acetabular height varied by 3.3mm (0.0–13.7), anteversion varied by 8.2° (0.0 to 28.7), coronal stem alignment varied by 1.1° (0.0 to 6.9), and sagittal angulation varied by 2.3° (0.0 to 10.5). The anterior approach resulted in more variability in stem angle position in both the coronal (1.3° vs. 1.0°, p=0.036) and sagittal planes (2.8° vs. 2.0° p=0.012) compared to the posterior approach. The posterior approach generally led to more anteversion than the anterior approach. Use of robotics or navigation for acetabular positioning did not increase side-to-side variability in cup-related position or leg length. Despite considerable side-to-side variability, Hip dysfunction and osteoarthritis outcome scores (HOOS JR) were not affected by higher levels of position inconsistency.Staged, bilateral THA results in considerable variability in component position between sides. The anterior approach leads to more side-to-side variability in sagittal stem angle and cup anteversion than the posterior approach. Navigation and robotics do not improve the consistency of component position in bilateral THA. Variation in implant position was not associated with differences in PROMs, suggesting that despite variability, patients can tolerate these differences between sides.

Optimizing Outcomes in Distal Tibial Deformity Correction: The Role of Supramalleolar Osteotomy with Computer-assisted Hexapod External Fixator.

Distal tibial deformities can significantly impact patients if left uncorrected, often leading to pain, alterations in gait, and the eventual development of post-traumatic arthritis. The criteria for surgical correction in these patients continues to be a subject of debate, while supramalleolar osteotomy (SMO) is an effective method for correcting distal tibial deformities. The purpose of this study was to evaluate and compare the clinical results of SMO using internal fixation or using computer-assisted hexapod external fixator in the treatment of distal tibial deformity. A retrospective study was conducted on 290 patients who underwent SMO between June 2015 and January 2023. Forty-four patients met the inclusion and exclusion criteria. Among the participants, 19 underwent SMO combined with a computer-assisted hexapod external fixator, while 25 received SMO with plate and screw internal fixation. The tibial anterior surface (TAS) angle, tibial lateral surface (TLS) angle, the tibiotalar (TT) angle and the talocrural (TC) angle were assessed on weight-bearing X-ray films. Functional assessments were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. The study followed patients for an average duration of 31.7 ± 15.3 months, with a range from 12 to 67 months. Successful bone union was achieved in all cases. For patients treated with the computer-assisted hexapod external fixator, significant improvements were observed: the mean deviation in sagittal plane deformity parameters decreased from 14.3 ± 10.4 degrees preoperatively to 2.8 ± 3.8 degrees postoperatively (p < 0.05). Similarly, coronal plane deformity parameters showed a reduction from 25.9 ± 22.5 degrees preoperatively to 5.9 ± 11.0 degrees postoperatively (p < 0.05). The AOFAS ankle-hindfoot score improved markedly from 66.0 ± 14.9 to 86.1 ± 11.7 points (p < 0.05). For patients undergoing internal fixation, the absolute difference in coronal plane parameters improved from 15.4 ± 12.6 degrees preoperatively to 3.7 ± 3.4 degrees postoperatively (p < 0.05). A significant enhancement in AOFAS ankle-hindfoot score was also noted, increasing from 68.3 ± 14.3 points to 79.4 ± 13.5 points (p < 0.05). There were no significant differences in gender, side, follow-up time, postoperative deviation of deformity, pre- or postoperative AOFAS between the two groups. In conclusion, comprehensive preoperative planning of SMO combined with either internal fixation or a hexapod external fixator for treating distal tibial deformities can achieve satisfactory outcomes. The utilization of a computer-assisted hexapod external fixator facilitates a gradual and precise correction process, which proved to be an effective and relatively safe method.

Addressing sagittal plane imbalance in primary total knee arthroplasty.

Sagittal plane imbalance (SPI), or asymmetry between extension and flexion gaps, is an important issue in total knee arthroplasty (TKA). The purpose of this study was to compare SPI between kinematic alignment (KA), mechanical alignment (MA), and functional alignment (FA) strategies. In 137 robotic-assisted TKAs, extension and flexion stressed gap laxities and bone resections were measured. The primary outcome was the proportion and magnitude of medial and lateral SPI (gap differential > 2.0 mm) for KA, MA, and FA. Secondary outcomes were the proportion of knees with severe (> 4.0 mm) SPI, and resection thicknesses for each technique, with KA as reference. FA showed significantly lower rates of medial and lateral SPI (2.9% and 2.2%) compared to KA (45.3%; p < 0.001, and 25.5%; p < 0.001) and compared to MA (52.6%; p < 0.001 and 29.9%; p < 0.001). There was no difference in medial and lateral SPI between KA and MA (p = 0.228 and p = 0.417, respectively). FA showed significantly lower rates of severe medial and lateral SPI (0 and 0%) compared to KA (8.0%; p < 0.001 and 7.3%; p = 0.001) and compared to MA (10.2%; p < 0.001 and 4.4%; p = 0.013). There was no difference in severe medial and lateral SPI between KA and MA (p = 0.527 and p = 0.307, respectively). MA resulted in thinner resections than KA in medial extension (mean difference (MD) 1.4 mm, SD 1.9; p < 0.001), medial flexion (MD 1.5 mm, SD 1.8; p < 0.001), and lateral extension (MD 1.1 mm, SD 1.9; p < 0.001). FA resulted in thinner resections than KA in medial extension (MD 1.6 mm, SD 1.4; p < 0.001) and lateral extension (MD 2.0 mm, SD 1.6; p < 0.001), but in thicker medial flexion resections (MD 0.8 mm, SD 1.4; p < 0.001). Mechanical and kinematic alignment (measured resection techniques) result in high rates of SPI. Pre-resection angular and translational adjustments with functional alignment, with typically smaller distal than posterior femoral resection, address this issue.

Differential neural mechanisms for movement adaptations following neuromuscular training in young female athletes with a history of sports-related concussion

Sports-related concussion (SRC) in adolescent athletes is associated with an increased risk of subsequent lower extremity injury. Neuromuscular training (NMT) has shown promise for reducing lower extremity injuries following SRC, however, neural adaptations in response to changes in lower extremity biomechanics following NMT in athletes with a history of SRC (HxSRC) remains poorly understood. Therefore, the purpose of this study was to identify changes in neural activity associated with lower extremity movement adaptations following a six-week NMT intervention in athletes with a HxSRC. Thirty-two right-hand/foot-dominant female adolescent athletes (16 with self-reported HxSRC, 16 age- and anthropometrically-matched controls) completed a bilateral leg press task with 3D motion analysis during functional magnetic resonance imaging (fMRI). Movement adaptations were defined as a change in frontal and sagittal plane range of motion (ROM) during the fMRI bilateral leg press task. Significant pre- to post-NMT reductions were observed in the non-dominant (left) mean frontal plane ROM. Whole-brain neural correlate analysis revealed that increased cerebellar activity was significantly associated with reduced mean left-knee frontal ROM for matched controls. Exploratory within group analyses identified neural correlates in the postcentral gyrus for the HxSRC group which was associated with reduced mean left-knee frontal plane ROM. These distinct longitudinal changes provide preliminary evidence of differential neural activity associated with NMT to support knee frontal plane control in athletes with and without a HxSRC.

The Traditional Intramedullary Axis Underestimates the Medial Tibial Slope Compared to Transmalleolar Sagittal Axis in Image-based Robotic-Assisted Unicompartimental Knee Arthroplasty.

The medial unicompartmental knee arthroplasty (mUKA) has been recognized as an excellent treatment for medial knee osteoarthritis. The posterior tibial slope (PTS) is measured radiographically with the intramedullary axis (IMA) to the tibial baseplate on the sagittal plane radiograph. However, in most computer-navigated or robotic mUKAs, the PTS is set from a transmalleolar axis (TMA).The PTS difference was evaluatedbetween the sagittal TMA and the sagittal IMA of patients undergoing a CT-based primary robotic-assisted mUKA.We retrospectively reviewed the preoperative computed tomography (CT) scans taken according to the MAKO system protocol (Stryker) of 67 patients undergoing mUKAs. We measured the angular difference between the IMA and the TMA in the sagittal plane.Using the TMA to set the PTS the estimation of the slope of the medial tibial plateau would increase by an average of 1.9 ± 3.2 degreescompared to the IMA. Furthermore, in nineknees, PTS was decreased.Tibial components implanted with the help of a CT scan-based preoperative planning MAKO will show an average of 1.9 degrees more than those measured on sagittal radiographs potentially of concern for knee kinematics. A universal language is needed to standardize the slope calculation and the respective reference axis used.

Evaluation of the efficacy of posterior hemivertebrectomy combined with two or more segments fusion

BackgroundAlthough early hemivertebra (HV) resection and short fusion (within 4 segments) have been successful in treating congenital HV, there is limited research comparing the outcomes of the shortest-segment fusion (2 segments) versus 3 or 4 segments, particularly in young children. To evaluate the efficacy of posterior hemivertebrectomy combined with two or more segments fusion in children under the age of 10 years with a solitary simple lower thoracic or lumbar HV (T8-L5).MethodsThis retrospective study included patients under the age of 10 with lower thoracic or lumbar solitary simple HV who underwent hemivertebra resection (HVR) and transpedicular short fusion and were divided into HV ± 1 group (2 segment fusion) and HV ± 2 group (3 or 4-segment fusion). The study recorded preoperative, postoperative (1 week), and the latest follow-up radiographic parameters and complications. The results of the coronal and sagittal planes were analyzed, and the main curve, segmental scoliosis curve, compensatory scoliosis curve, segmental kyphosis curve, and trunk shift were compared.ResultsThe study included 35 patients (15 in the HV ± 1 group and 20 in the HV ± 2 group) with a mean age of 5.26 ± 2.31 years and a mean follow-up of 22.54 months (12–68). The mean preoperative Cobb angle was 32.66° ± 7.339° (HV ± 1) and 29.31°±6.642° (HV ± 2). The final Cobb angle was 10.99°± 7.837° (HV ± 1) and 8.22° ± 4.295° (HV ± 2). The main curve corrected by 72% (HV ± 1), 75% (HV ± 2) postoperatively and 67% (HV ± 1), 72% (HV ± 2) at the final follow-up (P > 0.05). There were no significant differences in the correction of the segmental scoliosis curve, compensatory scoliosis curve, segmental kyphosis curve, and trunk shift between the HV ± 1 and HV ± 2 groups (P > 0.05). The unplanned reoperation rate for HV in the thoracolumbar region (T11-L2) is significantly higher (P = 0.038).ConclusionIn the context of solitary simple lower thoracic or lumbar HV (T8-L5), HV ± 1 segment fusion suffices and yields comparable correction outcomes in the midterm period when compared to HV ± 2. The reoperation rate exhibited a statistically significant increase in the thoracolumbar region.

Surgical Treatment Strategies for Severe and Neglected Spinal Deformities in Children and Adolescents without the Use of Radical Three-Column Osteotomies.

Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient's individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures.