Soft Tissue Tension Research Articles

Can mobile-bearing unicompartmental knee arthroplasty achieve natural gap-balancing? An observational study with a novel pressure sensor

BackgroundMobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists.MethodsThis was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes.ResultsThere was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05).ConclusionsObjective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release.Study registrationChinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900024146.

P14. Analysis of physiological stress shielding within the lumbar musculoskeletal system as a consequence of mechanical adaptations associated with bilateral and unilateral low back pain: a finite element study

<h3>BACKGROUND CONTEXT</h3> Low back pain (LBP) is a public health crisis with nearly 85% of cases considered idiopathic. With the emergence of research analyzing the role of the thoracolumbar fascia (TLF) in spinal biomechanics, it is possible that the fascia may play a role in the progression of LBP. Previous studies have demonstrated changes to the TLF thickness and shear strain, as well as stiffness and morphological changes within lumbar spine-stabilizing muscles (eg, erector spinae [ES] and multifidus [MF]) in LBP patients. Such modifications to lumbar soft tissues suggest the plausibility of stress shielding, defining a load allocation bias, within the lumbar spine's soft tissues. <h3>PURPOSE</h3> The aim of this study is to develop and compare finite element models representing healthy, along with both bilateral and unilateral LBP-affected lumbar musculoskeletal systems to determine the potential for stress shielding within the lumbar spine from soft tissue property augmentation associated with LBP. <h3>METHODS</h3> Using a finite element platform, three models depicting the lumbar musculoskeletal system undergoing trunk flexion were created and compared. The first model represented the tissues of a healthy lumbar spine. The remaining models depicted lumbar soft tissues reflective of bilateral LBP (bLBP) and unilateral LBP (uLBP) patients. Each model was composed of vertebrae, intervertebral discs (IVDs) and soft tissues (including the MF, ES, TLF and tendons) from L1-S1. Material properties were selected from published literature. For the bLBP model, tissues on either side of the vertebral column were modified to reflect the changes in morphology and stiffness in the MF, and TLF as documented in literature involving bLBP patients. For the uLBP model, the MF and TLF located laterally to the right of the vertebral column ("symptomatic tissues") were augmented to reflect changes found within clinical studies involving uLBP patients. Remaining uLBP tissues were unchanged. Relevant model context of use validation preceded testing. <h3>RESULTS</h3> Validation was achieved as results demonstrated agreement in IVD pressure and intervertebral rotation with clinical data and in silico spine models. Compared to the healthy model, the cumulative average tension exhibited by soft tissues in the bLBP and uLBP model increased by 15.6 and 9.24%, respectively. The average tension exhibited by the bLBP model's MF, ES, and TLF changed by 13.0, -4.03, and 15.6%, while the uLBP model's symptomatic MF, ES, and TLF exhibited changes of 19.0%, -10.4%, and 16.1%, respectively. <h3>CONCLUSIONS</h3> The bLBP and uLBP models exhibited an increase in soft tissue tension by 18.4kPa and 10.9kPa relative to the healthy model soft tissues. In each LBP model, 99.8% of the overall stress increase, relative to the healthy model, was distributed towards the TLF. This demonstrates potential for the TLF in both the bLBP and uLBP scenarios to withstand the majority of increased tension, indicating a stress allocation bias within the lumbar soft tissues. This may initiate stress shielding whereby the TLF prevents adjacent spine-stabilizing soft tissues, such as the MF and ES, from receiving loading. Tissues may thus undergo atrophy and become less capable to withstand loading. To compensate, patients may depend on additional soft tissues, leading to irregular muscle activation and force balances, trapping the soft tissues in cyclical stress shielding. Ultimately, stress shielding within lumbar soft tissues may potentially lead to the progression of LBP. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis.

In the treatment of knee periprosthetic joint infection with a two-stage protocol, static spacers allow for the local delivery of high doses of antibiotics and help to preserve soft tissue tension. Articulated spacers were introduced to better preserve flexion after the reimplantation. The aim of this systematic review is to provide a comprehensive data collection of the results of these different spacers. An in-depth search on the main clinical databases was performed concerning the studies reporting data on the topic. A total of 87 studies and 4250 spacers were included. No significant differences were found both in pooling data analysis and meta-analysis of comparative studies about infection recurrences, complications, and clinical scores. Mean active knee flexion at last follow-up after total knee reimplantation was found to be significantly higher using articulated spacers (91.6° ± 7° for static spacers vs. 100.3° ± 9.9° for articulated spacers; p < 0.001). Meta-analysis also recognized this strong significant difference (p < 0.001). This review has confirmed that articulated spacers do not appear to be inferior to static spacers regarding all clinical outcomes, while they are superior in terms of active flexion. However, the low quality of the studies and the risk for selection bias with complex patients preferentially treated with static spacers need to be accounted for.

Prior Instability is Strongly Associated With Dislocation After Isolated Head and Liner Exchange

BackgroundIsolated head and liner exchange is an appealing alternative to a more extensive revision total hip arthroplasty in patients who have well-fixed components. Despite efforts to increase femoral offset and restore soft tissue tensioning, limited component revision may be associated with higher rates of postoperative instability. MethodsThis retrospective analysis assessed 209 patients who had a head and liner exchange conducted at a large academic medical center between 2011 and 2019 and had >2 years of follow-up. Functional cup positioning within the Lewinnek safe zone was assessed on postoperative weight-bearing radiographs. Included patients were 56% women, had a mean age of 64 years (range, 24-89) and a mean body mass index of 28.8 kg/m2 (range, 18.2-46.7). The most common indications for surgery included acetabular liner wear in 86 hips (41%), instability in 40 hips (19%), and infection in 36 hips (17%). ResultsTwenty-eight hips (13%) had a dislocation within 2 years after surgery. The best-fit model predicting postoperative dislocation included a history of dislocation (adjusted-odds ratio [adj-OR] 5.67, 95% CI 2.39-14.09, P < .001), age (adj-OR 1.04 per 1-year increase, 95% CI 0.99-1.08, P = .10), and body mass index (adj-OR 0.90 per 1-kg/m2 increase, 95% CI 0.80-0.99, P = .046). ConclusionIn a large cohort of patients who had isolated head and liner exchange, patients who had prior instability had 7-fold elevated odds of postoperative dislocation. This risk remains significant after controlling for cup positioning outside the Lewinnek safe zone, liner type, head size, neck length, soft tissue compromise, neuromuscular disease, and dual mobility constructs. Level of EvidenceIII, retrospective cohort study.

Intraobserver Assessment of Shear Wave Elastography in Tensor Fasciae Latae and Gluteus Maximus Muscle: The Importance of the Hip Abductor Muscles in Runners Knee Compared to Healthy Controls.

Background: Iliotibial band syndrome (ITBS) represents one of the most common running related injuries. The pathophysiology is postulated to be caused by excessive ITB tension, impingement and irritation of soft tissues at the lateral femoral epicondyle. However, direct evidence has yet to be found and the multifactorial etiology is under discussion. The purpose was to evaluate stiffness of ITB, gluteus maximus (GM) and tensor fasciae latae (TFL) muscles using shear wave elastography (SWE). Methods: In 14 patients with clinically verified ITBS and 14 healthy controls, three SWE measurements each of ITB, GM and TFL in both legs was performed to determine measurement reliability and between-group and -leg differences. Results: The mean value of ITB was 12.8 m/s with ICC of 0.76, whereas the values measured in the GM were 3.02 m/s with an ICC of 0.87. No statistically significant difference in controls compared to patients were found (p = 0.62). The mean value of TFL was 5.42 m/s in healthy participants, compared to 3.89 m/s patients with an ICC of 0.98 (p = 0.002). Conclusion: Although SWE showed no difference in ITB stiffness, significant differences for TFL muscle stiffness in runner’s knee was found, suggesting that the hip abductor muscles might play a bigger role in the pathophysiology of ITBS. We aimed to implement baseline values for stiffness assessments and prove reliability for further prospective studies of SWE in runner’s knee.

Preoperative Planning for Anatomic Total Shoulder Arthroplasty.

The success of total shoulder arthroplasty is dependent on both proper patient selection and restoration of the native anatomy. After proper patient selection, preoperative planning is essential to select implants that will allow the surgeon to properly restore soft-tissue tension and correct for deformity. Although it is possible to template implants with plain radiographs, these do not allow accurate measurements of the complex three-dimensional anatomy of the glenohumeral joint. CT can be used to further examine version of the glenoid and humerus, as well as humeral head subluxation. Three-dimensional reconstructions also allow for virtual implantation, resulting in a more reliable prediction of implant appearance. Commercial software is available that calculates parameters such as version; however, these have been shown to have variability when compared with measurements obtained by surgeons. Patient-specific instrumentation can also be obtained based on preoperative measurements; however, although it allowed for improved measurements when compared with two-dimensional imaging, there has been no difference in version error, inclination error, or positional offset of the glenoid implant when comparing patient-specific instrumentation with standard instrumentation. Intraoperative navigation can also be used to give real-time feedback on implant positioning; however, additional studies are needed to fully evaluate its benefit.

Assessment of alternative techniques to quantify the effect of injury on soft tissue in closed ankle and pilon fractures.

IntroductionLocal soft tissue status (STS) guides the timing for definitive surgical treatment strategies of fracture fixation around the ankle joint. The aim of this study was to assess different types of new technical devices in relation to the surgical treatment in closed ankle and pilon fractures.MethodsThis study was designed as a cohort study. Adult patients admitted between February 1, 2019 and December 31, 2020 presenting with closed ankle fracture requiring surgical treatment were eligible. The exclusion criteria were previous injuries to the lower extremity, acute deep venous thrombosis, skin diseases, and delayed presentation (admission >24 hours after injury). Moderate-energy trauma includes injuries sustained during team sports, biking, and running. The primary outcome was the assessment of the degree of soft tissue involvement following closed fractures by comparing different techniques focusing on the ankle region and including ankle and pilon fractures. The variables of interest included the circumference of soft tissue swelling around the ankle, determined within a 5-mm range in the area of the medial and lateral malleolus and the bone-skin distance on a plain radiograph, determined by the largest distance from the malleolus to the border of the soft-tissue shadow. STS assessment included optical measures of local perfusion (O2C, Lea Inc. Germany) and tactile measures of mechanical characteristics (Myoton® tensiometer AS, Estonia). Measurements of Group Temp (temporary stabilization) and Group Def (definitive surgery) were taken on admission and prior to the treatment strategy decision. The contralateral non-injured ankle served as a control. The quality of assessment tools was quantified by calculating the smallest detectable change (SDC).ResultsIn total, 38 patients with a mean age of 40.4 (SD 17.8) years were included. The SDC was 3.2% (95%CI 2.5 to 3.8) for local blood flow and 1.1% (95%CI 0.4 to 1.7) for soft tissue stiffness. The circumference of the injured area at admission was significantly higher than that of the healthy site (28.2 [SD 3.4] cm versus 23.9 [SD 2.4] cm, p < 0.001). The local perfusion (blood flow 107.5 (SD 40.79 A.U. vs. 80.1 [SD 13.8] A.U., p = 0.009), and local dynamic stiffness of the skin (668.1 (SD 148.0) N/m vs 449.5 (SD 87.7) N/m, p < 0.001) were significantly higher at the injured site. In Group Temp, the local blood flow was significantly higher when compared with Group Def (109.6 [SD 39.8] vs. 94.5 [SD 13.0], p = 0.023). The dynamic stiffness of the soft tissue was significantly higher in Group Temp (679.4 N/m [SD 147.0] N/m vs. 573.0 N/m (SD 93.8) N/m, p < 0.001). The physical properties of STS were comparable among the fracture types. None of the included patients had local soft tissue complications.ConclusionClosed fractures of the ankle and the pilon are associated with an increase in local circulation and local soft tissue stiffness and tension. These changes of the STS following injury can be quantified in a standardized and reproducible manner.

Accuracy of virtual surgical planning and custom three-dimensionally printed osteotomy and reduction guides for acute uni- and biapical correction of antebrachial deformities in dogs.

To report clinical experience using virtual surgical planning (VSP) and surgical application of 3D printed custom surgical guides to facilitate uni- and biapical correction of antebrachial deformities in dogs. 11 dogs (13 antebrachial deformity corrections). Using CT-based bone models, VSP was performed, and surgical guides were designed and 3D printed. The guides were used to execute osteotomies and align bone segments. Postoperative CTs were obtained to compare limb alignment with the VSP. Long-term assessment of lameness and cosmesis were compared with preoperative status. Guides were successfully utilized and postoperative analysis was available for 10 of 13 deformities. Guides were abandoned in 2 deformities due to soft tissue tension. Evaluation of postoperative frontal, sagittal, axial, and translational limb alignment revealed that over 90% of parameters were within the acceptable range of ≤ 5° angulation and rotation or ≤ 5 mm of translation from the VSP. Lameness scores were improved in 7/8 deformities with associated preoperative lameness, and posture was improved in 10/10 deformities in which guides were deployed. Complications included reduced range of carpal motion (n = 2), implant sensitivity (n = 2), fracture (n = 1), and tendon laceration (n = 1). VSP and customized surgical guide application facilitated accurate antebrachial limb deformity correction in the majority of deformities in this case series. The use of VSP and 3D printed guides would appear to be a viable and accurate approach for correction of both uni- and biapical antebrachial deformities in dogs.

Use of custom-made acetabular components (CMAC) as part of atwo-stage procedure in patients with severe periacetabular bone loss

Implantation of custom-made acetabular components (CMAC) with load transmission onto the remaining bone stock and reconstruction of the "center of rotation" (COR) in cases of severe periacetabular bone defects. Severe periacetabular bone loss (Paprosky type IIIA/B) with or without pelvic discontinuity after septic or aseptic loosening with inadequate load capacity of the dorsal pillar and/or large supraacetabular defects. Acute or local infections, lack of compliance, taking into account the risks and complications: missing or limited expected postoperative functional gain, multimorbid patients with potential inoperability during the first and/or second intervention. Lateral transgluteal or posterolateral approach while protecting neurovascular and muscular structures. Preparation of the implant site based on preoperative planning with augmentation of bone defects as far as possible. Primarily stable anchoring with 2angle-stable pole screws in the ilium, an optional pole screw in the pubic bone for determination of COR, and stabilization screws in the iliac wing (optionally angle-stable). Use of dual mobility cup according to the soft tissue tension and intraoperative stability. For the first 6weeks postoperative partial weight-bearing (20 kg), followed by agradual increase of the load (10 kg per week). Between 2008 and 2018, 47patients with a Paprosky typeIII defect underwent implantation of amonoflanged CMAC. Main complication was aperiprosthetic joint infection with subsequent need for implant removal in9 of 10cases. Harris Hip Score improved from21.1 to 61.5points. X‑ray imaging displayed an angle of inclination of42.3 ± 5.3°, an anteversion of16.8 ± 6.2°, a∆ H of0.5 ± 0.2 mm and a∆ V of17.7 ± 1.1 mm according to Roessler etal.

Revision Amputation with Press-Fit Osseointegration for Transfemoral Amputees.

We demonstrate the fundamentals of a single-stage procedure involving an impacted press-fit porous-coated titanium osseointegration implant. The preoperative evaluation is summarized and the specific surgical steps are described: exposure, osteotomy, canal preparation, implant insertion, (optional) targeted muscle reinnervation, muscle closure, soft-tissue contouring and stoma creation, and abutment insertion. Amputees who are dissatisfied with their quality of life or mobility when using a socket prosthesis can attempt to modify their socket or activity level or accept their situation. Non-osseointegration surgical options to try to improve socket fit include bone lengthening and/or soft-tissue contouring. An alternative design is a screw-type osseointegration implant1. Press-fit osseointegration can be provided for amputees having difficulty with socket wear5. Press-fit osseointegration usually provides superior mobility and quality of life compared with nonoperative and other operative options for patients expressing dissatisfaction for reasons such as those mentioned above, including poor fit, compromised energy transfer, skin pinching, compression, and abrasions. Review articles describing the clinical outcomes of osseointegration consistently suggest that patients have improved prosthesis wear time, mobility, and quality of life compared with patients with a socket prosthesis3,4. In a recent study2 of 18 femoral and 13 tibial amputees who had osseointegration, Reif et al. showed significant improvements in prosthesis wear time, mobility, and multiple quality-of-life surveys at a mean follow-up of nearly 2 years. The most common postoperative complication for this procedure is low-grade soft-tissue infection, which is usually managed by a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to manage infection. Periprosthetic fractures can nearly always be managed with familiar fracture fixation techniques and implant retention6. Template and choose an implant with an optimal diameter that encroaches the inner cortex at the narrowest bone diameter; an implant that is too wide may not fit without causing a large fracture, and an implant that is too narrow may fall out. Do not cement the implant7.Ideally, the abutment of the implant should rest against a flat transverse bone end with cortical contact and leave the correct amount of room for the prosthetic knee so that it matches the height of the contralateral knee; avoid inserting an implant too distally or in too wide a metaphyseal flare.Gentle impaction pressure is necessary and small contained distal fractures are acceptable, but avoid causing a propagating fracture. Do not place cerclage cables or loose bone graft at these small fracture sites.Avoid the use of a tourniquet during intramedullary reaming to prevent potential heat-induced osteonecrosis.Nerve surgery such as targeted muscle reinnervation, if indicated, can be performed in the same surgical episode as the osseointegration.The muscles should be closed at the bone-implant interface with use of a tight purse string in order to provide a vascularized tissue barrier against bacterial ingress8.The skin surrounding the stoma should have unnecessary fat removed, but not excess removal leading to skin necrosis. The skin fascia should be sutured to the muscle surrounding the stoma to stabilize the peri-stomal skin.Soft-tissue contouring is needed to achieve the optimal soft-tissue tension around the stoma and abutment. Single-stage surgery has a distinct advantage in this regard. MVA = motor vehicle accidentAP = anteroposteriorCT = computed tomographyTMR = targeted muscle reinnervationQTFA = Questionnaire for Persons with a Transfemoral AmputationEQ-5D = EuroQol 5 DimensionsLD-SRS = Limb Deformity-Scoliosis Research Society (questionnaire)PROMIS = Patient-Reported Outcomes Measurement Information System.

Personalized Hip Joint Replacement with Large Diameter Head: Current Concepts.

Hip arthroplasty is a common procedure in elective orthopaedic surgery that has excellent outcomes. Hip replacement surgery aims to create a “forgotten” joint, i.e., a pain-free joint akin to a native articulation. To achieve such goals, hip arthroplasty must be personalised. This is achieved by restoring: the centre of rotation of the native hip; leg length equality; femoral offset; femoral orientation; soft tissue tension; joint stability with an unrestricted hip range of motion; and having appropriate stress transfer to the bone. In addition, the whole pathway should provide an uneventful and swift postoperative recovery and lifetime implant survivorship with unrestricted activities. At our institution, the preferred option is a personalized total hip arthroplasty (THA) with a large diameter head (LDH) using either monobloc or dual-mobility configuration for the acetabular component. LDH THA offers an impingement-free range of motion and a reduced risk of dislocation. The larger head-neck offset allows for a supraphysiologic range of motion (ROM). This can compensate for a patient’s abnormal spinopelvic mobility and surgical imprecision. Additionally, LDH bearing with a small clearance exerts a high suction force, which provides greater hip micro-stability. With appropriate biomechanical reconstruction, LDH THA can restore normal gait parameters. This results in unrestricted activities and higher patient satisfaction scores. We use LDH ceramic on ceramic for our patients with a life expectancy of more than 20 years and use LDH dual mobility bearings for all others.

Risk of Instability After Revision Total Knee Arthroplasty for Periprosthetic Joint Infection.

Periprosthetic joint infection (PJI) remains a major source of morbidity after total knee arthroplasty (TKA). The risk of recurrent infection has been more extensively studied than the risk of mechanical failure. We sought to define the incidence of instability after revision TKA for PJI and to compare this incidence with that for revision TKA for instability. We retrospectively reviewed patients treated by 4 arthroplasty surgeons at 1 institution. The primary outcome was a new diagnosis of clinical instability after index revision. We analyzed potential risk factors that may contribute to postoperative instability after PJI, including demographic characteristics, implant alignment, number of previous procedures, level of constraint during index revision, and type of spacer used. Patients were matched 1:1 with patients undergoing revision TKA for instability. Continuous variables were compared with Student's t test for normally distributed variables and Mann-Whitney U test for non-normal variables. Categorical variables were compared with Fisher's exact test. Thirty-seven patients who underwent revision TKA for PJI were identified. Twelve (32.4%) had clinical instability after revision, compared with only 3 (8.1%) in the matched cohort (P=.019). Use of a revision, midlevel constraint device in the PJI cohort did not correlate with a lower risk of instability (P=.445). A greater number of previous surgical procedures increased the likelihood of instability (P=.041). Revision TKA for PJI is associated with a high risk of subsequent instability. Midlevel constrained implants may not be sufficient to prevent instability. A focus on soft tissue tension and a lower threshold for increasing constraint may be prudent in this cohort. [Orthopedics. 2022;45(3):145-150.].

FRENECTOMY WITH Z PLASTY TECHNIQUE FOR HIGH ABERRANT FRENUM (FRENEKTOMI DENGAN TEKNIK Z-PLASTY PADA ABERANSIA FRENULUM YANG TINGGI

An aberrant frenum can cause gingival recession and plaque accumulation due to a muscle pull. It also presents an aesthetic problem and inhibits the orthodontic result in a case with midline diastema, thus causing a recurrence after the treatment. This case report describes how periodontal surgery can accomplish such an aberrant frenum like a frenectomy procedure. This case report shows the abnormal maxillary labial frenum removal in a 21-year-old through the Z-plasty technique. The Z Plasty was made with an angulation of about 60° on the left and right sides of the vertical incision to obtain a double rotational flap. The two flaps were then transposed to the opposite side of the apex of each flap for relief of soft tissue tension. This pattern has shown uneventful healing and minimized scar formation, which was favorable in aesthetics.

The Z-Plasty Technique on the Frenectomy Approach of the Aesthetic Gingival Recession In Frenulum Labial Mandibular Case

The frenulum is an anatomical structure in the oral cavity. Its formed folds of mucosa membranes attach the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Abberansia frenulum is one of the causes of aesthetic and functional problems such as gingival recession, which occurs either due to plaque control or muscle pull issues. One of the treatment options for the anomaly of the frenulum case is by performing a frenectomy procedure. This paper aimed to explain using the z-plasty technique in abberansia frenulum treatment with hypertrophy frenum associated with midline diastema and short vestibule. A 36-year-old female patient came to Periodontic Clinic in Oral dan Dental Hospital, Universitas Padjajaran, Bandung, Indonesia, with chief complaint pain in 41 teeth, and clinically the gingiva appears recession and short vestibule. This situation is alarming in terms of aesthetics and functionality. The treatment of frenectomy with the z-plasty technique is an indication for this case. The frenectomy with the z-plasty method has shown favorable results in aesthetics and functional appearance. The z-plasty technique helped in reducing soft tissue tension so that it can minimize scar formation

Design of an Affordable, Modular Implant Device for Soft Tissue Tension Assessment and Range of Motion Tracking During Total Hip Arthroplasty.

Background: In hip arthroplasties, surgeons rely on their experience to assess the stability and balance of hip tissues when fitting the implant to their patients. During the operation, surgeons use a modular, temporary set of implants to feel the tension in the surrounding soft tissues and adjust the implant configuration. This process is naturally subjective and therefore depends on the operator. Inexperienced surgeons undertaking hip arthroplasties are twice as likely to experience errors than their experienced colleagues, leading to dislocations, pain and discomfort for the patients. Methods: To address this issue, a new, 3DOF force measurement system was developed and integrated into the modular, trial implants that can quantify forces and movements intraoperatively in 3D. The prototypes were evaluated in three post-mortem human specimens (PMHSs), to provide surgeons with objective data to help determine the optimal implant fit and configuration. The devices comprise a deformable polymer material providing strain-based displacements measured with electromagnetic-based sensors and an inertial measurement unit (IMU) for motion data. Results: Device results show a relative accuracy of approx. 2% and a sensitivity of approx. 1%. PMHS results indicated that soft tissue forces on the hip joint peak in the order of ~100 N and trend with positions of the leg during range of motion (ROM) tests, although force patterns differ between each PMHS. Conclusion: By monitoring forces and force patterns of hip soft tissues, in combination with standardised ROM tests, the force patterns could shed a light on potential anomalies that can be addressed during surgery. Clinical and Translational Impact Statement: The development of an instrumented hip implant device for use during surgery knowledge will eventually allow us to develop a predictive model for soft tissue balancing, that can be used for pre- and intra-operative planning for each patient on a tailored and personalised basis. Ultimately, we hope that with this device, patients will benefit from a faster recovery, from a more-precisely fitted hip, and an improved quality of life.

Superconstructs in reconstruction surgery of Charcot foot Brodsky 1: A case report

IntroductionCharcot neuropathic osteoarthropathy (CN) is a chronic, progressive condition of joints, soft tissues, and bones. CN causes considerable high mortality and morbidity. A common issue is early diagnosis and appropriate treatment. Thus, the operative treatment is indicated when patients have progressive deformities, infection and ulceration. The superconstructs method for Charcot foot (CF) is considered giving better clinical outcome than other methods.Presentation of caseA 61-year-old male admitted to an outpatient clinic with chief complaint of swelling and pain on a left foot with history of diabetes mellitus type 2. From the physical examination, left foot revealed a swelling with rocker bottom deformity and limited range of motion. The radiological examination showed sclerotic appearance of bone deformity metatarsal joint of midfoot of toe. The patients were diagnosed with left Charcot foot Brodsky Type 1, Eichenholtz grade III with diabetes mellitus type 2.DiscussionWe made superconstructs rather than standard fixation which is frequently inadequate due to changes accompanying the Charcot process. Thus, we performed an adequate reduction of deformity, reduce soft tissue tension, fixation extension beyond a zone of injury, then use of strongest fixation devices that are applied to maximize mechanical function.ConclusionThis study showed that superconstructs provide satisfactory clinical and outcomes. This method is useful for achieving construct and stable fixation especially for Charcot foot.

Reproducibility of an Intraoperative Pressure Sensor in Total Knee Replacement.

Appropriate soft tissue tension in total knee replacement (TKR) is an important factor for a successful outcome. The purpose of our study was to assess both the reproducibility of a modern intraoperative pressure sensor (IOP) and if a surgeon could unconsciously influence measurement. A consecutive series of 80 TKRs were assessed with an IOP between January 2018 and December 2020. In the first scenario, two blinded sequential measurements in 48 patients were taken; in a second scenario, an initial blinded measurement and a subsequent unblinded measurement in 32 patients were taken while looking at the sensor monitor screen. Reproducibility was assessed by intraclass correlation coefficients (ICCs). In the first scenario, the ICC ranged from 0.83 to 0.90, and in the second scenario it ranged from 0.80 to 0.90. All ICCs were 0.80 or higher, indicating reproducibility using a IOP and that a surgeon may not unconsciously influence the measurement. The use of a modern IOP to measure soft tissue tension in TKRs is a reproducible technique. A surgeon observing the measurements while performing IOP may not significantly influence the result. An IOP gives additional information that the surgeon can use to optimize outcomes in TKR.

Current Concepts in Humeral Component Design for Anatomic and Reverse Shoulder Arthroplasty.

The history of humeral component design has evolved from prostheses with relatively long stems and limited anatomic head options to a contemporary platform with short stems and stemless implants with shared instrumentation and the ability to provide optimal shoulder reconstruction for both anatomic and reverse configurations. Contemporary humeral components aim to preserve the bone, but they are potentially subject to malalignment. Modern components are expected to favorably load the humerus and minimize adverse bone reactions. Although there will likely continue to be further refinements in humeral component design, the next frontiers in primary shoulder arthroplasty will revolve around designing an optimal plan, including adequate soft tissue tension and providing computer-assisted tools for the accurate execution of the preoperative plan in the operating room.

Robot-assisted joint arthroplasty-An emerging technology of the present and the future

To review and evaluate the research progress of the robot-assisted joint arthroplasty. The domestic and foreign related research literature on robot-assisted joint arthroplasty was extensively consulted. The advantages, disadvantages, effectiveness, and future prospects were mainly reviewed and summarized. The widely recognized advantages of robot-assisted joint arthroplasty are digital and intelligent preoperative planning, accurate intraoperative prosthesis implantation, and quantitative soft tissue balance, as well as good postoperative imaging prosthesis position and alignment. However, the advantages of effectiveness are still controversial. The main disadvantages of robot-assisted joint arthroplasty are the high price of the robot system, the prolonged operation time, and the increased radioactive damage of the imaging-dependent system. Compared to traditional arthroplasty, robot-assisted joint arthroplasty can improve the accuracy of the prosthesis position and assist in the quantitative assessment of soft tissue tension, and the repeatability rate is high. In the future, further research is needed to evaluate the clinical function and survival rate of the prosthesis, as well as to optimize the robot system.

Pressing Intervention Promotes the Skeletal Muscle Repair of Traumatic Myofascial Trigger Points in Rats.

ObjectiveTo observe the effect of pressing intervention on the skeletal muscle repair of myofascial trigger points (MTrPs) in rats and explore the mechanism of pressing intervention on the deactivation of trigger points.MethodsThirty SPF rats were randomly divided into blank group, model group and press group, with 10 rats in each group. The MTrPs models were established by blunt striking plus eccentric exercise, and then evaluated. The press group was given a pressing intervention with a self-made device for 14 days, and the rats in the other two groups were fed normally. Soft tissue tension (STT) D0.2 and pressure pain threshold (PPT) were measured before and after intervention. The skeletal muscle tissue at MTrPs was extracted and assessed by hematoxylin–eosin (HE) and Masson staining. The expression of collagen I, collagen III, α- smooth muscle actin (α-SMA), myosin heavy chain (MHC) and fibronectin (FN) were detected by Western Blotting. Enzyme linked immunosorbent assay (ELISA) was used to evaluate the expression of substance P (SP), 5-hydroxytryptamine (5-HT), cyclooxygenase 2 (COX-2) and prostaglandin E2 (PGE2).Results(1) Compared with the blank group, the PPT and D0.2 reduced (P < 0.05) in the model group; while compared with the model group, the PPT and D0.2 increased (P < 0.05) in the press group. (2) Compared with the blank group, the model group showed obvious spontaneous potentials with higher amplitude and frequency, which were also much higher than those of the press group (P < 0.05). (3) The HE and Masson staining results showed evident fibrosis in the muscle tissue of the model group, with a larger area of collagen fibers relative to that of the press group (P < 0.05). (4) The amount of collagen I, collagen III, FN, α- SMA, SP, 5-HT, COX-2 and PGE2 increased and the content of MHC decreased (P < 0.05) in the model group, as compared to the blank group; while all the substances (P < 0.05), instead of MHC which increased (P < 0.05), in the press group were decreased as compared to the model group.ConclusionPressing intervention on the MTrPs in rats can alleviate chronic inflammation, inhibit fibrosis, promote skeletal muscle repair and relieve pain.